He became known as the doctor who doesn’t wear a white coat, who put an end to the morning queues outside the health center at eight o’clock, and who closed the doors to medical information delegates. When he took over the coordination of the new Baixa Family Health Unit (USF) in Martim Moniz in 2016, Martino Gliozzi and his entirely new team revolutionized primary healthcare in that area of the Santa Maria Maior parish, where no one wanted to work.
The challenges posed by the characteristics of the population were numerous.
Eight years later, the Baixa USF, the health center in the area, is a success story, and Martino Gliozzi is a Lisboeta who has even experienced, like many of his patients, the consequences of gentrification and real estate speculation – which led him to move from Sé, where he lived, to Anjos.
The interview took place in the Caracol da Penha Garden, where, at one point, Martino waves to his wife and youngest daughter at the window in a closeby building. This garden received the doctor’s vote in the 2016 participatory budgeting, even before he lived there. “It must have been the only time I voted for a winning project”.
You arrived in Lisbon in 2009 to do your medical residency. What was your impression of the city?
I came to take the admission exam and ended up staying. I started working in January 2010 at the Central Lisbon University Hospital Center.
In reality, I already knew Lisbon because I had done an Erasmus program in Coimbra in 2005 and had spent a few days here. I remember that what impressed me the most was the light. At that time, I was also a photographer, documenting my travels, and I had a thing for light. I still do. I think the light here in Lisbon has to do with the ocean, the breeze, the wind, I don’t know, the white houses as well, but it’s something special.
Then, I thought it was still a very genuine city, simple, and so were the people. In Italy, everything is more built up. I don’t think it’s a flaw to be simple; it’s good, that genuine side.
Fourteen years later, does Lisbon still maintain that simplicity?
In 2009, when I came to live here, there wasn’t the mass tourism we have now, so there were many places and corners of the city where you could live almost as if you were in a village, but at the same time, you were in a capital with the cultural aspects of a capital – cinemas, theatres, concerts, festivals. I still think Lisbon is the best capital in Europe, despite the changes it endured. Now you need to know the city well to find hidden corners that haven’t been swallowed up by mass tourism and gentrification, but there are still beautiful places.
What are these places?
Well, some are cafes, some are restaurants, some are sports clubs or collectives, and some are gardens and viewpoints that haven’t been invaded by tuk-tuks.
Of course, it’s a trend throughout Europe. I remember when I came to live here, fearing that it would become like Amsterdam or Barcelona, cities that gradually became a bit distorted, a bit soulless.
When you arrived, where did you live?
I lived in Alfama, and now going to Alfama is a bit sad. You have tourists taking pictures of other tourists’ laundry because, in reality, it’s already difficult to find Lisbon locals living there.
With my work, I experienced a lot of eviction dramas. The boom of Airbnb and evictions was about five years ago, I would say, and at that time, I saw a lot, a lot of people having to leave downtown. I was also a victim; I had to leave the house where I lived near the Sé. I received a letter saying I had two months to buy the entire building, which was 12 apartments, several million euros, or leave. Some people had been living there for 30 years and were evicted. Alfama and, in part, Mouraria were among the neighbourhoods that suffered the most from this gentrification.
In Alfama, you still have Tejo-Bar, and you still have some corners, but when I go back there, I always feel a bit… it’s hard to believe it’s the same place. But good things also happened: you have electric bicycles, and some buildings have been rehabilitated. There are always two sides to a story, but the truth is that the energy is not the same.
Now, you live in Anjos. You mentioned earlier, before we started recording, that the Caracol da Penha garden, where we are, was the only thing you voted for and won.
Yes [laughs]. It was in the participatory budget of 2016. I didn’t even live here in Anjos yet, but I liked the project. The alternative was a parking lot, so I thought a green space made more sense because there are few in this area. And the truth is, as soon as it opened, it filled up with people, always, all the time. So, clearly, it was a need for the population. And well, at that time, I voted for a project that won, it was the first and only time. And it’s beautiful, eight years later, to enjoy the result of my vote.
And to see the result, right?
Yes, sometimes we vote, and there are changes, but it’s harder to understand the impact the vote has. And in this case, it clearly had a visible, tangible impact.
I read in a piece about the Baixa Health Center that you told your patients that you would always stay with them. Is Lisbon forever?
Well, I’m not sure if I’ll stay in that Health Center forever, but when I arrived, it was important for people to know that we hadn’t come and changed everything just to leave right away. So, I said I came to stay, and I think it makes sense. Most of the team stayed, and people need to trust you. Eight years have passed, and I think the therapeutic and trusting relationship has been established.
