Services on Demand
On-line version ISSN 1807-5762
Interface (Botucatu) vol.11 no.21 Botucatu Jan./Apr. 2007
Selma LancmanI,1; Laerte Idal SznelwarII; Seiji UchidaIII; Tatiana Amadeo TuacekIV
IProfessora, Faculdade de Medicina,
Universidade de São Paulo (FMUSP), São Paulo, SP.<email@example.com>
IIProfessor, departamento de Engenharia de Produção, Escola Politécnica, Universidade de São Paulo (USP). <firstname.lastname@example.org>
IIIProfessor, Fundação Getúlio Vargas <email@example.com>
IVGraduanda, curso de Terapia Ocupacional, USP; bolsista de iniciação cientifica PIBIC/CNPQ. <firstname.lastname@example.org>
This study was done with transit agents, who
for various reasons related to the organization of their work and the fact that
the street is their work space, are exposed to situations of intense verbal,
and sometimes physical, aggression. By studying this situation it is hoped
to make a contribution to understanding the impact of violence on the mental
health of workers who work on the streets and its reflections in their health,
their work development and relationships.
This study was based on theoretical/methodological principles of the psychodynamics of work. This is a reserach-action method in which doing research presupposes having a transformative action on the situation studied. We verified that living with violence in the exercise of their profession has a strong impact on workers' mental health on the one hand, and on the other, they develop strategies and use work-related intelligence in order to be able to continue working.
Key words: mental health and work; psychodynamics of work; violence at work.
Since the 1980s, violence has risen from fourth to second place among overall causes of mortality in the country (Souza, 1994) and is still today the second cause of death in Brazil, behind only cardiovascular disease.
Many researchers in Brazil and worldwide have tried to explain violence, its new forms of manifestation and its impact on people's lives and mental health. For our part, we would like to turn our attention to a specific reality, that is, violence at work in its most explicit forms, situations where people who have been attacked physically or psychologically in the course of their work. Even though we recognize other expressions of violence such as: poor working conditions, the growing exclusion of workers, the increasing pressures on those who remain at work and various forms of harassment, these are not the subject of this study.
The list of workers exposed to violence is significant: bank employees, police, transit workers, security personnel, bus drivers and fare collectors, subway cashiers, taxi drivers, personnel who transport valuables, health workers, teachers, jail personnel, supermarket cashiers, restaurant and bar workers and gas station workers, among others.
Research in the European Union reveals that 4% of the economically active population has experienced violence at work and that the places of greatest risk are concentrated in the service sector, such as health, transportation, retail sales and education.
There is a growing comprehension that violence in the workplace does not come in isolated episodes, nor is it an individual problem, but is a structural issue related to the organization of work (ILO. 2002). Contact with customers increases the risk of violence. Among the most common risk factors are: handling merchandise and money; isolated work; carrying out enforcement tasks; issuing bills and fines; exercising authority or control; contact with problematic customers; poorly managed organizations that can increase aggression on the part of customers, etc..(AGENCY FACTS, 2002). The aggressors are usually men and the victims usually women.
The European commission responsible for occupational health and safety (1996-2000) identified violence in the workplace as an emerging risk based on the finding that 16% of the economically active population in Europe is exposed to violence at work, especially public employees who are in direct contact with customers. Violence has been treated more as an general safety issue and not as an issue of safety, health and work (EUROGIPINFO, 1998).
In this article we will discuss the violence directed at workers whose jobs are on the street, that is, who work in open spaces, without personal safety equipment proper to a closed environment, with no mediators and who due to direct contact with the public during the work day, are vulnerable to possible attacks (PAES MACHADO, 2002; SCHAIBER, 2003).
Concern with this issue suggests arose during a study of transit agents, the focus of this article, but in the course of that study and reflecting on the theme, we came face to face with a problem which is common to several professions whose activities take place in "open" environments.
Frequent, unprotected contact with the public without colleagues or bosses to help mediate situations of conflict and the lack of protective equipment that exist in other work contexts, make these workers more vulnerable to conflict and direct attacks whether directed at their physical bodies or their psychological integrity. This situation of excessive exposure frequently causes these workers to experience risky situations and to work under conditions of fear.
