Under Foreign Skies – Nanko van Buuren

This entry is part of the series Under Foreign Skies
Nanko van Buuren, Braziilian Institute for Innovations in Public Health
Nanko van Buuren (Flickr)

Nanko van Buuren is the co-founder of the Brazilian Institute for Innovations in Public Health (IBISS). It is based in Rio de Janeiro and has won international acclaim for its work. The organisation deals with the people in greatest need in Brazilian society, for example street children, vagrants, male and female prostitutes and transvestites. The group also works in some of Rio de Janeiro’s most violent favelas or slums, which the authorities don’t dare to enter.

Van Buuren died in Rio de Janeiro on February 11, 2015. Shortly afterwards, a leading Dutch newspaper, NRC Handelsblad, published an article, accusing him of sexually abusing children and misappropriating donor funds. In response, the executive board of IBISS issued a statement, saying that it was “utterly disgraceful to write such a negative story about a person who is no longer able to defend himself”.

“Under Foreign Skies” is a series of portraits of Dutch people abroad doing remarkable things.

Original broadcast: August 29, 2007


Radio Netherlands, the Dutch International Service, presents “Under Foreign Skies: Portraits of Dutch People Abroad doing Remarkable Things”. The programme is presented by Eric Beauchemin.

In Brazil when you look that almost 8% of Brazilian society earns 85% of the national income.

Nanko van Buuren is the co-founder of the Brazilian Institute for Innovations in Public Health. IBISS – as it’s known – is based in Rio de Janeiro and has won international acclaim for its work. The organisation deals with the people in greatest need in Brazilian society, for example street children, vagrants, male and female prostitutes and transvestites. IBISS also works in some of Rio de Janeiro’s most violent favelas or slums, which the authorities don’t dare enter. The Brazilian Institute for Innovations in Public Health works with slum dwellers to help improve their living conditions and lives. I asked Dr. Nanko van Buuren how they manage to get into these no-go shantytowns.

We started with working in favelas years ago that we made contacts with people who lived in the favelas and then we tried to enter little by little. We have small meetings near the bars and then we try to establish a kind of relationship with the people in the favelas, that they trust us and based on that trust, we do a kind of community organisation. EB: But how difficult is it to gain the trust of people in the favelas because I mean you often hear that these places are ridden with crime. As you said, the police don’t even want to enter there and yet you do go in. It takes a long time. It takes years to get that kind of confidence by organised crime, but nowadays when we see that we often are asked by other slums to enter, and when we come to the slum, already the big boss of the slum already know who we are and they like us to enter. So nowadays the situation is quite different. EB: And so you enter into one of these slums and what exactly do you do there? First of all, we make a kind of analysis of what is the main problem and what are the problems in the slum. So we can stimulate the forces inside the slums to do all kinds of activities what can make the circumstances in the slum better. EB: For example? For example, when the slum every time has too much water after the rains, too much water in the slums that we flooding flooding in the slums, we try to elaborate a system of sewage and we do an awful lot of activities together with the people inside the slums, so that we call it multirun. Multirun is a kind of mass action from inhabitants who do together or make together the light inside the slums, so the electricity system or the water system. In some slums, where we see an awful lot of illnesses, our own organisation makes a kind of pre-medical post inside the slum to do the first diagnosis and to refer people to the public system. EB: Because that doesn’t exist in the slum itself. No, in the real socially excluded slums that we call the state in the state, there doesn’t schools, no form of education, no form of health and even our organisation has the objective not to create parallel services to the public system. In some slums we organise medical health posts to make a bridge between the socially excluded people and the public system. EB: Besides creating these health posts and for example trying to solve the problem of sewage and other things, what else are you doing in the slums? Well sometimes when people go with us on our work in the slums, they think what are you doing? You are talking, you are walking around. You talk with the guy of the church. You talk with the guy of the association of inhabitants. It’s a funny job just to talk around and have a beer in one bar and the other bar. But I think that’s exactly the basis of community organisation. We try to network inside the slums and to empower the people inside the slums to fight for their own rights, so not to do the things for the slum inhabitants but to stimulate them to do the things by themselves and that is also much more structural because when they fight for their own sewage system, they keep the sewage system clean. When you get a sewage system from the government or from something else, then in less than 2 or 3 months it’s totally blocked, and that’s why sometimes you can see so very much what is community organisation is about because networking is an awful lot of talking, sitting, to change ideas, and to try to open space for other people to realise their own thoughts, their own ideas. The work inside the slums, from slum to slum, is totally different.

