I find him studying documents that are more than a century old. Talking with him is hearing about part of the history of teaching and institutions. It is understanding that life is about cycles that repeat themselves like litanies intended to repeat an idea until it is dealt with and, therefore, it takes centuries for the litany to stop repeating itself.
He explains that in order to understand the content of the many pages he reads every day, you must know how to do it transversally, a technique he has perfected with intense study and, I would say, that surely few have mastered like he has.
He touches the old sheets of paper as if touching new skin that is still forming layers of resistance to life. The age of the books deserves his special respect because they bring with them the wisdom and the answers that explain that life and History come in stages and repeat themselves.
Telling the history of stories, he talks about the roots of the matters after gaining in-depth knowledge about them. Between times of silence and flirting with his books, he listens to them and looks for them in an unrelenting confluence of knowledge and commitment to the truth of things.
Too correct to miss the time shown on the clock, he postpones our conversation for half an hour because an appointment forces him to arrive a few minutes late. He shows me a book with a rare content and price, which he rescued in time to quench a thirst for knowledge that never ends.
We met at the inauguration of the new Faculty Library, "you have to interview him, because it is an opportunity for you to learn about what he did for our teaching and for the Faculty," said someone who worked with him for years. When I realised he was a former Faculty Director, I quickly looked for him and asked if we could have a chat. At first he explained that when he is working on something he is almost obsessive about his method and focus, but "maybe one day, who knows"; two days later he called me and we scheduled an interview.
A good natural science student, João Alcindo Martins e Silva was particularly interested in dissecting animals, collecting images and diagrams to learn more about the subject. Maybe that was the reason why he chose medicine. Committed to finishing the course and despite all his interest he says, however, that he never cared too much about his grades, even though they were good. He graduated with a thesis on blood, specifically on porphyrins, which are important biochemical components of haemoglobin and other haemoproteins, co-responsible for the transport of oxygen in the bloodstream, and in other tissues, intervening in cellular respiration and detoxification systems. Interested in the experimental area, which involved analysing animals in the laboratory, he realised that it was research that aroused his greatest interest. So, after graduating in July, he was doing upgrades in laboratory haematology and continuing his previous work, and he eventually got delayed in his application for a medical internship. But he needed to find a professional opportunity, because research was surviving virtually without support, and Gulbenkian was the only institution providing funding at the time. His mentors at the time advised him to go to Mozambique, to the Medical Research Institute, whose director, Dr. António Franco, had visited Lisbon and was looking for an assistant, albeit more focused on microbiology and parasitology studies. Later on, thanks to an agreement between the directors and his own personal preference, he was posted to the University of Lourenço Marques, as 2nd Physiological Chemistry assistant, where he would be able to continue developing the work in which he was interested.
As he had gotten married as soon as he had finished his degree, he moved to Mozambique with his wife in 1968. He is the father of four daughters - the first and third ones were born there, the second in the USA, and the youngest one after his return to Lisbon. In addition to teaching, he started researching on porphyrins, based on human screenings. He would eventually complete his PhD in Physiological Chemistry, always pursuing his interest in porphyrins. First, however, we had to overcome a difficulty: "One month after arriving in Mozambique I was drafted to join the army, in Mafra. At that time, Professor Veiga Simão, the then Dean and an extraordinary man, moved heaven and earth and got the Armed Forces General Staff to allow my military obligations to be transferred to Mozambique, provided that I completed my PhD." He used the four years of waiting (the deadline ended at age 30) to complete his first internship at an internationally renowned centre at the University of Cape Town (South Africa) and a second internship, in Seattle, at the University of Washington, where he was able to complete the experimental part of his doctoral thesis almost in its entirety.
When asked if he had thought about staying in the USA, he said that he wouldn't break his word, he was a man of honour. "That's not what had been agreed. Gulbenkian and the University of Lourenço Marques had paid for me to go to the USA to do my research, so I wasn't going to betray those Institutions. Besides, I had undertaken to complete the compulsory military service." Not even an invitation to stay in the USA made him think twice.
After completing his PhD, he served in the military in Mozambique, between 1972 and 1975. "In four years, which was the time limit, I was able to complete the thesis, writing the last part while I was in the military. At the age of thirty, he had to reconcile his thesis with his "military role". I would wake up at 4 a.m. to write and then I would go to the barracks. I had to go thirty kilometres to get there every day".
