By nfiszer
Suddenly it is April, and I can't wrap my mind around the fact that I have already been in Brazil for two months. My experience so far has been a whirlwind, and I have come to love Brazil so much that it is difficult to imagine ever having to leave. Alongside some amazing cultural experiences and beautiful sights that I have come across since my last update, I have also had great exposure to the topic of my research here in Brazil, the Brazilian unified health system, SUS. Through initial background research and interviews, I have been able to outline my plans for my large-scale research project that is taking place in May. Most recently, I got to spend time in and get to know workers at local community health posts that serve all Brazilian citizens and serve as the basis of Brazilian health care.
In a very short explanation of a very complicated system, Brazilian public healthcare is anchored by the Programa Saúde da Familia (PSF), which can be translated into the Program of Family Health. A family health team includes a doctor, a dentist, a nurse, several nurse technicians, and up to ten community health workers. These teams are assigned to a specific region and usually care for 3,000 to 4,000 Brazilians that reside within their area. As the core of the health system, they offer primary care services, preventative services, and they promote community health. While I will be studying community health workers more thoroughly in the future, I recently had the opportunity to begin to understand the PSF system by visiting various posts of the program.
I had the opportunity to spend the day shadowing professionals at a post in a rural area of Brazil, as well as visiting and interviewing the professionals and patients at several posts within the city of Salvador, focusing on lower-income areas. I have had the opportunity to speak with the nurses, doctors, and dentists, as well as various community health workers. Each of these professionals was passionate about the public health care system, and about providing adequate health care to their area, which they acknowledged to be impoverished and in need of help. The professionals had chosen careers in public health care, over more lucrative careers in the private sector because of their passion for helping others. Some of the community health agents had worked in the same area with the same residents for over 12 years, and talked about how meaningful their personal relationships are and how beneficial it is to track each family's health over the years. Over several visits to these posts, I got to sit in on pre-natal consultations, as well as a tooth-brushing seminar that the dentist held for the local preschool. I also witnessed two local men that came in following a motorcycle accident, and were patched up by the doctor. I had the opportunity to go on several home visits with community health workers, which included a weekly check-in on a resident with hypertension, as well as a check-in on a woman who had delivered a baby the week before.
I was inspired by the dedication and hard work of these health professionals, and it was amazing to see their interactions with patients that they know well. I am looking forward to spending more time at this level of the system, and especially getting to know a particular health team very well over a month-long period. Both the professionals and patients at the posts have been very open and willing to answer my questions and to let me watch them conduct their daily business. The biggest challenge I have come across is the language barrier, particularly when watching consultations, where the Portuguese is spoken rapidly and often with complicated medical terms. Overall, I had been proud of my ability to speak with people and to conduct interviews, despite the language barrier. I have been able to convey all of my questions, and my Portuguese will only continue to improve with continuous observations and interactions.
SUS is a system that covers every Brazilian, and therefore the family health program is an issue that relates to everybody, though these programs are more essential to those with less economic opportunity. After spending long periods within these health posts, I had the chance to notice almost as many problems with everyday functions as I did interactions that really impressed me. Many everyday problems come down to lack of funding and lack of human resources. As my research continues, I will be focusing specifically on relationships between community health workers and local patients, and how these impact the quality of care and overall health of the community. I hope to identify any underlying problems within this program as voiced by the people closest to it. I also hope to identify the strongest aspects and which approaches can be shared and utilized in other areas, even in health systems of other countries. I strongly believe in the efficacy and potential of this program, and I hope to understand it better and to shape and present these findings in a way that can improve the program on a local level, particularly by strengthening successful aspects.