The Doctor
By Dr. Germano Bonow*
The Medical Student
Moacyr Scliar graduated from the UFRGS Faculty of Medicine in 1962. As a student, he was a regular contributor to the newspaper published by the Sarmento Leite Academic Center (CASL), called O Bisturi (The Scalpel) where he published some of his first short stories. Years later, on the occasion of the 80th anniversary of the Faculty of Medicine, he published an article in the newspaper Correio do Povo, referring to this fact and to the critical comments he had received from a colleague at the time. (At first, he had thought his colleague was wrong, but years later, when reread this particular story, he decided to accept the comments and rewrote it.)
He engaged in student politics, taking part in demonstrations for university reform and the completion of construction on the Clinical Hospital (URGS), among others. In the wake of Jânio Quadros’ resignation in 1961, he was part of the demonstrations known as “The Legality Campaign” that advocated for defense of the constitution.
The medical students would attend political events in front of the Government Palace (the Piratini) to applaud Leonel Brizola and prepare for emergencies that might arise in the event of armed conflict.
As a student, he also served as an Administrative Aide for the state government, first in the Office of the Director of Administration, and later at the Parthenon Sanatorium Hospital of the Health Department, when he started his fifth year of medical school.
At the time, he sat for a civil service exam to provide services for SAMDU (Urgent Home Medical Assistance Service) and when he passed, he was assigned to one of the towns in the metropolitan region of Porto Alegre.
Years later, in Cenas médicas (Medical scenes), he recalled this experience, which, from the description, greatly impacted his medical career:
“My work as an attending physician involved going to the impoverished neighborhoods in a jeep or an old ambulance, where almost all the calls came from. What I saw in those shacks horrified me; sometimes there were five, six, ten people crammed into a small, stuffy, smelly shack. I had never had such a close encounter with poverty, not at the Santa Casa, the Parthenon Sanatorium, or the São Pedro Hospital. It was appalling, brutal. At times, my despair led me to a state of impotent rage against the resignation, the numb passivity, and the fatalism of these people. I was aware that there was little I could do for them; a child’s diarrhea would recur two, three, four times until he died from dehydration. It occurred to me that the problem had to be solved collectively; I started going to the town’s radio station to do some very basic health education. But it wasn’t much, I knew very little. In the life of every doctor (or, in this case, doctoral student), there comes a time when one longs for a more far-reaching action, beyond the bedside. It reminds every Brazilian doctor of the legendary Oswaldo Cruz.”
Speech at the 1962 graduation ceremony of the Faculty of Medicine. / Photo: Personal archive.
Scliar, seated first on the left, with the Medicinal class of UFRGS. / Photo: Personal archive.
At the end of his final year of medical school, he was elected class speaker. He began his speech by quoting Ferreira Gullar:
“Four people die every minute in this Latin America...”
Throughout the speech, he described the difficulties Brazilians face in getting to university, especially to study medicine.
He mentioned the entrance exam, the cadavers in the first year, the basic courses,
“… the Santa Casa, a repository of the diseases of an entire state.”
And questions from students:
“...there’s the clinical picture of malnutrition, but why is there malnutrition?”
Then, referring to the immense difficulties faced by Brazilians, the Cold War anxiety, and the dreams of those young people completing medical school in late 1962, he said:
“… Only under these conditions will it be possible to practice true medicine, all the more so, when the terror of an atomic war disappears from the face of the Earth, when the right of every people to decide their own destiny is respected, when swastikas and the lynching of Black people vanish...”
The speaker also mentioned the ancient prophecy of Isaiah: “The wolf will live with the lamb, and the leopard will lie down with the goat. The calf and the young lion will feed together, and a little child will lead them.” (Isaiah, Chapter 11, Verse 6).
And he concluded by urging his colleagues towards a purposeful practice of medicine.
Graduation ceremony of the Faculty of Medicine at UFRGS, 1962. / Photo: Personal archive.
