More Doctors program "confronts" the Baixada Fluminense region.

Vinícius Lisbon
Reporter for Agência Brasil

Rio de Janeiro - By joining the first stage of the Mais Médicos program, the municipality of Duque de Caxias, in Baixada Fluminense, which has about 855 thousand inhabitants, offered 32 vacancies. After registration, 11 Brazilians and two foreigners were selected to work in the city. When the day of the presentation arrived, six Brazilians attended, and, of these, four completed one month of work last Wednesday (2), as two dropped out of the program.

One of them is Wendel José, 26, who graduated nine months ago and is enthusiastic about his contact with patients in the Parada Angélica neighborhood, where he filled a vacancy at the Family Health Program Unit. He already lived in Duque de Caxias, but was born in Guaíra, in the interior of São Paulo.

"The staff has been very receptive. There was a real shortage of doctors here. We see people with chronic problems, such as diabetes and hypertension, who were without follow-up care, some even with complications from these diseases," says the doctor, who focused his training on emergency medicine but migrated to family health with the program. "We see so many patients who arrive at the emergency room in bad shape, with complications that could have been avoided. With prevention, a hypertensive person doesn't experience a hypertensive crisis or stroke. It all starts with primary care," he said.

In the state of Rio, where all the doctors from the first phase were allocated to the metropolitan region, the Baixada Fluminense was expecting 37 professionals trained in Brazil, while Itaboraí and São Gonçalo, in the East Fluminense region, were expecting seven, and the capital, 16. In Belford Roxo, however, none of the seven expected showed up. The same occurred in São João de Meriti, where one doctor was supposed to attend. In the capital, 11 doctors dropped out, and in São Gonçalo, the second most populous city in the state, of the three doctors expected, two showed up and one abandoned the program.

In another city in the Baixada Fluminense region, Mesquita, Eliazar Estevam de Barros is another doctor in the program who has completed a month of service. With 23 years of experience, he applied because of his experience in family health and the salary of R$ 10, and had to move from Angra dos Reis to Rio. His arrival, along with that of another professional who is not part of the Mais Médicos program, at the Family Health Strategy post in Santo Elias broke a period in which the teams were without doctors for about a year.

"Our biggest problem, which is a nationwide issue, is retaining doctors. We can't offer them high salaries, and doctors don't have the necessary available hours to work in primary care and build a connection with the population. This program has come to help us solve this problem of retaining doctors," argued Gláucia Almeida, coordinator of Primary Care in Mesquita.

The municipality offered eight positions when applying for the program. It received applications from six Brazilian doctors and one foreign doctor, but only four of those trained in Brazil showed up. Of those, two withdrew, citing a lack of availability for the 40-hour work week. According to Gláucia, Mesquita currently has two family health teams with a shortage of doctors.

The health unit occupies a three-bedroom house with some minor maintenance issues, such as peeling doors and a wall with dampness, although much of the building has been recently painted, and patients wait in an airy waiting room adapted from the house's garage. Eliazar's office has air conditioning and simple furniture: a narrow cabinet, a bed, two chairs, and a white-painted iron table: "The clinic provides the bare minimum for care. The rest depends on the team's determination," says the doctor.

The building housing the unit where Wendel works was inaugurated in August, and, according to the doctor, it doesn't hinder his work. "The only complaint is that the unit is small for three teams. There are three consultation rooms: one for preventative care, one for vaccinations, and one for dentists. We are three doctors and three nurses, who also provide care. On Wednesdays, the pediatrician also comes, occupying another room. But everyone says I'm privileged to work in a new unit. There are no problems here at all," he explained.

Despite this, he mentions another difficulty: the lack of a car to transport the teams to people who need home care, which means he only visits houses close enough to walk to. Regarding transportation, the dangerousness of some areas covered by the clinic is another concern: "There are places we don't usually go because they are high-risk zones. We don't refuse to go, but it depends on the case," he noted.

Eliazar has already taken his demands to the Basic Care Coordination of the municipality, a computer with internet and a night watchman at the post. "The internet was installed on Monday (30) and they were supposed to send the computer. The computer is needed for several things, and one of them is the telecourse of the program and the reports that I have been filling out from home. This should be done during working hours."

The doctor stationed in Mesquita recounts that, in his first month of work, his main patients were diabetics, hypertensive patients, and pregnant women, since he is an obstetrician, but other cases surprised him: "Following a visit from community health workers who noticed something strange, we reported to the child protection services a minor who was being abused. The program also has this social care aspect, which is important."

Already known to some families in the neighborhood, Wendel also has stories to tell: "There are people who come just to chat. There was a lady who came to the appointment just to ask if she could eat peanuts, because she had high cholesterol and triglycerides and felt the urge. That's also family health. The goal is to create a bond with the community. There are people who come here every week and even bring fruit that grows in their backyard for us," he said.

The young doctor states that the program is good, but questions the way it was formulated: "I don't agree, for example, that doctors from other countries enter Brazil without having their diplomas revalidated, nor that Cubans earn less than others. The program is good, but it's not just about bringing the doctor. You have to structure the unit and keep the doctor there. The doctors aren't against the program, they're against its formulation," he observed.

Eliazar, on the other hand, praises the initiative and assures: "I am very happy here. People have many doubts, but at least as far as I'm concerned, the program will be a success," he concluded.