But do you are you thinking about staying in Lisbon?
Well, with these changes we talked about, one starts to think if it still makes sense to live in a city that has become less friendly, less pleasant than it was, and much more expensive. Most people I work with gradually moved to the outskirts and only come to central Lisbon to work. It’s a bit sad, isn’t it? I don’t know if it will happen one day; it depends on how things go, on how the city evolves.
You have two young children. Is Lisbon a good city for kids?
I’m from a city in Italy, near Bologna, with 60,000 inhabitants, and every time I go there for some time with my family, my parents, my children, and my partner, I realize that the quality of life there is much higher.
When I push a stroller here in Anjos, I go crazy, the ground is always full of dog poop, and everything is uneven because of the Portuguese pavement, many architectural barriers. And it’s hard to find a nursery; I managed because I enrolled before the child was born, but I know people who couldn’t. On the other hand, green spaces like this one in Caracol da Penha are very important but not very common. As soon as this opened, I realized the difference between having and not having a space to go with the children because there are playgrounds that are 10 square meters, if that, with 100 children on top of each other, next to cars. So, honestly, I think it could be much more kid-friendly.
Compared to other places in the world, of course, life here is good, but I think with small things, with small investments, we could have a city that is more user-friendly in terms of services, traffic, bike lanes, and everything else.
Would you venture onto the Almirante Reis bike lane with your children, for example?
I would if it were safe, but it’s not. And considering all the environmental issues, the intensification of traffic and cars in Lisbon doesn’t make sense.
Every time I go to Italy or the interior of Portugal, to the Alentejo or the Algarve, I see that there are smaller cities that manage to have a quality of life that no longer exists in Lisbon: a nursery nearby, services closer, the possibility of doing everything on foot, less traffic. You can improvise much more. In Lisbon, it sometimes feels like you have to organize yourself I don’t know how long in advance just to, I don’t know, go out for dinner or just go to the garden. When you’re young and without children, it’s easier. Then it becomes more complicated.
Why did you leave Italy?
The main reason was that at that time, in 2009, to enter the speciality, there was no national exam in Italy as there is here, and I didn’t accept that method because a person had to bootlick the director of the service, and the process was not at all transparent. Meanwhile, that has changed, but at that time, many of my friends left Italy when they finished their medical studies because of that.
I had already worked in Mozambique and Brazil…
In the favela, wasn’t it?
No, I was in the favela during my residency. When I was in college, I was in São Luís do Maranhão, doing surgeries in a somewhat crazy situation in the Northeast. But, as I was saying, I had been in Mozambique and Brazil, and my dilemma was whether I wanted to go to a poorer country, so to speak, outside of Europe, or stay in Europe. And the choice of Lisbon was also related to that.
In what way?
On the one hand, the language, which I already spoke, on the other hand, the belief that Lisbon is the capital of Europe closest to the rest of the world, more open. It is said that the Iberian Peninsula is like two Siamese brothers, connected at the back, with Spain looking at the continent, at Europe, and Portugal looking at the ocean, at Latin America, and at Africa. And I feel that. Of course, there is racism too, but I think Lisbon integrates other cultures much more than France or Germany or the United Kingdom, which were the other European countries I considered at that time.
When you were invited to coordinate the Baixa’s healthcare center, you created quite an alternative model, different from what existed in other health centers, more horizontal, more community-oriented. Was this due to your approach to medicine and service to the populations, or did it have to do with the context you found?
Well, I already had ideas on how to organize the work, so many of my decisions and my way of being a coordinator have, let’s say, an ideological, philosophical character. For example, the way I relate to the rest of the team, the more horizontal and less vertical nature of the work, I think I would do it anywhere in the world. Also, the way we changed healthcare in terms of day consultations, and emergency consultations, which had a significant impact on organization and service to the population, I think makes sense everywhere. Now, naturally, other things, including many of the projects we created and developed, are adapted to the community we are working with.
And what is this community like?
We work in the Parish of Santa Maria Maior, with a population with a high level of illiteracy and poverty, many elderly people, some problems with alcoholism and domestic violence, the issue of migrants and integration difficulties, the problem of drug trafficking and consumption, and prostitution. Therefore, we have several community projects that seek to respond to these issues. For example, we have a project with the Bangladesh community, which is the largest foreign community in that area; we have social prescriptions, we have walks, and all projects created to meet the needs of the population.
