P. Leocir Pessini

By Leo Pessini[1]

In the year 2017, as regards the world of Camillian publications, there is an important event that should be remembered and celebrated: the fortieth anniversary of the uninterrupted publication of the review O Mundo da Saúde. This is a scholarly publication connected to the educational field of the university world of the Camillian Province of Brazil. It was with great pleasure and a sense of honour that I accepted the invitation of Fr. João Batista Gomes de Lima, the current chief editor of this publication and the rector of the University of the São Camilo Centre (SP), to write an article for the edition commemorating the fortieth anniversary of this publication. I will not focus on producing an article of a scholarly character, which others will certainly write or which I myself will prepare for another occasion. Rather, I will take the liberty of bringing together and presenting historical reminiscences about some of the most important facts that have characterised these last forty years.

The authenticity and reliability of my description of the most relevant facts of these forty years depend on the fact that I experienced intensely the history of this scholarly publication for many years. I had the responsibility of being the editor (the third of this history of four decades) for almost twenty years (1995-2014). In addition, at the end of the 1970s, and more specifically in March 1977, when the first number of this publication appeared – to begin with it was a quarterly – I was also its secretary for three years (1978-1980) while I was still a student of theology. I graduated at the end of 1980 and I was appointed by the Provincial Superior of that time to another post in the Camillian Province of Brazil.

I would like to organise these memories of mine connected with the review O Mundo da Saúde around four points. I will introduce my paper with the force of the thought of an authentic Camillian leader (Fr. Calisto Vendrame): ‘What is not written down – it is as though it did not exist’, and the publication of a historical work, ‘Eu vu Tancredo morrer’[2] (I).

What follows is a short historical survey of the people and the facts that contributed to the birth of a publication that was new in the field of health in Brazil, a publication that sought to spread Camillian Christian humanistic values through its reflections and to point out to the vast public of public health, and to professionals in general, a new area of inter-multi-trans-disciplinary knowledge, namely bioethics (II); a reading anew of the most significant facts of the scientific and health-care world of the last four decades (1977-2017) (III); and a look at the future, indicating the need to address the ethical challenge of conjoining science with human and Camillian wisdom so as to be able to construct a new culture of health care (IV).

‘What is not written down – it is as though it did not exist’ and the publication of a historical work

When writing down these historical memories of mine I could not fail to mention with great gratitude Fr. Calisto Vendrame, the former Superior General of the Camillians (1977-1989) and distinguished Bible scholar. His personality, with its great sensitivity, marked the lives of many people for the whole period of his presence in our Order. When he was Provincial Superior of the Camillian Province of Brazil, he was for two years also my spiritual director. Fr. Calisto, from the outset, was one of the greatest supporters of the publication of a Camillian scholarly review in the field of health: O Mundo da Saúde. He always exhorted his religious to never stop studying in the their lives and he exhorted the young religious to lean to write correctly. Indeed, it was he who encouraged me in 1985 to write my first book – an account of my pastoral experience of twenty-seven days as chaplain of the Hospital das Clinicas at the Faculty of Medicine of San Paolo (1982-1994), with the patients’ family relatives and health-care professionals, on the occasion of the illness and the death of the then President-elect of Brazil, Tancredo Neves. Tancredo Neves was the first civilian president after twenty-two years of military dictatorship in the country, the so-called ‘years of lead’ in Brazil, and he embodied the hope for better times, freedom, democracy, economic growth, and respect for the human rights of all Brazilians.

His death provoked an authentic feeling of ‘national mourning’. Fr. Calisto repeatedly asked me to write on this personal experience of mine: the repercussions in the mass media of the case (TV, radio, newspapers) would be an excellent opportunity to point out to the general public the importance of spiritual and pastoral care for sick people in hospital and of the mission of hospital chaplains. I wrote that book of memoirs which went into a number of editions and the preface was written by the then Cardinal of San Paolo, Msgr. Paulo Evaristo Arns (1921-2016). It was published with a title that was chosen by the publishing house Santuário which at the time rather frightened me, but it was very effective in capturing the attention of the reader: Eu vi Tancredo morrer.

