Maria Emília and Social Work

At that time, the Escola Normal Social de Coimbra operated next to Praça da República. Some professors were from the Faculty of Medicine (University of Coimbra) and so there were classes from their course in that building. While studying, she resided in Lar de Santo António, on Rua Antero de Quental and did internships at Ninho dos Pequenitos, which at the time operated in buildings that existed in the place where the Gil Vicente Academic Theater is located today. Mrs. Maria Emília still remembers the uniforms she wore – “for the internships, it was composed of a gown, apron and white veil and for walking on the street, a pleated skirt with a blue coat and a green blouse”.


Shortly after completing the course, she learned that they were recruiting auxiliary social work techniques for the Hospital Colónia Rovisco Pais (HCRP) in the Tocha and so she applied. Dr. Pedro Magalhães Basto was then director, who later went to Porto.


Mrs. Maria Emília says that in 1956 “when we came to the HCRP, me and four other auxiliary social work technicians, there was no Social Work. It was the administrator, Dr. Alberto Machado, my countryman, who organized the service at HCRP. Until then, there was only one lady working in this area, who was at the daycare center, and who later joined us. I came with my eyes closed, I didn’t know what a service like that was. But Dr. Alberto Machado guided us, imagined and told us what he understood should be Social Service at the Hospital. ”


The Social Service was located below the sisters’ residence, at Conventinho and Mrs. Maria Emília says that “the office was at the end of the corridor, after the administrator’s office and the secretary’s office and had a glass office.”
Initially the head of the service was Mrs. Maria Augusta Moutinho Pereira and later became Mrs. Maria Madalena Rico.


The work of Social Work was broadly structured in two sectors – the internal and the external, whose operation, Mrs. Maria Emília was described as follows:
“When inpatients went to the service, they chose which technique they wanted to talk to. They usually presented problems related to the family. We listened to them, then communicated the situation to our boss, who decided if we would respond promptly or if we were going to make a home visit ”.


In addition to the Medical Brigades “which always included a HCRP Social Service technician, and which were used to screen cases, there were also Social Brigades held regularly by Social Service technicians for patients or their families”. As part of these, social and epidemiological inquiries, home visits and other measures were carried out. When recalling these visits, Mrs. Maria Emília says that she relates to the current situation of the Coronavirus because “(…) it reminds me a lot of my principle at the HCRP, when we entered their house, we left the shoes at the door, we did not touch the sick … There was a set of distance rules ”. And she adds: “In the Medical Brigades one of us attended the consultations”.
When the patient was hospitalized in another way, “we made home visits in order to get to know their land, their way of life and their family. In any of the ways, we followed all social cases… And when there was already a hospitalized member, we saw the rest of the family and brought news of them to those who were already at the HCRP and vice versa”.


Often these patients “had children and, whenever they wanted, we would guide them into our Day Care or Preventory. Children rarely stayed with other family members when their parents were hospitalized”.


In her work, Mrs. Maria Emília liked everything, but admits: “(…) it cost me a lot when I had to receive the children of the sick, who were often babies, and go to take them to the Preventory… And in the meantime I had a little son… It was a difficult thing… I always ran away from doing this service, but we had a time when there was a lot of children… And there were cases when the children were also already sick… They had been infected and so they lived with their parents in a family center. Like the case of a patient from Penacova who brought three children, all of them already with the disease! ”.


Mrs. Maria Emília adds that “there were also cases in which the mother or father appeared with the disease and only then, in the next Brigade, symptoms appeared in the children or in other“ communicants ”. Often, the patients themselves said that they suspected that someone in their family had the disease, as they were already getting to know the symptoms. I remember a child who went to the Preventory and shortly afterwards appeared with the disease! ”.
According to her, “children generally healed before their parents, but there were some parents who were well and left, leaving their sick children still in hospital”.


Direct contact with the regions of origin and with the families allowed her to see the conditions in which most patients lived. Mrs. Maria Emília says that “(…) normally the patients were all from the poor class, very rare patients from another class appeared to us. They were very poor houses, they had no hygiene conditions… There were many patients in Pombal and Cantanhede. There were counties with more cases”.

