The Collapse of Health Care in Pará

In June last year, the deaths of 13 babies in just one weekend in Santa Casa de Misericórdia do Pará in Belém bringing the total at 260 dead babies in just 45 days, shocked Brazil. Since then, finally, it was recognised that the chaos in health care was structural. The historically overcrowded (public) emergency hospitals had reached their peak, due to the large number of people coming from the interior, where emergency care in the municipalities is lacking completely.
The problems reported in the capital are in fact a reflection of a disorganized management system at the three government levels (federal, state, municipal), which afflicts the entire federal state of Pará, historically discriminated with unfairly low federal funds. The Plano Diretor de Regionalização da Saúde (RDP = Master Plan for Regionalization of Health Care), released in March of this year by the state government, is not much more than a piece of paper as long as there is no federal support for the financial resources required.

The RDP designed a network of regional hospital clusters in the interior, but the actual Secretary of Health of Pará, has to admit that the RDP master plan will never leave the drawing board without federal funds.

While the northern region, in its entirety, is hampered by a lack of federal funds, the situation in Pará is more severe, due to its continental size and its epidemiological profile. The federal government pays monthly through the Ministry of Health per capita the amount of BRL 8.29 (€ 2,90), to cover the health care costs of medium and high complexity. The lowest value per capita compared to any other Brazilian state, including the northern region. Tocantins, for example, with about 2 million of inhabitants, (five million less than Pará), receives BRL 12.24 (€ 4,30) monthly per capita, Roraima and Acre, respectively, BRL 14,48 (€ 5,08) and BRL 19,33 (€ 6,78).

The logic of the governmental Unified Health System (SUS) is simple. The system pays for services rendered. Each consultation or examination computed by SUS is paid afterwards. SUS pays materials and also the services of professionals. But without investments to create and structure services, most municipalities, being very poor, are not getting more resources from the SUS, other than for carried-out treatment. So they are condemned to water and bread, just waiting for fixed (federal or state) funds, which are distributed with regard to the number of citizens.

In addition to the scarce resources, small steps in pursuit of improvements are harmed by politics, as a change of government could result in a halt of concrete actions. As happened to the five regional hospitals, of which the construction started in 2003 under the previous governor. Three of the five are completed, Santarém, Marabá and Tucuruí. In Breves, as well as in Redenção, the conclusion of the hospitals is not even forecasted by the sitting governor, our (in)famous Ana Júlia Carepa. Of the hospitals ready to operate, the government is unable or unwilling to operate them at full capacity.

Most municipalities in Pará, most of them very poor, can not even offer the most basic health care of average complexity to their citizens, who as a consequence migrate in cascades to Belém in search for health care. Belém, indeed, has the largest infra-structure for health care with its hospitals, doctors and specialists, but should only treat the serious cases from the interior. But what happens is a reversal of the patient’s profile. The funds under the agreement between the municipalities and Belém should be used for the serious cases, however it is mostly used in treatments of low and medium complexity, and consumed last year BRL 178 million (€ 62,4 million), while the SUS (Unified Health System) paid BRL 175.8 million (€ 61,7 million) leaving Belém with a deficit of BRL 2.2 million (€ 0,7 million).

The emergency rooms of the hospitals in Belém are a reflection of that. Data from the Municipal Secretary of Health (Sesma) show treatment in both hospitals have reached the average of 50% being patients from the interior, and of this volume, 60% are cases of medical practice, i.e. cases without high risk to life according to the medical classification and should be treated at home in the individual municipalities.

Furthermore, the more severe cases, which, in fact, have to come to Belém in search of health service, arrive in the capital in an aggravated state due to poor transport conditions, usually in common ambulances without a doctor, without oxygen facilities for the patient, and in many cases, with only the driver, without a companion. That is, as far as, the health departments in the interior have an ambulance available. It is quite common, however, that patients are transported in vans or kombis without any infra-structure to make the pilgrimage from hospital-door to hospital-door in Belém. No place, no problem, patients are laid down on stretchers which fill the corridors.

In contrast with this, the daily paper O Liberal reported, that last year there was not a shortage of federal funds transferred to the government of the state of Pará for health care. Pará received more than BRL 1.1 billion (€ 386 million) for the 143 municipalities, with almost half of that amount just for the capital of Pará. Belém snapped up BRL 533.4 million (€ 187 million) exclusively for health care. The amount refers to all the money released by the National Health Fund (FNS) to the state of Pará.

The State Health Fund (Fespa) was the body most favoured by the federal money transfers, with BRL 231.4 million (€ 81 million).

What have they done with all that money? Hospitals are falling apart, equipment broke, emergency rooms are not functioning due to a lack of doctors, beds, medicines and equipment. Simple question: Where is all that money?

Remember Ana Júlia Carepa, the (socialist) governor of Pará? Remember her words?
We “….. believe that another world is possible and in the name of this ideal, we have built our government. In the name of this ideal, we work to transform Pará into a constitutional state.

Constitutional state? Not when you are poor. Don’t expect health care at your side, even worse don’t expect the socialist governor at your side. Like to know where Ana Júlia spends the money:
The governor of Pará, Ana Júlia Carepa has launched an “aid” package for some ‘low-division’ football clubs in Pará. The value of the aid is almost BRL 1.5 million (€ 550.000). Among the three clubs is Remo, for which the Ana Júlia’s father is an adviser.

I end this post with some words regarding this item taken from the blog: ‘Movimento da Ordem Vigilia Contra Corrupção’, which crucifies the governor of Pará:

The heinous opportunism of Ana Júlia Carepa
Ana Júlia doesn’t give a damn ……. As a matter of justice, that “petralha”*) woman has to be held liable for this barbaric crime, which resulted in the deaths of nearly 300 Brazilian babies, due to her omission and neglect.

Certainly, she will not lose the opportunity to try to “scrape” a little money with the excuse to build more hospitals in a state, where she (already for two years) criminally maintains the Hospital in Santarém, all finished and equipped, closed, only because it was built by the previous governor. (By Gaúcho/Gabriela)

Next year there are elections, not only for a new president, but also (among others) for a new governor. Let’s hope, that the people in Pará will remember the devastating results of 4 years Ana Júlia Carepa. I doubt it, but I hope, as Pará and its people deserve better.

*) Petralha is the contraction of PT (Brazilian socialist party) and the Irmãos Metralha (The Beagle Boys in English). The word identifies a member of a moralistic political party that when in power, deceives, steals, kills, lies, corrupts, installing a cleptocracia, in other words a state governed by crooks)