As classes for my program have ended and we have moved into the field learning portion of our program, I had the opportunity to spend the last two weeks travelling to different parts of Bahia, live in a few different settings, and see the public health system in Brazil, the good and the bad, in action. This last week, we spent time in Ilhéus, a city along the coast about 10 hours south of Salvador. While on the outside the city seems like another one of Brazil’s beautiful tourist destinations, there is much that lies below the surface.
After learning about the history of the city, the influence of cocoa plantations on income disparities, and becoming acquainted with different neighborhoods that we would be observing and visiting, we got to participate in one of my favorite conversations that we have had: talking with a Cuban doctor who is a part of Brazil’s Mais Medicos program. One of the downsides of SUS (Brazil’s medical system) is that there is a lack of doctors, especially for lower income communities. The basic health centers are broken down into teams that serve specific communities; a team consists of community agents, nurses, and a doctor who oversees them. In Ilhéus, there are many teams of community agents who do not have a doctor, causing long waits for patients. That is where the Mais Medicos program comes in. The Brazilian government has a contract with the Cuban government through which Cuba sends doctors to Brazil for a 3 year period in order to fill the gaps that Brazilian doctors cannot or do not want to fill. Part of the requirement is that you have been practicing medicine for 10 years and have experience working outside of the country in the field of medicine. The doctor we were able to speak to had been a doctor in Cuban for over 20 years and had spent 3 years in Venezuela on a similar program.
I had many questions about how this program worked. Did the community receive the doctors well? What was it like having to learn an entirely new language and practice medicine in that language? Was leaving your family for 3 years worth it? She explained to us that many of the patients she worked with had not been to a doctor in years and had no idea in what shape their health was; they were extremely excited that finally something was being done to get them care and that there was someone who wanted to do whatever they could to help their community. Although she had never spoken Portuguese before coming to Brazil, our doctor said that she had amazing support from other Brazilian doctors that she worked with and they were extremely helpful in teaching her in any ways they could. Although she missed her family, she explained to us that she felt she was where she needed to be and she was doing something that she loved. Although the Mais Medicos program and other Cuban doctor exchange program like it are somewhat controversial, from my perspective it is providing communities with resources and care that they otherwise would go without. These doctors see a need and they do what they can to fill it. Since the doctor we spoke to had entered that community, she was able to see roughly 35 patients a day, work with community health agents to get people's diabetes and hypertension under control, and has delivered multiple babies over the last 6 months with zero complications.
While this program is working well, why is it that doctor's need to be brought in to begin with? A big issue is that since medical school in Brazil is extremely expensive (so expensive that many doctors chose to leave the country in order to attend medical school), doctors who do invest in their education have no choice but to search for higher paying jobs in order to pay off their schooling. The lack of willingness of doctors in Brazil to go and work in lower income communities speaks to a need for restructuring the system and allotting greater resources to medicine in these areas and creating incentives for doctors to want to work there. Once again, while SUS is a great system in theory, there is much that still needs to be worked out in practice. Hopefully through my next few weeks of research, I will be able to see how community organizations are taking the health of their communities into their own hands and, doctors or not, finding ways to make life healthier for themselves and their families.
I am spending this next week prepping for my research project and setting up my interviews, so look forward to my next post as it will likely have some great stories on my challenges in interviewing in Portuguese, what I've learned from the organization I am researching, and some reflections on the implications of my findings on healthcare in Brazil!