EB: Why is it totally different from slum to slum? In some slums, the people think that the health problems are the main problem. So we start to do something about the health problems. In another slum, we had a programme to try to transform the slum in a neighbourhood, a neighbourhood with normal circumstances. We had to do planning how to make the circumstances better. What you will see is that nothing will happen when we make the plan, the government will not help. But what do you really want? We want to have a soccer field inside the slum. And then I said to the people from the government and to the people from the Inter-American Development Bank who were financing that programme that this was the first thing they want. And they said that’s impossible. We have to do more structural things, but at the end, we could convince the government to start with a soccer field and that was very funny: the moment they saw that it was realised, they said, oh, now we want to plan this, we want to plan that, we want to plan that and then all of a sudden, the planning was going on. So many times the people in the slums don’t have confidence that when they have the right plans that the plans will be realised. So sometimes it’s better to do a very basic, a grass-roots plan that you really are realising so that they see and feel the results and then they are stimulated to do other things like sewage systems, water systems. EB: So is your role simply to encourage people or is it to act as an intermediary between the slum dwellers and the government and other financers? It’s both. It’s intermediary. It’s to stimulate people and also to sit together with the people to defend their interests, to do advocacy, to do political lobby, because we think that social equality, social work is not possible without a strong political lobby, without advocacy because we have to show the government what is wrong inside the favelas. So when nobody in the favela has access to education or doesn’t have access to health, we have a kind of social watch role to make the government aware of what’s going on and to try to stimulate them to do also something for the most excluded people in society. In how many favelas are you actually working? We work in 48 different favelas that are the most violent, the most inaccessible favelas in Rio de Janeiro. It seems an awful lot but when you see that we have over 400 favelas in our city, it’s just a part but it is exactly the part where the problems are very big and where the violence is so very strong that for example we have an awful lot of victims of shootings, of gunfire between this kind of favelas. I think we have around 800,000 people in those 48 favelas, so it’s still an awful lot of inhabitants.

EB: Your organisation started in 1979. Are you still working in the same favelas that you were working in at the very beginning or have you changed? No, we change favelas. When we succeed in changing the favelas in more decent neighbourhood, we change from favelas. EB: To what extent have you succeeded in what you’ve done because you’ve been working for 25 years now? You said that have moved from one favela to another when the situation has improved. In how many favelas has the situation actually improved? I think the last 15 years, we succeeded in around 20 favelas in which the favelas changed from favela to a normal neighbourhood. But it’s very hard to say what is a normal neighbourhood because we call a slum in Rio de Janeiro the moment that the neighbourhood is not accessible. So sometimes the circumstances in the neighbourhood improved an awful lot: there is water, there is electricity, there is education, there are schools, but still the organised crime is ruling. So when the organised crime is ruling, still ruling, we keep calling it a slum. And that last part, to succeed that organised crime goes out of this kind of neighbourhood, it is an objective, but it is not objective of our organisation to fight organised crime. It’s much more to elaborate alternatives for the people inside that they don’t need crime to survive.EB: Does that mean that you have to work hand in hand with the criminals in the beginning?No. We have a kind of status quo with organised crime. We don’t work with organised crime. We also don’t accept nothing from organised crime. And they offer very often a lot to our organisation. For example we have a school in one of the most heavy favelas and our freezers and things broke, and they said, oh, no problem. We give you a freezer, we give you things. Then we have to explain no, we don’t accept things from organised crime. They understand that because we say we accept, we respect what is your objective and we say you have to respect our objective. And so we both have to work in this favela or in this slum and often what we both want is that the slum inhabitants get a better life because many people don’t understand very well that organised crime in the favelas of Rio de Janeiro, one of their objectives is to offer a better life to the slum inhabitants. It’s not just organised crime to exploit people but it is also very often a way to organised crime to make the circumstances inside the favelas better.

