Some thoughts on the healthcare system in Brazil

I have been repeatedly impressed with the “universal healthcare” system here in Brazil. That being said, coming from the US and our/their “get insurance or get screwed” system, it may not take much to impress me. Things here are not a bed of roses, for sure, but there are some important plusses and minuses.

On the plus side is the language in the Brazilian constitution that says (essentially):

Article 6. Education, health, work, leisure, security, social security, protection of motherhood and childhood, and assistance to the destitute, are social rights, as set forth by this Constitution.

Article 196. Health is a right of all and a duty of the State and shall be guaranteed by means of social and economic policies aimed at reducing the risk of illness and other hazards and at the universal and equal access to actions and services for its promotion, protection and recovery.

In short - healthcare is a citizen's right and it is the duty of the government to provide it.

The healthcare matrix here in Brazil is a complicated mix of public and private providers. Only about 25% of Brazilians have private health insurance, the rest access public clinics and hospitals (which vary wildly in terms of quality and efficiency depending mostly on whether they are in urban or rural areas). More than half of registered nurses and nearly half of doctors are public employees.

The stated principles of the Unified Health System (Sistema Único de Saúde or SUS) are universality, integral care, health promotion, and community participation, with public funds to provide free health care to all Brazilian citizens.

That’s the good news. And for many, many Brazilians it has been very good news. According to this summary article, over the past three decades infant mortality decreased by about 6.3% a year, and life expectancy increased by 10.6 years. Mortality due to infectious disease decreased from 23% of total deaths in 1970 to less than 4% in 2007.

But then there is the bad news. Well, let’s remember that nothing is perfect.

There is a wide gulf in service and efficiency between those with private health insurance, accessing private hospitals, and those going to public facilities. This is certainly not always the case, but in many poorer areas (urban or rural), the conditions at the “hospital” can be alarming.

But I think what I’ve found more disturbing in my reading on this subject is that there is an insidious dynamic at play within the university education system that is broadening the gap between public and private healthcare. No surprise, really, but it’s a bummer to see it studied and articulated.

Capitalism. There it is again, f*cking things up. Early on I saw the irony of the public university system here. It’s free, but only the privileged can access it (with notable exceptions, of course). Competition to get in is fierce and students take expensive preparatory classes to score their best on the entrance exam. No money, no prep course – no high score, no free university. The poor and working class pay to attend private universities.

But that’s not the real problem. The problem seems to be the ethos among the privileged class that financial reward and status are the end goal and working in the public sector is viewed essentially as a lower-paid job with little status. So many educated professionals are self-selecting out of the national healthcare system in favor of the more profitable private system. Many people will tell you that there is a shortage of healthcare providers in the public system.

So we have the ever-corrosive dynamic of private enterprise and personal desire for wealth working against the common good. Nothing too strange about that – but it would be a shame if it erased the benefits gained to date seen with the public healthcare system here in Brazil. I would prefer to see the momentum moving in the other direction.

So tell me – if you can afford it, would you choose to buy private health insurance here in Brazil? Why or why not? While it is cheap by USA standards, it still costs a lot. Is it worth it when you have universal coverage provided by the government? Is it necessary, or just a convenience?

[To view Brazil’s constitution in English, go here. It’s a good read.]

Oh my sweet Detroit - what happened?

There is a word in Portuguese that is often mentioned as one without a real equivalent in English: “saudade.” It essentially means longing, or homesickness, or emotional wishing-for, missing.

Sorry to say, I rarely, rarely have saudade for the United States. Sure, I miss my friends, but the country itself? – not so much. Even when Brazil drives me crazy with its high prices, under-educated populace and corrupt elected officials, I still do not pine for the days of living in the United States.

But at times my heart aches for the folks living in places I used to haunt. In this case I am referring to Detroit. I was born in Detroit. I went to school in Detroit (well, a block or two from the border of the City). My first real girlfriend (yes, I had a girlfriend) lived in Detroit. I loved Detroit.

But nowadays I’m sad for Detroit. It has fallen so far. I have saudade for how things used to be.

When my extended family lived in or near Detroit it was the heyday of the auto industry. The Big Three, we would say (GM, Chrysler, Ford). Almost everybody’s parent worked for the auto industry, or some other job supporting the industry. My grandmother used to joke that if she had a dollar for every slice of pie she served to auto workers in the diner she spent her working life in, she would be a millionaire.

