5) Description of health product/service offering: The primary health issues are: lack of full time and human care to adult patients with HIV/AIDS and other complex and chronicle diseases; lack of hospital human care and possible interfaces with knowledge areas that health could be in touch with; the health institution thinking and rethinking its services along with the public and the insertion of new professionals to complement the treatment of the patients. My primary beneficiaries are low-income adults patients from publlc hospitals from the city of São Paulo, Brazil, with HIV/AIDS, infectious diseases and other chronicle and complex diseases come from many parts of Brazil. The services are mainly visual arts classes (painting, drawing and art history) given by artists that introduce not only art techniques, but also apply proposals that stimulate the knowledge, self-confidence, comprehension of the act of art and reflection on the creative process, in a way that the participant is able to find out and assume potentialities. In this way, to have access to art and its creation process and comprehension, makes it possible to the patient to revert his passivity to activity during his time hospitalized. We strongly believe that this action reinforce and and gives potential to the concept of the World Health Organization towards the society based on ots constitution: “Health is a state of complete physical, mental and social wellbeing and It is not only about lack of disease and illness”. This service is contributing to: increase the self-confidence of patients; get more adhesion to the treatments, because by developing his abilities in visual arts ends on making new life projects; reversion/prevention of depressive cases in chronicle states patients; reversion in passivity cases (laziness and no productivity) to activity (personal development and productivity).

6) Description of innovation: 1402 Carmin, the name of my project, differs from other specially to HIV/AIDs holde and other chronicle diseases in three aspects: the relationship with the health institution, the health and medical professionals and hospitalized patients. The insertion of visual artists at the hospitals with its work proposals with patients, contribute and review that it is necessary and fundamental to the hospital to “rethink” its role and need to open mind for changes with the public sector, besides medication. Can’t it be a fecund ground for the growth, development and transformation of people? Art sensitizes and teaches health professionals to become involved and interested to look for deep meanings about the human existence. Therefore, the hospital, its professionals and the patients establish a new look at ways of complementing and reinforcing the maintenance of patients at the hospital, offering full time care and attention in a way that humanized policies get to be implemented by the Health Ministry (“Humanize Program”). As soon as the patients notice that (through the guidelines of the artists), that they don not deal with illness only, but that they have different potentials noticed by the practice of art, discussion and reflection about strengths and to be developed points, change their behavior, leaving passivity and getting back to activity. The new and unique components of my work are: our own methodology focused essentially on art in hospital environment and prevention and treatment places; art transformation and intervention done by patients at the hospital, breaking the paradigms (for example transforming the patients rooms into art studios); placing the patient as the main character of the changes in his life and routine at the hospital during his treatment.

7) Operational model: Our focuas are: educational action at the hospitals with HIV/AIDs patients; education and entrepreneurship through art (youth and adults); alternative income rising; education of patients with multiple sclerosis and arthritis - “Art and Health agent” (spread around many cities in town); Multiplication and expansion of Carmin concepts through the education at Carmin Social School of Arts (business plan). We have a basic structure, easy to be applied, which is used to keep our work with our public. Because of the characteristics and specifications of our work with this public with have the structure that follows: classes are held at the hospitals, not been necessary to have big rooms ate our centre; a team of visual art artists or even educators working weekly with patients at partners hospitals; material collect with partner companies (donations); training and monthly meetings with the team of artists. At the moment, the organization is looking for partnerships to develop and reinforce its actual structure to grow its capacity of holding classes to patients, as well as to extend the program to other geographic areas in Brazil. This work has been done with the help of volunteers, financial help of people, donation from companies that produce or sell our work material and contributions of hospitals.

8) Human resources: Our team is compounded for a management, visual art artists and interns graduated in visual arts, ex students from Carmim Social School of Arts (unit of the organization that educates and prepare people to make use of Carmin methodology, generating financial resources and self maintenanceof the organization. All of them until the moment are volunteers with the exception of six teachers from Carmim Social School of Arts. We count with: 1 coordinator: Bachelor in Visual Arts and post graduated in Studies of Art Museum; 6 Visual Artists: four of them have Bachelor in Visual Arts, one have Bachelor in Dramatic Art and one have graduated in our course at Carmin; 1 intern: Bachelor in Visual Arts.

9) Key operational partnerships: We believe that companies are not interested in investing in programs for the adults, specially a public holder of chronicle diseases like HIV/AIDs. It is a public that is still excluded from investments of the private sector. The biggest interest of the companies is directed to children and youth. It supports the belief and entrepreneur action of Carmin to create new strategies to revert this situation. One of them was to present this program to be analyzed and approved by the Ministry of Culture in Brazil. As been already approved as a social-cultural project, Carmin makes use of Rouanet Law created by the Minitry to offer discounts on income taxes to companies that sponsor the company. 6 public hospitals: responsible for the art material. Communication and Advertisement companies help us with volunteer job; Abbott Laboratories (International Health and Pharmaceutical company), Votorantim Cement (leader in cement industry in Brazil); Barbieri Consulting; Novesete Communication and Impaes. Our strategic partnership is with Abbott Laoratories and Pharmacy. For one year already, we have been developing a project for the formation of low- income patients in different cities of Brazil (13 in total). The strategy is that from this new project we became enable to expand our attending capacity by having health-art agents in many regions of Brazil. In this way we were able to increase the potential of Carmin Project.

