the other side of universal healthcare.

Good morning blog readers —

We thought it was about time for another guest blogger. Meet Shravya Kakulamarri, a rising sophomore from Redmond, WA majoring in Biochemistry and minoring in Global Health Technologies at Rice. This summer, she’s completing a Rice 360 internship in Barretos , Brazil. 

Shravya has been a communications and marketing person’s dream, taking a real interest in contributing to this blog, in addition to the one she’s required to keep for her internship. She’s an incredibly thoughtful young woman, and a fantastic example of the students we love so much at Rice 360. 

Together back in April, Shravya and I sat down to come up with ideas for potential blog prompts and left it at that. Several months later, after Shravya had gotten her bearings in Brazil, she sent me a post to the prompt: what is something in global health-related work you would have to see to believe? Her answer:

Death due to incompetence and an ineffective system. 

I was standing in the nurses’ station when Dr. Juliana, an oncologist in the Palliative Unit at Hospital de Câncer de Barretos (HCB) in Brazil, told me about one of her patients. His name was Robbie and he suffered from gastric cancer. One day, after being hospitalized for some time, he had recovered enough to go back home and was discharged. Unfortunately, soon after returning home, he fell ill and could not stop vomiting. He was immediately rushed to the clinic closest to his house — not HCB, but a local clinic. Upon arrival, all he needed was an IV to prevent dehydration – a simple IV would have saved his life. Yet, the nurses did not have the experience to properly start an IV. Hours later, Robbie passed away. I was struck by the difference something as simple as an IV and basic nurse training can make in the most critical moment of one’s life. 

You don’t hear or see incidents like Robbie’s unless you visit a low-resource region. The experience of such is — and has been — invaluable. You have to immerse yourself in the native culture in order to gain a better perspective of the problems that plague the area.

A local clinic in Severínia, a city thirty minutes from HCB.

After spending the last month in Brazil, Elisa Arango, a rising sophomore studying psychology, and I have seen things we would have never been exposed to had we stayed home this summer.

To begin to understand, Brazil has a universal healthcare system, meaning all patients have access to healthcare for free – a nearly incomprehensible idea to any American. In Brazil, healthcare is a right. However, it is not until you visit a place like Brazil that you realize problems still exist despite this system.

After speaking to another mentor in the Palliative Unit, Dr. Rodrigo, Elisa and I became aware of the lack of a universal standard of care throughout the country. The absence of standardized care explains the discrepancies in the way patients are treated at different institutions, much like Robbie’s inadequate care at his local clinic. Many of the doctors we have spoken to here have said that Hospital de Câncer de Barretos (HCB) is an exception in Brazilian healthcare. Professionals are meticulously and extensively trained to ensure that extraordinary care is provided to the patients.

For example, at Ambulatorio Medico Especialidades (AME), a unit of HCB, there are quality control boards that indicate how long a medical professional spends with each patient during a consultation or a procedure. If they habitually take too long or spend too little time, they’re then required to go through training again.

Professionals at local clinics must be given this same level of training in order to address the lack of expertise in local clinics. As of now, these clinics are not providing effective care, and the clinical staff at these locations often lack basic training.

Dr. Juliana also spoke to us about how important it is, as a healthcare professional at HCB, to establish connections with professionals at local clinics, as very few physicians at local clinics reach out to HCB to ask about the care plan for individual patients. If the medical practitioner doesn’t know how to take care of the patient, the patient is referred to CIAP (the emergency room) and then referred back to the Palliative Unit. This cycle leads to an influx of patients at the Palliative Unit, a hospital which can only accommodate fifty patients at a time.

This problem could be avoided entirely if the professionals at these clinics were given the same quality and quantity of training as those at HCB. This seems to be a very simple solution; however, due to limited funding and locals physicians’ lack of interest in help, the solution is harder to implement. Professionals at local clinics are often not willing to accept the help they receive from more established and renowned institutions.

A sense of safety must be created for the patients and we must be the ones to create this sense of safety. Patients should not feel skeptical about being discharged from hospitals like HCB. They should feel safe going home. And, if any problem were to arise in the future, they should feel comfortable undergoing treatment at their local clinics. This goal is attainable through educating professionals at local clinics, and establishing a connection and respectful line of communication between HCB and local clinics. This problem may seem daunting, but I do believe it can be tackled, if only one part at a time. 



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