After the deeply painful and tiring experience of the illness and the death of Tancredo Neves, because of its political implications as well, it was very comforting to receive the thanks of Msgr. Luciano Mendes de Almeida, the then General Secretary of the CNBB (the Bishops’ Conference of Brazil). This unexpected note of thanks was published in one of the largest and most important newspapers of Brazil, the Folha of San Paulo, on 12 April 1985, two days after the death of Tancredo Neves. In his weekly article in Folha, entitled Lições de Vida, Mendes de Alemeida wrote as follows:[3]

‘To Father Leo Pessini, a young chaplain who for four years has accompanied the sick in the Das Clinicas Hospital, we owe our gratitude for his discreet and tireless dedication: he has conserved for us the humble lessons of life of President Tancredo. Father Leo found the President at prayer on many occasions. It was in that way that he was able to face up to his illness. On Good Friday he asked to be able to read the gospel of the passion of Christ. On the wall in front of his bed there was a picture of the crucified Jesus. The President, apparently at peace, turned towards the cross, joined his hands in prayer and whispered “God is great: without Him we are nothing”.

At a time of the exhibitionism displayed by many politicians who wanted to be seen by the people at that moment of suffering, exploiting the mass media, to listen to the words of Msgr. Don Luciano Mendes de Almeida who spoke about ‘discreet and tireless dedication’ was for me an authentic fillip.

Fr. Callisto always used an aphorism that I have never forgotten and which I have used many times over the years in the field of formation and the academic world, when I led the União Social Camiliana, and within the framework of the Centro Universitário São Camilo: ‘What is not written down – it is as though it did not exist’! How true this is in the academic and scientific world! Therefore, if to exist a work has to be written down, a work begins to be written by inviting other people who are expert in the various specialisations of the field of health to cooperate through their writings: thus the review O Mundo da Saúde was born as a project and became a reality.

A New Publication in the Field of Health in Brazil: Bioethical, Camillian, Christian and Humanistic Values

It may be of help on this pathway, with its reading anew of the history of this review, to go back to the two editorials that were written during the course of years, in particular those to celebrate the ‘20 anos de vida’[4] and the thirtieth year of publication, Uma marca histórica: 30 anos de publicação ininterrupta.[5] No less relevant in obtaining an overall vision of what has been published, and which authors have most contributed to the growth and the continuity of the review, was the publication of the Index of authors and titles of articles on the occasion of the commemoration on the thirty-fifth anniversary of the review (1977-2011).[6] A rapid glance can immediately bring out my personal and professional investment in the drawing up of editorials and articles for all these years: about 162 texts written as editorials and/or articles of a scholarly nature. This highlights my interest in exploring humanistic subjects relevant to thought about health, the humanisation of health care, bioethics, and questions connected with the Camillian charism.[7] We may remember with gratitude other authors who offered their significant production of scholarly literature to the review: Hubert Lepargneur, Joao C. Mezzomo, Augusto A. Mezzomo, Niversindo A. Cherubin and Christian P. Barchifontaine.

A scholarly publication is never the outcome of one person. It is always the outcome of an inter- multi- and trans-disciplinary effort. This applies above all in the field of the variegated world of health, as, for example, the name of the review indicates with its concern with questions of O Mundo da Saúde. For reasons of justice and above all of gratitude, we should recall the names of some of the Camillian religious who were the pioneers of the birth and the development of the review. We cannot forget the Camillian religious: Hubert Lepargneur, (the first editor), Joao C. Mezzomo (the second editor), and Niversindo A. Cherubin. In addition, we may remember Ademar Rover, Augusto A. Mezzomo, Calisto Vendrame and Christian P. Barchifontaine, who were advisers and directors. During the course of the years other lay co-workers followed one another who offered their professional expertise to the editorial department (the revision of texts, the composition of indexes, the mailing of the review to subscribers and to health-care institutions in Brazil) and to the editorial committee. An attempt to name them all would run the risk of forgetting some of this long list but here we may extend our sincere and heartfelt gratitude to all those professionals who made their contributions so that O Mundo da Saúde could become today a historical reality.

