The Collapse of Health Care in Pará

In June last year, the deaths of 13 babies in just one weekend in Santa Casa de Misericórdia do Pará in Belém bringing the total at 260 dead babies in just 45 days, shocked Brazil. Since then, finally, it was recognised that the chaos in health care was structural. The historically overcrowded (public) emergency hospitals had reached their peak, due to the large number of people coming from the interior, where emergency care in the municipalities is lacking completely.
The problems reported in the capital are in fact a reflection of a disorganized management system at the three government levels (federal, state, municipal), which afflicts the entire federal state of Pará, historically discriminated with unfairly low federal funds. The Plano Diretor de Regionalização da Saúde (RDP = Master Plan for Regionalization of Health Care), released in March of this year by the state government, is not much more than a piece of paper as long as there is no federal support for the financial resources required.

The RDP designed a network of regional hospital clusters in the interior, but the actual Secretary of Health of Pará, has to admit that the RDP master plan will never leave the drawing board without federal funds.

While the northern region, in its entirety, is hampered by a lack of federal funds, the situation in Pará is more severe, due to its continental size and its epidemiological profile. The federal government pays monthly through the Ministry of Health per capita the amount of BRL 8.29 (€ 2,90), to cover the health care costs of medium and high complexity. The lowest value per capita compared to any other Brazilian state, including the northern region. Tocantins, for example, with about 2 million of inhabitants, (five million less than Pará), receives BRL 12.24 (€ 4,30) monthly per capita, Roraima and Acre, respectively, BRL 14,48 (€ 5,08) and BRL 19,33 (€ 6,78).

The logic of the governmental Unified Health System (SUS) is simple. The system pays for services rendered. Each consultation or examination computed by SUS is paid afterwards. SUS pays materials and also the services of professionals. But without investments to create and structure services, most municipalities, being very poor, are not getting more resources from the SUS, other than for carried-out treatment. So they are condemned to water and bread, just waiting for fixed (federal or state) funds, which are distributed with regard to the number of citizens.

In addition to the scarce resources, small steps in pursuit of improvements are harmed by politics, as a change of government could result in a halt of concrete actions. As happened to the five regional hospitals, of which the construction started in 2003 under the previous governor. Three of the five are completed, Santarém, Marabá and Tucuruí. In Breves, as well as in Redenção, the conclusion of the hospitals is not even forecasted by the sitting governor, our (in)famous Ana Júlia Carepa. Of the hospitals ready to operate, the government is unable or unwilling to operate them at full capacity.

Most municipalities in Pará, most of them very poor, can not even offer the most basic health care of average complexity to their citizens, who as a consequence migrate in cascades to Belém in search for health care. Belém, indeed, has the largest infra-structure for health care with its hospitals, doctors and specialists, but should only treat the serious cases from the interior. But what happens is a reversal of the patient’s profile. The funds under the agreement between the municipalities and Belém should be used for the serious cases, however it is mostly used in treatments of low and medium complexity, and consumed last year BRL 178 million (€ 62,4 million), while the SUS (Unified Health System) paid BRL 175.8 million (€ 61,7 million) leaving Belém with a deficit of BRL 2.2 million (€ 0,7 million).

The emergency rooms of the hospitals in Belém are a reflection of that. Data from the Municipal Secretary of Health (Sesma) show treatment in both hospitals have reached the average of 50% being patients from the interior, and of this volume, 60% are cases of medical practice, i.e. cases without high risk to life according to the medical classification and should be treated at home in the individual municipalities.

Furthermore, the more severe cases, which, in fact, have to come to Belém in search of health service, arrive in the capital in an aggravated state due to poor transport conditions, usually in common ambulances without a doctor, without oxygen facilities for the patient, and in many cases, with only the driver, without a companion. That is, as far as, the health departments in the interior have an ambulance available. It is quite common, however, that patients are transported in vans or kombis without any infra-structure to make the pilgrimage from hospital-door to hospital-door in Belém. No place, no problem, patients are laid down on stretchers which fill the corridors.

