Thursday, May 14, 2009

Ensuring access to health care

Last week, I participated in a multi-disciplinary conference, "The Arts, Human Development and Human Rights" at the University of Pittsburgh. (Earlier post.) A week later, an intriguing fact about the Brazilian public health program in the Rio de Janeiro favelas (above) is still bouncing around my mind: the doctor working at each neighborhood clinic visits every single home in her assigned neighborhood. (photo credit)
In fact, she spends half of her work week visiting those homes in turn, one after another, until she has gone to every one – and then she starts over again with the first home.
As someone who has spent some time thinking about access to justice in poor and conflict-ridden settings, this approach to access to public health services caught my attention. It’s a very direct, very proactive approach, and an approach to resource allocation very different from the American strategy for medical care -- or for that matter, than any approach to access to justice that I'm aware of. (Indeed, in this period of détente, I should mention that the Brazilian Family Health Program was modeled on a Cuban initiative.)
These visits are, presumably, a low-cost endeavor in some respects. They rely on observation and conversation rather than expensive technology or tests. But they are high-cost in another way: they devote an enormous amount of time and energy to developing relationships with people who do not necessarily require immediate medical care. These relationships can then be put to many health-directed uses, as well as some broader purposes:
► They can be used to offer preventative health advice and information and to gather public health information.
► They can be used to facilitate and provide a health background for medical care when the need arises.
► And they contribute to other projects in the community – including the Communiarte arts project that was one focus of the conference.
Fundamentally, the Brazilian program places medical care in a relational context and collapses the problem of access into that context.

1 comment:

redwood said...

Speaking of the Cuban system, I once visited a doctor in Cuba a couple of years ago. It was a Friday night, about 6pm. My back had broken out in a rash that spooked me. So I showed the owners of the Casa Particular (a Cuban B&B) I was staying in. They became very serious and, without asking me, telephoned a doctor. When they got off the phone, they said I will have to wait five minutes. And then they would walk me over to her house.

About thirty minutes later, the doctor was writing out a prescription for a cortisone. Prior to the trip, I, being pasty white and insecure, had my back waxed, which I might have known had to be kept very clean in the hot tropical climate.

For payment, the doctor asked for $10 USD, maybe $5. I gave her $60 and thought I got the better end of the deal.

The whole experience was sublime, especially the without-asking-me part. It felt like collective system to keep everybody healthy, albeit whether they want to be or not.

In the doctor herself, I saw a level of compassion I've never seen in US physicians.

I came away thinking about the word care in health care.