In the United States, healthcare is a notoriously complicated system and a source of political discourse. In Brazil, healthcare is a constitutional right that is free for everyone, even foreigners. The government’s system is called Sistema Único de Saúde (SUS), and while the coverage is accessible to all, it is still limited. Dr. Vinicius explained that the government’s system only covers one third of Hospital de Amor’s cost while the rest of the hospital’s funding comes from private donors. Hospital de Amor qualifies as a public hospital because of their government funding, but without the involvement of the private sectors, they would not be able to provide the quality and quantity of care that they do.
Last week, we joined Elaine and Naitielle of the Prevention Institute to visit neighboring cities that have partnered with Hospital de Amor.
Mammograms are covered by SUS, so women can go anywhere to receive their mammogram. Pap-smears, however, are not covered by SUS so there is a very large push towards filling the pap-smear appointment spots. Naitielle explained this is challenging because the women are more apprehensive about getting a pap-smear. The hospital is trying to quantify the hesitations while also offering an alternative to appointments at the mobile clinic.
The women’s health mobile clinic visiting a neighborhood in Monte Azul.
At each clinic we visited, Naitielle handed staff a poster with information on how to participate in at home, self-performed pap-smears. “Faça seu exame sem sair de casa!” – “Do your exam without leaving your home!” the sign reads.
Naitielle explaining the at-home program a community health worker.
The goal as we traveled from city to city was to check the clinic’s progress in filling appointment slots. Elaine would sit down with the community health workers and review their list so far. The week leading up to the truck’s arrival, the clinic needs to call the women and confirm their appointment spots. This task seems straightforward enough, but some clinics informed Elaine they don’t have a phone or any other way to contact the women. We piled back into the cars and drove to city hall, where Elaine organized the use of city phones for the appointment confirmations and Naitielle hung an at-home pap-smear sign. Problem solved.
The at-home program poster hanging in Monte Azul’s City Hall.
Going through the day with Naitielle and Elaine made me realize how challenging it is to design one system that works for everybody. The purpose of SUS, Hospital de Amor, and the mobile clinics is to increase the accessibility of care. But what is deemed “accessible” differs between each city, person, and condition. Observing how Hospital de Amor uses SUS as a platform to build up patient care has helped my understanding of the public health system and what constitutes accessible health care.