But now things are different. Most of that is gone.

My brother and his wife moved to a cute little historic block in Detroit some time ago, bought an old Victorian house and refurbished it (Dan did a fantastic job!). They were one of the star homes on the neighborhood Christmas walking tour. But they saw the writing on the wall, sold the house, and moved to the country.

Now Detroit lays feral – or mostly so. Good luck my friends in Detroit. I know you are all rooting for success.

For a real taste of Detroit today – go take a look at the Sweet Juniper blog.

Keeping things real in the USA

Even though I maintain a blog in Brazil, I keep an eye (albeit wearied) on the politics in the USA. In that regard, let’s take a look at the lie that is the Republican’s idea that they are economic conservatives and Democrats are the party of spending. (Barf.)

Just a simple graphic reminder.

 The Conservatives/Republicans have a communication machine that feeds ideas into the general public’s mind – but they are lying, based on the facts.
My cardiologist is so happy I live here. If I had to confront this felony of truth and/or stupidity on the TV every day – I would not be as tranquil as I insist on being…

Good luck my US American friends (and I also vote).

You know it is winter in Brazil when

Photo source: http://www.madeinbrazilblog.com/blog/too-hot-for-monday-the-boys-at-frankie-morello/

You know it’s winter in Brazil when:

The women break out their shin-high boots (even if it’s still warm out).

You close your windows for the first time in 10 months.

The electric shower head water heater does not have the oomph to heat the cold water.

All the windows on the bus are closed, and the air conditioner is off.

Scarves are everywhere – everyone is wearing a scarf.

The gringos’ toes are white in their Havaianas.

Ice cream parlors are selling hot chocolate and coffee drinks.

Weekend street festivals (Festa Junina) feature hot corn on the cob and a super delicious piping hot stew over polenta to warm the belly (Angu à Baiana).

Locals will spend an hour in the sun on the beach (for exercise), but gringos will try to pretend it is sunny and warm all day.

Even the most unlikely among us will learn to cook bagels – if only to heat the kitchen.  =;-)

The mosquitoes are oddly absent.

You dig around and find your socks.

Even my surgeon has an angle

Once I decided to get gastric bypass surgery it was necessary to choose a surgeon. Luiz and I asked everyone we know in Niterói for a recommendation. Surprisingly, lots of people knew someone who has had this procedure. We got several suggestions, but one surgeon kept coming up again and again.
Dr. W was recommended by two of our doctors, a couple friends and even one of my students who is a doctor. Sealing the deal was the fact that he is among the doctors participating in my health insurance network.

Our first meeting with Dr. W went well. While waiting for our appointment (they were running 40 minutes late) Luiz took the opportunity to tell my whole story to the women waiting alongside us. But as you know, there are few secrets among patients in a doctor’s waiting room in Brazil. The secretary brought us each a glass of water.

Talking with Dr. W felt a bit like talking with a salesman. He asked a few questions of me, but mostly he spent the time touting his Cracker Jack team and the sure success associated with the procedure. He did reference the need for me to make behavioral changes so as not to balloon out again in two years, but mostly he kept moving things forward.

Turns out Dr. W’s team is mostly off the grid. In addition to my appointments with Dr. W I was to make three appointments (each) with a psychologist, a nutritionist and a physical therapist (all on his team) but they do not accept UNIMED insurance and their fee is R$100/visit. It seems pretty clear to me that, since UNIMED requires a referral from each of these professions stating the appropriateness of the procedure, Dr. W hires these specialists to do just that. He has eliminated the unpredictable.

I began to feel like the place was a “Tummy Mill.” Whatever – I still felt confident with the Dr.’s skill (he has done the procedure more than 130 times). And I, too, didn’t want anything less than a positive referral from the other professionals for the procedure.

If you have had to have a bunch of tests done here in Brazil you know that it is YOU that wanders the neighborhood from lab to lab to get the tests, and it is YOU that collects and files the results in a safe place. In my experience results are not sent directly to the doctor. I had my work cut out for me to complete my numerous tests and to keep a file with the growing pile of documents and films listing the results.