One of the tasks assigned to the transit agents who are mostly women, is to regulate the use of public space. The nature of the services provided does not always agree with the public (inspections, collections, restrictions on the use of public space, issuing fines, etc.) This direct contact with the public often makes the workers targets and lightning rods irritation, dissatisfaction, frustration and attacks which are most often aimed at the institutions they represent. These workers, in addition to working alone, are exposed to all the risk factors detailed in the European Union study.
The sense that the target for attacks is above all, the work they do and the company they represent creates an additional problem: an identity conflict between the importance, legitimacy and credibility that they attribute to what they do, the effort expended during their work and the lack of social recognition.
Violence at work and mental health
The concept of violence in the work place usually includes insults, threats and physical and psychological attacks by people outside the organization, including customers, against workers which constitute a risk to their health, safety and welfare. Violence can contain a racial or sexual component. The acts of aggression or violence take on the form of rude behavior a lack of respect for the other; verbal or physical aggression with the aim of hurting or attacking the intent to harm to other person (AGENCY FACTS, 2002).
The impact and cost of violence in the workplace needs to be considered at different levels: on the individual level, the suffering resulting from violence causes lack of motivation, loss of trust, low self-esteem, depression and anger, anxiety and irritability. These effects are aggravated if the causes of the violence are not eliminated and if the worker continues to be exposed to the same risks at the workplace; violence causes a rupture in interpersonal relationships; the dissolution of the organization of work, reduced efficiency and productivity and deterioration of the quality of the product and the image of the company. At the social level the costs of violence include health care, the costs of rehabilitation to reintegrate the victims, the costs of disabilities if work abilities have been affected and the costs of unemployment if workers are unable to do their jobs (ILO, 2002).
It is impossible that verbal attacks not be included in the realm of violence, since they are equally sources of suffering [as physical attacks] due to their humiliating content and because workers never know whether they will escalate into physical aggression. On the other hand, these attacks involve additional harm due to their traumatic potential for violence, the sense of powerlessness when faced with them and because of the suffering they cause. As Renault (2005) states "this new paradigm allows us to speak of a violent social structure or symbolic violence." The intention of those who attack verbally can be the same as those who attack physically, that is, to oppose another's intentions, to hit them, and kill them symbolically. and in this sense they are a substitute for physical attacks. In the same way, studies have demonstrated that the post traumatic psychological problems resulting from assaults do not always depend to the severity of the physical aggression suffered (DEJOURS, 2005), that is, the fear, the threat of aggression, have a psychological effect even when physical aggression is not realized.
Being the target of violence provokes, among other things, damage to the health of individuals and this damage includes the entire ranges of unhealthy aspects that affect workers' physical and psychological integrity. (Nascimento, 2003). The psychological effects of violence include psychosomatic symptomas, the appearance of diseases or the aggravation of pre-existing illness, sleep disturbance (insomnia, nightmares. sleep interruptions), depression, panic disorder, feelings of distrust about everyone and everything, and others. The experience of violence can compromise professional projects and affect the construction of professional identity. The importance of post-traumatic symptoms has to do with the degradation of social relations, to which those who work on the street are more exposed.
This situation is aggravated by the fact that that aggression and its consequences will not be described or included in reports on accidents or occupational diseases in line with Brazilian legislation (GOMEZ E THEDIM-COSTA, 1999. They are only recorded and reported as work related events when they result in bodily injury or when they cause temporary or permanent incapacitation. The underreporting ends up masking data on work-related violence, and does not generate either preventive policies or attention for the victims of aggression. In the case of verbal attacks, the situation is worse, because they go unreported, leave no evidence; there is a risk that they be considered banal, of no great consequence.
According to Dejours (2004) work is the privileged mediator between the unconscious and the social field, not the only one of course, but one of the major ones. This should be understood as a continuum that extends beyond its restricted space and influences other spheres of life. The relations that take place at work will be one of the major sources for the individual to use in developing an identity and transforming suffering into pleasure through various processes of recognition. When the doing is not recognized, the subsequent devaluation reach into other spheres of daily life. Work can be a place to develop one's identity or a factor of psychological wear and tear and even the psychological breakdown of the individual. In this sense, the failure to recognize violence as a consequence of work relations and the intelligence workers of necessity develop to manage to keep working despite the risk and fears that ends up doubly victimizing workers.
