The day started with a big WOW!! We were welcomed into the office of the Parana Secretary of Health by the Secretary himself, Miguel Caputo. He came in during his vacation time to share with us information about Curitiba’s Mother, a program that provides services to at risk women who are pregnant, throughout their pregnancy and beyond to the child’s age of 2. The program provides resources such as housing, food, medical care and clothing. Since the inception of this program 12 years ago, infant mortality in Curitiba has dropped from 16% to 8.5% and transmission of AIDS from mother to baby has dropped to 0%. The program has started expanding into Parana’s Mother and Brazil’s Mother, an interesting twist on a traditional top down model. Curitiba is leading by example.
At this same meeting, we met Vinicius Budel, an oncologist who was able to answer a broader set of questions regarding health care. He talked about preventative medicine being the base of the health care system, with consultation with physicians as a second tier and hospitals as a third tier. The base of the system includes four programs: children, gynecological, seniors and chronic disease such as diabetes and hypertension. Citizens access the health care system through its base, navigate through the portions of the system they need and always return to base.
One interesting story that Vinicius Budel shared was about an event of eight years ago where Curitiba offered free mammograms on a Saturday. The event was highly publicized and 33,000 women showed up. The following Saturday, free prostate exams were offered. 800 men showed up. This differential is being taken into account this year with the introduction of Blue August. This event, similar to Pink October to raise breast cancer awareness, is designed to raise awareness of prostate cancer.
Another fascinating discussion item:
- health care is a Constitutional right in Brazil (This leads me to the question of how “health care” is defined and who is entitled to publicly supported health care. We were told that 30% of the citizens of Curitiba have private health care.)
- 12% of all state budgets must go toward health care
- 15% of all municipal budgets must go toward health care
- there is no mandated percent of the federal budget toward health care.
We were also told that the “right” to a mammogram for women not “at risk”… how is that defined?… exists for women ages 50 – 70. How many of my friends and acquaintances who have traveled the breast cancer journey would have qualified for a mammogram before the age of 50? Hmmm? This is becoming a discussion item in the U.S. too. Something we have in common with Brazil, I guess.
Toward the end of the meeting, we realized that we, as Americans, had opened the door to a conversation that one of the local women attending with us had hoped to have for some time. As a radiology technician specializing in mammograms, she has been concerned with the division of funding for the public health care system. From what I could tell, she was concerned with the lack of funding for training in the reading of mammograms and said that all the great technology in the world does no good if the individual reading the mammogram cannot determine whether the exam shows indications of breast cancer. It was fascinating to think that she had taken this opportunity to escort us to this meeting in order to get her foot in the door with people in high places. Yet, I think that is exactly what she did.
At the end of the meeting, I presented Miguel Caputo with a token gift that I had purchased at Historic Northampton. A WOW ending to an amazing meeting and another example of the welcome that we are receiving in this gracious city.
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