While my previous post focused on the inner workings of mobile unit 3 and what the experience was like in traveling with it for a few days, this time it will be about the “second circle,” or the calculated organization that makes the mobile unit’s activities possible.
Like I mentioned earlier, my initial image of the mobile unit’s activities was very vague and extremely disparate to reality — I envisioned the mobile unit traveling around cities that were known to have more difficulty accessing cancer treatment / testing, and providing care there. I never really gave much thought to how exactly these cities were selected or how the travel routes were planned out.
Well, for starters, let me clarify with the fact that the cities are not random. Each city that is attended by the mobile unit is in fact called a “Partner City,” with which the hospital has established an agreement and date for a visit by the mobile unit.
The process of becoming a Partner City is still not entirely clear to me, but I will explain at least of the ways (and the one that seems most common) in which this occurs.
Again, it is actually the origin of it all that has been the most elusive to fully comprehend, but as it was explained to me it is the city itself that initiates the partnership. Most of these cities do not possess any kind of cancer treatment or testing, and they seek out the hospital to add them to the list of locations to be visited by the carreta.
From my understanding, the department responsible for handling these partnerships, or at least their beginnings, is the Captaçao department. Captação literally translates to “catchment” or “captation,” so that gives you an idea of their role. However, the Partner Cities also participate in a fundraising activity for the hospital. Since the hospital runs entirely on donations, it is through the fundraising that the hospital is able to sustain the addition of further Partner Cities in their mobile unit route.
Enter the City Coordinator. The City Coordinator, selected by the city and the Captação department (I believe), is not only the main liasion between HCB and the partner city, but is also responsible for organizing the fundraising activity and officially donating it to HCB. Fundraising activities include benefit dinners, bingos, and raffles. But really, the most common one are leilões de gado (or cattle auctions) that amasss the necessary funds.
Now at first, this may cause some confusion and could even seem problematic. But here’s the thing — people love this hospital. At every city, we were greeted like superheroes (the mobile unit team), given large amounts of food and nourishment, sometimes gifts, and even had a live music group at a restaurant give a shout out to the “Barretos Hospital doctors and nurses,” expressing their gratitude. More often than not, the City Coordinator was either a patient of HCB at one point or had a family member or friend as a patient at HCB, and they are really driven to help. Word spreads amongst their family and friends, and inhabitants of small towns are actually empowered to donate as much as they can for a real cause they believe in, and are then able to witness their fruit of their donation. We even heard about places who just organized fundraising events without requesting a mobile unit, just because they want to support HCB in what they’re doing. I swear, hearing some of these stories give you goosebumps — you really sit and wonder why you’ve never heard of such an incredible hospital.
But anyway, that is only one part of how the partnership works.
Enter the City Nurse. The City Nurse, selected again by a combination of HCB and the City Coordinator, becomes the liasion between the City Coordinator and the Health Team at each city. The City Coordinator is usually not involved in healthcare, so the City Nurse becomes key in establishing that aspect of the partnership.
The City Nurse’s responsibilities begin by attending a mandatory training at HCB every October. At that training, the City Nurses receive instructions regarding the preparation needed for the day the mobile unit arrives. In particular, the City Nurse must select an appropriate location for where the mobile unit will station, which must be easy to access and have some kind of building in which blood can be drawn. Moreover, the City Nurse needs to find a Food Team to prepare breakfast for the patients who have been fasting for their blood tests, as well as a Health Team to help with organizing the patients and collecting all of their paperwork. At each location, it is really the City Nurse and the collaboration between the different teams, including the mobile unit team, that really sets up the efficiency of the whole ordeal.
One of the most important parts begins at least sixty days before the mobile unit arrives, if not earlier. In addition to what I outlined above, the City Nurse is also responsible for selecting the patients that will receive care / testing from the mobile unit. Again, the mobile unit has very limited resources, so they have a fixed number of patients they can help. It’s up to the City Nurse to identify which patients are at higher risk and will benefit the most out of the care. As evident to an engineer, this is a matter of optimizing to gain maximum utility from the mobile unit’s limited resources and time.
Not only does the City Nurse have to select the patients, but must also procure and complete all of their paperwork before the mobile unit arrives. Sixty days before the arrival of the mobile unit at any of the destinations, the City Nurse receives the paperwork to be filled out. This is the amazing part — the mobile unit arrives at each destination, and the patients are already scheduled with appointments and have their paperwork ready to be processed for the care they received that day.
Maybe now what I said earlier is becoming more clear? Even though every city is different, and the level of preparation varies a lot (as explained by the mobile unit personnel — all of the cities we visited were very orderly and well prepared), the mobile unit still functions within a very structured framework.
Of course, there are always things to improve! But in conclusion of the mobile unit chapter, I want to really emphasize what an amazing system this is. This hospital, which is really only supposed to serve inhabitants around the state of São Paulo, manages to send care to people all over in Brazil, including a indigenous reservation (to which Dr. Carlos is going later this year!). The head nurse once showed me a folder of all of the Partner Cities and all of their City Coordinators and City Nurses, and it was a massive folder — Partner Cities sometimes only receive the mobile unit once every two years or so due to the high demand. HCB actually runs on a deficit, due to the way the public health care system works, yet the hospital continually manages to sustain its operations locally in Barretos, and nationally in all of these towns, some of which would never have received any kind of cancer care / testing.
In sum, my trip with the mobile unit in Mato Grosso was without a doubt one of the most impacting and inspirational voyages I’ve ever been on. Really set the bar high for what people can achieve when collaboration truly happens.