A specific pragmatism has been imposed on all dimensions of daily life, which believes education is restricted to instrumental training. Based on this conception, education has been limited to training men and women to adapt to the needs of technological life [...] adapted, practical, and operative. This approach trains human beings for the neoliberal capitalist technological model, and all training is an obstacle to the political health of human beings. [...]. On the other hand, the Third World progressive educator’s work seeks to overcome certain limitations that are striking at the end of this century. These are global social, economic, and cultural limitations rooted in a particular conception of progress and civilization. [...]. A progressive education emphasizes the human potential to interact and collectively constitute its surroundings. Therefore, overcoming insists on opening up to collective interaction [...]. In this other approach, instrumental and technological competence would be commanded by the need to transform oneself to become more of a person, and, in doing so, the human being constitutes himself collectively with the world¹1 Freire P. Introdução. In: Nogueira AS, organizador. Reencontrar o Corpo. Ciência, arte, educação e sociedade. Taubaté: Cabral Editora; 1996. p. 11-12..

Paulo Freire returned to his country after a long exile forced him to live abroad. The 1964 military coup in Brazil took Freire away from his work at the university, in the circles of culture, and the National Adult Literacy Program. It also interrupted his contact with his family, friends, and the Brazilian people he loved [...]. Freire had to learn to live with other people - Americans for a short time, Europeans, and, above all, Africans, in countries where his theories and methodologies were embraced with strength, credit, limits, and courage! [...]. Back in Brazil, the educator brought images, fantasies, desires, imagination, and the will to resume his personal and academic work, which had been conducted in teams, conversations and dialogues, and culture circles violently prevented and interrupted by the dictatorship... In these new times and spaces of his life, returning to his people [...] part of Paulo Freire’s experience as a wanderer of the world was received at Unicamp, at EF, in the Department of Social Sciences Applied to Education, in the academic life interaction with young people in classrooms, professors, and researchers who were his peers [...].

With love and patience, which always marked his presence, Paulo spoke and gave his opinion on different subjects and peers, regardless of their theoretical, methodological, political-partisan, or national positions, their personal experiences, and previous acquaintanceships, trying to reintegrate himself into subjects from which he had been distanced for so long. His experience transcended the classroom and extended to social movements, religious groups, grassroots education, liberation theology, and health workers who worked on the outskirts of Campinas and São Paulo through his work at the FE of Unicamp and PUC/SP. One of Paulo Freire’s pedagogical practices I would like to highlight was his collaboration with a group of public health doctor-professors from the FCM at Unicamp, who worked with student trainees at a health center in Paulínia, working with residents in public health social movements²2 Pino IR. Paulo Freire, andarilho do mundo, de regresso ao seu povo, de volta ao seu país! Educ Soc 2021; 42:e254877..

The attitude of the then State Secretary of Health, Walter Leser, and his team was of unparalleled competence and lucidity when they proposed the creation of 17 School Health Centers (CSE) under agreements between Health Secretariats, Medical Schools, and Municipalities in the 1970s, with dictatorship in full swing. In the experience in question, I will discuss the rich activities and lessons learned at the Paulínia CSE (CSEP) from 1978 to 1983, when teachers and students intervened in the health reality of the municipal population. It is crucial (apparently common sense today) to relate to the patient comprehensively. Back then, preventive actions were separate from curative actions. Some health professionals and units only did prevention, and others only engaged in treatment, which happened when the reality of life, especially for the most wronged majorities, required both prevention and treatment. The state provided a fragmented response.

CSE aimed to provide the population with comprehensive care: vaccinations, basic home sanitation, food, living standards, and prenatal care for normal births. As for the sick, the huge challenge was to work on early diagnosis. Why not catch the disease in its early stages, where diagnosis is much simpler, less expensive, and specialized: a right of citizenship for the person who can resolve their illness before it deteriorates and triggers greater suffering? This CSE was one of the seeds of what is now constitutionally established in constructing universal, comprehensive, and equitable healthcare, simultaneously preventing and treating.

The dictatorship closed down CSEP in 1975 as if it were crushing an animal’s paw on it. Repression affected the Center and Unicamp itself, just as many public entities bowed to the dictatorship’s paws. It is important to record this because it was an institutional event, the subjection of a university like Unicamp, whose role and obligation of a public institution is to interact in research, teaching, and extension.

In 1978, three years after its closure, the Paulínia CSE resumed its activities, reducing its services to a small number of pediatricians, adult physicians, and gynecologists in the face of a demand that exceeded availability. However, leaders from the Pan American Health Organization (PAHO) and Unicamp sought to return to CSEP practices. I was responsible for coordinating this task.