When I finally had all the results in hand, we returned to Dr. W’s office for a consult. During the “consultation” Dr. W went through all the documents and entered the results into my data file in his computer. That was it. I had to say, “Excuse me, but are you going to discuss with me the results of these tests? What does each test tell us about my suitability for the surgery?” In one case I said, “Why are so many of the results printed in red ink?” To which he replied, “That means you have high blood pressure.” I said, “So don’t you think you should tell me that? Don’t you think you might want to refer me to a cardiologist for follow up?” Sigh.

I’ve found that doctors here are often focused on getting you in and out quickly, don’t explain things well unless they are asked and are annoyed with patients that have a brain and ask questions (this goes for our experience at the Cancer Institute as well). It seems very old school – just do what they say and say “thank you doctor.”

So my opinion over time of Dr. W has been less than stellar.

Each time I went for a consultation with any of the professionals in his stable I got a stray piece of paper that filled in one more piece of the overall puzzle. What I wonder is – if every patient is basically going to go through a similar process, why not put together three or four pages, double sided, that lays it all out and give that guide booklet to the patient? No. It was all disjointed and a bit confused.

Trust me, the secretary was never busy. She could easily have printed and collated said booklets.

To the team’s credit they host a 3 hour meeting once a month for patients to go and listen to presentations by the members of the team and to ask questions. But I found the meetings more like a Mary Kay sales pep talk than a careful presentation of the details and procedures associated with the surgery.

In the end I didn’t actually go to all three consults with each of the team members, but I didn’t miss anything. I was not going to part with my money that easily.

Then two days before the surgery the secretary just happened to ask, “Have you called to arrange the anesthesiologist?” What!? Who knew? It was our job to call the anesthesiologist and tell him when we needed him (because, of course, the secretary had no time between chatting with her girlfriends on her cell and standing in the hallway talking with the other secretaries in neighboring offices).

So we called the guy and made arrangements to meet so he could get a sense of what he needed to bring to the surgery. While he was examining me (now the day before the surgery) he said, “You’re pretty big. I think we will want to use an extra instrument to ensure there are no difficulties. There will be an extra charge.” “How much?” we asked. “We can talk about that tomorrow,” he said. WTF?

The Brazilian penal code has a section addressing fraud. The first three numbers of that section are 171. There is a popular expression when something is illegal that it “looks like it’s 171.” That was our take on this last minute extra charge.

The day after the surgery the anesthesiologist came to my room and checked in. Mostly he came to show off the shiny stainless steel instrument he used “just to be safe.” “I bought it in America!” he said with enthusiasm. (I was not impressed.) With his voice lowered so my roommate could not hear, he let us know that his additional fee was R$1,000. We firmly asked for a bill (which he did not have prepared) and said we were first going to submit it to our insurance company for reimbursement. He got all freaked out and told us that the insurance company would not cover it. Winking at each other, Luiz and I just smiled and said we were going to give it a try anyway. We offered our phone number so he could call us when his bill was ready. He said “No, no, you just give me a call.” Yeah, right. We’ll get right on that! Ha! What was up with that?

There were a few other bits of shenanigans we came across in the final days, but I’ll spare you.

In the end my experience was (unfortunately) similar to what I have with so many business people here; so often people have an angle, or a gimmick, or a scam to squeeze a few extra bucks out of you. Money is tough to come by in Brazil, no doubt, but thinking I’m getting scammed by my surgeon and anesthesiologist… that’s a bit much.

[I continue to heal well and lose weight at an incredible pace.]

Where have all the pennies gone?

If you live here I’m sure you have noticed that there are no pennies.

In fact, centavos do exist and they remain legal tender.  But nobody pays with them.

When you buy a bunch of broccoli at the produce store it may cost R$3.67. But when you get to the checkout counter you will pay just R$3.65.

Or if your new shoes cost R$120.98, you will certainly pay R$121.00

No pennies.

To their credit, stores always round in your favor.  But what’s up with the charade of centavos?  Why not price to the nearest R$.05?

It’s all a game, I suppose. "It sounds cheaper..."

Brazil is too advanced for me

Sometimes I feel a little out of the loop. I wonder: Is life passing me by or am I stepping out of the way of a ridiculously speeding train barreling by? Luiz and I moved to Brazil to get out of the rat race that was our daily lives in San Francisco.

Slow down. Notice the sunshine. Kiss each other more. Don’t chase rainbows. Just be. Be together.

It has been more than a month since I have placed a call on my cell phone. Really. In fact, I’ve recently forgotten to check it for missed calls and text messages.  One of my translation clients is not happy with me.