Working in the public health sector
Even though the service and productivity expected from the public sector are not comparable to the private sector, the logic of the organizational models of private companies have for some time been systematically applied to public sector institutions. Among the strategies developed we can cite the adoption of various means of downsizing their personnel that run from instituting voluntary retirement programs to not replacing workers laid off due to sickness or retirement. Since the demand for services is increasing, this could result in a reduced ability of the services to meet it, making it difficult for workers to develop their activity and compromising the quality of the care provided.
Despite there being less unstable work relations (less exposure to the risk of summary firing) the professionals in the public sectors are exposed to other types of instability and precariousness in work, such as, privatization of public companies followed by firings, outsourcing of sectors inside the company, deterioration of working conditions and the image of public employees and being held responsible for the deficiencies in services and for possible crises in public institutions, etc.
They are further exposed to the instability caused by political oscillations and planning that cause discontinuity in projects in process; changes in the quality and quantity of demand for services provided; accumulation of functions; changes to work organization or to the nature of activities that collide with their sense of responsibility and beliefs about the carrying out their work. These oscillations are aggravated by changes in municipal, state or federal administrations which can cause changes or ruptures in continuity and to the course of on-going projects. These forms of instability and precariousness expose them to intense suffering due to the difficulties in creating a personal and professional narrative (Sennett, 1999) which gives workers a sense of coherence in their work and which protects them socially and psychologically.
Public employees end up mediating the public and private spheres in a society where the interests of individuals are sometimes superimposed over the public interest. It is up to the public agencies, and especially the workers that represent them and who are in direct contact with the public to absorb the impact of government failures and make the community interest prevail in a society where average citizens expects privileges and satisfaction of their personal needs. (ARENDT, 2005).
THE URBAN TRANSPORTATION SECTOR
The Traffic Engineering Company (CET) a company connected to the city of São Paulo, is responsible for several activities related to the road system, among them managing the rotating parking system (the sector known as the Blue Zone (Zona Azul ZA). The transit agents (position held by the Blue Zone workers) were, at the time of this data gathering, responsible for the sale of parking permit slips and giving fines, as well as enforcing regulations. We stress the importance of transit to the functioning of the city of São Paulo and understand what has give the CET company great visibility and importance and , at the same time, made it vulnerable to changes in political interests.
This study was requested by the CET in 2003 and the principal demand was for a study of the transit agents. The company identified a series of changes that had occurred in the functions of these workers over the years, heightened by a process of aging and wear and tear from the work can cause illnesses and the workers taking leave. They thus requested a study that could propose changes to this job position to make it less onerous.
THE RELATIONS BETWEEN MENTAL HEALTH AND WORK BASED ON A PSYCHODYNAMIC VIEW OF WORK
The discussion with respect to comprehending work and its impact on psychological health continues to be a big challenge for many researchers. That which millions of people really do in their everyday lives, often remains unknown and is relegated to the backstage of production. Thus, its consequences can be accessed only through symptoms expressed in the minds and bodies of workers. In this sense, little is known about "work" in relation to what can be discovered and about what is needed in order for tasks to be completed satisfactorily and production be accomplished with the quality and productivity defined by the institutions. Also there are few disciplines that, in studying the subject of work, are simultaneously concerned with its content, it consequences for mental health and for the lives of the working population and for production.
But the situation is changing little by little. Studies of occupational health relations have shown that work and its effects on disease processes cannot by reduced just to the aspects called "working conditions": but should also take into consideration the "organizational dimensions of work," that is, the division of tasks and the production relations, or further still the social relations resulting from work (GUÉRIN et al., 2001; DEJOURS, 2004; MAGGI, 2006).
The psychodynamics of work is concerned with understanding the psychological and subjective aspects that are mobilized based on activities, on the relations and the way work is organized. In this sense, it proposes diverse concepts to deal with the less visible dimensions of what workers experience during the production process, such as mechanisms for cooperation, visibility and recognition, psychological suffering, mobilization of the intelligence, will and motivation that develop based in work situations. It understands that work is a central element in creating the health and identity of individuals and that its influence transcends the time spent in the work day properly speaking, and extends to the family and social life, that is, the time spent not working. (DEJOURS, 1994; 2004,; BANDT et. al, 1995).