He wrote and defended his thesis and, "two days later, [he] was in the bush". Although he doesn't like to talk much about his time in the military, he says that he felt revolted, because he was teaching at the University, he had completed a medical specialty and ended up as an assistant physician in a post on the northern border. In addition to his military duties, he was a health delegate and ran a small hospital. When the revolution occurred, on 25 April 1974, he was in the bush and, coincidentally, listening to Zeca Afonso. He heard the news about his country on the radio. He had been looking forward for the good news that, indeed, was whispered among those who were close to him and knew that the Armed Forces would do something soon.
He returned to Portugal on the last plane that brought the last troops and civilians, leaving the country for good, the country where he had taken his first steps. About that period, he remembers the peaceful Lourenço Marques as a beautiful city, which would also be haunted by fear, reflecting a political and social unrest that did not bode well. "I put my daughters and my wife in a military ambulance to the airport. At the time we were travelling along the avenue that led to the airport, we were surrounded on both sides by "musseques" (the huts that flooded the city) and people had died there the day before...When we arrived at the airport we were surrounded by paratroopers, soldiers, things were agitated."
João Martins e Silva returned a few years later to Mozambique, where he revisited some of his places. "I went back to see the house where I had lived, it was blue, very beautiful and brand new. When I got there, the colour had faded, it was run down, and the city, which had been so beautiful, was filled with houses protected by metal bars and watchmen at the doors; it had been a very clean, cosmopolitan, very advanced city, but then the houses were overcrowded with people and had animals living inside, people were grinding maize inside the houses, the lifts had stopped working."
He strengthened his experience as a doctor in Portugal. "Until the mid-1990s I worked in private practice, but that was not my passion, I liked to find the right answers, concrete results, not to work with assumptions. There was a degree of inaccuracy in clinical medicine that, despite being very interesting, made me feel that between two passions, I preferred research".
As he had never lost his connection to the Faculty of Medicine and was settled in Portugal, he resumed his teaching career in 1975 at the Institute of Physiological Chemistry, becoming extraordinary assistant professor in 1978, and full professor in 1980. In the meantime, he had become responsible for the teaching of Biochemistry and, a short time later, for organising a specific department that would become a new institute, with the same name. Deputy Director of the Faculty since 1991, he would eventually replace Professor Torres Pereira in his position as Director in 1994. That year, following the retirement of Professor Carlos Manso, who had also been his director in Lourenço Marques, he became responsible for the two institutes and proposed a merger into a single institute - the Institute of Biochemistry. "Even when I was the Director I continued to teach classes three times a week, in addition to the responsibilities inherent to the direction of the Institute of Biochemistry, which included a strong research component".
The creation of haemorrheological and microcirculation studies allowed him to continue to pursue his previous research works.
He was the Director of the Faculty of Medicine of the University of Lisbon between 1994 and 2005, and those who worked with him at the time say that one of the characteristics that distinguished him was the fact that he documented everything, even routines. And that led to the creation of orders and regulations so that everyone knows where they stand. "Documents were very important, they were published and everyone was informed."
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Known for being a man of detail, his attention to the facilities led him to expand them and modernise them. Not even an unlit light bulb escaped his watchful, disciplined eyes. Strict when it came to teaching, he changed the 6th year in order to include an exclusively clinical internship in hospitals and health centres. Responsible for the creation of the IFA (Advanced Training Institute), he also believed that, in order to be able to demand more of the teams, it was important to specialise them, so the employees were given higher technical training.
IFA BuildingThose who worked with him remember that the day started early and work went on until dusk. They also remember that he listened to jazz and classical music while working and lent his albums to his colleagues. When his term of office came to an end, he left quickly and early, they say. After twelve years without meeting him, today they visit him and revisit shared memories, while regretting the fact that he left the way he did.
There are still some doubts as to why he retired so young, without a celebration or tribute. We are left with the reflections of someone who doesn't lack objectivity and accurate arguments.
You are clearly a private person, so why did you run for Director of the institution that had always been your home?
Professor Martins e Silva: I belonged to a group from Physiological Sciences, a group of Professors who complained about not having the necessary conditions. The hospital had grown a lot and there were several shortcomings, it needed more space and the existing facilities needed to be modernised. If the government agreed, it would be possible to have a new building, more specifically, a building designed specifically for the Physiological Sciences. The project for the Institute of Physiological Sciences was faced with several "accidents", successive delays, so time went by and the money eventually disappeared, with only a small amount remaining, that allowed for no more than a preliminary study. Speaking to Professor Torres Pereira, who was the Director at the time, I showed him how displeased I was with the situation. I think that, at the time, he believed that I could be of good help to him, and since he needed to find a Deputy Director, he appointed me. I accepted on the condition of being in charge of the Institute of Physiological Sciences. And that was it. He eventually retired and I ran for Director. And then there was a curious election ...
Curious why, what happened?
