Here’s an idea of what my day-to-day routine is like, or my “dia-a-dia” as they say in Brazil.
6:00 – Wake up to go for a run while the outside temperature is still bearable. Without doubt, this the most important activity of the day. Without my morning exercise, I’m cranky and miserable and running about has been a brilliant way to get to know the beautiful canals and bridges of the city they call “the Venice of Brazil”!
7:00 – Breakfast, prepared by my two incredible hosts, Dona Maria Helena and Zi. I am staying in an apartment with the most delightful Brazilian family, who insist on cooking for me and looking after me as if I was one of their own. Today’s ‘Café de manhã’ was tapióca (a pancake made from cassava flour), manguzá (a creamy pudding made from cornmeal) and fresh papaya. Actually, this part of the day may be even more important than the run!
7:25 – Walk to the hospital. On my way, I exchange banter with all the street-food vendors I have gotten to know (they look out for me on these dangerous streets) and slip on my white coat as I pass through the back-doors into the emergency department.
7:30 – Enter the emergency department (known affectionately as the “campo de guerra” or “war-zone”, due to the number of shooting and stabbing victims and the general chaos of the place). Most doctors and nurses walk around using face-masks because of the stench. I elect not to wear a mask, preferring that patients can see my face: I think it adds a human touch.
I find my colleague, nurse Nadja. She has already started going around looking for patients who might be suitable for our study and I join her to help search the rest of the emergency department. We are looking for anybody who has been recently admitted to the emergency department with a neurological problem. The syndromes we are particularly interested in are: paralysis of the lower limbs (GBS or myelitis), blindness or reduced vision in one eye (optic neuritis) or recent-onset seizures and confusion (encephalitis).
A couple more nurses (Anderson and Fernanda) then join us and we ‘recruit’ the patients into the study, explaining to them what taking part will involve and getting their written consent to be included in the project. We then take samples of blood, saliva and urine to be sent off to the laboratory.
Later, I’ll go around with Dr Tatiane (the study neurologist) to note down all the clinical details for each patient. We’ll take a history and perform a thorough neurological examination, carefully testing each of the patients muscles to determine the exact pattern of weakness.
For each of the patients with Guillain-Barré Syndrome we have to recruit four ‘healthy controls’. We need a group of people who don’t have neurological conditions with whom we can compare the results of the tests from the patients with neurological complications. This has been one of my main responsibilities on the project. I’ll go around asking patients’ relatives if they’d like to help out with the study and then take blood, saliva and urine samples and fill in our forms based on a quick medical history and neurological examination.
12:00 – Home for lunch. Today it’s a ‘galinhada’, a chicken stew with lots of rice and vegetables mixed in and seasoned with plenty of coriander. Mmmmmm! I’ve decided this is even more important than running AND breakfast!
After lunch, I settle down with my laptop to input some of the data collected in the morning onto our online study database and do some other computer-related work (spreadsheets, emails etc.)
14:00 – Afternoon neurology clinic. This isn’t related to the project, it’s just for my own learning and clinical experience really.
17:00 – Home for dinner. In Brazil, this is traditionally a smaller meal than lunch, which is the main meal of the day.
17:30 – Back to the hospital to shadow the neurologist or neurosurgeon on call. Again, not related to the project, just for my own learning.
20:30 – Back home. This is the bit of the day where I try and write up my reflections and (if I have enough energy left) write something for my blog, before collapsing into bed!
Portuguese is the only language I’ll speak all day (except for a brief WhatsApp call to my mum back at home), but I quite enjoy this level of immersion! My Portuguese is far from perfect, but it’s good enough to take a history from a patient and get them to co-operate with an examination.
In reality, lots of days are very different to the above. On Mondays we have a special clinic for patients returning after having had Zika or Chikungunya-related neurological complications. There, my job is to help with a side-project which involves taking blood from selected patients to do special tests to examine their immunological response to the virus.
Then there are always lots of additional meetings, Skype calls and video conferences. On occasion, I visit the research laboratory (FIOCRUZ) in the afternoon to help out there. I’ve also taken some days off to go and do other stuff unrelated to the project (simply for my own learning). For example, I’ve visited some community health posts in a very poor neighbourhood to go on home-visits with the community health workers, I’ve been to visit an indigenous tribe with a group of family doctors and I’ve been to some clinics where they are looking after babies with birth-defects as a result of the Zika virus.
My exact role within the project wasn’t very well defined before coming to Recife. However, working out how I could best fit into the team and contribute to the project has been part of what has made this such a great learning experience! I’ve had to learn to be flexible, to take initiative and to adopt a little of that “jeitinho brasileiro” that I talked about in my earlier blog posts!
As a treat, here’s a video of the Brazilian music legend Chico Buarque singing about his repetitive but satisfying, ‘quotidian’ Brazilian day: