Surgical treatment
in the Amazon
Md phd Fabio Tozzi
SUS
• universality
• equity
• Whole/Completeness
Amazon / Indigenous Health
Context - summary
• Low population density
• Great distances - scarce transport routes
• Difficulty of internalization - medical staff - low
physician / inhabitant ratio
• Small investment in health ($/ inhab.)
• Small supplemental coverage (private health
insurance)
• low currency circulation
• health services ill-equipped
• Injuries resulting from lack of access to health
services and infrastructure / sanitation
• Microregion - aggravated indices
Framework of Social Exclusion and Lack of Policies
•
Live by hunting, fishing, collection of forest, and
regional crops, being very low currency circulation;
•
No longer able to secure their livelihood due to
deforestation;
•
minor illnesses become serious lack of effective
intervention, with high rates of malnutrition and infant
mortality; low coverage in basic health
•
Only 7.5% with access to high school education;
•
47.5% of the population is under 15.
Roads in North region-Logic of by the river
health
different laws and rules for territories
Percentage of municipalities in terms of number
inhabitants.
v
IBGE-senso 2010
doctor / population ratio
Distribuição de médicos (coorte 1990 a 1999), segundo local de domicílio ou trabalho –
Brasil, 2013
inside of Pará, there is a
higher average ratio of the
country (1/4466 inhab.),
performance results from the
fact that 73.3% of the active
state doctors are concentrated
in the capital Belém, which
meets only 20.4% of the state
population
Fonte: CFM; Pesquisa Demografia Médica no Brasil, 2013.
HDI (Human Development Index)
density
Demographi
c
household head
Not literate(%)
house with
sanitation
(%)
House with /
supply
water(%)
HDI – M
Acre
3,65
29,04
19,50
36,09
0,692
Amapá
3,33
18,07
6,15
50,75
0,751
Amazonas
1,79
22,15
20,00
60,03
0,717
Pará
4,96
23,11
7,40
42,64
0,720
Rondônia
5,80
16,17
3,69
30,75
0,729
Roraima
1,45
17,58
10,71
79,24
0,749
Tocantins
4,17
22,43
2,75
66,26
0,721
Maranhão
17,00
32,00
9,21
52,95
0,647
MatoGrosso
2,77
14,95
15,66
63,67
0,767
Amazônia
Legal
4,99
21,72
10,56
53,60
0,721
19,92
16,73
47,24
77,82
0,764
States
Brasil
Government spending on health
Federal
UF
Total
Por
habitante
state
Total
Municipiality
Por
habitante
Total
Por
habitante
Total
Total
Por
habitante
RO
186
118,95
179
114,39
108
69,17
473
302,50
AC
149
240,86
133
213,93
37
58,86
319
513,65
AM
362
115,01
702
222,89
220
69,78
1.284
407,68
RR
66
172,63
85
221,40
29
76,79
180
470,82
PA
704
102,73
436
63,70
305
44,55
1.445
210,98
AP
77
140,90
142
259,63
28
50,65
247
451,18
TO
187
148,47
186
147,46
112
88,34
485
384,27
MA
636
105,60
374
62,08
231
38,34
1.241
206,02
MT
354
128,68
345
125,35
293
106,42
991
360,45
Legal
2.721
110,99
2.580
105,26
1.361
55,53
6.664
271,78
BRASIL
33.703
90,15 65.105
358,55
Amazônia
180,10 16.032
88,30 16.369
Total expenditure in million; expenditure per capita real.
Fonte: MS/SCTIE/DES/SIOPS/SPO/SE/FNS/IBGE
Health supplemental coverage
(private health insurance)
UF
Beneficiários
População
%
Cobertur
a
Rondônia
84.450
1.590.001
5,31
Acre
41.381
703.432
5,88
496.792
3.389.072
14,66
9.633
415.281
2,32
658.449
7.249.160
9,08
Amapá
57.584
636.654
9,04
Tocantins
50.353
1.358.922
3,71
Maranhão
285.237
6.265.077
4,55
Mato Grosso
286.295
2.910.264
9,84
Amazônia Legal
1.970.174
24.517.863
8,04
Brasil
46.225.819
189.335.187
24,41
Amazonas
Roraima
Pará
Santarém City- case report
240 doctors/300.000hab/1.200.00
Low complexity
ultra low investment
low coverage 30%
30 Family health teams
300.000hab / 1.5 M.R$/ month
per capita Investment
medium complexity
low investment
High Number users
900admissions/250surg/month
$
14 +Doctors-3provab
800.000hab 300,000 + /
only 1 medical consultation/year/inhab
3.5M.R$/month
per capita investment
HAS/Diabetes/parasitose / mal nutricion
$$
Water born diseases
Trauma/Emergency/Diabetic foot
High complexity
high investment
low coverage
few beds (130)
Only400admissions/350 surg. / Month
Difficulty of access
1.200.000hab / $ 9M.R$/month
percapta investment
$$$$$$
1US=2.25Real
Cancer surgery /
neurosurgery
general
Trauma orthopedic complex surgery
Surgery Suppressed Demand Media-STM
Rural areas = NO ACESS
Orthopedic surgeries
Cholecystectomies / Hernias /
Varices -vascular
Ophthalmic surgery
5.000
How to solve this problem??
Strategies
knowledge
Technology
Research
public health policies
1-Abaré
2-Use of technology for special areas
3-Surgery journey/Task force
4-New therapies
The Abare in Primary Health Care for
People of the Forest
PUBLIC POLICY
2010 - ministerial decree 2191- ESF Fluvial
2014 Ministry of Health resources
transformation into a Teaching Hospital
DEFINED
TERRITORIALITY
-Region of Western Pará
- 3 Municipalities
- 150 Communities
- 30,000 beneficiaries
MOBILE HEALTH UNITS
ABARÉ: since 2006 / Tapajós
New boat: 2009-10 / Arapiuns
ABARÉ – Fluvial Family Health
Team
Results
Fonte: Brasil, Norte, Pará – DATASUS (2007)
Abaré – Sosniski, Cristina (2008), Pesquisa Socioeconômica e de Saúde, e Relatórios do Abaré
ZOÉ laparoscopic colecistectomy one day 6 surg.
We need
preserve and
We
help them!
Pilot study to evaluate the treatment of
varicose vein with polidocanol treatment of
choice for inland areas: Task force/Journey
to eradicate varicose vein in Municipio de
Juriti -Pará (April 9 Hospital and City Hospital
Juriti)
Fabio L. Tozzi FL, Campos W jr ,
AzevedoER,Pedrosa A. Ana Marcia .
ONE DAY 130pacientes
5US$/each one
•video
240Medical students
!
10 courses of medical residency
Obrigado! Thanks
The important thing is not to give
the fish but teach to fish!