Professor Martins e Silva: Because for the first time there were three candidates, and the other two were older and not exactly unknown. I was the one who stayed and did the work that had to be done.
Does that mean you had problems?
Professor Martins e Silva: No matter what you want to implement, there are always vested interests. There's no point in scrutinising the obstacles, only the progress made. One of my first initiatives as Director was to lay the foundation stone of the Institute of Physiological Sciences where it is today, currently known as Egas Moniz Building.
First step of Egas Moniz constructionThe intention behind that ceremony was to unblock a process that was detrimental to the interests of the Faculty, and that was achieved through the reactivation of the PIDDAC in the following years. Even so, the process was slow: award of the international tender for construction to be completed in three years (1997); beginning of construction and appointment of the founding committee (1998). The new building, renamed Egas Moniz Building (2004), was officially inaugurated by Prime Minister Barroso only on 24 April 2004. The following September it was deemed suitable for teaching and research, and then an autonomous administrative management process was tested and proved effective.
Along with the construction and activation of the building there were many requests, both internal and external. The internal requests were focused on the degradation of the facilities allocated to the Faculty that, since its foundation in 1953/54, were integrated into a building shared with the Santa Maria Hospital. They were gradually repaired, and a number of small buildings occupied the "students' courtyard". In 1995, the Rectory of the University of Lisbon was requested to address the Santa Maria Hospital in order promote the definition of the FMUL campus within the shared premises (1995); the "FML Campus" project was approved and defined in 2004. There was also the need for administrative reorganisation, achieved by way of the introduction of training routine and refresher courses, the creation of new offices with specific duties which included administrative staff and were monitored by a professor, the gradual introduction of a multimedia network, with limited access to the Internet and the Intranet (1996); The gradual installation of a voice/data/Internet network in all the non-clinical units of the shared building (97 and following years), the introduction of an annual internal self-assessment (1994); the promotion of the definition of the FMUL campus within the shared premises (1995);
With regard to external requests, I should highlight the launch of the External Assessments, promoted by the European University Association (EUA) and on the initiative of the FMUL (sponsored by the Luso-American Foundation), in 1997. At the time, on the initiative of the four Faculties of Medicine that existed, and with the support of the respective Rectories, the need to change medical education was being discussed at the national level. Finally, a decree was published that established that the education reforms would be strongly monitored by the Government, which would make it easier for the institutions to meet their economic needs. So, the FMUL prepared a draft Development Plan (1998). Then, a proposal for Support of the Development and Modernisation of the FML was submitted to the Health Management Group, appointed by the government (2000); this was followed by the preparation of a Draft Contract for the Development of Medical Education (2001). Lastly, the Faculty, through the Rectory, signed, in the public presentation of the Strategic Plan for Training in Health Areas, the "Development Contract for Medical Education at the University of Lisbon" (December 2001) and, in 2002, the FMUL appointed a monitoring committee. The Development Contract covered three buildings. One was almost completed; it had been paid with PIDDAC funds, but the Government decided to include it in the Contract. With regard to the other two buildings proposed by the FMUL, and confirmed in the Contract, one was intended to accommodate the historical Câmara Pestana Bacteriological Institute (renamed Reynaldo dos Santos Building), while the second one, which was a lot smaller, would accommodate the new Central Library, which needed improved conditions, and receive the Advanced Training Institute, offering full access to post-graduate and continuous training for physicians who needed it. The space for this building is still there. The condition underlying the Development Contract was the acceptance of more students, which indeed happened.
Building ProjectIn the meantime, the new curricular plan for the undergraduate degree in Medicine was launched for the 1st year of the course (1995/96) and, successively, for the following years until the 6th, as a vocational clinical internship (2000/01). With regard to undergraduate education, I should highlight the international collaboration in a bachelor's degree in Biotechnology (which, in a way, anticipated engagements developed within the scope of the "Bologna Process"); the national organisation of two new undergraduate programs in the field of Health (Nutrition and Microbiology); the co-participation (with the Higher Technical Institute) in a course in Biomedical Engineering, the activation of the pedagogical support for the extension of the 1st cycle of the medical course at the University of Madeira, and the preparation of the experimental phase for distance learning, due to be launched in advanced training courses promoted by the FMUL.
Egas Moniz Building (2004)Was the construction of that second building already being discussed at the time?
Professor Martins e Silva: Yes. At the time there was an earlier plan, agreed with the Rectory.
And what would that second building be used for?
Professor Martins e Silva: It would also be used for research. The Rectory's intention was to transfer the Câmara Pestana Bacteriological Institute, which was very limited in terms of both staff and duties. The aim was to renew the Institution and transfer it to this new building. This project was entirely awarded, as we've already said.
