Download - Surgical treatment in the Amazon
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
• Live by hunting, fishing, collection of forest, and regional crops, being very low currency circulation;
Framework of Social Exclusion and Lack of Policies
• 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.
• No longer able to secure their livelihood due to deforestation;
Roads in North region-Logic of by the river health
different laws and rules for territories
vv
Percentage of municipalities in terms of number inhabitants.
IBGE-senso 2010
Distribuição de médicos (coorte 1990 a 1999), segundo local de domicílio ou trabalho –Brasil, 2013
Distribuição de médicos (coorte 1990 a 1999), segundo local de domicílio ou trabalho –Brasil, 2013
Fonte: CFM; Pesquisa Demografia Médica no Brasil, 2013.Fonte: CFM; Pesquisa Demografia Médica no 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
doctor / population ratio
HDI (Human Development Index)
States
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
Brasil 19,92 16,73 47,24 77,82 0,764
Government spending on health
UF
Federal state Municipiality Total
TotalPor
habitanteTotal
Por habitante
TotalPor
habitanteTotal
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
Amazônia Legal 2.721 110,99 2.580 105,26 1.361 55,53 6.664 271,78
BRASIL 33.703 180,10 16.032 88,30 16.369 90,15 65.105 358,55
Total expenditure in million; expenditure per capita real. Fonte: MS/SCTIE/DES/SIOPS/SPO/SE/FNS/IBGE
UF Beneficiários População
% Cobertur
a
Rondônia 84.450 1.590.001 5,31
Acre 41.381 703.432 5,88
Amazonas 496.792 3.389.072 14,66
Roraima 9.633 415.281 2,32
Pará 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
Fonte: ANS/ Período:Jun/2007
Health supplemental coverage (private health insurance)
Low complexity
medium complexitylow investment
High Number users 900admissions/250surg/month
800.000hab 300,000 + / 3.5M.R$/month
per capita investment $$ Trauma/Emergency/Diabetic foot
High complexity
Santarém City- case report 240 doctors/300.000hab/1.200.00
high investment low coverage few beds (130)
Only400admissions/350 surg. / Month Difficulty of access
1.200.000hab / $ 9M.R$/month percapta investment
$$$$$$
Cancer surgery /neurosurgery
general Trauma orthopedic complex surgery
ultra low investment low coverage 30%
30 Family health teams 300.000hab / 1.5 M.R$/ month
per capita Investment$
14 +Doctors-3provabonly 1 medical consultation/year/inhab
HAS/Diabetes/parasitose / mal nutricionWater born diseases
1US=2.25Real
Surgery Suppressed Demand Media-STM Rural areas = NO ACESS
Orthopedic surgeries Cholecystectomies / Hernias /
Varices -vascularOphthalmic surgery
5.000
Strategies knowledge Technology
Research
1-Abaré2-Use of technology for special areas
3-Surgery journey/Task force 4-New therapies
How to solve this problem??
public health policies
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
-Region of Western Pará
- 3 Municipalities
- 150 Communities
- 30,000 beneficiaries
DEFINED TERRITORIALITY
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
WeWeWe need
preserve and
help them!
ZOÉ laparoscopic colecistectomy one day 6 surg.
4
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
!
Obrigado! Thanks
240Medical students10 courses of medical residency
The important thing is not to give the fish but teach to fish!