Tai Chi Chuan and Psychoanalysis for low-income population in Brazil

1987 Dr. Ronaldo Pereira Azem invited me to work as psychoanalyst at the first free acupuncture assistance service for poor people he held up at a public Rio de Janeiro’s hospital.

Rio de Janeiro City is the capital city of Rio de Janeiro State

Public Health Assistance in Brazil is quite different from here. People that uses it are generally poor people that don’t have any other choice. Higher and mediam classes are normaly assisted by private assurance health plans.

Ronaldo started at that hospital as student there. He usually asked to elder doctors to let him try acupuncture with patients that conventional treatments had no results at all.
His goods results had as consequence to be aloud to use it at a small room at the hospital.
As he is also one of the founders of Rio de Janeiro’s Acupuncture Institute, which offers acupuncture classes he started to bring his pupils to the Hospital for practical classes.
When I arrive there the department had already two acupunctors - Ronaldo and Laudino and about 4 students.
They used 4 stretchers and chairs (for auriculo therapy) using acupuncture, moxibustion, massage and dietetics. There was also an assitant for scheduling and notes.
Latter Dr Gao Yin He, that used to be clinical vice-director of Childrens Traditional Chinese Medicine of Beijing joined him and developed, absolutely free, a wonderful Pharmacy service on Chinese Plants Therapy.
Procedures I adopted there can be call "Applied Psychoanalysis".

First listening the institution as if it was a patient I noticed: A lot of people waiting for a long time for consultation. Solution choose was founded on Ballint’s waiting groups which goal was to reduce anxiety face medical consultation and procedures. I start to make conversation with those that were waiting for clinical consultation.

I’ve placed myself with them at a small wall that separated the hospital’s corridor from an open area around 12 carries meters close the acupuncture department they use to sit down.
Few days latter we had already a co-therapy waiting group placed at that open area.
My job was to clear up the manifest speech in order to let anxiety appear and be worked through.
Ronaldo, the Doctor, was the one to give necessary information about treatment. For instance: Fear from AIDS often appears. Ronaldo was the one to show the use of one way needles.

Piece of session:

Patient a) My son is so afraid of injection.
Patient b) A bee bite me when I was.
Patient c) The dressmaker let pins at my costume, I could be hurt.
Anna: Well so much picking stuff... what else, here can pick? May be acupuncture needles?
Paciente d) Is it true one can be hurt, maybe get some infection by using it?
Anna: Let us ask the one who applies them. Ronaldo would like to tell us something on that subject?
Ronaldo: You don’t need to be afraid. We use one way needles look (showing the pack of needles to the group). If you want you can also by your needles and keep them with you.

Movement’s inclusion came out naturally in these groups.
Once one of the patients started to remember she used to practices yoga years ago, she tried to do it there and the group felt it could help them to make some exercise.
So I started to do Pa thuan ching with them.
It was a small place and it is such a good sequence for health.

Long haired Marcio Lacerda and Mario Gusmao at a waiting group.

I used to form 2 or 3 groups each morning, twice a week.
Those groups were open but there was some regularity on frequency, as people used to come several times to the hospital, some weekly others each 15 days.
The greatest number of patients were female and the most common illness the osteo articulars one.
Soon I noticed that patients of this kind of group achieved understanding and over passed their difficulties easier than others I used to treat (without movements).
Ex: Patient G, female, 50 years old, high body pressured. Despite having already get a good control of pressure after an year of treatment, she continued afraid of getting out home alone. The only place she used to go was the hospital. Less then 2 months with the group she went, alone, by bus to another state of Brazil to visit her sister.
Another important thing I’ve notice by compairing then with those on steady groups treatment is how movements added to psychotherapy turned easier to have insight on their own bodyness, meanwhile sexuality.

I remember a woman that used to call horse posture as pissing position.
It has not being hard to the group to find out that to piss was the unique use she could imagine for her sexual organ.
By clearing that immediately she come to manage better her horse position and, l presume, sexual life.
About six months latter my entrance at the department Edson Marcio Lacerda my Master (today representing Yang Family Tai Chi Chuan Center on Rio de Janeiro) come to help me with support of others teachers from Brazilian Center of Tai Chi Chuan.

Exercises start to be taught. By the Tai Chi Center ‘s instructors while I kept working group’s dynamic. Ronaldo used to come always when clinical approach was necessary.

Soon tree sort of groups took place:
  1. Waiting Room Groups
  2. The Huge Group
  3. Sorting Groups
  1. Coordenated by the Tai Chi instructors and me, with Ronaldo presence when necessary.

  2. A bigger group placed at the hospital’s parking place and held on only by instructors - that taught a growing number of patients. Even 50. There they applied also the 108 form. All hospital’s workers where invited to participate but they rarely did. Good results achieved there and press interest made demand on acupuncture to grow in order to increase the number of incoming patients in such a way the doctors working there were not enough to treat then without a long waiting time (till 2 months for first consultation).

