This Friday will mark eight weeks since my completion of the Rice360 Summer Internship Program at the Hospital de Câncer de Barretos (HCB). Although I only spent three days at home before being swept into the whirlwind of Rice’s Orientation Week and classes soon after, this has given me some time for my experience to set in and for me to reflect a bit. So here we go…
The People
During our last day in Barretos we handed out as many mini banana breads as we could and I realized how geographically far we wanted our treats to travel. We had established great connections to the medical professionals in the prevention department, palliative care, physical therapy and the Ambulatorio Médico de Especialidades (AME). Everyone was extremely welcoming not only when we arrived and during our stay but also during our goodbyes. They kept so many doors open, so it’s impossible to not imagine coming back to work in an environment where every department is looking for ways to innovate and grow.
Dr. Luis and Landina at a UBS (unidade basica de saúde) told us to take a picture to not forget them… Definitely will not happen
Our friend Rejane, a physical therapist, took us for Brazilian hot dogs (yes! they are not American)
Nikhil, Tendai and I with our angel Carol at the Parque do Peão, one of Barretos’ treasures
Nikhil, Tendai and I with our favorite churros vendor
Nikhil and I with the amazing Dr. Silivia, head of the mammography department
The Place
Before I even placed foot inside the hospital, I already heard to expect HCB as a reference point for cancer care. After my time in the various departments, I realize their quality of care is derived from so many sources. From the common rooms with coffee and snacks for the patients’ families to the surgery rooms everything is in place to ensure comfort. One of my favorite parts was getting to experience all the many areas that comprised the full spectrum of cancer treatment. Starting with prevention, then treatment (check us out with the radiotherapy machine Dr. Bruno showed us!), surgery, rehabilitation and palliative care. The fact that all these units were there providing top notch care and looking for ways to continue to grow was incredible.
Nikhil and I with the radiotherapy device Dr. Bruno showed us
The Mobile Units
With the tradition of excellent care established, the hospital proceeded to extend help to communities that lacked easy access to cancer care through their mobile unit system that Nikhil and I were given the opportunity to see in action for a week. While looking up some of HCB’s history I stumbled upon one of their research papers studying the means of innovatively distributing cervical cancer screening to poor populations. The innovation took the form of a portable gynecological table transported by bicycle (check it out here! http://fampra.oxfordjournals.org/content/19/2/189.long) It was incredible to see how much has changed since 1994 and how the original mission remains alive. The mobile unit we experienced is used as a reward for cities that complete an auction to raise money for the hospital. I thought this was a great idea because of the excellent relationship it created between the local community and the hospital with each party feeling extremely proud and grateful.
The incredible giant that is the mobile unit in Montividiu, Goiás
The even more incredible mobile unit team and the team from Santa Helena
Future Collaboration and Considerations
It only took a week to realize the nature of the issues faced in Barretos were fundamentally different than the typical “Here is a small gadget that can solve some of your troubles.” HCB already works with high quality instruments and even where we thought their quality could take a step down as they expanded the reach of their care, our week in the mobile unit showcased their success in putting the hospital on wheels.
However this does not mean we as undergraduate students cannot help. Although the hospital is able to provide its care for free, the patient population is often of a low socioeconomic status and would benefit from low cost devices made for in home use. This is only one of the many examples developed in our meetings with the medical professionals of Barretos. Needs finding is definitely not an individual process. We greatly depended on the doctors and nurses living through the needs of the system to point them out to us for our conversation to begin. The professionals of Barretos proposed most of our best ideas, which we developed into more fully, documented project proposals.
As for future collaboration there seems to be plenty of opportunity. Here are some of the big ideas I took to heart…
- Nurse presence and sustainability: Many of the projects currently being developed have to do with filling the gap in doctor deserts by taking advantage of the growing presence and power of nurses in local clinics. Creation of devices that can assist nurses in performing functions generally performed by doctors would be a grand help for HCB to disseminate not only good care but also sustainable care throughout Brazil.
- Education: This was a big theme in almost all of the departments we got to know. The hospital would run smoothly with patients that are actively seeking care. Because the culture is generally not one to value yearly check ups and preventative medicine, educating people on its importance and inspiring them to seek treatment are crucial. These educational devices work best with the population when it can be experienced with various senses like seeing and touching. HCB also has close connections to the medical school in Barretos medical school (Faculdade de Ciências da Saúde de Barretos, FACISB), so the realm of educational devices can expand its populations to not only patients, but also medical students and staff.
- Rehabilitation: HCB is undergoing a huge expansion of their efforts in rehabilitation, and are set to open their own prosthetics factory. There is a focus on how to best help those patients who are cured but at the cost of another part of body. A lot of the patient population at HCB come from low socioeconomic backgrounds and low cost devices to be used in home to help accomplish tasks, would be a sustainable way to care for them.
Overall, this was an amazing experience that has expanded my notion of the meaning of global health, the challenges in distributing access to health and the need for people that are constantly innovating and challenging the norm.