In contrast with this, the daily paper O Liberal reported, that last year there was not a shortage of federal funds transferred to the government of the state of Pará for health care. Pará received more than BRL 1.1 billion (€ 386 million) for the 143 municipalities, with almost half of that amount just for the capital of Pará. Belém snapped up BRL 533.4 million (€ 187 million) exclusively for health care. The amount refers to all the money released by the National Health Fund (FNS) to the state of Pará.

The State Health Fund (Fespa) was the body most favoured by the federal money transfers, with BRL 231.4 million (€ 81 million).

What have they done with all that money? Hospitals are falling apart, equipment broke, emergency rooms are not functioning due to a lack of doctors, beds, medicines and equipment. Simple question: Where is all that money?

Remember Ana Júlia Carepa, the (socialist) governor of Pará? Remember her words?
We “..... believe that another world is possible and in the name of this ideal, we have built our government. In the name of this ideal, we work to transform Pará into a constitutional state.”

Constitutional state? Not when you are poor. Don’t expect health care at your side, even worse don’t expect the socialist governor at your side. Like to know where Ana Júlia spends the money:
The governor of Pará, Ana Júlia Carepa has launched an "aid" package for some ‘low-division’ football clubs in Pará. The value of the aid is almost BRL 1.5 million (€ 550.000). Among the three clubs is Remo, for which the Ana Júlia’s father is an adviser.

I end this post with some words regarding this item taken from the blog: ‘Movimento da Ordem Vigilia Contra Corrupção’, which crucifies the governor of Pará:

“
The heinous opportunism of Ana Júlia Carepa
Ana Júlia doesn’t give a damn ....... As a matter of justice, that “petralha”*) woman has to be held liable for this barbaric crime, which resulted in the deaths of nearly 300 Brazilian babies, due to her omission and neglect.

Certainly, she will not lose the opportunity to try to "scrape" a little money with the excuse to build more hospitals in a state, where she (already for two years) criminally maintains the Hospital in Santarém, all finished and equipped, closed, only because it was built by the previous governor. (By Gaúcho/Gabriela)
”

Next year there are elections, not only for a new president, but also (among others) for a new governor. Let’s hope, that the people in Pará will remember the devastating results of 4 years Ana Júlia Carepa. I doubt it, but I hope, as Pará and its people deserve better.

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*) Petralha is the contraction of PT (Brazilian socialist party) and the Irmãos Metralha (The Beagle Boys in English). The word identifies a member of a moralistic political party that when in power, deceives, steals, kills, lies, corrupts, installing a cleptocracia, in other words a state governed by crooks)

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Brazil’s Economically Active Population

- or - Over 70% never attended a professional qualification course

The professional education, which includes courses aimed at training and professionalizing employees, still leaves much to be desired, according to the Pesquisa Nacional por Amostra de Domicílios (Pnad = National Survey by Household). According to the survey, 72,4% of the economically active population never attended a professional class. Or in absolute numbers, 71,5 million working people. Among the unemployed, 5,3 million people never went to a professional education course (66,4%).

The figures also show that the professional education run by the government has the lowest impact, clearly demonstrating the disinterest of the Lula government in education in general and professional education in particular. Only 22,4% of the total of students enrolled in professional education attended public institutions. Institutions offering private education (NGOs, private schools, trade unions etc.) had 53.1%. Professional education linked to the System "S" (SESI, SENAC, Sebrae, among others) had 20.6%. System S is the collective name of eleven professional categories, established by Brazilian Law.

Among the courses of professional training, also known as free courses, because in general they do not require a certain level of pre-education, computer courses came on top with 41.7%. Then, there are the areas of commerce and management (14%) and industry and maintenance (11.2%).

Students protesting Lula's education policy

To be honest I have to say, that end of December last year as a New Year’s present Lula announced to create 38 federal institutes of education, science and technology in the country. Two of them will be in Rio de Janeiro. The measure, according to the government, increases the number of students in technical courses at secondary level, technology and higher degrees from 215 thousand to half a million. (Tell me, what is, half a million out of a population of some 180 million for an emerging economy, which - according to Lula - has to be one of the economic forces in this world.)