The hospitalization process was naturally a moment of rupture with the daily reality of the patient and their families and Mrs. Maria Emília said: “it was rare for the patient to accept hospitalization willingly, even because they were usually quite long”. There was a mandatory internment for contagious patients (Decree-Law 36.450 of 1947) and “most patients had lepromatous leprosy”. According to Mrs. Maria Emília, “the sick resisted because they had several younger children, they had a partner”. She confesses: “at the beginning I saw very dramatic situations. I did not hurt the patients in any way… But they, poor people, did not expect to be hospitalized, they were always at their ease, before the HCRP existed, no one treated or assisted them, nor were there family doctors… ”


In fact, those who were known in the community in which they live coexisted with stigma making their lives working on their land or in other activities, sometimes with immense difficulties. Mrs. Maria Emília remembers telling her that “there were patients who came to the fair, they never got to enter the Tocha, because even then, people wouldn’t let them in. And in Pombal it was the same. They were afraid! ”

With the creation of the HCRP and the legislation on Leprosy, the situation gradually changed. But Mrs. Maria Emília recalls that “in the beginning, there were many cases, especially of men, who accused the disease in positive tests, carried out in the screenings, and being notified by the guard, they did not comply, so they received an arrest warrant, and then they were sent for HCRP with compulsory hospitalization. The women, in turn, accepted it with difficulty, but accepted it. And, we often had to go and convince them”.


Prolonged hospitalizations and the existence of patients with relative autonomy required a more diversified Social Service intervention, which extended to the domains of ergotherapy and play therapy, either through the various workshops and schools for patients, which operated within the Hospital, or through the holding parties.


Mrs. Maria Emília recalls that: “There was a school with a female sector and a male sector, where they did primary education, which worked in the Asylum and where two more educated patients were teachers – Mr. Marques and Mrs. Catarina. There was also a school at the Preventory for children. The teachers would tell us how the students were doing and when they didn’t want to go to school, we would talk to them and convince them to come back”.


There were also places for learning trades and other handicrafts. Mrs. Maria Emília recalls the embroidery school: “there was a lady who was hospitalized from Castelo Branco who taught girls between 13 and 16 years old and they embroidered it was wonderful! And as there were patients who had been coppersmiths, shoemakers, stonemasons, painters, taught the youngest and did what was necessary in the hospital ”.


Remember also that “(…) we organized a lot of parties, it was even our specialty! Christmas and Easter parties, processions … And there was always a ranch, an accordionist or someone singing … We always had artists! After the 25th of April (1974), with the decrease in the number of patients, it was possible to join them in a single pavilion and one of the workers’ houses that remained free and was used to perform shows – it even had a stage, chairs and lights”.


In addition to the aforementioned social and medical assistance from the HCRP, monetary and other assistance was provided through the Social Service of that institution, granted to patients and their families through the Hansen Patients’ Association (formed by the hospital and its employees) , or by Social Security. These could materialize, as exemplified by Mrs. Maria Emília in “subsidies for minor children, support funds in the process of building houses, especially in the finishing phase, payment of debts, payment of trips to families of inmates at Easter and at Christmas (those who did not have a license or who were unable to travel), purchase of goods or tools to create a workshop where they could perform a learned trade and earn a living… We also found some jobs. We were helping to guide their lives outside, after leaving the Hospital ”.


The HCRP was not an institution so closed in on itself, as one might imagine. The conversation with Mrs. Maria Emília ended up reiterating this idea. In this regard, she said that in the beginning “the sick could not cross paths, the girls could only go out with their sisters… Later that was over, the sick already left the pavilions, were already dating and there were even many marriages. I was the godmother of a wedding and a baptism and my godson still comes to visit me today”.


A relative openness to the outside was also noticeable in the fact that patients could receive visits: “There were only visits on Sundays, and there weren’t many, because it was far away. Generally, visitors entered the various pavilions and centers, and coexist
(without barriers or separation glass) with patients in the visiting rooms or in the gardens. When it was time for Christmas or Easter, the Social Service provided for the payment of trips for families to come and visit the sick, when they could not leave ”. Only visits by parents hospitalized to children who were in the Preventory were made at the entrance. Before the locutorio (built in 1962) “there was no collective visit by the children. It was rare for patients to ask to see their children, only one or two patients did it and when they did, they saw each other at the gate”.