We worked hard to restart deactivated programs and internships for residents, interns, and undergraduate medical and nursing students. Everything was done carefully because the country was still under dictatorship, and the proposed initiatives were extremely sensitive to conservative sectors and the government, such as placing undergraduate and graduate medical and nursing students within the population in activities the civilian-military government condemned. Internships were seen as dangerous, as was increasing the number of teachers at the CSEP. Despite these restrictions from the authoritarian system, the departments of general practice, gynecology/obstetrics, and pediatrics received more teachers to rotate in Paulínia to expand their activities.

In the 1980s, José Aristodemo Pinotti, from the Department of Obstetrics and Gynecology at the FCM and dean of Unicamp (1982-1986), recognizing Paulo Freire’s national and international contribution to what has come to be called university extension, invited him to advise this sector of the Dean’s Office and accompany several programs, projects, and actions. Training doctors and nurses, monitoring CSE Paulínia residents, and contacting patients, families, the community, and health are considered popular education.

Sometimes municipal health secretaries do not see the improvement that working together can achieve in public health. The project worked very well, and the Municipality’s vaccination coverage statistics were the highest in the country, reaching around 95%. However, everything in health is very politicized, and the drafting, implementation, financing, and evaluation of public policies depend on people in charge and political will.

Today, neoliberalism is lashing out at us from all sides. It has erased this perspective of popular and public education in health, which has a detrimental effect on the quality of training of undergraduate and postgraduate students and outpatient care. However, some professionals dedicate themselves to humanist education, inducing an interactive approach to medical practice and health promotion. The very ethics of the profession make doctors responsible for a form of medicine that protects and cares for patients. Otherwise, the quality of medical training will suffer. Students must be responsible for patient care and must not be mere test takers and professionals who misinterpret results and misdirect diagnostic hypotheses. Many doctors do not examine, ask questions, or listen to others. We learned these procedures from Prof. Paulo Freire when he insisted that the priority was to listen to the other person and that the doctor’s relationship with the health team, patient, family, and community was an exchange of experiences and knowledge. We are all interconnected because the doctor is also a community member, which is a reality.

Then, the multidisciplinary, dialogical, and interconnected perspective formed us as students, residents, doctors, and professors at Unicamp. The students identified many inappropriate examples as models we did not want to repeat. Through simple attitudes and respectful behaviors of caring for others, some professors marked us powerfully and effectively.

Care at the SCMC and CSEP involved residents, students, and professors in a powerful outpatient training program. We followed the example of Prof. Nelson in Collective Health and Prof. Ronan José Vieira in Internal Medicine and Emergency. They were there and taught us through respectful conduct with patients, an inclusive attitude with the team, proper procedures, and assertive intervention, which defined our training as doctors. Everyone met at the SCMC and CSEP, and we learned a lot from talking, evaluating, and organizing training and work. After we moved to the campus, to Unicamp’s Hospital das Clínicas (HC), we isolated ourselves in our offices, and the meetings declined, which saddened our relationships.

Is health any different? Is it about transforming the health condition of patients? Is it possible to find interesting solutions by integrating the knowledge of doctors, teams, and patients through a shared power relationship? These questions were answered by the 1988 Federal Constitution (FC) when it started to design a health and education model for all. Prof. Nelson was one of the creators and implementers of the SUS, one of the most advanced systems on the planet. The 1988 Federal Constitution draws health closer to human, social, and universal rights. It is therefore virtuous to remember the links between Paulo Freire and the advice given to the FCM team working at the Paulínia CSE as an important and successful action regarding training, outreach, and the realization of rights.

Regarding the population profile, it was striking to see that the waiting rooms in the outpatient clinics started to become too small for so many patients. People came in the early morning hours before the CSE opened and formed queues. Concern began to arise about the arrival of people with more advanced illnesses and whether care should start with them or with those who arrived first. How would the necessary early appointments be? What were the workplaces and homes like in the outlying neighborhoods and rural areas? This jostling and tension in nursing and medical care at the CSEP would be the beginning of the reproduction, albeit on a smaller scale, of what was happening in the more traditional outpatient clinics in all medium-sized and large cities, i.e., the difficulty of making an early diagnosis that would prevent illness, or late care with greater suffering and cost. Contact was made with the places where this population had been before arriving at the CSE to counter this logic, and visits were made to industrial and agriculture and cattle-raising companies. There were two huge farms where many of the population lived and worked. Furthermore, Paulínia is an oil hub with dozens of chemical industries around the refinery and satellite industries, with thousands of employees who live there or in neighboring towns. Most had an occupational doctor as a legal obligation. We asked ourselves: How were the causes of illnesses, diagnoses, early treatment, and health at work? We had a large company that was a railroad terminal and trucks that transported cereals with tons of corn, soybeans, beans, and other grains, which arrived daily to be stored and redistributed by dozens of manual workers.