The Clinician
As an intern in Ward 29, Scliar became interested in internal medicine and was selected to do his residency in the unit of Prof. Rubens Maciel. Ward 29 of the Santa Casa Hospital in Porto Alegre was a multidisciplinary unit that carried out activities in many areas, especially cardiology, pulmonology, and others.
The physician in charge was Dr. Rubens Maciel, a remarkable clinician, an exceptional teacher, and also a brilliant intellectual.
Among the assistants was a professor with a strong interest in nephrology, Prof. Anto nio Azambuja, and an exceptional team of nephrologists was formed, including Dr. Moyse s Lerrer. According to Scliar, these mentors, along with Oly Lobato, were among the pioneers of nephrology in Rio Grande do Sul.
Scliar recalls:
“… as if it were just yesterday, the first hemodialysis session performed in Rio Grande do Sul. I had just graduated from medical school, I was a resident, and it was early in the year, I’m not sure if it was January 1 or 2.” (1963)
He also mentioned:
“We were very proud to belong to that unit.”
Medicine and literature, Scliar’s two great passions.
At the time of his residency, he also worked in the clinic of Dr. Rubens Maciel and in the Parthenon Sanatorium, first as an intern and later as a doctor.
In 1964, he was invited to teach Internal Medicine at the Catholic Faculty of Medicine of Porto Alegre. The classes were held at the Santa Casa Hospital, and he became an assistant professor in the Medical Clinic Ward of that institution.
The Jewish community in Porto Alegre had a home for its elderly members and Scliar was the doctor for this group. Fla vio Kanter, in an article in the newspaper Zero Hora, commented on the work of “Dr. Mico”: “When I was in my last year of medical school, he invited me to keep the medical records of the elderly residents of the ‘Home for the Elderly,’ where he served as doctor. Each resident needed to have a complete medical record, and he was constantly busy with immediate medical needs and didn’t have time for anything else. As I collected the medical histories, I saw that many spoke of a ‘Dr. Miqui’ with affection and trust. It took me a while to realize it was him. His nickname was Mico, and there, with the predominant accent of the Bom Fim neighborhood, he was ‘Dr. Miqui’.”
Scliar in front of the ambulance of that time. Photo: Personal collection.
His work at the Parthenon Sanatorium brought him closer to the São José do Murialdo Health Center. This community center was a precursor to community medicine in Rio Grande do Sul. Scliar, together with a few colleagues (C. H. Tigre, A. Fishmann), was in charge of tuberculosis care there, as the Sanatorium covered the Health Center.
Gradually, he became involved with a group of public health professionals who made their mark on the history of public health in Rio Grande do Sula and Brazil itself.
The State, through the Ministry of Health’s FSESP (Foundational Public Health Services), signed an agreement with the federal government, which provided for the training of postgraduate professionals working full-time in public health. Scliar was invited to join the group and gradually reduced his activities at the clinic.
In a conversation with Rubem Alves, he recalls his transition from clinical practice to public health:
“I graduated from medical school in 1962 and worked as a clinician for several years, including in a tuberculosis sanatorium. It gave me a different perspective on disease: I realized that it could be viewed as a public problem, to be diagnosed, prevented, and treated. Brazil had an excellent program, renowned world-wide. So, I made a decision: I started working in public health, which I did for the rest of my professional life.”
The Public Health Professional
In the early 1970s, he began to “specialize,” if one can call it that, in public health. It was in Israel. He had been granted a scholarship from the OAS (Organization of American States) and went to see firsthand that country’s community medicine. He described it in the book O Texto, ou a Vida: uma trajetória literária (The text, or life: A literary journey):
“... I took a course in community medicine in Israel... I learned about the health care system, visited historical sites, and re-examined my beliefs. I discovered that Israel is a country of tremendous vitality and dynamism. And a country in which I experienced great emotions. I remember the first time we went to the Western Wall. It was a Friday afternoon, and the place was full of religious people praying, their heads covered with prayer shawls. Little black birds were flying above them... It was strange and moving at the same time... Tears streamed down my face.”
