This purpose of this meeting of health care officials that administer this particular PSF was to discuss the biggest problems facing the staff on a daily basis and to discuss the example of another PSF in a different state of Brazil that recently was reformed and is now functioning in a more successful way. The word equipe first came up when the staff was discussing the challenges in the PSF. There were three equipes in one PSF and the equipes were not equal. Finally, at the end of the meeting, I finally was able to understand one person's explanation: an equipe is like a team (in fact I think that is the direct translation) that functions as one health care unit responsible for the care of a sector of the population. One equipe consists of a head nurse that is the supervisor and, under the supervisor, there is a doctor and other nurses. Generally, they have about ten people, but one equipe in the PSF I went to today has only four people. That being said, that equipe, which only has four health care providers, is responsible for nearly one thousand five hundred families (!!!!!!). That means there are four medical workers for what is probably more than six thousand people (1500 x 4 people per family). Whether or not you fully understand the concept of an equipe (I am sure I do not), that ratio is outrageous! Is it possible for a doctor to do a proper or thorough job with six thousand patients and only three nurses?
Now, back to the discussion of the meeting... The main point the staff brought up were that they have trouble prioritizing which patients they should see and in what order. It is impossible to see everyone who comes to the PSF because there are so many people and the facility is so crowded, but the workers generally do their best. The other problem they have is how to communicate with the patients and change their thought process. Many patients arrive at the PSF early in the morning, before the doctors and nurses even arrive. Some even sleep in the street outside, just to be sure that they will be seen and attended to. This however is not necessary or helpful to the patients. Though I am unsure of the system used to decide the order in which patients are seen, it was made clear that this would not be helpful for them and really made things more difficult for the staff. Aside from these challenges, I learned many general challenges/facts today about Brazil's health care system and the attitude of many of the health care providers, especially some doctors. Until recently, the public medical school here in Goiania, UFG where Thaynara and Karen study, was the only one. The one in which I observed, PUC, the private Catholic school, was non-existent until about five years ago. There are also many differences in the ways that students are taught at these two schools, a fact which requires more investigation. Also, it was very interesting to learn that President Dilma's comment in her speech the other day regarding her plan to bring foreign doctors to Brazil to fill the need here really was more of a threat! Many doctors here only want to work in cities, in large hospitals and do not want to serve areas that are already under served. There is a difference in salary, in quality of living and working environments and many other obvious differences. It is a troubling question for the public health care system here, how to attract doctors to places that are under served and in less wealthy areas (really I suppose this is a universal problem). Whether or not President Dilma is correct that the solution is foreign doctors, there is a consensus that something has to be done. I think for many here, who live and work in the area, and who have seen both the public and the private systems, changing the reality will begin only with greater communication and recognition of the universality of health.
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| The meeting commenced with a speech about inclusion in the workplace. |
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| There was also a musical demonstration during the meeting...though I am not sure why.... |