  3. Anna and Marcelo Gusmão with waiting group patients

  4. Ronaldo and I glided consultations adopting coo-therapeutic sorting groups. These groups, held up first each 15 days, and latter monthly could have from 30 to 35 patients. It took place at hospital’s the study center room.
    The sessions had 4 hours or more with a 15 min brake.
    We planned it in order to give the patients not only drove for treatment he would star - Tai Chi Chuan’s huge or waiting group, acupuncture and moxibustion, massage or herbal and personal feeding prescription (all).
    So it was more than a sorting group - it was sorting plus treatment already; Once for Chinese Traditional Medicine dietetics is an important therapeutic proceeding - all patients leaved the session with a personal written dietetic precription.
    We introduce scheduling by phone better than personal.
    At the meetings, after presenting ourselves, Ronaldo used to give an explanation on how traditional Chinese Medicine process uses to be before anamnesis and checking pulse and tongue of patients.
    For anamnesis we invited patients to present themselves, telling their health complaints and also asking about their food ingestion habits. I worked in order to make attention to hidden anxieties. Always clearing the field to make the doctors work easier with less resistents patients.
    I remember a 40 year man, that asked what do you usually eat for breakfast?
    He started to list a great number of medical drugs. Even after Ronaldo repeating the question twice more that guy keep on giving the same remedies answer.
    So I interfered by showing he as the part of the group that felt medicine like food. He actually ate medicine.
    After that we develop a nice discussion on symbolic necessities supply drugs could fulfill and he could answer properly Ronaldo’s question.
    Sorting groups enabled us to schedule the service income in order to patient’s needs. Some could be seen at the same day afternoon and get out without pain or even totally cured.

I want to emphasize that it often happened that patients that were already going to the huge group when first consultation data arrived were already cured, their health complains had been left at past time; nevertheless they kept going to the hospital just for practice Tai Chi Chuan. They were filling good and they’ve got awareness of needing to keep on practice.

At the huge group instructors used to teach not only the Pa Tuan Ching but even 108. The form differed in order to the one we use to practice now, althoug movements were very similar.

People were really enthusiastic on it. As I used to see them only twice a week one patient that happened to be a professional drawer copyed my postures in order for the group could consult at my absence. Like that they start to come daily to the hospital to practice I‘ve added some information on it and it was ready a quite useful class notes.

Latter I‘ve took part of a committee for the use of traditional and alternative medicine on health department and this class notes has been very useful for elaborate a project called “Taoistic Breathing Exercices”.

Follow up the project "Taoistic Breathing Movements" was based on Chinese experiment on barefoot doctors.

It consisted in training people, mainly leaders, of communities to develop their own training groups at their original communities.

We’ve choose tree training places placed at center, south and north zones of Rio de Janeiro city.

The project has been divulgated by press and at all over Rio de Janeiro’s City Hall departments by posters and invitations send to directors of each sub-departments.

During the first six month instructors took care of more or less 40 people at each of the training places.
Next six months, as the pupils had acquired enough aptitude to it they started their owns groups under instructor’s supervision. That means instructors went to the community were the pupil’s group was held on to follow up their performance.

Classes of follow up still took place once a month on previous training places.

Dr. Carlos Alberto Barreto Director of Health Department Center of Caju till 1995 told us that the group developed at his working place success can be measured by this short story:
Once the leader of the group get unemployed. Like that he have told others members he could no more come to the Health Center twice a week as usual. He could not afford paying transportation Patients there, as all those that uses public medical aid in Brazil, were very poor - (monthly gain media around $250 USA today).
That is quite significant especially because generally this kind of patients lack initiative; they show often a tendency to wait the doctor to solve everything for them. As if not being possible for them to solve anything. In a single word; they are usually very dependents. The group decided to collect the money between their members to pay the leader transportation.
.

1994 I’ve retired and instructors of Tai Chi Chuan Brasilian Center that for almost 6 years were working without any payment teaching not only on health deparments but also at several squares at Rio gave up too.
Tai Chi at Paulino Werneck Hospital get a great repercussion on press and on community opinion.

Nevertheless the only payment we could get for the Tai Chi Chuan instructors that kept going there absolutely free was the right to lunch at the hospital restaurant.

Anna, Ronaldo, Marcio and Carla


Ronaldo keep on his brilliant career. He came to be one of the greatest responsibles for introduction of alternative medicine, mainly Chinese Traditional one at Brazilian Health Assistance program (S.U.S) and the forum of Medical spetiality acupuncture holds today at our country.

I’ve no doubts that Tai Chi at this hospital repercussion had been like throwing a small stone at the sea for helping him to reach that result; as media repercussion gave more visibility close people that make brazilian laws.

During 2003 master Yang Zendhuo workshop at Rio de Janeiro I’ve asked him if he had science of anyone that had developed a similar work at another place of the world.

His answer:
Not even in China made me thing it could have some interest for you at this Symposium.

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