The review began in a pre-ICT age; we did not have computers, it was not possible to go to internet to obtain information, and social links obviously did not exist. These tools, which slowly began to populate the editorial and copyediting spaces of newspapers and reviews in the 1980s, were only present in our minds as a ‘scientific fiction’. For example, I never thought that the day would come when a review could be published in digital form and that this would be the preferred form of publication for most of the principal Brazilian and world universities. For writers and editors of reviews and newspapers, such as we were, this was the epoch of the Olivetti or Remington typewriter, which at first was manually operated and later became electric. I still have impressed in my memory the metallic noise of these mechanical tools that we used to write our texts. Another curious defect was the use of these machines during the night: the noise of the typing could disturb the sleep of a confrere at my side. This was also the time when the first Xerox photocopying machines appeared, even if the Photostat machine still reigned supreme. The innovation of the first faxes for the transmission of documents and texts provoked amazement and admiration at the time. Today we have, quite literally, entered the digital age.

The printing of O Mundo da Saúde for the first ten years was entrusted to the Gráfica da Editora dos Criadores. This was located in buildings at the bottom of the St. Camillus Seminary of Pompéia (SP), the place where previously the Gráfica São Camilo had been operational. This was the moment of a printing machine called the Lindenberg and of photolithography. You wrote on two small lead plates that were then placed on plates of lead: this was the stage that we call today pagination! When the photolithography was arranged, metal plates were used that were then placed in the printer. After the printing, the cutting and binding took place and finally the review was ready! This was pre-eminently craftwork – we could even say that it was artistic – and it required a great deal of time and patience during the various stages of production. What a revolution has taken place in publishing since that time and today!

As regards the initial purpose of this publication, Fr. Hubert Lepargneur, in the editorial of the first number of the review (March 1977), declared: ‘the aim of the review is to publish original research in the field of health’. Later on he explained the people the review was aimed at: ‘all those people and institutions linked in one way or another to the world of health, in particular for professional reasons, but also because of a human interest: surgeons and humanists, psychiatrists and psychologists, patients; but also people in charge of pastoral care in health or other sectors; in churches that follow the modern development of the world and are concerned with the salvation of every man. The dimension to do with information will make this review a unique instrument in the hands of the administrators of hospitals and health-care institutions’.

Some Elements that have Characterised the Scientific and Health-Care Panorama over the Last Four Decades (1977-2017)

Over the last forty years the world has changed a great deal in geopolitical terms: we have witnessed real revolutions in the field of scientific knowledge in the world of health and health care, as well as in society in general.

Brazil, which today has more than two hundred inhabitants, in 1977 had about half that number. During the course of these years we have been surprised by various types of diseases, some of which of an endemic character, which were unknown prior to their appearance. In 1983 we encountered the first case of infection by the HIV/AIDS virus: Brazil would be one of the countries in the world most struck by this disease. More recently, Brazilian society has lived a new experience of new tension because of so-called bird flu, Dengue fever, the Zika virus and the Chikungunha virus.

In the context of the policies of public health care, one fact that strikes one is the birth with the new Constitution of Brazil in 1988 of the SUS – the Single Health System – on which the lives of 160 million Brazilians now depend. This public health-care system is rooted in a wonderful philosophical approach, internationally recognised in theory but unfortunately at a practical level still marked by many failings: a lack of resources, of administrative skills and of a political will to serve the population with dignity, safeguarding the sacred right to health.

Unfortunately, today this ‘right’ is undermined and practically denied by an exaggerated and unjust economic approach. Where previously health was seen as ‘charity’, and then proclaimed a ‘right’ in 1988 with the creation of the SUS, today what we are experiencing is an authentic business. In this critical context, between charity, right and business, the most vulnerable parts of the population are those that most suffer because of the denial of the right to health. In 1990 work was begun for the largest conference in the history of the United Nations, a conference on the environment, in Rio de Janeiro: ECO 92. Humanity was beginning to reflect seriously on the ecological drama we are going through today, with the danger that global warming poses to the lives of millions of people in the world.