EB: What is the ideological background to the organisation? We say we can’t accept a society which is excluding the part of society which has no opportunity or has no ability to contribute to that society, especially in Brazil when you look that almost 8% of Brazilian society earns 85% of the national income. We think that we have to fight this process, that we have to fight for better circumstances and that we want that everyone has the same rights to participate and has the same right to have access to services like health, education and that’s the only way to make a society more healthier. EB: Do these ideas come from Holland or do they come from Brazil?I think that they are ideas that come from Europe but there are ideas in our organisation which are discussed inside our staff, inside our board so many times that we incorporated this type of ideas totally and it became the heart of our organisation. EB: But to what extent have you as the executive director of the organisation played an important role in forming these ideas? One of the main roles I had in the beginning is to stimulate our staff, our people who wanted to contribute to make better circumstance, that they first had to make an analysis how this situation was created and this part of society or this process is responsible for social exclusion because in the beginning people wanted to elaborate all kinds of little projects just to resolve one little piece and not make a profound analysis that you can elaborate projects that have a more holistic approach, and I think that was from the beginning one of the biggest inputs I took from Europe. EB: How did you actually get involved in this? Already in Europe I was working for disadvantaged groups and from my study – I studied anti-psychiatry EB: which is? What is anti-psychiatry? It is a movement what was created in Italy where the movement saw that society doesn’t have the right to put all kind of people who have a different kind of reaction or who can’t deal very well with society, to put them in hospitals and psychiatric hospitals or colonies outside society but that society needs to deal with the problems society is creating. I think this almost the same what we are doing now, that we say that we have to deal with the problems from the shantytowns, from the slums. We can’t say no, that is only a problem from them inside because society is responsible for the ghettos which the own society was creating. So I think there is not such a big difference between what I was doing in Europe and what I’m doing over here.

EB: How did you actually wind up in Brazil? It was a kind of coincidence. We had a process in Holland where all kinds of organisations who were involved in social work, involved in work with socially excluded people…all these kinds of organisations had to come together in one big institute in Holland and at that time, I knew some people who were also involved in this kind of work, and one of them said well, I’m a member of the board of a foundation and we pay a lot of donations to the national movement of street children in Brazil but we don’t know what we are paying for. We don’t know what the results. We don’t know what they are doing with the money. Is it possible that you go one month, one month and a half off to Brazil to visit these projects to make a little report what you think about it and what you can do to improve the results of our donations. That’s why I went to Brazil. I visited the projects and I made a report in which one of the things was that I suggested that they should create a training centre for street educators to improve their work, to not only take care of children on the street but also elaborate more educational processes, to stimulate children on the streets to be aware of the situation, and this organisation thought this was a nice idea to create such a training centre, and then they asked me to go to Brazil for 9 months to found this training centre. During the first year, we had contacts with several social workers with street workers, who had very creative, nice innovative ideas what they could do, what should make the things better, and then every time we asked them, why don’t you do this kind of work? Why don’t you execute all your ideas? And then they said, ah no. But we are linked to the church or we are linked to the government and when we do this, they will throw us out. It will be impossible to do that. And after 9 months, we brought 8 of these people together and said, look, when we create together an innovation institute where you can experiment with your ideas and where you have space enough to realise these kind of ideas, you will join this new institute. That was more or less the creation of IBISS, the Brazilian Innovation Institute and Social Health Care.