He pursued postgraduate work at the School of Public Health, which had a program with the Oswaldo Cruz Foundation (FIOCRUZ/RJ). In addition, he studied family planning in Tokyo, Japan, and epidemiology in Massachusetts, US.
He also held key roles at the Health Department from the 1960s until his retirement.
Invited to work at the State Health Department, Scliar left the Sanatorium and joined the Planning Unit, where he headed up the Health Education Team. There, in addition to being involved in a period of significant transformations, he served for many years as editor of the Health Bulletin and several other Department publications.
One of the most important transformations was the shift from simply giving educational lectures to high-risk groups to using mass media communication channels such as newspapers, radio, and television. While direct interaction between health care teams and individuals leads to positive outcomes, radio or television has a very powerful impact.
Scliar with Governor Jair Soares, Germano Bonow and Ellis Busnello. Photo: Personal collection.
Assignment to the Planning Unit brought him closer to all of the program areas of the Health Department. As a result, he was able to help with communicable diseases, chronic degenerative diseases, maternal and child health, and other areas of the Department’s work.
Sometime later, he was appointed Coordinator of the Integrated Medical Care Unit and then Director of the Department of Public Health. It was here that his knowledge of clinical medicine, combined with what he had learned in several postgraduate courses, proved extremely valuable in the period leading up to the creation of the Unified Health System (SUS). The agreement that linked the Ministry of Social Security to the Ministry of Health found an excellent team in Brazil’s Southern region, of which Scliar was a part. He was a pioneer in everything from the Tuberculosis Agreement, led by Werner Otto, the Prev. Health, the Integrated Health Actions, the SUDS and finally the SUS.
In 1978, 1982, and 1986, every document published by the Health Department reporting on the state of health in Rio Grande do Sul had Scliar’s name on it, either as editor or contributor.
He was invited to assist the State Constituent Assembly in 1989. A few years earlier, he had been one of the Brazilian representatives at the PAHO/WHO meetings in Washington, DC, for discussions on Regional Strategies (for the Americas) for Health for All in the Year 2000.
During the Second State Health Conference of Rio Grande do Sul (Porto Alegre, July 1996), he played an important role as coordinator of the Executive Committee. At that time, he underscored:
“the fruitful interaction, the establishment of cooperative bonds and the comradeship among people who live in distant areas of our State and who rarely have the opportunity to meet.”
He also stated that:
“SUS is not just a bureaucratic apparatus: it is made up of people who suffer, who struggle, and who dream of a better future for Rio Grande and Brazil.”
However, in the “Introduction” to that same report, he cautioned:
“SUS is currently facing a magnitude of challenges commensurate with the task to which it has set itself. It is clear that it can only overcome these obstacles through the concerted and supportive efforts of an organized public. In other words, SUS is not a finished, ready-made reality: it has to be developed, a process that will be strengthened through broad, democratic debate.”
The Professor
“SUS is not just a bureaucratic apparatus: it is made up of people who suffer, who struggle, and who dream of a better future for Rio Grande and Brazil.”The experience that began in the 1960s as a professor of clinical medicine continued in the Department of Public Health at the Federal University of Health Sciences, where he served as an assistant and later, chosen by his colleagues, took on the role of Department Head.
He was one of those who helped build the history of the Catholic Faculty of Medicine in Porto Alegre. The school was affiliated with the Santa Casa, and many of the staff, including Scliar, cared for patients while teaching in the clinical wards.
The Catholic Faculty later became a federal institution and was renamed the Foundation Federal School of Medical Sciences of Porto Alegre. Years later, the Foundation incorporated new courses and became the Federal University of Health Sciences of Porto Alegre.
Speaker at the 20th Brazilian Congress of Clinical Neurophysiology in 2005.