Please don’t laugh at the following: “What is happening today is that the country is experiencing a time of increased investment in science and technology. This year (2009) we will open 100 colleges, in a country that had opened 140 in a century,” Lula said.

This sounds nice and hopeful, but there are two problems with Lula. First Lula always announces plans and uses words as ‘we will’ and at the final end people discover that of all the announced plans almost nothing is really implemented. Second, the announced plan covers mainly investments in higher education, and that’s the problem in this country, there are almost no professionally educated blue-collar craftsmen. If there is money available, all money goes to universities and higher technical institutes, as only half of the new-to-create openings is reserved for the professional education at mid-level. But developing a future and filling the shortage in the industry the country needs many more blue-collar professionals. When confronted with these critical remarks, Lula, after almost seven years of his reign, still blames previous governments or the sitting state or local governments. But as a matter of fact it is Lula’s government that fails in the first place, as ........

In 2008 the Ministry of Education used only 27% of its investment budget. For 2009 the budget for this ministry faced a BRL 1.6 billion (€ 570 million) cut. And to make it worse, among the programs affected by the budget cut, is ‘Brasil Alfabetizado’ (Literate Brazil)

Public school in the township Sabonetinho-Maranhão

Of the 141.5 million people in Brazil older than 15 years, an estimated 14.1 million is illiterate, of which only 547 thousand attend alphabetisation classes (3.8%).
A recent study focussing on the Education of Youth and Adults (EJA), the Alphabetisation for Youth and Adults and the Professional Education shows, that there were (2007) 13.5 million illiterate Brazilians (9.5% of the population older than 15 years) with no prospect of change, as they do not attend classes to learn to read and write.

In absolute numbers, Bahia was the state with the largest number of illiterates who were not enrolled: 1.8 million people. Then comes São Paulo, with 1.4 million. Among the states which are trying to overhaul their backwardness is the Amazonas: 19.3% of the illiterate population over 15 years was attending classes.

Is it any better with the literate population? Another study reveals that 77 million Brazilians (almost 50% of the population) never ever read a book.

Lula’s daily repeated rhetoric, criticising his predecessors sounds hollow. His: “Tell me of any government, in any period of time, in this country, which did 50% of what we are doing for education,” trying to shoot down critics, is laughable. Just drive around and see with your own eyes the devastating status of school buildings, let alone the poor low level of public education and the lack of (even the most basic) educational material.

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A Good Yankee Conquered Latin America

The judgement of the first hundred days of the Obama administration might have had all the attention in the US, it is, as a matter of fact, a global affaire. The foreign policy of the Bush/Cheney administration was ruinous in its approach to and contacts with Latin America. Bush’ few visits to Latin American countries were always characterized with massive, sometimes even violent protests and demonstrations. Neither the Latin American leaders nor the people expected anything positive from Bush/Cheney, and as a consequence any American initiative, commercial or charitable, was met with mistrust and suspicion. Exponents of this disastrous foreign policy were the dubious American interventions in local affairs in Venezuela, Bolivia and Paraguay and the re-instalment of the 5th US Navy Fleet in the Caribbean. The US, personified by George Bush, was “el diablo” as Hugo Chávez stated openly and with which statement many a Latin American government leader silently agreed.

Although the 5th Summit of the Americas, sarcastically called the G-34 (the number of countries attending the meeting of three days in Trinidad and Tobago) as part of a soup of letters and numbers in which leaders dive, was distinguishably unimportant, it was, however, the perfect event for the new president of the USA to meet efficiently with all government leaders of Latin America, notably the Left-Wing leaders with anti-American feelings, among them Hugo Chávez (Venezuela), Evo Morales (Bolivia), Fernando Lugo (Paraguay) and Daniel Ortega (Nicaragua). But it was also crystal clear that the meeting in a country once a haunt for pirates and smugglers had to offer some thrilling bids and a bit of suspense.

The Summit was created in 1994 by the then US President Bill Clinton. The initial objective was to create a single trading system, the FTAA (Free Trade Area of the Americas) for the whole region. After several dead ends, especially between the United States and Mercosur, the initiative was buried after the last meeting in Mar del Plata.

