OCTOBER 2005. THE BOOK ‘THE STRUGGLE FOR HEALTH’¹1 Sanders D. The Struggle for health: Medicine and the Politics of Underdevelopment. Macmillan Publishers LTD: Hampshire; 1985. , published in 1985, fell into my hands. Sent by my mother, as a gift, on the eve of my departure to work on a humanitarian mission in Angola. Revisiting the book, 14 years later, I reread some excerpts that have marked me so much. Just at that moment, when I was wondering exactly what the author of the book was about to explain:

On the following pages, the preface ends with a ‘slap in the face’, a call to action: “For too long health has been widely looked upon as an issue apart from the real problems of society. The time has come to redress the balance”¹1 Sanders D. The Struggle for health: Medicine and the Politics of Underdevelopment. Macmillan Publishers LTD: Hampshire; 1985.⁽¹²⁾. Written in 1984 in Harare, Zimbabwe, signed by D.M.S. It was David M. Sanders. But who was this person, who wrote things so true, so assertively and unequivocally? An African pediatric doctor who seemed to know very well what he was talking about.

Following the next pages, many dramatic photos, of severely malnourished children, of families living in inhuman conditions, slums, garbage, lack of sanitation, people working at risk in the informal market. David wrote about the association of the harmful consequences of social injustices in people’s health. It made us understand how health status is so directly influenced by living conditions, which in turn are affected by political and economic issues. He talked about the social determinants of health. The answers to the initial questions were in the structural causes of illness, which went far beyond the provision of health services, and that was what David spoke about with such firmness and propriety. It was exactly what I needed to read to reaffirm the feeling of indignation at the unacceptable inequalities in health.

It all made sense. I went to Angola, stayed a year and returned to Porto Alegre. With the same concerns and an even greater sense of indignation. It was 2007, I started my doctorate in epidemiology, always inspired by what I had read in David’s book. Until then, for me, he was a distant reference for a doctor, writer and teacher. Until my advisor, Bruce Duncan, another role model for a committed researcher, who shared the same view regarding the structural causes of disease, one day told me that he wanted to invite Professor David Sanders to be one of the speakers at the International Epidemiology Congress, that would take place the following year in Porto Alegre. In addition, he told me that a colleague, a dentist, Denise Antunes, had contacted him, to organize some activity with David, who would be coming to visit Porto Alegre in July of that year. He invited me to help organize the activities and to translate the lecture that David would give at our university.

Denise had a master’s degree in South Africa at Western Cape University, inspired by David Sanders and the People’s Health Movement. It was on that occasion that I got to know about the Movement. During David’s stay, we talked a lot. Everything I had read was being reaffirmed again and in an even more forceful, emphatic way, straight to the point, as only he knew how to be. It was also at the meeting with David that I came across a different view of primary health care, or comprehensive primary health care, which really included the social determinants of health. As a family and community doctor, I was able to expand my references and my critical capacity. David taught a lot about it. He knew how to be critical, ironic in the right measure. His sentences were short and to the point. So, before leaving, he challenged Denise and me:

And still with David in Porto Alegre, we held the first meeting of the embryonic PHM Brasil Porto Alegre, in a classroom of a municipal hospital.

Several meetings followed, people came, some came back, some did not. Fluid as the Movement is. Around September, still in 2007, a call for an International People’s Health University course in Savar, Bangladesh, birthplace of PHM, popped up in my email. I wrote to David, asking his opinion, and he encouraged me to go. In November, for 14 days in immersion, Denise and I were in Gonoshasthaya Kendra, known as GK, one of the founding organizations of the PHM. We met many other PHM activists there, and the course was a very important driver for us to continue building the PHM Brazil Circle in Porto Alegre. We left there with an ‘impossible mission’: organizing an IPHU course in Porto Alegre the following year.

In September 2008, we received more than 50 activists from around the world at Vila Betânia retreat place in Porto Alegre. We spent 14 days in immersion, discussing the structural causes of health and illness, sharing experiences of activism, discovering new forms of organization to combat social injustices. David Sanders was one of the teachers of the course. He arrived a little later, closer to the Epidemiology Congress, to which he was invited. It was nighttime, and I received an SMS on the cell phone of an international number saying, “Why am I away from everyone? Am I in quarantine?”. It was David, complaining because he was in a five-star hotel, away from the movement’s activists and energy. He wanted to be there with us, in shared rooms, with collective bathrooms. The next day, he came. The ‘famous teacher’ was also an activist just like each one of us. And he was so happy with so many young people around. He loved teaching, and he had the gift of doing it in a horizontal way, not only in classes, but during lunches, snacks, sitting in a circle, or on the bus seat. Talking to him was always a lesson. And he was as comfortable in a simple environment such as that one, as he was in a formal and imposing one, like that of the pompous international congress. He knew how to speak and behave with such different people: from grassroots activists to famous researchers. And he managed to be, in a few words, always direct and clear, touching exactly the point of discomfort. He was a great and talented provocateur. In that spirit, he went to the streets of Porto Alegre to express, in total solidarity with the Municipal Health Council, his claim to defend the right to health.

In one of the conversations I had with him, I shared a concern about my experience of having worked in Angola: “What is left, in fact, of the work we have done there? Was it good for anything?” Without thinking too much, he replied: “This is more difficult to know, but one thing is certain. You will never be the same again. Your practice is forever transformed”. In that clear and certain way, very characteristic of his way of speaking. He spoke sentences with a full stop. It left us thinking. I never forgot.

On another occasion, during another edition of the IPHU course in La Havana, Cuba, in 2009, we talked during a bus ride. We were going to a dinner organized by the Cuban hosts. Upon arriving, in a very tidy place, unlike the most common landscape of the city, he complained, with his peculiar sarcasm, because we were going to a ‘chic place’. “What are we going to do here?” But then he had fun, had dinner, and danced. He just couldn’t help evoking his restlessness.

David was like that, he was always ahead of his time and of current thoughts. Provocative, he was never satisfied with half answers. Assertive, he had the gift of talking about complex things in a simple and clear language, which everyone understood. It transformed the ideas of many people around the world. We last saw each other in 2016, in Vancouver, during a meeting of the research ‘Civil society engagement for Health for All’, of which he was one of the leading researchers. A pleasant interaction, he was a workaholic, but he enjoyed moments of relaxation, social gatherings, always interested in people, wanting to know how the family was doing. David left many memories and teachings, which will continue to change the world, just as he wanted. In the classroom, in books and articles, on Skype meetings, on countless trips, on excursions, on walks, at meals, in the fineness of each encounter, we will miss you, David, and we will echo your call in all languages and geographies. Health for all now!

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