The knowledge workers have is a key element to understanding their work. This knowledge, their know how, is learned based on a process of elaboration that workers do in relation to their work, through reflection groups, understood as a privileged space that make possible a transformation of individual experiences into collective reflections. These groups also allow us to comprehend the defensive mechanisms and strategies that individuals create to be able to perform their work (DEJOURS, 2004). We stress that a proposal in psychodynamics of work also refer to transformative action, to the extent that they have as a proposal that workers in reinterpreting their actions, begin a process of transformation that could serve to catalyze deeper transformations in their work.
The objective of this article is to comprehend some aspects related to violence at work for workers whose work space is on the streets. A recent study of psychological suffering and premature aging in work (LANCMAN et al., 2005) points to violence as one of the main causes for the high levels of psychological suffering among transit agents of the CET. We try to comprehend the impact of violence on job performance, mental health and the strategies workers develop to be able to continue working despite the risks of exposure and the fears they experience.
The study was developed based on the method proposed by the Psychodynamics of Work. This is a method circumscribed the by the ambit of research-action where research presupposes transformative action of the situation studied. In this case, the expected action is not just to change the situation under study, but above all, that there be a collective engagement of workers in assuming co-responsible for the activities in themselves.
This method seeks to create a collective expression composed on the one hand, by groups that work directly inside the situation to be studied and, on the other, by researchers who coordinate and participate in groups and who are, at the same time, linked to a broader group that works simultaneously as a control collective. This means that the group that acts in the field and the research team overall develops an expanded reflective work on the activities in progress (DEJOURS, 2004).
The method proclaimed is not mere observation or data collection, the subjective aspects of work are understood based on a discussion undertaken in an open forum for deliberation. Interpretations and the meaning of facts presented are constructed from the outside by researchers, but are the product of the meanings that the situation has for the individuals themselves. Dejours call this process collective working through, which is only possible through the reappropriation and the will for emancipation of the participant worker
The several stages in this method have been described in various places, but can summed up by the following : a) pre-research: trying to create the conditions necessary to carry out research; b) re-configuration of the demand: stage in which one tries to understand, together with participants, not just the demands expressed by managers who requested the study, but the demand for comprehension and work analysis of the workers themselves, what mobilizes them and what engages them in a search for intelligibility of the situation; c) presentation of the project to the workers, so that they can learn the objectives of the research-action and so they can decide whether to participate in the groups; d) restitution and validation: at this stage the product of the discussions is presented to the participants in report form so that there is an interaction with researchers, validate the evaluation and the results presented, in addition to providing an opportunity to reappropriate and elaborate the material produced (DEJOURS, 2004). After this stage, the final report is present to the set of workers who don't participate directly in the groups and to the institution or company.
In this study two reflection groups were set up: the first was composed of six workers, using the inclusion criteria of agents who continued to enforce the rotating parking system. The second group was comprised of 8 workers who had been transferred from the ZA to traffic operations. The two groups met weekly during the second semester of 2004 during working hours for six ninety-minute sessions. In the end, after a period of report writing, they were validated by the group participants. Only after this validation was the report presented to the entire group of workers and discussed at the different hierarchical levels of the company. The excerpts presented in italics are quotes from workers taken from the report they approved.
Some changes have been incorporated into the work of the agents over the years, among them the tasks of selling parking permit slip and writing up fines. These changes brought about even greater exposure to risk of aggression and assault due to their carrying money (both money and the permits themselves), in addition to sometimes being attacked when they are surprised writing tickets: "The population sees us as people who are there to take money from them, to charge one more tax and not as agents to democratizing public space."
The way the system is organized also does not distinguish the particularities of the various regions of the city or that certain locations are more dangerous than others due to the occupation and/or control of the rotating parking spaces by ambulatory vendors and scalpers (who sell the permit slips more expensively than the official rate).
Direct contact with the public without intermediaries or shields ends up leaving the agents vulnerable to attacks, whether physical or psychological. In these situations the agents are almost inexorably alone, have no one to whom to appeal, other than other citizens. The stance the traffic agent takes at the moment of confronting the citizen can smooth or sharpen the conflict, "The user is already cursing, and you have to be rude or polite, depending on how you approach and how you are approached."
They encounter many irregularities in their sector (control of parking spaces by private security guards and informal car watchers, scalpers, appropriation of public space by ambulatory vendors and merchants) and can do nothing about them. They feel uncomfortable with their complicity and with impunity, they question their solitary role in enforcement of the urban space. This contributes to their feeling even more exposed to attacks.