We began the new millennium with the glorious announcement of the completing of the Human Genome Project in the year 2000. President Clinton, in a famous speech, announced that this could already be seen as one of the discoveries of the twenty-first century. Someone, paraphrasing a theological phrase, deeply troubled atheists and non-believers when he said: ‘we are discovering the language with which God wrote the book of life’. An authentic revolution in genomics had begun. We began to talk about genetically modified organisms, genetic engineering, gene therapy and its modification of genes with the discovery of Crisper-Cas, a pair of molecular scissors that eliminate defective genes and correct hereditary genetic diseases.

Humanity is frightened by the possibility of cloning man. We all remember that dear sheep Dolly! But there is also much hope that it will be possible to find a cure for the 2,500 diseases with genetic origins that today humiliate humanity and for which, so far, no cure exists. Reference is made to finding a cure for AIDS, for cancer, for Parkinson’s disease, for Alzheimer’s disease, and for very many other diseases. At the culminating point of the AIDS pandemic in 1987-1995, many scientists stated that by the year 2000 we would have a vaccine against AIDS. Almost two decades have passed and we still do not have such a vaccine! We may, however, have good news in this field shortly. It is evident that the advance of genomic science will have profound consequences in the field of human health. The task of humanity is to engage in effective discernment on the basis of what is good. In this scenario, the emergence of bioethics is a great hope for humanity.

To return to ‘our beloved country’, Brazil, one element that should be noted is that in the field of public health we have one of the largest programmes for ‘organ transplants’ in the world. Naturally, this has to be constantly developed further. In the field of the ethics of research on humans, we received the first ethical rules that should guide every experiment, experimentation or research that involves human beings. These rules were drawn up in 1996 and approved by resolution 196/96 of the National Health Council/Ministry for Health. Thought about bioethics made giant steps forward with the birth and the consolidation of the Brazilian Society for Bioethics in 1995, and with the appearance of the first university programmes for master’s degrees and research doctorates in this field. In this sense, our review O Mundo da Saúde was the Brazilian review that brought discussion about bioethics to the country at the end of the 1970s and the beginning of the 1980s, when bioethics, which was born as a discipline at the end of the 1960s and the early 1970s, was spreading throughout the world.

In the Catholic Church in Brazil the creation of the Fraternity Campaign involved at least two initiatives that were directly concerned with the subject of health: in 1981 with the theme ‘Health for All’ and in 2012 with the theme ‘Public Health’. To this subject of health are connected other important dimensions such as work, the land, ecology, and instruction, just mention some of the most pressing questions. Various Brazilian Camillian religious were directly involved in these campaigns of the Bishops’ Conference of Brazil. Numerous questions connected with these fraternity campaigns were transformed into informative and scientific articles that had a vast resonance during the forty-year history of O Mundo da Saúde.

This has been the context in which the thought of our review O Mundo da Saúde has developed down the years. A concern that has always been present – and this formed a part of my approach as editor – is to be always in line with current and pressing topics of the field of health and health care (and with the historical circumstances of the time) in order to allow the dissemination of information about scientific research and technical training and thereby channel human values (humanisation, ethics, bioethics, care, spirituality…). We may remember some of the principal subjects: the humanisation of health care; spirituality and health; the ethics of research on human beings; the management of hospitals; professional skills and expertise and ethics committees; human longevity: ethical and socio-political challenges; biodiversity and health; ecology and the environment; the promotion of health and the construction of citizenship; family health; rehabilitation and the reconstruction of citizenship; public health; bioethical questions and care at the end of life (palliative care); the humanisation of primary health care; and the promotion of health and environmental sustainability.

In addition to this gamut of questions, our review has also addressed other kinds of scientific knowledge of various fields of professional health care (nutrition, breastfeeding, hospital administration, rehabilitation, medicine and others). At the outset, we privileged academic production inside the Camillian world, but in order to avoid production called ‘endogenous’ – one of the maladies of scholarly publications – we always tried to be open to cooperation with other universities. An internal editorial staff and external referees that can assure ‘peer review’ – a competent reviewing of texts ‘by peers’ – is of fundamental importance in assuring innovative scholarly articles endowed with the right requisites of scholarly seriousness.

The Challenge of Constructing a New Future of an Alliance between Science and Human and Camillian Wisdom!