We have an answering machine for our home phone, but for some strange reason Brazilians do not leave messages! And to leave voice mail is a scandal – you pay to leave the message and the recipient pays to listen to the message.  What’s up with that!? Few people even have voice mail service.

I recently downloaded the new, super cute, animated movie “Rio” and enjoyed watching it on my 21” computer screen.  Luiz, on the other hand, wants to watch it on the big plasma screen, with home theater sound.  So I bought the necessary cable, but today I utterly failed to figure out how to connect the computer to the TV.  I need a 14 year old nephew who can come solve my problem.

I used to think I was a pretty modern guy.  But now I fear I have fallen behind. (I KNOW I have fallen behind.) I rarely send a text message. I certainly do not know the short-hand text language abbreviations used in said messages. I don’t Tweet.

Make no mistake – Brazilians are at the front of the line in terms of technology.  EVERYONE has a cell phone (if only a “pai de santo”). As the saying goes: “kids these days” are all about the technology.

I have a client company that specializes in video games technology and I have had to learn a whole new language to translate their press releases. (Actually, two clients.)

Ok – so I am getting old and I don’t care about instant messaging while driving (except that it should be illegal). But I would at least like to be able to hook up our plasma TV to show a movie from my computer.  Is that too much to ask?

That's surprising

Things about the United States that surprise my Brazilian friends:

- Hotels, even fancy ones, do not provide a fabulous, free, fresh breakfast (B&Bs yes, but hotels, no).

- You can get a perfectly good education in public schools.

- The bill collector can seize your home if you get sick and have mounting medical bills.

- Your parents will likely shoo you out of the house once you reach 18 years old.

- There are city law enforcement agents who actually issue traffic/parking violations, really.

- Chinese take-out costs about US$7.00 (and you can find it for less).

- Clothing stores sell XXXL T-shirts or sweatshirts.

- There are no dessert pizzas.

- Classes to learn English as a foreign language are often free.

- If you buy a twelve-pack of Coke it costs less than 12 individual cans.

- There are no vendors on the beach.

- Drivers yield for pedestrians, most of the time.

- Most restaurants close at 10:00 p.m. (except for the 24 hr variety that you generally do not want to eat in anyway).

- Meat cooked on the grill is not covered in salt, rather, a sloppy, spicy sauce.

- Your cell phone service does not cost more than your car payment.

What am I forgetting…

Country comparisons, the macro version

 Comparing things in Brazil to things left behind in our country of origin is a favorite pastime for many expats, at least among the newbies.  I’ve found that these comparisons start out listing all the wonderful new things discovered in Brazil that were either not available in the States (or wherever) or are simply way better here (like varieties of bananas or singing at BBQs).

Over time the comparisons switch to the quality of consumer products, or maybe the lack of certain items here in Brazil.

If we don’t check ourselves, the comparisons can spiral out of control and turn into ugly, whiny, bitch sessions.

One of the first realizations expats need to come to, in my opinion, is: DON’T COMPARE.  It will only make you crazy, and probably not a lot of fun to be around. Just live locally and love it.

However – I’ve found this really cool website that ranks countries in terms of numerous points of comparison, like: population, health, crime, sports, wealth, etc.  So let’s have some fun.

Retail shrinkage (shop lifting) as % of sales, 2010.        Brazil:  1.64        USA: 1.5

Prevalence of adult obesity, 2010.       Brazil: male 8.9%, female 13.1%           USA: male 32.2%, female 35.5%

Greenest countries, most livable places, 2008.   Brazil ranks 40^th          USA ranks 23^rd

Prison population, per 100,000 people.          Brazil: 191         USA: 738

Price of a Big Mac in US$, 2010.          Brazil:  US$5.10          USA: US$3.73

Road traffic deaths, per 100,000 people, 2009.          Brazil: 18.3         USA: 13.9

Circumcised men (%), 2006.    Brazil: 7.4%      USA: >80%

Women in Parliament, 2011.    Brazil: 8.6%      USA: 16.8%

Diabetes prevalence, % of adult population, 2010.      Brazil: 6%       USA: 12.3%

World Cup football championships.  – OK, not fair…

You can find a lot of fun facts to know and tell at this website.

One person’s rain is another’s refreshment

Welcome to the land of rain. We live in a wet environment. People have lived here for hundreds of years. Rain is normal. Rain does not stop everyday life.