We started with a few residents and a lecturer rotating visits to these places, setting up a small clinic for weekly care in each of these companies. For example, on one farm, we found that the principal health problem for these adults was simply alcoholism. We asked ourselves: what answers could there be for alcoholic rural workers who came to the clinic with several symptoms in the organs of their bodies affected by alcoholism?

There was a case of a quarry worker who was urgently brought to CSEP from work with hypertensive crisis symptoms. The peer who attended suggested visiting this quarry. At the time, we could not ascertain and prove the causes of this hypertension, but one of the possibilities was the psychological stress caused by the explosives used to break up the stone and turn it into small granite blocks. Eighteen people were working there. We measured everyone’s blood pressure, and only one had normal pressure. The others had hypertension and nervous tension from the work of exploding and running away to avoid being stoned. There was a history of traumatic accidents and one death as a result of these explosions. Almost all of those hired were informal workers. As for the farm, it was agreed with the manager to set up a small local clinic once a week and, as for the quarry, a monthly visit to monitor pressure and encourage the company to adopt preventive measures in its work operations.

Also, in Paulínia, we visited a chicken factory that employed around forty women. The chickens were killed and immediately placed on a conveyor belt, which butchered, separated them, removed the skin and the entrails, and they came out at the other end of the conveyor belt ready to be sold in the supermarket. The chicken was transformed into 20, 30, or 40 butchered pieces. The workers were exposed meter by meter on this treadmill. The number of fainting spells was noteworthy, and one of the women fainted more than the others due to nervous tension from hours of standing and exposure to that setting. This pathological event appeared at the end in the drop in pressure and the fainting spells. We had lung diseases at the grain terminal. The loading and unloading of train wagons and grain trucks raised dust that we could not see each other from a meter away. Workers were exposed to this all day, and soon, lung diseases were detected.

We tried to combine early diagnosis of those who fell ill before the others with working with companies’ owners to make the working environment healthier. It was a traumatic and surprising experience for the CSEP team.

This learning led us to propose a circulating outpatient clinic once a week for early diagnosis and, from a preventive viewpoint, to improve working conditions and the environmental conditions that led to illness. The CSEP did not have the structure and staff to do this. So, we mobilized the authorities, the city council, and state sectors to issue precautionary measures to improve working environments.

From this experience, an extremely human lesson was the difference with which patients relate to the CSEP. In the circulating outpatient clinic outside the Center, before the disease diagnosis, the patient spoke more confidently and in a more autonomous tone, like someone telling their life, feelings, and fears of getting worse. There, stories flowed with greater clarity and richness of causality than at the CSEP outpatient clinic. The privileged location of primary healthcare was clear to us: close to homes and workplaces.

These initiatives were the subject of conversations with Paulo Freire at the CSEP. He was impressed by the stories about what the workers talked about and how they became aware of their illness by telling their health story and that of their families. The professor’s proposal at CSEP was to interact with the doctors and nurses who worked in the children’s, adult, and women’s areas. He made a point of talking to everyone, including staff and clients. On one occasion, he borrowed a lab coat and a small white apron. He put it on so that he could talk to the patients and test the relationships they would establish with the nursing staff and anyone who presented themselves as an educator. When we talked about the possibility of the health system reaching the people’s place of life and work, he told us: “You are facing a knot that needs to be untied, and I confess that I also feel implicated and challenged in this quest that you are processing”.

In the first cycle of elementary school, a school health program was discussed with the students’ teachers and parents. When they mentioned worm eggs in feces, the children’s eyes widened. Then, a CSEP microscope was brought to the school, and worm eggs and bacteria were shown on slides. Thus, they saw a world of beings invisible to the naked eye for the first time. A nutritionist also talked to the students about food and school meals. Important yet simple, obvious, and basic actions.

The other initiative was expanding activities. With the urban growth of Paulínia, CSEP proposed to the Municipality that it make two properties available, one in a suburban neighborhood and the other in a recent housing development, both with a high population density, to install two PHC units as an extension of CSEP, which had a positive effect.