This means that, supposedly, there was money for it, right?
Professor Martins e Silva: Well, no, that was the problem. Promises were made, official commitments were signed, but then there were budgetary problems. (Note: António Guterres was in his first term of office as Prime Minister). In fact, the Rectory was only able to raise the funds for the Câmara Pestana Bacteriological Institute's building after I had left. The third building never became a reality but, who knows, maybe one day it will. There is always hope and, as an example, we have the construction of the Lisbon School Hospital, for which we had to wait about 30 years...
In the meantime, you retired...
Professor Martins e Silva: Yes, at 63, I didn't want to carry on.
Why?
Professor Martins e Silva: (Smiling) You know, I believe I had, and still have, an enormous capacity to put up with certain things, but there comes a time when we have to be able to say that enough is enough.
One of my issues had to do with the Building. When this Hospital was built it was supposed to be a hospital/faculty and the person who fought for it was Professor Francisco Gentil, an extraordinary man who achieved incredible results. Did you know that he managed to sell this idea of combining a hospital with a school to Salazar? And he did it. The Institute of Oncology was envisioned by him since the 1910's in a surgery ward, under his direction, at the then Santa Marta School Hospital. This Institute, stripped of the various obstacles related to the Santa Maria projects, was inaugurated a few years later. I have his works, he was a leader. At one point, as I was reading his writings, I realised that he repeated the idea that when people are not at the forefront of something, they don't want that something to happen. And he systematically addressed this issue. Professor Francisco Gentil, with the funds that the Government had granted to the Faculty of Medicine of Lisbon, purchase of some land known as Quinta da Nazaré at the time, where the facilities of the Santa Maria Hospital are now located. The construction of the Faculty-Hospital began under the name Lisbon School Hospital, and when the hospital was about to be inaugurated, the Government issued a decree changing its name to Santa Maria Hospital, claiming that, by tradition, hospitals were always named after saints. Cardinal Cerejeira actually came to bless the chapel.
There was a period when the hospital administrators were sensitive to the Faculty. And what I've been reading confirms that. The first school hospital outside of Santa Marta, and the one that directed it was the Faculty, the administrator of the hospital reported to the director. That wasn't the case in Santa Maria. Initially and for many years (until recently), full professors were naturally chosen to be the directors of the hospital services, in addition to being appointed for internal committees and clinical direction. However, they are no longer hospital directors, as its administration was transferred to the Ministry of Interior and, later on, to the Ministry of Health. The relative importance of the Faculty in the whole of which it is a part was affected by these changes, which were gradually consolidated by legislation aimed, almost exclusively, at the medical care provided by central hospitals, like the Santa Maria Hospital. There were "timid", occasional references to the medical education provided by "school hospitals", but everything related to this education (budget, staff recruitment, possible logistical support) was the responsibility of the Ministry of Education, despite the fact that, in practice, it was "absent" from the joint governance scheme.
Was there a time when it possibly realised that it had little support from its own peers...
Professor Martins e Silva: Yes. Perhaps there was some interest in the Faculty being quieter, less proactive.
You were telling me that one of your issues had to do with the new buildings, but that wasn't the only issue...
Professor Martins e Silva: Another issue was the reform of medical education and I was also able to implement that. The reform was facing many obstacles. This hospital had been built for a total of a little over 600 students. That's it. At the time of the revolution, on 25 April 1974, the Faculty had more than 4000 students. Everyone was admitted because there was no numerus clausus. Currently, the Faculty admits about 370 students each year. But this Faculty-Hospital building was designed for 90 students a year; maybe a little over one hundred were admitted in the first year, because there were always some who gave up. But this means that any surplus would immediately cause problems. In the various papers he wrote on the subject, Professor Francisco Gentil warned that the students would not be given the same attention and that this would give rise to potential risks, both in training and in medical practice. There were times there when we had patients leaving because they had a doctor and dozens of students looking at them. It made no sense.
But you warned of the need to create limits, right?
Professor Martins e Silva: Exactly, and what we did was subdivide the clinical subjects, in order to reduce the number of students in nursing classes. There were shifts. There was an intensive teaching schedule based on alternating subject blocks. But some people were against this, because it meant repeating subjects two or three times a year. So, this measure was implemented, but it seems that, after I left, everything went back to the way it used to be. I also reimplemented, in 2000/2001, the 6th year clinical internship (as a vocational clinical internship), in what had been a regular year with theoretical and practical classes until then. The subjects taught in the 6th year were redistributed or integrated into earlier years, creating the need to redesign the entire system. Of course this caused additional problems. Thanks to successive year meetings with the heads and coordinators of the clinical subjects, as had been the case with basic and pre-clinical subjects, and to the valuable collaboration of the monitoring and curricular evaluation committees, we were getting things done.