This is work that goes far beyond the clinic. It is true public health, working for a healthier community, isn’t it?
Let’s say that any family doctor or any general practitioner, who works mainly in primary care, in their daily clinical practice, realizes that many of the answers people need do not come from prescribing medications. The root of the problems is more social or psychological, and no drug can solve it.
Science shows that more than half of the problems have a strong social influence, and our empirical experience, our work in the field, confirms it. Therefore, the idea is to try to provide a more effective response than medication.
Hence the social prescription project, which Dr. Cristiano and Dr. Andreia were the first to implement in Portugal, in collaboration with various community institutions. In fact, we found a more structural and organic response to something that all doctors would like to do and sometimes do, but on an occasional basis.
What about the walks?
It’s another idea from Dr. Cristiano; he’s the inventor of all these things. The social prescription was “imported” from England, and the walks were inspired by Walk With A Doc from the United States. The idea is to have a health education moment on a specific topic at the health center once a month and then take a walk with patients through the neighbourhood. Each month we choose a different area. People liked it a lot, and there was great participation, especially before the pandemic.
Now, we are gradually returning to numbers as before, and it’s funny because we have several generations joining. All these projects help people feel that the health center is part of the community, not something that comes from above, and they also helped break down the somewhat paternalistic view of doctors or nurses. The fact that the doctor takes a walk with us helps break down barriers.
I imagine that the initial reaction of the patients was one of strangeness. How has their relationship with the health center evolved?
It was. I don’t think we were the first to invent certain things, nor that the National Health Service has stood still. Some health centers changed more, others less; some are more modern and reflect more on projects, and others are more traditional. The big difference at Baixa’s healthcare center, besides the population itself, was that it was a health center with many difficulties, where there was a line at the door before seven in the morning, people looking for an appointment, and few family doctors. In 2015, a new team was created from scratch. All the faces changed, and the rules changed. In the beginning, people didn’t understand, hence the importance of saying that we had come to stay, which we mentioned earlier, and explaining why we were changing certain things.
At that time, I was 32 years old and the oldest on the team, and I was the coordinator. When someone asked for the boss and I showed up, people were surprised. So, let’s say that initially, a part of the patients – we are talking about a lot of people, 16 thousand people, so there is a bit of everything – did not understand some basic rules.
One of the big changes had to do with the same-day appointments and the huge lines at the door early in the morning.
Yes, in the past, there were x slots distributed early in the morning, and then there were no more appointments. We changed the rules, distributing slots throughout the day. In fact, this way, we could see more people, and after 15 days, a month, there was no longer a line at the door. It worked, and it was important because both we and the patients realized that it was a change worth making.
We have some indicators that assess the quality of our work, and clearly, we understand what works. And when patients understand from the beginning that we are concerned about them, about their health, and more, it becomes easier. People adhere better when they understand our ideas and proposals.
Is Baixa’s healthcare center and the problems that arise there a reflection of the city of Lisbon and its evolution in recent years?
I always thought that those working in primary healthcare, especially family doctors, have access to the richness of the community and the population as a whole. Much more than a doctor working in a hospital or in private practice, who interacts with a more specific type of patients.
The family doctor, at the health center, sees everyone from the poorest person to the richest, who sooner or later needs you. People from all professions come, all types of families, reconstituted or more classic, and all nationalities [at Baixa’s healthcare center, there are patients from 94 different nationalities]. During the Airbnb boom, we had people starting to work for Airbnb and tuk-tuks; we had those being evicted. We had and still have elderly people living on the top floors without elevators in buildings where all other floors were vacated, and they were left alone, raising the issue of isolation. It’s impossible to work there and not realize what is happening in the city.
Catarina Pires
É jornalista e mãe do João e da Rita. Nasceu há 49 anos, no Chiado, no Hospital Ordem Terceira, e considera uma injustiça que os pais a tenham arrancado daquele que, tem a certeza, é o seu território, para a criarem em Paço de Arcos, terra que, a bem da verdade, adora, sobretudo por causa do rio a chegar ao mar mesmo à porta de casa. Aos 30, a injustiça foi temporariamente corrigida – viveu no Bairro Alto –, mas a vida – e os preços das casas – levaram-na de novo, desta vez para a outra margem. De Almada, sempre uma nesga de Lisboa, o vértice central (se é que tal coisa existe) do seu triângulo afetivo-geográfico.
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