They are frequently victims of attacks which at times are not directly related to the work they do. They report "gratuitous" cursing and believe that "people take out their problems on the blue zone workers." The agents face situations of violence on the streets originating from minors, beggars, prostitutes and people who throw dirty water or cans from buildings. They often hear verbal assaults such as "go home and wash clothes" or "Go find something to do." They report a case of a worker who was "beaten up in the crosswalk" because someone was upset.
The agents believe that part of the attacks they suffer are in reality directed at the company or at city government. They end up becoming shields for both institutions. They feel like "scarecrows put there to frighten people;" "People attack the ZA workers since they can't attack city hall," "People take out everything they have against the city government on us. We are a shield and a half...on the street."
The experience of attacks is made worse by what they consider to be oversights by the company. When these [situations] occur, the CET does not try to find out what happened, leaving workers with a sense of abandonment and that some conflicts could be avoided if there were intermediation, "there is no preventive work to get to the root of the problems. The company asks a lot with respect to physical attacks. There are customers that provoke them and the employee then 'blows up" on the street, picks fights, but the company doesn't follow up to find out what the problem is." Workers also say that the CET has no policy for publicizing and clarifying the importance of their work to the public.
Another experiences of negligence is related to the lack of standard procedures and legal precautions taken by the company "this is a risk of the job, some days are heaven; others are hell." When they go to the police station to file a report of assault or aggression, they feel doubly penalized. On the one hand, they are forced to wait for long hours to make the report and sometimes this wait extends beyond their work shift; on the other, the complaints almost never result in an investigation or any action. This reality provokes feelings of arbitrariness and being neglected with respect to their work. "Going to the police station is just asking for an exhausting waste of time, the police report is registered for a non investigation".
Another aggravation that the agents suffer is that sometimes they have to return to the same location where they were assaulted and/or attacked, which increases their sense of vulnerability. This occurs independently of the degree of seriousness of the violence suffered or fear of re-encountering their attacker: "After a situation of violence you are forced to return to the same place. You are abandoned."
The fear of being targets for new aggressions and the exposed state in which they find themselves make them feel afraid to work, which according to them results in psychological wear and absenteeism. Even though they distinguish verbal attacks from the physical and these latter are less frequent, the feat and the sense of exposure and vulnerability are constant: "You turn into 'mush- come into the company firm and strong and get worn down, that's when the practice of taking time off begins.."
They also refer to not receiving special attention that would help them deal with the aggressions suffered and to overcome the psychological difficulties experienced. This could helm them prevent new situations of violence "The person can't stand to work anymore and the company doesn't care. Thus the employee takes leave in order to be able to breathe."
Sometimes there is a tendency to blame colleagues and hold them responsible for the attacks, "they aren't flexible enough," "they bring personal problems to work," "they don't know how to deal with the public," " good employees don't get attacked."
The belief that attacks occur due to some lack of preparation for dealing with the public gives them the sensation of protection -if they knew how to act at the moment of conflict, they will be spared. Knowing how to act means being prepared to avoid conflict: "you don't have the right to be upset, you have to be cool, if not, you attract trouble." "There are some unbalanced people who don't have the ability to deal with the public, this person is a danger to themselves and to the company because they don't have the means of dealing with the public, they just aren't prepared."
The agents report liking what they do in their job on the street and believe that the main function of their job is the democratization of the public space. They try to enrich their activities by developing tasks that go beyond selling parking permit slips and enforcement: they instruct the public in how to fill out and use the slips, provide general information on the neighborhood where they work, helping travelers and others. On the one hand, these activities help to increase opportunities for recognition by the public and merchants, and on the other, it creates a network of community relations ending up in establishing a network of protection against attacks.
For these agents, there is constant conflict between creating a social role and a professional identity. On the one hand, they attribute great importance to their work and the contribution they believe they are making to the city. On the other, aggression from the public, the negligence they believe the company shows with respect to assaults and the transgressions that occur every day on the streets, perpetrated by those who have "privatized" public space, conflict with their belief in their importance. .
The downsizing of the work force increased the tension and the disbelief of the public in the company's effectiveness. This reduction increased the work load of those who stayed and favored the growth of illegal commerce in the rotating parking spaces and consequently conflict and disputes over urban space.
