Brazil’s ‘broken’ healthcare system

The public health system run by Rio’s government reached breaking point after authorities admitted to a budget shortfall

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Rio's state government health system has admitted a budget shortfall [Priscilla Moraes/Al Jazeera]

Rio de Janeiro, Brazil – Beside the elevators were four patients on hospital gurneys. Down the corridor were three more. And tucked away beside a fire hose were two others. The doctors were doing their rounds not in the wards but in the public areas of the hospital.

And this was the calm after the storm. The Getulio Vargas state hospital in Rio de Janeiro was admitting patients again after an unprecedented funding crisis had forced doctors to board up the entrance in December.

“I’ve never seen anything like it,” one pediatric and neonatal doctor said. “The health system is practically broke.”

The public health system run by Rio’s state government reached breaking point at the end of last year after authorities admitted to a budget shortfall, which was blamed on the drop in oil revenue.

Getulio Vargas Hospital was among the worst affected and over a weekend, staff resorted to putting up wooden boarding to prevent anyone from entering.

Patients were sent to emergency care units, a support service designed to take less serious casualties, instead of hospitals.

“We didn’t even have saline,” the doctor, who preferred not to be named, added. “Saline is a basic material for hydration, for various conditions, and which is fundamental for basically every consultation.

“So when you don’t have saline or sutures, and an emergency comes in or someone who needs operating on, I don’t have the means to do it. It reached a point of total bankruptcy.”

In response, a federal government convened a crisis cabinet under President Dilma Rousseff and announced emergency funding of R$155 million ($39m), with an immediate cash injection of R$45m ($11m).

‘I needed a respirator and there was none’ 

Two hospitals were taken over by City Hall while the state government started issuing daily bulletins to confirm which hospitals were functioning normally.

But the measures have been seen as merely a sticking plaster on what doctors have said was a crisis long in the making.

A woman holds a poster reading 'Mister policeman, don't shoot at me, I'm fighting for you too' as people demonstrate in front of policemen during a protest to demand better funding for health and education in Rio de Janeiro in June 2013. Doctors say the healthcare crisis has been a long time in the making [EPA/MARCELO SAYAO]
A woman holds a poster reading ‘Mister policeman, don’t shoot at me, I’m fighting for you too’ as people demonstrate in front of policemen during a protest to demand better funding for health and education in Rio de Janeiro in June 2013. Doctors say the healthcare crisis has been a long time in the making [EPA/MARCELO SAYAO]

Brazil’s public health system was one of the key issues when mass protests erupted across the country in 2013 before the country hosted the World Cup the following year.

One of the most vociferous activists was Dr Angela Tenorio, whose face was seen around the world in viral videos protesting against the country’s public spending priorities.

Since then, she said, the situation has continued to worsen.

“Many have died waiting for a transfer to another unit that had the conditions to complete their diagnosis,” she told Al Jazeera.

“In bankrupt health units, there are few or no alternatives. I needed a respirator and there was none. I needed to use a hand-held device to keep the patient breathing.”

Misused resources

Tenorio, who worked in public hospitals from 1996 to 2012 and now works in a private hospital, blamed the problems on corruption.

“This crisis will only improve when the people learn to vote and 90 percent of the leaders are replaced,” she added.

Rio’s doctors’ union, SinMed, and the state’s Regional Medical Council (CREMERJ), also suggested that public funds had been misused. Jorge Darze, the SinMed and CREMERJ president, said it was “unacceptable” to blame a fall in oil royalties as a result of the oil crash.

“No public administration makes their budget based on unstable income,” he said at a press conference in January.

“This needs rigorous investigation. There were probably other causes that brought Rio to this situation.”

Last month, prosecutors in Rio found that R$48m ($12m) of public money had been misappropriated through the not-for-profit social organisation Biotech Humanas, which was contracted to support two municipal hospitals in Rio.

Meanwhile, federal police carried out several arrests in the neighbouring state of Minas Gerais as part of Operation Asclepius into the misuse of public money by a philanthropic organisation linked to the public health service.

‘A legacy of sadness’

Some doctors said that they feared funding issues in hospitals around the country was a strategy to revive the CPMF, a tax on financial movements used to fund the federal health budget.

Yet in the short term, the spectre of the Rio 2016 Olympic Games is looming.

SinMed warned that the city did not have the resources for the extra burden of up to a million tourists during the Olympics, while evidence has emerged that the state government has denied money for hospitals now in order to save for the Games.

In a letter-headed document seen by Al Jazeera and signed by the state health secretary’s supplies managers, Gloria Sardenberg and Henrique Guitton Neto, a request for eight new resuscitation masks by a health unit in Sao Goncalo, Rio, was denied.

The official response to the request made last May was dated December and said: “Please be advised that the balance of the item is blocked by the Health Units Secretariat for the Olympics 2016.”

The state government did not reply to inquiries about the refused items but said hospitals and emergency units had returned to normal service by New Year’s Eve.

“The state secretary of health informs that the priority at the moment is to restore fully the operation of their emergency units, not only for visitors but for the entire population of the state of Rio de Janeiro,” a spokeswoman said.

“For the Olympic period, the state health secretary, in conjunction with the Ministry of Health and the municipal health secretary of Rio de Janeiro, developed a Care Plan for Health, which designated municipal hospitals as a reference for the necessary transfers of all patients that may need to be treated at a sports venue.”

The most recent hospital to face a crisis was the Pedro Ernesto state hospital in Rio, where admissions were suspended last week. Staff protested over late payments and for better working conditions on Friday, January 29.

Edmar Santos, the president of the hospital, claimed it would resume normal activities this week, but by Monday morning only pre-op tests for emergency surgeries were being carried out.

For those on the front line now, the long-term outlook for Rio’s health service is far from ideal.

“[Recently] we had five vials of saline to treat patients in 24 hours. If you think that one child will use five vials … we had to avoid taking in more patients,” the doctor interviewed by Al Jazeera said.

“Today, we’re not lacking in the way we were … because the demand has reduced but we still have patients in the corridor.

“We have the Olympics coming so I’m sure that they will do everything they can to avoid problems in this period. But when it’s over, how will it be?

“The legacy could be a legacy of sadness.”

Source: Al Jazeera