These were the early years of the 1980s when the provision of PHC Units was advancing at a national level and consolidated in the larger municipalities. This intervention impacted the 1986 Eighth National Health Conference, which debated and approved the SUS guidelines. At this point, Paulínia’s Municipality started building the Municipal Hospital and municipalized all the health units based on the CSEP.

To conclude, I would like to stress that bringing health to the population is not a stroke of genius nor an unattainable scientific and technological discovery. It is simply the democratization of what has been known for a long time, making knowledge available to the population in their living and working spaces. With great satisfaction, our term at CSEP was succeeded by Gastão Wagner de Souza Campos, a renowned and competent hygienist and professor at Unicamp, who continued to make innovations in favor of the population and health workers.

Paulínia was a special territory, not because of its financial status as a privileged municipality, which raised much money as a result of Petrobras and the multinationals that were there, but because of its ability to promote actions and reflections on the social, economic, political, and cultural reality of the place and the country, based on the people who moved around there and who left significant achievements, particularly in Education and Health. The training the students received there predestined them for a type of care and engagement with public health, both from a collective and individual viewpoint, based on community action to address need-related health issues. The desire for qualified professional training was also marked by a perspective pointing out that the doctor did not have all the answers; he needed the patient, peers, and the team to diagnose and find the best solutions. The production of a way of thinking and practicing education and health mixed the contributions of academia with those of different community players, pointing towards an equitable and participatory vision of health.

The circulation of thought focused on the desire to understand reality and exploit nature less, including human beings, university work, health services, and community education. This agenda was maintained from the 1970s to the 1990s, which included the passage of Paulo Freire and new managers who were in the Municipality and open to more democratic initiatives.

A community approach pointed to a different future, including the environment, associated with a vision of health in the city and not restricted to individualized outpatient care. A dimension of more solidary, communal lives of mutual support was being discussed, and happiness was seen as a collective possibility and not just an individual one. It was a very ambitious proposal, and the journey involved respect and love.

When we talk about the thoughts circulated in Paulínia between the 1970s and 1990s, the references are to the influences and constructions in the social areas that went hand in hand in the Municipality, particularly in children’s health and primary education. As Aoki recalls, “As FCM students and residents, we were privileged to take advantage of an unforgettable innovation in the training of professionals as political beings defending public policies and reducing inequalities”.

Here, Aoki and I (Silvia) were residents and then professionals. We put ourselves in the reality of the client’s life, and our learning did not only occur within the health services. We were often taken to farms, neighborhoods, and companies to work with occupational health, understanding the processes of work and illness and talking to the people who were our patients at the Center. Our learning environment comprised the outside (risk situations) and the inside (outpatient clinics, groups for pregnant women, hypertensive patients, and pediatrics). Education as a “practice of freedom” was transposed to Health and Health Education in individual and collective contact, interacting with diverse groups, urban and rural areas, and public and private institutions. The exercise was an invitation for professionals and clients to share and build new possibilities for health. The fight against oppression occurred in the context of the client’s life and the republican exercise of Medicine. It reminds me a lot of Foucault’s “The Care of the Self”, but focused on community care political action. Based on these issues, we learned from fearless teacher-builders like Paulo Freire to organize ourselves in an open, inclusive, and receptive way without fearing the client.

• The health services needed to want people to be there and to visit the multiple territories of health professionals and clients. The health services and their workers needed to understand their clients as a richness and the reason for the existence of the health facilities.

• Health workers needed to understand that learning and teaching occur in the relationship with clients, despite a different initial expectation that led to a more vertical power relationship between the doctor and the patient;

• Health services deserved to be configured as places where knowledge is exchanged, in other words, Health Education should be at the heart of interventions at any point in the system, especially in collective and individual primary care.

• Technical performance should always be of the highest possible quality of technical knowledge, available equipment, and relational technologies developed in care;

• Health work could express the dimension of pleasure and enjoyment as a strategy based on interpersonal relationships.

Health policies began to recognize the specificities generated by situations of social vulnerability and demanded new models for organizing services. Initiatives such as the More Doctors Program, the Family Health Support Centers, the Street Clinics, the Riverine PHC Units, the Mobile Oral Health Units, and the National Comprehensive Health Policies for the Black Population have added to the expanded network and the increase in SUS services⁴4 Campello T, coordenadora. Faces da desigualdade no Brasil. Um olhar sobre os que ficam para trás. Brasília: Clacso, Flacso, Ag. Igualdade; 2017..