The notion of contagion and preventive measures have changed over time. And in this sense, Mrs. Maria Emília explained that from the beginning she noticed that “the patient himself seems to be prepared not to touch, to grab… he would withdraw! It was as if he already had that mentality of not approaching, and the same happened with the employees, with us. However, “the sick always thought that they did not infect their children …”


In addition to visits to patients, the Hospital received visitors from different sources. Mrs. Maria Emília remembers the visit of Raoul Follereau, of Dr. Roland Chaussinand, head of the Leprosy Service of the Pasteur Institute of Paris and of the various groups of fifth year medical students from Coimbra and Porto. In this regard, she recalled an episode that occurred with Professor Bissaya Barreto: “Once the fifth year medical students  from the University of Porto came with a well-known doctor and when they passed by the“ Castelo Branco embroidery school ”which was supervised by Mrs. Catarina , a patient, Professor Bissaya Barreto offered a quilt to the professor in Porto, but contrary to what was usual, he did not want it to be disinfected… It was usual, when the patients finished a job, ordered or on offer, that they went before the disinfection sector in the hospital, where they also disinfected the clothes of the patients who were discharged”.


The Hospital was also at the service of the local community and Mrs. Maria Emília recalls that “Every day there was an internal consultation for the hospital’s patients. But on Fridays there was an open consultation with people in the region for all kinds of patients and all kinds of problems”.

Hansen’s model of care for patients has undergone changes. In 1976, Decree-Law No. 547 defined the outpatient treatment regime as preferential and in 1985, collective discharge was granted to internal and external patients. Regarding the departure of patients, Mrs. Maria Emília said: “The discharge was made based on clinical conditions, on the results of the tests. Then Social Work came in. Many times we had to go to the family’s house to convince the children or husband / wife to receive the patient back because he was already able to return home … But it was a prolonged hospitalization … And often the families did not accept them, did not want them to return. At other times they also had no family, children, husbands / wives or were single … Or they didn’t want to leave, as it seemed that the hospital was not a hotel for them … Women generally stayed because they were social cases. ” But “there were many patients who did not want to be discharged”.


In order to assist the patient in the transition between the hospital and the community, the Espariz Recovery Center in Tábua was created. And about this, Mrs. Maria Emília said: “(…) it was a large farm where sick patients could develop agricultural work and stay for some time until they left permanently. The idea was for the patient to adapt and then leave with definitive discharge. The patients were upset but the house was beautiful, had tapestries on the ceiling and had a cook, and whoever took care of their clothes. Everything that was excess production went to the hospital”.


Gradually, Creche and Preventório also had fewer children. The closure of those two valences according to Mrs. Maria Emília “resulted from the ideas of 25 April 1974… They came to the conclusion that it was more expensive at the hospital. There were no more children in the nursery, only in the Preventory ”. On the other hand, “some parents had left the hospital with discharge, leaving their children in the institution, especially the girls. We had guidelines for the children/ young people to be returned to family members. And in some cases, Social Work helped to get some of the older girls into the domestic service of private homes… But many did not have training at this level. Some of the older boys had already left and lived in the employees’ neighborhood where they worked for a while in a printing shop that operated there before 1974”.


Mrs. Maria Emília hears news of some patients or children because they still call her from time to time. She keeps many memories and recalls, for example, the story of a boy who was placed in a Seminar in Porto: “He was an extraordinary boy. Today he is a missionary priest in Mozambique, but he stayed at our house when he came from the seminary to visit his mother who remained at the Hospital. And his first new mass was made in the chapel of the Hospital”.


Mrs. Maria Emília worked for thirty-seven years at HCRP and when the hospital was reformed, it was still in full operation.


Taking stock of the time she was in service at that hospital, Mrs. Maria Emília says: “I was satisfied that a case was resolved. I liked the work, the service, the contact with the sick, the brigades… So when I was single, it was fun! I ran the whole country, from east to west, from north to south and it was many years! The brigades were weeks and months! Sometimes they even sent the sick files from the next municipality to us by rail and we did not come to the hospital”.


And she concludes by saying: “I think that during all the years that I worked at Hospital Rovisco Pais, I always got along well with patients and staff… I have no feelings whatsoever. Even today I have sick friends who still speak to me… Who remember me! And every year, for my birthday, the first call I get is from an ex-patient. I liked everything! It was a happy time for me!”


(Text based on oral testimony, in 2020, validated by the interviewee. Interview and writing by Cristina Nogueira – CulturAge)