But this time, it was the Latin American and Caribbean debutante ball for prince Barack Obama, and you never could know whether Hugo Chávez would try to spoil the party and steal the show (he anticipated that he might veto the final declaration) and the absence of Cuba was remarkable since the island of the Castro brothers was the predominant theme of this picnic.

Several Latin American leaders agitated as usual against the financial shenanigans perpetrated by Big Brother America, albeit knowing they need to work with Obama. You just had to observe the body language and juggling rhetoric of Lula in relation to Obama. Again, as in the G-20 summit in London, we had the flawless performance of the US president stating that he was here to listen, to recognize flaws and trimming edges, but let's remember the obvious: the US is still the indispensable superpower, maybe weaker, more limited and less arrogant, but still the No. 1 Superpower.

There were also limits to achieve necessary change. Before the trip to Trinidad and Tobago, Washington broke some ice in relations with Havana, allowing more travel and financial remittances from Cuban-Americans to the island. But not enough to make an immediate reversal of the economic embargo, in force for 47 years, the age of the President. This will depend on tortuous negotiations with the anti-Castro lobby in Congress, and positive gestures of the Castro brothers.

Who was to know, that Chavez, supported by his vassals, might lay an ambush, but what fun could there be with "el diablo" George W. Bush not present? It should have been difficult to repeat the waves of protests and bullshit targeting Bush during the 2005 summit in Mar del Plata.
Before the Summit started Itamaraty, the Brazilian Ministry of Foreign Affairs, released a statement: “President Obama is new in office and it makes no sense to create a "negative" situation during the summit”, and continued to say that the Cuban government itself would have no interest in a confrontation with the Obama government, because of its willingness to a "dialogue."
"President Lula goes to Trinidad, aware that neither Obama, nor Cuba are interested in transforming the embargo in a big controversy during the summit.”
For many, the US remains an imperialistic country, but Obama is a good Yankee.

Before the summit started The New York Times published a sombre toned article, emphasising the erosion of the US influence in Latin America and the deeper engagement of China in the hemisphere, but it is ridiculous to imagine that one day the “Emerging Asian Superpower“ will have a hegemonic role in American’s backyard.

The veteran "Brazilian-expert" Abraham Lowenthal, professor of international relations at the University of Southern California, said that Obama’s trip to Latin America during its first 100 days of government is prove of the importance he gives to the region, given the alarming economic crisis and geopolitical challenges in other parts which consume all attention of his administration. Latin America, however, is not a priority of this government. The urgent national issues, like the economic crisis, drugs and immigration, dominate his domestic agenda.

What is the importance of the summit for Brazil? And can somebody tell me how many summits President Lula has already participated in during the four months of this year? Since the summit in Mar del Plata, Brazil is more prominent and influential. For Lula, it is great to be charmed by Obama. But in the words of Rubens Barbosa, former Brazilian ambassador to Washington, the summit is a "non event" because it was originally initiated to stimulate a dead FTAA (Free Trade Area of the Americas), against which Brazil resisted. FTAA is not any longer, but there is Hugo Chávez’ Alba. Leaders can always find a reason for another summit.

Although heavily criticized in the US, Chavez friendly handshake and gesture to present the new US president with the book “Las venas abiertas de América Latina” (or in English: “Open Veins of Latin America”), written by the Uruguayan Eduardo Galeano in the seventies of the last century, was one of the most remarkable public expressions of seeking a rapprochement with the US and at the same a signal to the ‘imperialist’ that the future had to be laid out with mutual respect. Remember, the book - which is arguably Galeano's best-known work, analyzes the history of Latin America as a whole from the time period of European contact with the New World to contemporary Latin America, revealing what he views as European and later US economic exploitation and political dominance over the region - is clearly a signal of the Latin American leaders to Obama, that continuation of this loathed policy can not and will not be accepted any longer.

Whether US policy to Latin America will change dramatically in a positive direction requiring mutual respect, we have to see. But for the time being “A Good Yankee Conquered Latin America”.

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