I remember a trip I made to French Guiana probably 20 years ago. My aspiring author roommate at the time was doing research for a romantic novel about two gay men from France who fell in love in Paris and then later found themselves, independently, in the prison colony of French Guiana. The book was supposed to have a happy ending. We spent three weeks in French Guiana doing “research.” (Those were the days.)

At any rate, it exposed us to French Guiana, where I first saw construction workers working through a downpour. Heck – if you stopped working every time it started to rain – shit would not get built.

Cayenne, French Guiana, was the first city where I noticed eroded ruts in the sidewalk made by the rain runoff from the roof above.

We get some rain down here in South America. Trust me.

And with all the “Global Weirding” going on – the downpours of late can be record-breaking.

But the fun part is that so many people in my neighborhood do not shy away from just a bit of rain. If it is only raining a little bit, not everyone opens an umbrella. Walking in the rain can be a nice, refreshing antidote to the heat. Clothing is thin, so it dries quickly – what’re a few rain drops on your shoulders? It feels great.

Give me a sprinkle during a hot afternoon. I’ll take it. Don’t fight it. Find the positive. Está bem fresqinho.

Public / private healthcare observation

Today we went to a private hospital followed by a public health clinic.

Zozó wrecked up her big toe on her right foot two nights ago. She was returning from some travel and while dragging her heavy rolling suitcase up the stoop to her apartment, she yanked it over her foot and (since she always wears open-toe shoes) ripped open her toe (and nearly tore off her nail) – OUCH! But it was 2:00 in the morning, so she took one for the team, wrapped her foot and went to bed.

The next morning she called me to come help her clean and dress her wound. It was NASTY! I got her comfortable, and then I went to the pharmacy to get what I needed to attend to her toe and the pain it was giving her.

Then today we thought it best to take her to the ambulatory urgent care center at a nearby private hospital to make sure we were not in over our heads. I waited in the air conditioned waiting room and enjoyed a coffee from the machine in the corner while Luiz and his mother were seen within about 10 minutes. We did not have an appointment.

The doctor took off Zozó’s toenail, cleaned up the torn flesh and wrapped her up. But for some reason they referred us to a public health clinic for Zozó to get a tetanus shot. I have no idea why they did not just give her one there on site.

A quick bus ride later we were dropped off in front of the public clinic. The line in front of us had about 20 people in it. No air conditioning, in fact, the waiting area was outside with cement benches. No coffee machine (or drinking fountain for that matter).

Zozó never lets a line stop her from walking right up to the front to inquire about the best course of action. Being a senior female with a bandaged toe and a story long enough to stall the line for 20 minutes, they decided to escort her to the nurses giving shots (Hep B, rabies, flu shots, baby vaccinations, and tetanus). In spite of the line we were in and out in less than 15 minutes.

Work it girl!

There is definitely a gulf between the realities of private and public healthcare here in Brazil, but if you’ve got a no-nonsense 79 year old Brazileira (whose middle name is jeitinho) on your team, you can often bridge some of the gap.

Pucker faces

My latest ‘torrent’ affair is with the TV series “Being Human,” the US version.  The lead vampire character is played by Sam Witwer.  He’s got this weird look about him that is so distracting.  Something cute, but something strange.  Like a sour puss cutie pea.

Then I placed it.  I think Witner and Renée Zellweger are of the same spawn.

[Talk about off topic…]

Driving each other crazy

Some things are just cultural.  They don’t translate.  For example:

Try putting a slice of avocado on your Brazilian friend’s hamburger.

Or – try putting ketchup on your American friend’s pizza.

Try giving your female Brazilian friend a pair of panties bought at Costco.

Or – try getting your female American friend to wear Brazilian-style women’s panties.

Try getting your Brazilian friend to show up at your party on time.

Or – try getting your American friend to relax while waiting for Brazilian guests to arrive.

Try convincing your male Brazilian friend to not pee on the street (when he feels the need to).

Or – try convincing your male American friend that it is OK to pee wherever he likes (at least your cultured male friend!)

Try feeding roasted vegetables or a cold pasta salad to your Brazilian friends.

Or – try feeding a delicious frango ao moliho pardo to your American friends (when they understand what it is).

Try getting your American friend to sing out loud at a friends’ gathering.

Or – try getting your Brazilian friend to NOT sing out loud at a friends’ gathering.

