After participating in the PSF meeting on Tuesday, I was able to return today to see a little bit of how the PSF functions. It really was a great experience and I saw a lot of new things. It was a very interesting way to experience the public health system, especially after hearing all the downsides to how the PSF functions on Tuesday. Today was the "see-it-in-action day," if you will.
I arrived at 7:30 AM and was given a chair because I had to wait for the doctor to arrive before we could see the three patients who had appointments scheduled for the morning. All three were already waiting. Finally, around 8:30, the doctor arrived, ninety minutes late (she was supposed to be there at 7). She was young, probably twenty something, and she just graduated from medical school six months ago. She has not done her residency yet and does not know in what she wants to specialize. Crazy! Once she finished explaining for me how we would meet with the patients, we quickly saw each of them, spending maybe ten minutes with each. The doctor explained for me how these three patients were a good representation of what she does on a normal day because they were middle aged and combating hypertension and/or diabetes. The only other majority group that was not represented was the pregnant women, of which there were plenty waiting in the waiting area to be seen by the doctors and nurses of the other two equipes (health care teams, see June 25).
When we finished with our three patients, the doctor, two nurses, and I waited for a car from the city of Goiania's department of transportation to take us to the homes of patients who need home care. There were four homes to which we went today to take care of patients for whom it is difficult to come to the PSF. For the first house, we were about one hour late since our driver did not arrive on time. Therefore, when we arrived, the patient was not even home. Apparently they went somewhere and decided to not wait until the doctor arrived. We arrived at the second and the driver waited for us in the car. Our patient at the second house was an elderly woman with hypertension, diabetes, and obesity for whom the doctor merely described some previous test results. Also, since Goiania is entering a dry period which has very low humidity and nearly zero precipitation, the doctor stressed the things that the patient needed to do to prevent a cold which could turn into pneumonia or the flu. The theme of this visit, PREVENTION, was really a key for the whole process of the PSF, including the time in the clinic and the home visits. Due to the fact that the doctor is inexperienced and the way the public health system operates here, the PSFs are mainly for prevention. If patients have an ailment, they are directed to the appropriate doctor who will accept public health care patients. The rest of the houses we visited were much the same, entering to find the patient well and just with a few questions about basic preventative measures to take for the season or looking forward to the results of recent tests. But, the last house we visited had a patient much younger than the others. This house had a girl who was about four years old who was born with her heart outside of her chest. I think her ribs did not form completely so that her heart was inside them, but rather her heart is protruding out from her body, but is covered with skin. You can see it beating heartily through her shirt. This patient too did not need a lot of care. She was recovering from a cold and was taking antibiotics according to her parents who clearly were worried about her. However, the doctor said that she was recovering very well and if she continued to stay hydrated and to rest, she would certainly return to normal. From this description, I am sure that the home visits do not sound all that interesting. And really, they are very basic. What was important for me to learn from them was that there are many factors, including living conditions, that impact the health of a patient. It was important for me to learn the type of people the PSF serves. It is much easier to learn about a person in his or her environment, rather than in a doctor's office. I think that is part of the reason I was given the opportunity to come to Brazil and learn about the reality here from those that are living it every day, rather than just being given a text book.
In the evening, I was given a tour of another maternity hospital here called Hospital Materno Infantil. It is much bigger than Maternidade Nascer Cidadao, having both a section for women and a section for children, and is quite different. I did not know that Maternidade Nascer Cidadao was the only hospital in Goiania that was designed for Humanized births. This means that births there are generally more natural, without drugs or very much other medical intervention, and woman have more choice during the birthing process as far as how they labor and in what position they will give birth. When I worked there I attributed this fact to the fact that the hospital is in a poor neighborhood and did not really have a choice but to operate in this manner. However, as the nurse who gave me the tour assured me, the births in Materno Infantil were much more civilized and people generally tried to have cesarean sections. The word civilized I would say is an interesting choice on her part...
During my tour there I was able to speak with one doctor about her opinion on President Dilma's plan to bring foreign doctors to Brazil to fill the deficit of medical professionals that Brazil is facing. The doctor made a very good point that whether or not the doctor is Brazilian, the first thing that needs to occur is to better the system, then Brazil can be concerned with the doctors. I think her point was that many places in Brazil lack doctors due to conditions in which the doctor would be required to work, not due to the fact that there are not enough people who want to be doctors. Interesting. I was also during this visit asked if I was one of "Dilma's people"!! There was a nurse who was very surprised to hear me speak in English with the doctor and even more she could not believe that President Dilma had acted so quickly. I was quick to assure her that I am far from being a doctor!