We were faced with another problem: it wasn’t possible to complete the internship solely in this hospital because there wasn't room for everyone, for the reasons I mentioned earlier. On the other hand, it was important for practical training to involve other clinical experiences in different hospital institutions and also, in the area of community health, in health centres. So, the great revolution came from the collaboration (enthusiastic and participative, I should say) with hospitals and health centres, mainly the ones integrated into the Regional Health Associations of the district of Lisbon, south Tagus and Islands. But the parents and students did not respond very well to the idea of a temporary removal from Lisbon. Simultaneously, there were many positive things, namely the commitment of the municipalities that provided accommodation and food; they felt their cities had something to gain and rallied round to offer their help. The students had a notebook that served as a guide to the specific aspects of clinical learning they were required to meet, which had to be certified by their internship supervisors. It was a one-to-one system (doctor and student). There was a "machine" in place to inform the students where and when their internship would start, who their supervisors would be, together with information about their performance.
And what was the problem with that? It was a problem with Ministries. The doctors were motivated and believed that they were helping these students to grow, but they were not being paid for this additional work. They were overloaded with work. We still managed to get them a position, some as "Volunteer Professor", but obstacles were starting to emerge.
Lastly, the Chairman of the Board of Directors of the Santa Maria Hospital, who took up his position during my last year in office, had a very negative impact on the interests of the Faculty. He was eventually replaced at the end of a controversial year. For example, breaking with tradition, he did not invite the direction of the Faculty to the ceremony commemorating the anniversary of the Hospital, attended by Jorge Sampaio, the then President of the Republic. I understood that I shouldn't invite myself, so I didn't go. My absence was not well accepted by some of my colleagues, whose actions used to dance to the tune of their own interests.
But did you serve the full term?
Professor Martins e Silva: Always. I simply did not stand for re-election. But I fulfilled my major and initial purpose, which was to build the Institute of Physiological Sciences, inaugurated in 2004. The fact that I had accomplished my mission was one of the reasons to leave. I won't speak about the others.
People tell me you left quietly and discreetly. And without a tribute.
Professor Martins e Silva: That's true, there was no tribute... I want to believe that it had to do with the precedent set by other teachers who left early; from then on, those who decided to leave on their own initiative were not particularly indulged.
Do you think they interpreted it as an early withdrawal? "He turned his back on us, so we don't show him the gratitude he is owed".
Professor Martins e Silva: Maybe...
Where have you been since you left?
Professor Martins e Silva: I didn't move away entirely, you know, I was a visiting Professor at the Higher Technical Institute, in the joint degree in Biomedical Engineering. I kept this connection for three years, until 2008, and then I returned to the Faculty to teach metabolism and endocrinology at the Egas Moniz building. Then I ventured to "other worlds". I have several interests; one of them is painting, which has allowed me to resume a practice I suspended early on, in my 20s. Another hobby is the history of medicine and contextual themes related to different eras. I have written and published several works. I've been reading and writing about the History of Medicine in the Middle East for nearly 10 years. I have a work ready to be published in the USA, which is missing only minor bibliographic adjustments. But I suspended both in order to make progress on a work on a series of key aspects of the history of the Faculty until 1955.
When did Professor Fausto challenge you to write about the History of this Institution?
Professor Martins e Silva: We met in the inauguration of the new Library and we had seen each other a few days earlier because I came to offer a book I had published - "On blood circulation and cardiovascular notes: comments on an 18th century book.". We talked for a while and it was at that point that Professor Fausto told me that there should be a book about the History of the Faculty. As I was already doing some research on documents from the school hospital, I eventually used some of the information I had and now I'm reading and researching a few other documents.
And now that you're back, are you reliving some of the enthusiasm of the past?
Professor Martins e Silva: (Thinking) You know that going back means reliving and some things are not pleasant. When we move away from something we stop thinking about it and when we return, first we remember one person, or another, then this moment or that one, and not everything is pleasant...But other things are.
Now I'm working on this book, this is what I want to commit to, and to finish it I have to do things well.
You write books on the History of Medicine, of Institutions. If you were to write a book about your life, would you omit any of its chapters?
Professor Martins e Silva: I never erase anything. I strongly defend transparency. Either good things and bad things, we know we don't do everything right all the time, but those are the things that shape us and for which we pay. No, I wouldn't erase a thing!
Joana Sousa
Equipa Editorial