Try getting your American friend to prioritize family over friends.

Or – try getting your Brazilian friend to prioritize friends over family.

Try getting your American friend to drink sweet avocado juice for breakfast.

Or – try getting your Brazilian friend to eat a sausage, bacon, ham omelet with hash browns and toast for breakfast.

Try to get your Brazilian driver friend to wait for a pedestrian to cross the street.

Or- try to get your friend from Berkeley to even contemplate cutting off a pedestrian.

Can you think of something that drives you and your Brazilian friends crazy?

What the United States can learn from Brazil

Don’t get me wrong.  There is WAY MORE that the United States can learn from humble Brazil than what I’m about to note.  But let’s just name a couple things.

According to the Brazilian Health Ministry, an estimated 33 million people, or 17 percent of Brazil's population suffer from hypertension and some 7.5 million suffer from diabetes.

If you were a concerned politician and you knew that about 34% of the deaths in your country each year were caused by hypertension- and diabetes-related complications, would you pick your nose up out of the trough long enough to consider a remedy?

Lucky for us we have a socialist-minded president who gets it that helping people AVOID these conditions will save lives and save a gazillion in health care expenses.

As such, Brazil’s new president Dilma announced recently that the government will now provide free hypertension and diabetes medication though the “Popular Pharmacy” program.

The diabetes medication was already available at nearly free prices, but this extends the wellness program even further.

As a further note (and one I extend to my policy maker friends in the US) I will mention that in the case of poor people with cancer, the government also offers a helping hand.

My mother in law is a breast cancer survivor.  When she completed her treatment she was placed on a drug called Tamoxifen, which is designed to prevent the recurrence of breast cancer.  It is state of the art treatment, and it is expensive.  She must take this drug for five years.

Well, my mother in law could not afford the R$500+ needed per month to buy this drug, so she went to the city government and said: “Look, I’m a poor old woman.  I’m retired.  How am I going to afford this drug?  Give me a break.”  And guess what?  The government said “OK, we understand.  We will provide the drug to you for free.”

And so my mother in law receives the drug at no cost to her and continues to live a robust life – and it is worth noting that she did not have to sell her house and all her family’s assets in the process.

Take a note United States.  If a poor country like Brazil can do this for its people, so can you.

The sounds of Brazil

So much is made of the sounds of Carnaval, samba, or a neighborhood pagode as the typical sounds of Brazil.  I’ve come to recognize a few more that remind me where I am.

OK, I won’t go so far as to say they are the sounds of Brazil.  Naturally, I mean the sounds I have come to recognize as ambient and daily in nature while living in our small corner of this expansive country.

Every morning at 7:00 a.m. I hear a low rumbling sound like distant thunder that slowly swells until it clarifies into what it is: 10 to 15 Niterói Clin workers freshly dressed in their bright yellow uniforms dragging their plastic trash bins along the road under our bedroom window.  It’s like a daily wake-up call.  The bins make their raspy rolling noise while the men and women starting their street cleaning morning shift chat with each other. (This reminds me of Shelly's crash in the night sound.  Once you know what it is you can sleep soundly again.)

Other morning sounds include the guy who calls out, peddling propane gas tanks for kitchen use or the knife sharpening guy who screeches out familiar tunes on his grinding wheel to let you know he is nearby.

Throughout the daytime hours you can hear the sound of caged songbirds.  I used to be really bummed to see the birds locked up, hanging from the wall of the auto repair shop or on the tree in front of the produce market – and this popular form of pet definitely drives Luiz crazy – but now I find myself smiling when I hear some of the incredible songs they sing.

All through the summer months there is a nonstop, quiet whooshing sound in nearly every room of our apartment: ceiling fans.  Whether they are gently exhausting air up or briskly blowing air down, they are on nearly all the time.  What we do not hear is the electric whine of an air conditioner.

Whether we are in our apartment, visiting Luiz’s mother or spending an afternoon at a friend’s apartment, there is the sound of a television on either right next to us or in the adjacent room.  Classic Brazil background noise.

And of course the beep, beep, beep, beep of moto boys scooting in between cars and trucks in traffic.  Those guys are fearless (or just plain stupid).  I used to utilize moto boys to get me across town quickly when I worked in Rio.  I can’t tell you how many times my knees bumped into truck fenders or my elbows hit car side mirrors.

