Infinite possibility in the palm of our hands

With some favelas nudging near to Rio’s famous beaches, the stark inequality of the two incongruous scenes came as no surprise to us South Africans. What did surprise us, however, was the quality of health care provided to the residents of this area. 

Infinite possibility in the palm of our hands

By Ashnie Padarath

First impressions of the Clinica da Familia Sergio Vieira de Mello

With some favelas nudging near to Rio’s famous beaches, the stark inequality of the two incongruous scenes came as no surprise to us South Africans. What did surprise us, however, was the quality of health care provided to the residents of this area.

Nestled below the hillside studded with rainbowed rows of dwellings, the Clinica da Familia Sergio Vieira de Mello offers itself as a nurturing hearth to some 100 000 inhabitants of the surrounding favela.

The very sight of the Clinic greeted us in a manner far beyond anything our fettered imaginations could have conjured.  For one brief moment, we breathed in a collective vision of what our South African public health system could be. We dreamed again.

Within the perimeter of the fenced-off Clinic premises, we saw brightly coloured adult gym equipment for the use of community members.  Within the clinic itself was ample seating arranged in a forecourt setting, with drinking water, health promotion messages being played on television screens, and an assortment of pamphlets on healthy living and social services.

The air was filled with the whoops and squeals of children playing in a designated space equipped with books, games and drawing materials, while mothers breastfed their babies unselfconsciously throughout the waiting area. The Clinic’s manager – who is not a medical professional – welcomed us at the entrance together with a group of young medical doctors.

Primary healthcare is designed to respond to community needs

In Brazil, apparently, the typical profile of a clinic manager is someone who is “energetic and displays problem-solving abilities”. The Clinic’s hours of operation extend after normal working hours to cater for people who are employed.

Our tour of Rio’s clinics taught us that Brazil’s system of primary health care services is thoroughly, respectfully and joyfully designed to respond to community health needs. The clinic staff tends to be made up of young, recent graduates who display great commitment and dedication to the cause of public health and their career in the public health sector.

Community health workers have a large office area allocated to them, each having a computer to record details of their areas and work. Using the clinic as a base, community health agents are responsible for visiting all homes within their allocated areas to promote healthy living, identify existing and potential health problems, and provide referral to social services.

The Clinic’s services are clearly mapped out to create a trouble-free patient experience

Reception areas in clinics are clearly divided by colour-coding into functional service sections, and patients present themselves at the appropriate section according to their health service needs. Here they discuss the reason for their visit with their community health worker and are duly referred to the attending doctor, who would have already received electronic information on the latest waiting patient.

Patients are given information on how they should expect to be treated, on patient rights and responsibilities, estimated waiting times, the types of medication available in the clinic, details of referral services, and individualised contact details of the people in charge of the various sections. All the facility staff wear uniforms designating their role in the clinic as well as name tags. Photographs of all staff designated to work in a particular area can be found in and around the consulting rooms, and doctors come out of their offices to invite and usher in the next patient.

Each consulting room displays a well-maintained chart depicting the health status of that particular location with the use of various coloured dots to denote illness and wellness levels, making it easy to identify at a glance how many people are living with HIV or diabetes, and how many are young children, for example.

Day rooms, where patients can be monitored, rehydrated and referred to hospital if necessary, are well-equipped with armchairs, reading material and a full complement of staff.  During our visit, we saw an elderly diabetic patient in this setting, who had been placed on an intravenous infusion for rehydration and glucose stabilisation.

Each clinic routinely offers dental services – seemingly at a very sophisticated level – as part of the Brazilian Ministry of Health’s “Smile Brazil” campaign, designed to reverse the trend of poor oral health care and outcomes among Brazilians.  We understood then why we had seen so many people brushing their teeth in public rest-rooms in airports, restaurants and clinics.

Healthcare is considered to be a collective community responsibility

Coming from South Africa, we invariably asked questions about whether the clinics are subject to crime and vandalism, but our hosts seemed bewildered by this question. We were informed that the community takes collective responsibility for protecting the clinic and in the one instance of theft, community members found and returned the equipment the following day.

As our excited, chattering group of South Africans left the Clinica da Familia Sergio Vieira de Mello, we made way for the ambulance that had to take the elderly diabetic gentleman we had met to hospital.

We exhaled in awakened, enlivened awe, wordlessly asking each other whether what we had seen was real and replicable in our own country.

An outlier? Possibly.

A smokescreen to impress visitors for the Soccer World Cup and Olympics? Perhaps.

Dedicated, co-ordinated commitment to providing world-class quality health care to all Brazilians? Undoubtedly.

Ashnie Padarath is the manager of the Corporate Communications Unit at the Health Systems Trust (HST) as well as the editor of the peer-reviewed South African Health Review.  In this blog, she reflects on her impressions of health systems during a recent HST fact-finding visit to Brazil.

HST is a health systems strengthening and research organisation which was established to support the transformation of the health system in a new democratic South Africa.

HST is a co-sponsor of the Third Global Symposium on Health Systems Research.

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