Knowing how to manage adversity: an excited public, the scalpers, the merchants who do business from their cars and the informal car and parking space guards is a sing of wisdom, astuteness and the ingeniousness in their work.
This astuteness, both individual and collective, constructed over the years has brought satisfaction, recognition among colleagues and is basic to the construction of a professional identity. Working on the street and excessive exposure require intelligence in order to be able to face various situations that occur everyday. As an example, they report the ability to detect fraudulent parking permit slips, a certain flexibility in dealing with the public, knowledge of the area where they work and greater facility in dealing with the adversities they experiences. They believe that developing this astuteness gives them greater resources for dealing with their everyday problems, at work as well as in their personal and family lives. .
If flexibility is indispensable to carry out their work, at the same time, it is invisible. Nonetheless, the lack of success and the aggressions are promptly identified created a sense of double jeopardy. In addition to being attacked , they are seen by their colleagues and by the company as responsible for the attacks they suffer and as "bad employees." That is, in addition to they lack of public recognition, neither are they recognized by their colleagues who know the difficulties they experience at work. Being the target of attacks seems not to generate feelings of solidarity and cooperation in some cases, from their colleagues, bosses or from the company.
With experience, they try to remain invisible to avoid conflict or to avoid exacerbating it. To reduce this risk, it is also worthwhile to build relationships with the social network of people who use the location: residents, merchants and service providers.
Based on our psychodynamic work analysis done with the traffic agents of the CET, we could observe that the way their work is organized means that workers are exposed to verbal and physical violence that cause wear and psychological suffering.
Authors such as Vezina et al (2001) and Dejours (2004) have called attention to the fact that even though serious, work-related psychological disturbances can sometimes occur, what is more often observed are phenomena that do not necessarily constitute classical mental disturbances but rather situations of marked psychological distress whose origin is attributed to situations experienced by workers as a result of work organization or transformations of the organizations. These forms of suffering can appear as feelings of powerlessness, lack of self confidence, sensations of loss of control or the inability to deal with the constraints imposed by the work. Prolonged exposure to these conditions can create lasting situations of loss of initiative and passivity, which are sometimes pathological and harmful to the workers as well as their institutions, especially when work effectiveness demands active engagement.
The violence experienced by traffic agents, not always expressed as physical violence, is most often hidden. Whether due to the absence of obvious signs and symptoms of violence in the majority of cases, or to the lack of characterization of the psychological effects of violence as pathological. Our findings are consistent with those of Gomez (1999) who had verfied the significant violence in the service sector in opposition to a very low number of registered work-related accidents. In this article we have tried to advance an understanding not just of the impact of violence on workers' mental health and the invisibility of its consequences, but also to heighten the visibility of the intelligence and strategies developed by workers so they can continue to work, despite the threats and the fears they experience.
The authors Lancman, S., Sznelwar, L., Uchida, S., participated equally in developing this article, in the discussion ,in the writing and the revision of the text.
Tuacek, T.A. participated in the bibliographic revision, discussion and revison of the text
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VEZINA, M.; DERRIENNIC, C.; MONFORT, C. Tension au travail et atteintes à la santé mentale: l'éclairage de l'ênquete ESTEV. In: ______. Travail, santé, vieillissement, relations et évolutions. Paris: Octares Editions, 2001. Collection Colloques. p.176-87. [ Links ]
1 Earned a bachelor's degree in Occupation Therapy at the University of São Paulo
(USP) , Master's in Community Health from the Federal University of Bahia (UFBA),
Ph.D in Mental Health from the State University at Campinas (UNICAMP), Post-doctoral
studies in the psychology of work at the Conservatoire National des Arts et
Metiers/ France, Associate Professor at the Medical School of the USP, Rua Ferreira
de Araújo 450, CEP 05428-001, São Paulo, SP. 30917454, email@example.com
1 Earned a bachelor's degree in Occupation Therapy at the University of São Paulo (USP) , Master's in Community Health from the Federal University of Bahia (UFBA), Ph.D in Mental Health from the State University at Campinas (UNICAMP), Post-doctoral studies in the psychology of work at the Conservatoire National des Arts et Metiers/ France, Associate Professor at the Medical School of the USP, Rua Ferreira de Araújo 450, CEP 05428-001, São Paulo, SP. 30917454, firstname.lastname@example.org