Perhaps my favorite sound of Brazil is the cacophony of a family gathering where everyone is practically screaming to be heard over everyone else; everyone talking at the same time – and everyone hearing what is being said by all.

The ambient sounds of my life here are definitely different (and louder) than I experienced in San Francisco.  It’s a constant reminder of the cultural difference.

Do pizza restaurants in São Paulo deliver - to Niterói?

Jana’s post describing the wonders of pizza in São Paulo and Ray’s full on reference guide to perfect pizza in SP comment got my stomach growling. 

It’s true, what Ray said, that pizza here in the Rio area sucks.  What they try to pass off as pizza just makes me shake my head: crappy crust, a full tablespoon of tomato sauce (if you’re lucky), a pinch of cheese, absolutely minimal vegetables or pepperoni evenly spaced apparently to make it look bountiful.  And if you are getting an extra fancy pizza with everything: one green olive placed right in the middle.   Did you see my previous post about ready-to-use pizza crusts at the grocery store?

Now I know we USA folks are fat and we don’t do portion control very well and we like our pizzas loaded, but not counting a Super Bowl Sunday bonanza extra large pie, I’m thinking every pizza in the US has more going on than what we find here.  To be fair, we have not visited every pizza joint...

We live directly across the street from a restaurant that hosts an all-you-can-eat pizza and pasta format every night.  We’ve been a couple times but have given up.  Actually, when we do go (usually for someone’s birthday) I eat the pasta and salad bar with maybe a little slice of chocolate strawberry pizza for dessert.

When Luiz and I want pizza we pick up an uncooked pizza from the bakery down the street and then add sauce, vegetables, pepperoni, cheese, etc. Then it resembles a real pizza.

I will tip my hat for the dessert pizzas, however.  Very clever.

Luiz has a cousin who got rich operating two delivery-only pizza outlets.  He used to joke that he used practically no ingredients and could sell it for a fistful of cash.

Zackary's unbeatable deep dish pizza.

If you’re thinking of moving to Rio or Niterói, check and see if Zackary’s Pizza in Oakland, CA is selling franchises.  Now that’s pizza! Then come open your shop near my apartment.  Please.



A delicious meal in a slice.



Rio and Niterói residents, do you have a recommendation?

Kitchen culture clash

There’s nothing better in my book than a rich seafood moqueca in the Bahian style.  Brazilian cooking with its use of coconut milk, fried bananas, salty meats, and desserts from every conceivable tropical fruit is amazing.  Luiz won me over on our first date eleven years ago with a rolito of spiced hamburger stuffed with ham and cheese served with augratten (ish) potatoes and collard greens like I had never experienced (couve).  Later, when he made a bacalhoada in a clay pot – forgedaboutit – I was sold.

I love Brazilian food. But I also love the light, so-called California Cuisine that I enjoyed for 20 years in the San Francisco Bay Area.  That type of food is best described as: what you see is what you get.  Carrots taste like carrots. You can tell which particular mushroom went into the mushroom sauce.  Vegetables have texture.  Flavors combine harmoniously without getting lost in the overall dish.  Meat is featured, but is a limited portion on your plate.  In general salt and fat are not used to boost flavors.

Herein we have the rub. My husband and mother in law would like nothing better than to please me with delicious regional Brazilian cooking.  Every day.  I, on the other hand, would like to eat a cruciferous vegetable once in a while.

We have had to strike a balance.  Luiz or his mother cooks a delicious meal that invariably congeals in the refrigerator into a layer of beef fat and otherwise edible ingredients (which I may beg off from) and I cook a meal of stir fried crispy vegetables and chicken bits served in a light sauce over brown rice (which they may beg off from).  We agree to disagree.

Crunchy vegetables do not translate.  If you were to take a cru de ta platter (even with a kick-ass dip) to a Brazilian party, the host would bag it all up at the end of the evening and send it home with you.

It has been my experience that Brazilians like what they like.  And it relates to what their grandmother used to cook.  Thai food? Mongolian BBQ? Ethiopian platters of incredible flavors? Burmese delicacies? Simple Mexican guacamole?  --  Sorry  -- it has not been my experience that my friends here are open to these new and delicious options.

But hey – I live here.  The food in the grocery store reinforces the particular narrow band of Brazilian flavors.  Exotic ingredients are not to be found.

