Fabiano Gonçalves Jucá; Mamede Johnson Aquino Filho
Congenital heart defects in the contryside of Northeastern Brazil: problems and solutions
I have been spending 10 years of my professional life working in the Northeast region of Brazil, initially in Barbalha-Ceará, Mossoró-Rio Grande do Norte and currently in Sobral-Ceará, and would like to present the difficulties faced so far in trying to develop a Congenital Heart Disease Service. The main difficulty is the contractualization with the payment source, our National Health System and its management, which is responsible for 99% of our surgical income. We managed to begin operating newborns, implemented the service with an outpatient clinic, physical therapy, pediatric cardiology and anesthesia, suitable material, but after a few months we started, a redistribution of funds of the Departments of Health was made, and the hospitals from the capital cities were in charge of the pediatric field.
But how? We were more than 500 km away in the first case, and 300 km, from the second and third cities. How can we make poor people, who barely had a place to live and feed in their homeland, travel to the capital and wait in long lines at public hospitals for a vacancy? What did we do? We continued our service did not discourage our group and continue operating patients over 12 years old, covered by the contractualization system, and the youngest ones could receive treatment through personal contacts with groups in the capital, and due to these difficulties, they created social organizations and support houses to help the system.
For better or worse, we could go ahead, operating on most urgent patients receiving administratively, and also refering patients to the Services in the capital. However, these support structures, private hospitals that helped the National Health System, could not survive the delays and negligence and, we now have a new difficulty, but we will not give up. Our Service has improved; the internalization of Medicine is a reality with the graduates of the first classes of medical schools returning after internships and residencies, joining the team to continue providing the best possible care to children with congenital heart disease [1-3].
Fabiano Gonçalves Jucá, Mamede Johnson Aquino Child - Sobral, CE
1. Pinto Jr. VC, Daher CV, Sallum FS, Jatene MB, Croti UA. Situação das cirurgias cardíacas congênitas no Brasil. Rev Bras Cir Cardiovasc. 2004;19(2):III-IV.
2. Maluf MA, Franzone M, Melgar E, Hernandez A, Perez R. A cirurgia cardíaca pediátrica como atividade filantrópica no país e missão humanitária no exterior. Rev Bras Cir Cardiovasc. 2009;24(3):VIII-X. View article
3 . Croti UA, Mattos SS, Pinto Jr. VC, Aiello VD . Cardiologia e cirurgia cardiovascular pediátrica . São Paulo : Editora Roca ; 2008 .