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!