I enjoyed hearing from the Graduate Students our last day at UFBA. I am an Epidemiology concentration and my area of interest is in infectious disease, specifically tropical diseases. I really enjoyed hearing about their research into dengue fever and new ideas to monitor and improve reporting. They discussed several barriers Brazil faces involving the reporting cases; such as, no cure and treatment is generic, rest and hydrate. Why would you go to a doctor when the treatment is common knowledge? In Brazil, seeing a doctor could take hours or days to wait in lines and in the US you would have to pay a co-pay with insurance or for the whole visit with no insurance. How do you successfully track a disease when the barriers to care outweigh the benefits?

Our last week in Brazil, we got to experience the thrill of a disease outbreak. Zika virus is similar to dengue fever with similar treatment options. One graduate student was absent during their presentation due to the virus and several girls in our programs had suspected cases. