Brazilian Health Care

On last Friday and again on Monday night, I have been able to shadow a doctor named Sandro from the Clinic Carmen Lucia. He has been very open with me and very patience while working through language barrier and my ignorance of medicine. On Friday, I shadowed him from 8-12 in the Carmen Lucia Clinic. This clinic is funded by the PCLB Foundation which is owned by the owner of Subway (This is who Daniel Weiss works for). The clinic is very clean and neat and not very crowded. They have one doctor, 4 dentists, and a few dental hygienists. The day that I shadowed Sandro we only had 5 patients and spent a lot of personal time which each. Sandro says that he really enjoys working here because it is rewarding.

The public hospital that I shadowed Sandro in on Monday night was a stark opposite. This hospital is apparently the premier children's hospital in the whole state and people come from pretty far to get the quality of care offered here. However, this hospital is total chaos.

We arrived at 7 at night to begin the 12-hour shift. Immediately as Sandro arrived he had people coming up to him asking to be seen next. Sandro is a very genuine and tries to help everyone he encounters (including me), but he eventually had to push through to get his stack of orders and make it to the physician's room. In this room there were 3 other physicians and only 2 patient tables. All 4 of the doctors work from 7 to 7 but after 1 in the morning only 1 doctor is on at a time. They must bring all of their own personal equipment in a doctor's bag (looks like something a doctor would carry back in colonial times). The hospital has almost all the divisions that you would see in a hospital in the US, but some of the building is in decrepit shape. Also, I think every bed in the whole place was taken. The waiting rooms are really the saddest part. There are people sprawled out everywhere while waiting to see the doctor or waiting to finish their IVs. Some people stay here for up to 3 days with there children in the waiting room because it is hard to get in once you leave, so they just live in the waiting room and sleep. These conditions were so different than what I am familiar with in the US, and with what I expected based on the standard set by Carmen Lucia Clinic. There seemed to be very little order what so ever, and the amount patients was astonishing. I didn't count how many patients we saw that night, but we probably only spent on average 10 minutes with each patient. Also, the paperwork was very time consuming. Multiple forms were needed for each patient similar to in the U.S., but here their were essentially no nurses and the doctors were responsible of ordering all the meds, x-rays, labs, etc. I really don't see how Sandro does this twice a week. I was starting to drag at about 3 in the morning and I don't know how many times I put the stethoscope on backwards.

You have to keep in mind that this was a triage or a kind of "Health Plus" or "Health Works" in the US. There were no emergencies in this department but there were a lot of unstable or "red" children in very close quarters with small babies with a simple cough or "green" patients. Also, the amount of time that these people waited showed extreme dedication to their children, but that amount of time worsened the condition of many of the patients. For example, there was a child there that had severe pneumonia who was not seen for 4 hours. By the time Sandro saw him, he immediately put him into surgery. Right before we left, we visited him and he had already drained over a liter of fluid out of his lung.

Being from "comfortable" America, this seemed like an injustice to me. The quality of health care in the US is so superior to what I experienced here. At one point in the night while watching Sandro scribble furiously, I had a sleepy reflection. Recently, I have not only been trying to stay up on the health care bill, but also trying to figure out what side of the fence I am on. I have my reasons for being both for the bill and against it, but I thought of a new variable that I had never factored in before. How will the hospitals handle the additional influx of 32 million people suddenly having health insurance? It takes at least 7 years to train a doctor once graduated from college, and decades to plan and build new hospitals. Do we have the infrastructure to do this? And it won't be a slow transition. The current bill calls for all people to buy insurance by 2014 or face fines. The insurance companies will no longer be able to discriminate against people based on pre-existing conditions, so how will we cope when this potentially "sicker" demographic suddenly has insurance? I am still trying to find answers about this but I haven't found many news outlets or even blogs that have addressed this question. Any answers?

After we left the hospital at about 3:30, Sandro was hungry so we drove around to find a bit to eat. Of course nothing we open so we just went back to his place and raided the fridge. I slept in the extra bedroom that actually had an operating fan! I slept really well but I had to wake up at 8 because Sandro returned from signing out of the hospital and wanted to eat breakfast with me. After this we took his dog "A Breezy" (Laurel, thought you might laugh at the name) for a walk and then went to the beach. I got back to my house just in time to leave for class. I ended up being 10 minutes late to class because I was so into my book "The Snow Leopard" that I stood in the wrong line and missed the right bus. Jiame was at the class since Daniel and Geli are leaving for the states tomorrow. He took us to Shopping after class and I ate a 30 cm Subway sandwich. So much for not eating American food while abroad, but I guess I already broke my creed with McD's last week. We were late for our Portuguese class and of course our professor was on time. In the second class, we had our first test of the semester. Even though this semester has been very challenging, I guess its been my easiest semester ever in classic academic terms. I mean I've been here over two months and I just took my first test! However, I never really escape education here. Everything is education here and I learn constantly. I'm just glad that the learning is getting easier now!