2008
WEB FEATURE
Fogarty scholar learned to think critically at early age
By Roberta Myers
"Brazil," says graduating Epidemiology M.P.H. student Joaõ Miraglia, "is a country full of contrasts and significant inequalities in wealth and income distribution." The socioeconomic elite live in "islands of welfare" that make it easy to forget the precarious life conditions of the majority of the population.
Joaõ Miraglia, second from left,
with indigenous patients in his
native Brazil
When Miraglia was four years old, his family moved from Brazil to Nigeria for a year, where he was exposed to a culture quite different from his own; from that point on, people from many parts of the world had an influence on his development and led to his acceptance of and appreciation for diversity. As a child of nine, Miraglia started to participate in track and field, a sport practiced in Brazil mainly by lower-income people. "Because of that, I ended up establishing lifelong friendships with persons from different social and economic backgrounds and transiting to different areas of the city besides the more wealthy neighborhoods where my home and school were. These experiences and bonds permeated every aspect of my life and were central to the direction that my will to work and to perform research has taken." Later, during medical school, he coached the male and female high-, long-, and triple-jumpers—his first teaching experience.
During Miraglia's childhood, Brazil was run by a military dictatorship. He feels that living through that era and the changes that followed the regime's end in 1985, when a popular movement achieved a new constitution and direct elections, led to his becoming a combative and critical person. His education through elementary and high school honed these traits, as students in Brazilian schools were encouraged to be critical and to form their own ideas about the surrounding world. These strengths have helped him achieve some goals of his own—like earning his M.D., deciding to specialize in Infectious Diseases, and then earn an M.P.H. at Berkeley.
Joaõ Miraglia with indigenous
patients in his native Brazil
Meanwhile, the new Brazilian federal constitution was written specifically stating that the government's duty is to provide health care to every citizen—so the public health care system (SUS) was founded on the principle of universal coverage, despite the fact that Brazil is a developing country with many low income citizens. The federal government created an indigenous health care subsystem, organized in Special Indigenous Sanitary Districts (DSEI), comprising one or more indigenous lands. The objective was to implement SUS in these remote areas.
When he was at the teaching hospital, in addition to being a co-investigator in a clinical trial of a preventive HIV vaccine and participating in the Working Group on Influenza, Miraglia became involved with the Xingu Project, in an indigenous land north of Mato Grosso, Xingu Park, where he led an active search for tuberculosis cases in 27 villages while also working as a family physician at an outpatient clinic dedicated exclusively to indigenous peoples. Miraglia also spent the three years before coming to Berkeley as an infectious disease medical resident at the Federal University of São Paulo, the leading HIV/AIDS research center in Brazil where he had received his medical degree.
As a medical resident in a federal and public institution, Miraglia "could experience the challenges and the great benefits of the implementation of such a democratic health care system," he says. "In addition, it also allowed me to have a vast and rich clinical experience, given that I was [expected] to make diagnoses and to treat HIV-infected patients with a great variety of problems and in many different settings." In this setting, "the professors and almost every attending doctor directly involved with the training of medical students and medical residents perform some type of research."
All these experiences led to reflection. "It was exactly my work as a doctor working in a public hospital that made me reflect constantly about public health issues. The gap between the private and public health sectors . . . increased my attention to the field of public health." Miraglia decided to get a master's degree in public health and came to Berkeley with support from the Fogarty International Center.
Family has also been an important force driving him toward the decision to perform research related to social issues. Both his sisters are social anthropologists. Both his sisters are social anthropologists. One has a master's degree and studies sustainable development; the other has her doctoral degree and deals with forming public policies for violence prevention among youth.
Miraglia wants to share and pass on what he has learned and contribute to the improvement of research quality in Brazil. "My plans now are to go back and start my Ph.D. at the School of Public Health of the University of São Paulo, and work with the female population of inmates in São Paulo, focusing on STIs and HIV."
This article originally appeared in the Berkeley AITRP News and is reproduced with permission.