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.

-
*) 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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“What State is this? What Justice is this?”

When I wrote about the World Social Forum, held in Belém, I quoted the words the governor of Pará, Ana Júlia Carepa, used in her closing-speech. I repeat:

“…….. here in Pará we demonstrate that it is possible to construct a new development model for Pará and the Amazon. We feel one with these hundred thousand people, who 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.”
And I commented: If you know Ana Júlia and her political results, you get weak knees listening to these words.

Well, let’s have a look how weak our knees can get. First a few words as introduction.

Marajó

Marajó. A pearl dwelling in the delta of the Amazon River. With a land area of 47.573 km² (larger than the Netherlands) it is the largest island in the world surrounded by freshwater. Although its northeast coastline faces the Atlantic Ocean, the outflow from the Amazon is so forceful that the water around the island is brackish. Its beautiful beaches, creeks, vigorous nature, the primitive handicraft, the breeding of buffalos and culinary specialities created the eco-tourism attracting many a tourist to this beautiful island.
It is this island we will talk about in this post and (unfortunately) not about its beauty.

The Bishop of the Prelature of Marajó criticizes the government of the Federal State of Pará for omitting cases of paedophilia

“The omission of the State is the worst thing facing the people of Marajó in all sectors, which contributes to the persistence of sexual exploitation of young children, teenagers and to the misery in the 16 municipalities of the archipelago”, according to the testimony of the bishop of the Prelature of Marajó, dom Luiz Azcona for the Parliamentary Commission on Paedophilia, installed by the Legislative Assembly of Pará, to investigate cases of abuse and sexual exploitation of children and adolescents in Marajó.

The bishop, the first person to denounce publicly that there is an integrated paedophilia network by politicians, businessmen and other people in the towns of the archipelago, related that since 2005, when the first complaints were filed, till this very moment, nothing has been done to change this situation. He repeatedly denounced trafficking routes for girls from Melgaço, Portel and Breves to Spain, through Belém/Airport Guarulhos São Paulo/Madrid.

Dom Azcona recalled that in June 2006 there was a complaint against sailors who navigate the river Tajapuru between Melgaço and Breves, where 11 and 12 years old girls are sexually exploited in exchange for some kilos of meat or litres of diesel oil. “Until now, the authorities have done nothing. Members of the Pastoral of the Child who made the complaint and subsidized the reportage are suffering death threats”, he complained.

During his testimony the bishop presented a report, containing photos, video recordings, documents, names of parliamentarians, businessmen and other authorities involved, and statistics of social entities, a list of public and private establishments, involved in sexual exploitation of children and minors in the State of Pará.

The bishop of Marajó believes that the problem is very serious not only because of the scope and number of occurrences but also by the ‘modus operandi’, in plain daylight, near police stations, in classrooms, in the streets and public places, such as ports and bars with large movement.

“We are no man’s land, there is not one single navy vessel controlling the entry and exit. There is bio piracy, arms trafficking, distribution of drugs, and trafficking women to the exterior. The presence of the State is extinct” said dom Luiz Azcona.

In Portel you can find the sexual exploitation of girls between 12 and 17 years at the riverside and, according to the report of the church, in the bars Altas Horas, Mormaço and Tropical. In Breves, it is the central square of the town. In Anajás, gangs of lesbians are luring girls into sexual exploitation in neighbouring municipalities or tempting them to go to Suriname and French Guiana. In Bagre, at the riverside, boys and girls meet fishermen and owners of vessels, offering them “programs” that cost BRL 3,00 (one euro)

Another major complaint made by dom Luiz Azcona is that young people are enrolling in public schools with the aim to entice minors for sexual exploitation, scheduling meetings with businessmen and politicians in the region. “There are principals, teachers and public servants involved and all that happens in plain view of the police,” said dom Azcona.

Another case is the former councilman of Portel, Roberto Terra, son of the then mayor of the municipality, who was convicted for raping a 13 years old girl, but never went to prison. “The victims had to flee to not die, and the criminals are walking around freely. The municipalities continue to be miserable and with total absence of public policies.”

“What State is this? What Justice is this?” he exclaimed.
Parliamentarian Bira Barbosa, president of the CPI, said that after the official testimony of the bishop the commission had sufficient and concrete material to execute the investigations.
But as always a date for the following hearing was not set. And as always nothing will happen.

In the last two days more than twenty new cases of sexual abuse against children and adolescents, both in the interior of the capital, were brought to the attention of the parliamentarians and senators who participated in Belém in a joint session of the CPI’s about Paedophilia of the Senate and the Legislative Assembly.

Two cases are in this context of immense importance to the public. The accusations against the parliamentarian Luiz Afonso Sefer and João Carlos de Vasconcelos Carepa, a.k.a. “Caíca, brother of the Governor of the federal state of Pará, Ana Júlia Carepa. Yes, the same, who I quoted in my introduction to this article,
A dossier sent in February by judge Paulo Gomes Jussara Júnior addressed to police-inspector Socorro Maciel, who chaired the investigation in which João Carlos de Vasconcelos Carepa was accused, disappeared mysteriously, according to the judge himself.
The judge, hearing that the dossier did not come in the hands of the police, went to the post room, where he got the confirmation that the document had arrived on February 9, but then got lost.

So tell me, what will be next? Don’t dream of a conviction and prison. Forget it, be realistic! Nothing happens as usual.
“What State is this? What Justice is this?” You give the answer.

Source: CNBB, O Liberal and Agência Pará de Noticias
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World Social Forum - The final balance

The previous articles described the run-up to, the opening and the proceeding of the forum. Now the final balance.

The final balance of the World Social Forum (WSF) in Belém was positive. At least according to the organizers, the mayor of Belém and the governor of the federal state of Pará. Eventually 135 thousand people participated from 142 countries, with 15 thousand participants in the encampment and 4,830 volunteers, translators, technicians and representatives of the organizers.

The governor of Pará, Ana Júlia Carepa emphasized the positive influence of the forum on the economy of the state. (I had expected that, as a socialist, she would highlight the results of this ‘human’ forum, but no, the true socialists: only money counts). She stressed that in Great Belém 40 million reais (€ 13.5 million) was spent, of which 18 million for housing, 16 million with meals and 6 million with transport. According to the governor “the choice of Belém could not be at a more opportune moment, because here in Pará we demonstrate that it is possible to construct a new development model for Pará and the Amazon. We feel one with these hundred thousand people, who 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.” (If you know Ana Júlia and her political results, you get weak knees listening to these words.)

But the official view is not shared by the university students, who made their appearance to the lecture-rooms on Monday after the forum. Kyone Oliveira, 18 years, of the faculty Zootecnia, says she is shocked by the state the campus is in after the forum. “They have polluted everything and then go away. I thought, that it would go this way, that’s why I have not participated. Neither my university nor the city of Belém has the infrastructure to organize a forum like this. If we as students already suffer from poor toilets, think of all those people. They improved only the roof of the lecture-room and now they say that everything is in order.”

The day after the World Social Forum 2009 ended the two campuses that hosted the event showed significant differences. While the campus of the Federal University of Pará (UFPA) was clean and quiet, on the campus of the Federal Agriculture University of the Amazon (UFRA), you could observe the mess, the stench and the dissatisfaction of the participants.

After the forum many students said they had a ........ continue reading and see more images of the event

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