Scliar participated in numerous conferences on clinical medicine, public health, and geriatric health. In addition to being a conference participant, he took part in panel discussions and gave lectures and presentations in Porto Alegre, other parts of Brazil, and abroad. He was invited several times to give courses and lectures as a visiting professor on “Public Health in Brazil” at American universities. He participated in doctoral committees, gave inaugural lectures, received numerous awards, served as chairman of examination committees for public competitions, and was a member of editorial boards for journals. In short, he led a very active academic life.
In the late 1990s, he defended his doctoral thesis at the National School of Public Health – Oswaldo Cruz Foundation, in Rio de Janeiro. His thesis was entitled, “From the Bible to Psychoanalysis: Health, Disease and Medicine in Jewish Culture,” and it was approved on October 29, 1999.
In the book Rubem Alves e Moacyr Scliar conversam sobre o corpo e a alma: uma abordagem médico-literária (Conversations between Rubem Alves and Moacyr Scliar about the body and soul: A medical-literary approach), published in 2011 (Editora Saberes), Scliar makes the following observation:
“I began to discover several interests in the field, such as the history of medicine and public health. I always read a lot to understand how doctors thought in the past, especially those who had to deal with endemic diseases and epidemics.”
Indeed, some of his books describe historical events, demonstrating the physician-writer and historian that he was. Some books are purely historical, while others are mixed with an educational component, as the author sought to help readers maintain their health.
An article published in the newspaper ZH (Zero Hora) and transcribed in the posthumous work Território da Emoção (The land of emotions), published by Cia. das Letras (2013), mentions measures that protect against Alzheimer’s disease.
The book Do mágico ao social: Trajetória da saúde pública (From the magical to the social: The trajectory of public health) is a work of history. On the first page, he mentions that Pharaoh Ramses V had smallpox and that tuberculosis had been diagnosed in the skeletons of pre-Columbian Indians. In the chapter on “Predictions,” he discusses the emergence of new vaccines:
“... it will be possible to prevent or treat hereditary or congenital diseases that today claim the lives of children in the first few months or years of life...”
In an article published in the collection Médicos (Pr)escrevem (Doctors write and prescribe), when considering the reasons behind the illegibility of a doctor’s handwriting, he delves deep into the heart of the profession, saying:
“The old doctors know that the fight against disease is not based on certainty, but on attempts: ‘dans la me decine comme dans l’amour, ni jamais, ni toujours’ – said the eminent French clinicians: in medicine, as in love, ‘always’ and ‘never’ are forbidden words. Hence the doubt, the fear of doubt, from which the doctor frees himself by writing quickly. And not legibly.”
Writer, historian, novelist, professor, public health expert, doctor – so many titles, but it is important to remember that Scliar never abandoned his clinical perspective. The education he received during his medical school career was further refined by his practice of clinical medicine. Fla vio Kanter, in his article “Dr. Miqui,” did a good job of describing Dr. Scliar’s patient perspective. Colleagues who worked with him for many years were able to observe that whenever they needed a good clinician and turned to him, they found in him a friend and true doctor in every sense of the word.
Dr. Mico left us almost 50 years after graduation. He was the speaker for the class of 1962. His speech was controversial, ranging from the traditional words of appreciation for relatives, friends, wives and husbands, colleagues, professors, and fellow graduates, to the great needs of humanity. At the end of his speech, he challenged his colleagues:
“Let us go forth together, my friends. Today is our graduation day, when Brazil calls us to the path of honest and accomplished medicine. And we can answer, as we did so many times in medical school: ‘Present’.
* Brazilian physician and politician, a 1968 graduate from the former Catholic Faculty of Medicine of Porto Alegre, now the Federal University of Health Sciences of Porto Alegre. He served twice as Secretary of Health and Environment of the State of Rio Grande do Sul and has held positions in INPS (National Institute of Social Security) and BRDE (Southern Brazil Regional Development Bank).