10) Financial Sustainability

          • Fees charged to clients?: No

          • How do you assure affordability?: It does not apply.

          • Other funding sources: No, It is not sustainable because we focus the adults, while the private initiative does not have interest in investing in this public. In another way, we can say that in this period of work our organization have achieved great goals we very little resources, motivating our partners and collaborators and gathering the minimum resources needed for our daily work. For multiple sclerosis and arthritis patients we count on the help of our partnership with Abbott. In an alternative matter, we have developed some solutions of easy applicability to gather more resources, like: events promotion, exposition and sale of patient works, sale of Carmin products and contribuition of Carmin memberships.

          • Strategy for long-term sustainability: 1. To present the initiative we have with Abbot with the our social impact reviewed by our low-income patients as Art-Health agents, in a way to attract new investors from the health and pharmaceutical industry to support initiatives devoted to adults. 2. To increase the potential of others work units of Carmin to generate income by creating art studios of Carmin products (Business Plan has been developed); Carmin Social-Art School (Business Plan developed with Mckinsey & Company and Ashoka in 2001 – Social Entrepreneur Prize), to increase the number of students that pay for the classes, intensify the service of presentations and workshops for company employees. In the end reinvest part of our income in our hospital activities.

11) Current and Future Impact

          • Total number of clients: 15000

          • Clients in the past year: 2000

          • Impact: The percentage of low income and marginalized clients is between 90 and 95%. For developing our work at public hospital and associations, we end up by having 95% of patients from the many regions and careless communities in São Paulo and other regions in Brazil. The most frequent impacts are: collaboration of the patient with our multi professional team; more commitment to the treatment; selfknowledge of the patients towards his qualities, noticing that it not all about been sick; increase of self-confidence; creation of the “Humaniza SUS” from the Ministry of Health, a national policy of humanization; multiplication of Carmin methodology in new places and regions; stimulation to the recovery of the patients; a new way of treatment apart medication.

          • Overall "market": At Carmin, we notice that there was a demand the surprised us, because as much as we achieved results of impact with the program, media visibility, great participation in events related to the health area, impact testimonies of students, patients and professionals in the health sector. In one year we have had 20 proposals from different hospitals to implement our work there. There is a demand, not only about the use of art in hospitals, but also at other places where human dignity is not respected. The increasing number of visual artists interested in this kind of work, new publications about humanization of hospitals and the services we offer have oriented and expanded to a great number of publics. Demand is escalating because in Brazil people are receiving the power of transformation of art with different publics. It happens because art enables people to see the positive aspect in their own fragilities. Therefore, we believe strongly that art has no geographic or social boundaries and specifically about Carmim, our methodology can be applied to any public. In São Paulo there are 1011 health institutions. In Brazil 2148 are public, attending 120 million pleople.

12) Scaling up strategy

          • Stage of the initiative: Mature stage.

          • Expansion plan: 1. To fortify the associations of patients with multiple sclerosis in town, making a control and evaluation of results obtained by our agents and their social-educational projects with others patients and associations. The associations that become successful, proving their impacts and results will gain a certificate of Carmin Methodology. Like this, the Carmin project that was started at the hospitals will be extended not only to hospitals, but also to places of prevention and treatment. 2. The formation of art entrepreneurs through Carmin Social-Art School have shown the great impact on the multiplication, having already formed 350 students between youths and adults that leave the school to complement what they have learned at their low-income community. Therefore, we have 38 projects spread around São Paulo that make use of Carmin methodology focused in using art in different places, like HIV/AIDs children shelter, HIV/ AIDs adults shelters, places that attend people with mental disease and other places.

13) Policy change: We must get together with other private and social organizations to create meetings about hospital humanization, discussing subjects, generating a network, seeking to sensitive the Ministry of Health of Brazil to structure a public health policy in the aspect of integral humanized treatment through art. To call attention of the middle class at universities that form future professionals in the health field has been one of our strategies, in the aspects of educational action to the formation of these students. We have found a greater acceptance at universities for classes and presentations about the interface of art, health and citizenship. Carmin for more then 4 years, in special occasions have given classes for medicine undergraduates and postgraduates.

14) Origin of the initiative: Back in 1991 I had the experience of being hospitalized for 25 days, sharing the nursery with three more patients. I've noticed that not only I was ill, but Health Care institutions needed also some intensive care: there was no human touch in health care, and the disease was treated, not the patient. I've noticed that what lay on those hospital beds weren't people, but diseases. In time, we lost our identity and fell useless, because this kind of place tend to fortify the passivity of people. It was needed to start something to revert this routine. So then, I got my drawing notebook and at the lonely nights I had art as a partner and company. I achieved my activity at the hospital.

Contact Information:
Eduardo  Valarelli
Ashoka Fellow
Founder and General Director
Projeto Carmim
(NGO)
eduardovalarelli@projetocarmim.org.br
Brazil
Tel: 55 11 3021-2103
Fax: 55 11 3021-2103
Email: eduardovalarelli@projetocarmim.org.br
Website: www.projetocarmin.org.br