EB: Is it difficult to get financing for projects like this because innovative projects, funders are often very reluctant to give money for things like that. It is difficult, especially with totally new ideas where you have to experiment and you don’t know if it will have some results. It’s difficult to get money for them. The funny thing is that sometimes we start with small donations from private funds to experiment with an issue what is a very hot issue in Brazil, for example to work with the child soldiers from the organised crime and in the beginning, organisations like UNESCO, UNICEF, ILO, say but that’s too difficult. And then when they see that we have results and it is possible to elaborate this group at aim, then all of a sudden it is possible to send proposals and to get funds. So what is very difficult to get funding for the first period to experiment. EB: To what extent have the innovative solutions that you have come up with – for example you just mentioned child soldiers in the favelas but I’m sure that there are many other issues that are plaguing Brazil – to what extent have the solutions that you have brought been adopted by other cities and by the rest of the country? We have several experiences that at the end also Brazilian government was implementing what we developed. For example in health care in ’92, we started with community health workers. We trained people inside the favelas in early recognising of illnesses and how to refer people from the favelas to the public system. We did this with normal people, informal leaders of the favelas. We experimented about four years with this community health workers. Then we did an awful lot of advocacy to make the Brazilian government aware that this was a good way to bring health care closer to the socially-excluded people and end of ’98, this system was included in the health care system of Brazil. Nowadays we have all over Brazil more than 3000 health units who have – each has about 8 community health workers. So sometimes we have nice results. Also in AIDS prevention we have results. You can imagine that in a Catholic country like Brazil, years ago, the idea to work with boy prostitution was not accepted. When we started to distribute condoms and that was the ‘90s, even our cardinal was saying that we were stimulating homosexual activities and he wanted that we were thrown out of the country. Nowadays in all states of Brazil, these kinds of activities are implemented. Of course we can’t say that it’s only IBISS who was doing this job because there were more organisations who was stimulating this process but I think that we really succeed to show what is happening, what is possible in all kinds of councils to implement these new approaches. EB: You said that you were working in 48 of the most violent favelas here in Rio de Janeiro. But you’re also working with the most socially excluded groups in society, for example male prostitutes but also you’re working with transvestites and other people who are completely rejected by society. Yeah, our group aim is especially the people who are not accepted by society and don’t have access to all kinds of services that society should offer. Yeah, boy prostitution is one of the parts. Transvestites is another part where are very discriminated, marginalised by society and this kind of area we are also working with people from the own group. So in our boy prostitution project we have ex boy prostitutes who are now social workers. For the transvestites, we have two transvestites who are working on the street, who are mutliplicating all the information that transvestites need and we think that the way to come as close to possible to this kind of excluded groups and also to make the bridges between these groups and the services inside services. EB: Why select the most excluded groups? We chose for this policy inside our organisation because first of all we think we have the ability and that’s why we have the obligation to work with these groups and not do the same as society is doing. An awful lot of social workers to exclude the people once more. It’s not to criticise our colleague organisations, but very often when we look to organisations who work with street populations, who work in our field, we see that the most violent, the people with a lot of psychological problems and everything, they are even excluded by social work. So to avoid that our organisation is doing the same, we each 2 or 3 months we are evaluating if we are still choosing for the right group at aim, and I can assure you that’s not easy. EB: Do you think you’re actually having an impact on the way Brazilian society deals with these most marginalised groups, with the favelas? I think more and more we have an impact because we have several activities inside our projects in which we try to show society what the people from favelas have to offer. For example we have each month we have a big activity what is called Artes en Complexo that is a big festival where all people of the favelas who do music, theatre, and things like that, they can show what they are elaborating. And this kind of big festivals, we have over 40,000 people who have assisted in the festivals and that are people from one side of society and people from the other side. So we try to make the ruling society aware of what favelas and what favela people have to offer, and I think little by little, the ideas about the ruling society, about the people in favelas, about what is happening is changing. But of course it’s not something you can do from one day to the other.

EB: Do you plan to stay here to follow this process? For sure. I will say in Brazil, I’m not saying to go back even after finishing my work, I will stay in Brazil and also to observe the improvements inside the social system. I love the country because this is a country which has an awful lot of opportunities to improve, to get a better social system, and I think when we are all together are discussing and make people aware inside our society how we can do that, that for sure in 20 years a total other society than we have at this moment.


Nanko van Buuren in conversation with Eric Beauchemin. “Under Foreign Skies” is a RN presentation. If you have any comments on this or any other RN programme, please contact us at letters@rnw.nl

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