Don’t bother looking in the archives if you want to see Emory historian Jeffrey Lesser at work. Look for him instead walking the streets of a neighborhood in São Paulo, Brazil, called Bom Retiro — “Good Retreat” in Portuguese — a bustling district of low-rise buildings with shops on the ground floor and, frequently, low-wage garment factories above.
Emory historian Jeffrey Lesser.
“Being a historian is a great way to be left alone,” says Lesser, the Samuel Candler Dobbs Professor of Latin American History at Emory. “But I started to realize I would be a better scholar if I was surrounded by people who had different expertise than my own, who challenged me as opposed to my doing it all in my own head.”
Successive waves of immigration over the past century make Bom Retiro a valuable laboratory for trying to understand the health dimensions of urban living. “It’s multi-ethnic,” Lesser says. “When you walk down the street, you see Bolivian immigrants and their Brazilian-born children, Korean immigrants and their Brazilian-born children, increasingly Chinese immigrants. It’s kind of a stand-in for lots of places. There’s something that, to me, feels like Atlanta, like New York, like L.A.”
Lesser and his students often accompany local health workers through the neighborhood, giving them a chance to see how living conditions become health conditions, for better or worse.
A member of a street-level health team walks down the street, carrying a cooler with medicine for patients. Photo by Jeffrey Lesser.
Then there are the cultural impacts on health. Coco Sandoval, a psychology, Spanish and Portuguese major, worked alongside care providers in Bom Retiro as a Halle Institute Undergraduate Global Research Fellow and saw first-hand the challenges faced by Spanish-speaking immigrants in Portuguese-speaking Brazil.
“There are Bolivian immigrants, Paraguayan immigrants, Venezuelan immigrants,” Sandoval says. “Even when they all speak Spanish, their different experiences with state institutions, authority figures and health care systems in their home countries can shape how they interact with Brazilian providers.”
Sandoval notes that a Bolivian patient who has experienced labor exploitation or discrimination may approach care with more hesitation or distrust than someone with a different migration experience. “Family structure and decision-making norms can differ, also,” she says. “Some health decisions may be made collectively, with spouses or extended family heavily involved. In others, individuals may prefer more privacy. A provider who assumes a single ‘Spanish-speaker’ cultural model may unintentionally misread a patient’s preferences.”
In Bom Retiro the team has had a direct impact on the communities they study, especially immigrant women, by helping them to better navigate the Brazilian public heath system. They’ve also helped providers such as physicians, nurses and community health agents see how cultural attitudes shape the different ways people think about their health as well as how social structures impact health, especially for the poor and powerless. For example, Lesser points to the difference between municipal trash pickup in elite neighborhoods — almost every day — and in poorer neighborhoods — once a week or less.
The uncollected trash becomes mosquito breeding grounds, leading to higher rates of diseases like dengue in the neighborhood. His team has created multilingual guides to help the generally Portuguese-speaking health care providers communicate with non-Portuguese speakers, and accompanied them on house calls to provide language and culture translation.
Beyond his longstanding collaboration with Brazilian authorities and communities, Lesser is proud of the partnerships he’s built with Emory students from multiple disciplines and interests. Students are encouraged to do their own research, which complements and pushes forward Lesser’s own work.
Lesser (center) and his student team in the neighborhood. Photo provided by Jeffrey Lesser.
The specialized training they bring to the task sometimes forces him to rethink his own perspectives, making this a very different kind of student-teacher relationship. “They challenge me and they terrify me,” he says. “Each in different ways.”
Among his students is Alexandra Llovet, an MD/PhD student in epidemiology, who works on perceived barriers to health among Spanish-speaking immigrants from both their perspective and the perspective of health care workers.
“I've found that they don't align,” she says. “Where health care providers cite language and labor conditions as essential barriers to providing care, the patients cite the cost of time in going to the clinic because they quantify their time as financial compensation. So they perceive wait times as a cost to health care.”
The precision of Llovet’s epidemiological training has benefited Lesser as well. “Often in the humanities, we think about data for its deep meanings,” Lesser says. “Every time I talk with Alex, she says, when you say ‘most people,’ how many is ‘most,’ precisely? And so that's taught me how to use epidemiological data, which I'd seen throughout my whole career and just thrown away. I didn't understand it.”
At the same time, Llovet says Lesser challenges her by making her think about how her own identity shapes the work she’s producing. “He challenges my writing too,” she says. “About what words I actually mean rather than what words I wrote.”
Other students include Paula Manfredini, pursuing a PhD in history, who studies how immigrant women manage their health in their daily lives — including through food traditions.
Mina Lee, a master’s student in theology, studies the relationship between faith practices and health practices in Korean immigrants. History undergraduate Lucia Alexeyev studies health on the Puerto Rican island of Vieques, which the U.S.Navy used for years as a bombing range, using similar approaches to the teams in Bom Retiro. “Even though the Navy left over 20 years ago, what remnants of that history do we still see in people’s lives today?” she asks.
Working in such diverse places makes Lesser aware of the value of a diverse team of researchers. “All of us together are helping each other understand things that we couldn’t do as individual researchers,” he says. “There are language skills, generational skills. What I learn about the neighborhood from having this team is different from what I would learn on my own because they have different kinds of relationships.”
“I’ve sat in this room a million times by now, sandwiched between Alex Llovet and Dr. Lesser,” says Alexeyev, sitting in Lesser’s office with the team. “I'm getting hit on both sides by new ideas. And they're both challenging me to think about things in different ways and try to do things. Then Coco and Paula read my work and tell me what they think from their different disciplinary perspectives. That kind of team has really shaped what my project is, which would have turned out completely differently had I not had them.”
Bom Retiro, a neighborhood in São Paulo, Brazil, whose name means “Good Retreat” in Portuguese. It’s a bustling district of low-rise buildings with shops on the ground floor and, frequently, low-wage garment factories above. Photo by Jeffrey Lesser.
Coco Sandoval, a psychology student, interviews a garment worker. Photo by Jeffrey Lesser.
Municipal trash pickup in poorer neighborhoods happens once a week or less. The uncollected trash becomes mosquito breeding grounds, leading to higher rates of diseases like dengue in the neighborhood. Photo by Jeffrey Lesser.
A typical storefront in Bom Retiro. Photo by Jeffrey Lesser.