Surgical treatment in the Amazon Md phd Fabio

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

Framework of Social Exclusion and Lack of Policies • Live by hunting, fishing, collection of forest, and regional crops, being very low currency circulation; • No longer able to secure their livelihood due to deforestation; • 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.

Roads in North region-Logic of by the river health

different laws and rules for territories

Percentage of municipalities in terms of number inhabitants. v IBGE-senso 2010

doctor / population ratio Distribuição de médicos (coorte 1990 a 1999), segundo local de domicílio ou trabalho – 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 Fonte: CFM; Pesquisa Demografia Médica no Brasil, 2013.

HDI (Human Development Index) 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, 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 Mato. Grosso 2, 77 14, 95 15, 66 63, 67 0, 767 Amazônia Legal 4, 99 21, 72 10, 56 53, 60 0, 721 19, 92 16, 73 47, 24 77, 82 0, 764 States Brasil

Government spending on health Federal UF Total Por habitante state Total Municipiality Por habitante Total 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 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 Amazônia Total expenditure in million; expenditure per capita real. Fonte: MS/SCTIE/DES/SIOPS/SPO/SE/FNS/IBGE

Health supplemental coverage (private health insurance) UF Beneficiários População % Cobertura Rondônia 84. 450 1. 590. 001 5, 31 Acre 41. 381 703. 432 5, 88 496. 792 3. 389. 072 14, 66 9. 633 415. 281 2, 32 658. 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 Amazonas Roraima Pará

Santarém City- case report 240 doctors/300. 000 hab/1. 200. 00 Low complexity ultra low investment low coverage 30% 30 Family health teams 300. 000 hab / 1. 5 M. R$/ month per capita Investment medium complexity low investment High Number users 900 admissions/250 surg/month $ 14 +Doctors-3 provab 800. 000 hab 300, 000 + / only 1 medical consultation/year/inhab 3. 5 M. R$/month per capita investment HAS/Diabetes/parasitose / mal nutricion $$ Water born diseases Trauma/Emergency/Diabetic foot High complexity high investment low coverage few beds (130) Only 400 admissions/350 surg. / Month Difficulty of access 1. 200. 000 hab / $ 9 M. R$/month percapta investment $$$$$$ 1 US=2. 25 Real Cancer surgery / neurosurgery general Trauma orthopedic complex surgery

Surgery Suppressed Demand Media-STM Rural areas = NO ACESS Orthopedic surgeries Cholecystectomies / Hernias / Varices -vascular Ophthalmic surgery 5. 000

How to solve this problem? ? Strategies knowledge Technology Research public health policies 1 -Abaré 2 -Use of technology for special areas 3 -Surgery journey/Task force 4 -New therapies

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

DEFINED TERRITORIALITY -Region of Western Pará - 3 Municipalities - 150 Communities - 30, 000 beneficiaries 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

ZOÉ laparoscopic colecistectomy one day 6 surg. We need preserve and We help them !

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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 , Azevedo. ER, Pedrosa A. Ana Marcia. ONE DAY 130 pacientes 5 US$/each one

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240 Medical students ! 10 courses of medical residency Obrigado! Thanks

The important thing is not to give the fish but teach to fish!