At the present time, one of the most important aspects of any scholarly publication is indexation which gives credibility and visibility to the publication in the context of the international scientific community. Our review has already done much in this direction with various indexations. A great deal, however, remains to be done. We have to enter the SciELO (Scientific Eletronic Library Online). We have made various attempts in this direction in recent years, meeting all the requirements, but the responses of the assessors repeatedly have not been forthcoming and thus our goal has not been achieved. I know many reviews in the health-care world that are not up to the level of O Mundo da Saúde and yet they have been indexed for a long time in SciELO. I hope that this objective will be achieved as soon as possible and that the current heads of this publication will soon provide us with good news to this effect.

Looking to the future, in order to try to be in line with the world health agenda, I would venture to recommend a subject to be addressed in the future questions relating to the 2030 Agenda for Sustainable Development of the United Nations. The question of sustainable development and health is of fundamental importance for the lives of all the peoples of the planet earth. In the year 2018 we will celebrate the fortieth anniversary of the famous Declaration of Alma Ata (1978) on primary health care and also the sixtieth anniversary of the Universal Declaration of Human Rights (1948). These are subjects that undoubtedly deserve attention when they are associated with human health.

I remember with a certain nostalgia what I wrote when ending my editorial role with the review in the edition that commemorated the thirty years of it existence in 2007: ‘Acknowledgements and gratitude go to all those who in one way or another have made the existence of this review possible. These professionals are the convinced developers of the horizon of values on the basis of which scientific knowledge must be transformed into wisdom, in order to help people to live in a happier and healthier way, in a society that is more just and inclusive’.[8]

I hope that this fertile historical trajectory of four decades will continue for a long time, without losing its vitality, expertise and human wisdom. In reality, this is an authentic mission: to seminate human and ethical values in the complex world of health and health care in a technocratic civilisation, so as never to forget that a human person in his or her full dignity must always be placed at the centre of the ‘struggle’! This pathway must always be followed in harmony with the fundamental values of the Camillian charism which can be summarised in that prophetic cry, which is of an incredible contemporary releance, uttered by Camillus de Lellis (1550-1614) more than four centuries  ago. This is a cry that should animate the spirit and the activity of those who work in the world of health and health care: “more heart in thosee hands!”

I will end these historical reminiscences of mine by sharing with you an aphorism of Henfil – the pseudonym of Henrique de Sousa Filho, a Brazilian cartoonist, journalist and writer – which contains a great deal of wisdom: ‘If there is no fruit, the beauty of flowers will serve. If there are no flowers, the shadows of leaves will serve. If there are no leaves, the intention of the seed will serve’.

Rome, 12 October 2017

The Feast Day of the Madonna Aparecida, the patron saint of Brazil.

[1] A Camillian religious; Ph.D. in the theology of the morality of bioethics; post-doctorate in boethics at the James Drane Centre for Bioethics of the University of Pennsylvania (Edinboro), USA. Currently the Moderator of the Camillianum – the International Institute for the Theology of Pastoral Care in Heath which is associated with the Pontifical Lateran University of Rome, Italy; Superior General of the Order of Camillians (2014-2020).

[2] ‘Ho visto Tancredo morire’ (editor’s note). This refers to Tancredo de Almeida Neves (São João del-Rei,  4 March 1910–San Paolo, 21 April 1985), a Brazilian politician who was elected President of the Republic as the candidate of the Party of the Brazilian Democratic Movement (PMDB).  He should have entered office on 15 March 1985 but fell seriously ill and was admitted to hospital on the evening before that day. After a number of surgical operations, he died of septicemia on 21 April of the same year without ever being able to take up his post.

[3] The newspaper Folha de São Paulo, Lições de Vida, p.2, 27 April 1985.

[4]Cf. O Mundo da Saúde, São Paulo, 1996; 20(1), 387.

[5]Cf. O Mundo da Saúde, São Paulo, 2007; 31(1), 5-6.

[6]Cf. O Mundo da Saúde, São Paulo, 2012; 36(1),143-196 (supplement of 114 pages).

[7]Cf. O Mundo da Saúde, São Paulo, 2012; 36(1), 93-94 and other references in the years 2013-14.

[8] Cf. O Mundo da Saúde, São Paulo, 2007; Jan./Mar. 31(1), 10.