My joy has been to investigate the local flavors: fruits, root vegetables, cooking with coconut milk, grilling with rock salt, and finding all things delicious for sale at street food vendors – anywhere, anytime.

The culture clash continues, but I am enjoying the back and forth.

President Dilma vs. President Obama

Making our way into 2011 I feel a huge gulf between US politics and Brazilian politics. 

My hopes for a strong policy turnaround in the United States have faded.  The obstructionism demonstrated by the obstinate, purely partisan and ethically challenged Republicans, combined with the run-from-their-shadow, strategy-less and forever politically calculating Democrats in Congress have made reading the morning news nearly intolerable.  I do, in fact, feel demoralized. 

Now here comes the emboldened Republicans with their whacko so-called Tea Partiers sure to begin anew with the fear mongering to repeal some of the little progress made.  Get ready for show trials on the taxpayers’ dime.

On the other hand Brazil has just sworn in its first female President who speaks in bold terms about assisting the poor, protecting the environment, and improving national services such as healthcare, education and domestic security. Nowhere in President Dilma’s inaugural address did she hint at tax cuts for the rich, executing wars, corporate welfare disguised as research and development assistance, or phony economic trickle down policies dressed up as  job creators.  Read her entire remarks here.

In fact, Dilma went out of her way to say that taking care of Brazil’s social commitments is expensive and the burden will be felt moving forward. (Duh!)

“It is [economic] growth, together with strong social programs, that will enable us to vanquish inequality in income and in regional development.”

“This involves high costs for the whole of society, but it also means that everyone is guaranteed a pension and universal health and education services.”

She reminded the titans of business that the national petroleum company, Petrobras, will remain guided by federal policies.  There was no talk of the wizardry of the private sector or the “logic” of lining the pockets of the rich so they can create jobs for the rest of us.

“The prime agent of [a modern policy of investing in research and innovation] was and is Petrobras, the historical symbol of Brazilian sovereignty in the production of energy and of petroleum.  My government will have the responsibility of transforming the enormous wealth from the Pre-Salt layer into a long-term savings account.”

Right on down the list Dilma spoke out for the neediest Brazilians.  There was no walking back campaign promises or gratuitously tossing conciliatory bone after bone to the opposition.

I did a few word searches on Dilma’s speech.  The results demonstrate the distance between what passes for liberal rhetoric in the USA and here in Brazil:

Woman – spoken 10 times

Poverty – spoken 9 times

Social – spoken 11 times

Health – spoken 9 times

Education – spoken 6 times

Commitment – spoken 7 times

Tax Cut – spoken zero times

I know, I know – this is just a speech.  Let’s see how it goes.  But you know what – I’ll bet a good sum that Dilma outperforms Obama in the toughness, fighting, and commitment categories.  Just sayin’.  (Sorry President Obama, I know you have done a lot, but nobody disappoints like a friend and ally.)

Eight years ago all my well-heeled Brazilian friends were decrying Lula’s election and warning that Brazil would go to hell in a hand basket due to his socialist policies.  (Cue the scary music.)

How did that work out?  (Text taken from here.)

Since his election in 2002 the middle class has grown by 29 million people (more than the population of Texas) creating a powerful new domestic consumer market. Another 20 million people — as many as in New York State— were pulled from poverty. The country that received a record $30 billion bailout from the International Monetary Fund as it neared economic collapse in 2002 now lends money to the IMF, making up to $5 billion available for loans to other nations.

The value of Brazil's currency has more than doubled against the U.S. dollar. Inequality has been reduced, as the income of the poorest 10 percent of the population has grown five times faster than that of the richest 10 percent (emphasis added). Inflation has been tamed, unemployment is at a record low and illiteracy has dropped. By the time Brazil hosts the Olympics, it is forecast to be the globe's fifth-largest economy, surpassing Italy, Britain and France.

President Lula left office with an 87% approval rating.

Conventional wisdom is that President Dilma will in large part continue the policies established by President Lula, with some tweaking around the edges.

Give me Brazilian “socialist” presidents over US “liberal” ones any day.  While I lament the opportunities lost by President Obama I see in Dilma the fighter we have longed for.  It is my hope that Brazil will continue to economically outperform most countries in the world so that stubborn (and often intellectually dishonest) conservatives have an opportunity to see Social Democratic economic policies triumph.  (Not that they would ever acknowledge this reality.)