 

 

Vinícius Lisbon
Reporter for Agência Brasil

Rio de Janeiro - By joining the first stage of the Mais Médicos program, the municipality of Duque de Caxias, in Baixada Fluminense, which has about 855 thousand inhabitants, offered 32 vacancies. After registration, 11 Brazilians and two foreigners were selected to work in the city. When the day of the presentation arrived, six Brazilians attended, and, of these, four completed one month of work last Wednesday (2), as two dropped out of the program.

One of them is Wendel José, 26, who graduated nine months ago and is enthusiastic about his contact with patients in the Parada Angélica neighborhood, where he filled a vacancy at the Family Health Program Unit. He already lived in Duque de Caxias, but was born in Guaíra, in the interior of São Paulo.

"The staff has been very receptive. There was a real shortage of doctors here. We see people with chronic problems, such as diabetes and hypertension, who were without follow-up care, some even with complications from these diseases," says the doctor, who focused his training on emergency medicine but migrated to family health with the program. "We see so many patients who arrive at the emergency room in bad shape, with complications that could have been avoided. With prevention, a hypertensive person doesn't experience a hypertensive crisis or stroke. It all starts with primary care," he said.

In the state of Rio, where all the doctors from the first phase were allocated to the metropolitan region, the Baixada Fluminense was expecting 37 professionals trained in Brazil, while Itaboraí and São Gonçalo, in the East Fluminense region, were expecting seven, and the capital, 16. In Belford Roxo, however, none of the seven expected showed up. The same occurred in São João de Meriti, where one doctor was supposed to attend. In the capital, 11 doctors dropped out, and in São Gonçalo, the second most populous city in the state, of the three doctors expected, two showed up and one abandoned the program.

In another city in the Baixada Fluminense region, Mesquita, Eliazar Estevam de Barros is another doctor in the program who has completed a month of service. With 23 years of experience, he applied because of his experience in family health and the salary of R$ 10, and had to move from Angra dos Reis to Rio. His arrival, along with that of another professional who is not part of the Mais Médicos program, at the Family Health Strategy post in Santo Elias broke a period in which the teams were without doctors for about a year.

"Our biggest problem, which is a nationwide issue, is retaining doctors. We can't offer them high salaries, and doctors don't have the necessary available hours to work in primary care and build a connection with the population. This program has come to help us solve this problem of retaining doctors," argued Gláucia Almeida, coordinator of Primary Care in Mesquita.

The municipality offered eight positions when applying for the program. It received applications from six Brazilian doctors and one foreign doctor, but only four of those trained in Brazil showed up. Of those, two withdrew, citing a lack of availability for the 40-hour work week. According to Gláucia, Mesquita currently has two family health teams with a shortage of doctors.

The health unit occupies a three-bedroom house with some minor maintenance issues, such as peeling doors and a wall with dampness, although much of the building has been recently painted, and patients wait in an airy waiting room adapted from the house's garage. Eliazar's office has air conditioning and simple furniture: a narrow cabinet, a bed, two chairs, and a white-painted iron table: "The clinic provides the bare minimum for care. The rest depends on the team's determination," says the doctor.

The building housing the unit where Wendel works was inaugurated in August, and, according to the doctor, it doesn't hinder his work. "The only complaint is that the unit is small for three teams. There are three consultation rooms: one for preventative care, one for vaccinations, and one for dentists. We are three doctors and three nurses, who also provide care. On Wednesdays, the pediatrician also comes, occupying another room. But everyone says I'm privileged to work in a new unit. There are no problems here at all," he explained.

Despite this, he mentions another difficulty: the lack of a car to transport the teams to people who need home care, which means he only visits houses close enough to walk to. Regarding transportation, the dangerousness of some areas covered by the clinic is another concern: "There are places we don't usually go because they are high-risk zones. We don't refuse to go, but it depends on the case," he noted.

Eliazar has already taken his demands to the Basic Care Coordination of the municipality, a computer with internet and a night watchman at the post. "The internet was installed on Monday (30) and they were supposed to send the computer. The computer is needed for several things, and one of them is the telecourse of the program and the reports that I have been filling out from home. This should be done during working hours."

The doctor stationed in Mesquita recounts that, in his first month of work, his main patients were diabetics, hypertensive patients, and pregnant women, since he is an obstetrician, but other cases surprised him: "Following a visit from community health workers who noticed something strange, we reported to the child protection services a minor who was being abused. The program also has this social care aspect, which is important."

Already known to some families in the neighborhood, Wendel also has stories to tell: "There are people who come just to chat. There was a lady who came to the appointment just to ask if she could eat peanuts, because she had high cholesterol and triglycerides and felt the urge. That's also family health. The goal is to create a bond with the community. There are people who come here every week and even bring fruit that grows in their backyard for us," he said.

The young doctor states that the program is good, but questions the way it was formulated: "I don't agree, for example, that doctors from other countries enter Brazil without having their diplomas revalidated, nor that Cubans earn less than others. The program is good, but it's not just about bringing the doctor. You have to structure the unit and keep the doctor there. The doctors aren't against the program, they're against its formulation," he observed.

Eliazar, on the other hand, praises the initiative and assures: "I am very happy here. People have many doubts, but at least as far as I'm concerned, the program will be a success," he concluded.