Mark Wilson gives you some tips on arranging your elective in Brazil

Brazil, the largest country in South America, is famous for its rainforest, the huge Amazon river, and its coffee, gold, and diamonds. The country has 1243 miles of Atlantic coastline and has a diverse population based on the original Indians, Portuguese colonisers, and the African slaves brought to work in the sugar plantations. Over the last century many of the Indian villages have been wiped out by disease or by Western force; the total number of Indians is now only 200 000.

Medicine

For those who can afford it, private health care is good. For most of the population, however, health care is much sparser. Only 20% of the country's hospitals are state run. Infectious diseases are increasing, in particular malaria, leprosy, and parasitic skin infections. This is because of the lack of preventive medicine, for which Brazil has been strongly criticised. The prevalance of HIV is estimated to be less than 1% but varies from area to area.

Visas and work permits

British students need a visa to enter.
32 Green Street, London W1K 7AT;
tel 020 7629 6909; fax 020 7399 9102;
Consult the embassy (Brazilian Embassy, www.brazil.org.uk) for more details.

High temperatures and relatively constant rainfall are usual in the Amazon basin. The north east of the country has little rainfall and over recent years has had episodes of drought. The Brazilian plateau has wider temperature ranges and most rain falls between October and April. The south has a temperate climate of warm summers and cool winters.

Over the past couple of decades, crime has risen sharply--particularly so in the shanty towns and urban conurbations, where street children have been murdered by uncontrolled death squads. Drug related crime is also on the increase.

Useful addresses

• Ministry of Health--Esplanda dos Ministérios, Bloco G, 5 andar, Brasilia 70.058; tel +55 61 223 7340; fax 61 224 8747
• Brazilian Medical Association: Associação Médica Brasileira, Rua São Carlos do Pinhal 324, Bela Vista São Paulo SP 01 333 903; www.amb.org.br

There are over 100 medical schools in Brazil, too many to list here. A full list can be obtained through the World Health Organization, or try www.iime.org or www.medicstravel.org

Some of the larger hospitals

• Fundação Hospital Felicio Roxo, 9530 Avenue do Contorno, Bairro Prado, Belo Horizonte, Minas Gerais; tel +55 31 339 7244
• Hospital de Base do Distrito Federal, Area Especial SMHS, Brasilia, Distro Federal; tel +55 61 325 5050

Opportunities in primary care

Fundacao Esperanca

Rua Coaracy Nunes, 3344, Caixa Postal 222, Santarem, Para CEP 68 040­100 Brazil; tel +55 91 522 2726; fax +55 91 522 7878; email fesperan@ax.apc.org or fesperan@ax.ibase.org.br

This clinic is a non-profit organisation run largely by North Americans and is based in Santarem in the mid-Amazonian basin. It is a primary healthcare facility that runs clinics. Santarem is a short flight or a three day boat trip down the Amazon from Belém. The region is poor, with deficient health services. Esperanca serves the town's 30 000 inhabitants and rural people scattered through the municipality, which is about the size of Belgium. There is a great deal of tropical medicine (leprosy, leishmaniasis, malaria) and general medicine (diabetes, hypertension, tuberculosis). Paediatrics and obstetrics and gynaecology are also busy. The elective surgery programme brings volunteer orthopaedic, plastic, and ophthalmological teams to the Fundacao every three months. At the education centre (with its good library), training is provided at various levels and in different areas of health work. There are few acute cases, but many tropical diseases, and gynaecological and paediatric problems. Students can also go out with a health worker on a four day journey into the jungle to check on remote communities and immunise and weigh children. Being able to speak Portugese is a big advantage, though not necessary due to the American presence. Accommodation is provided.

Good Samaritan Clinic

São Paulo, Brazil

This is a 100 bed unit which oversees a number of projects on the edge of a slum in which 1200 families live.

Porto Alegre

Hospital Nossa Sra da Conceiçã, Rua Francisco Trein, 556, Porto Alegre, Brazil

Porto Alegre, with its 1.5 million inhabitants, is the capital of Brazil's southernmost states, in the most affluent and developed part of the country. Many southerners are descended from Germans and Italians and take pride in their "non-developing-worldism." They are famed throughout Brazil for their work ethic, their barbecues, their money, and their lack of Brazilianess (no carnival and chaos).

The community health service in Porto Alegre has been in existence for almost 20 years. It is modelled on the UK system of general practitioners and is one of the only services of its kind in the country. It started from within a public hospital and gradually, through demand from local communities, spread outwards so that today it is the largest post, with 13 others scattered throughout the north of the city. Originally financially independent, the service is now subsidised by the government and offers primary health care free of charge to anyone within ill-defined catchment areas. Working at one of these posts means you can see the rich diseases (similar to those in the United Kingdom) as well as those of the terrible conditions in the shanty towns.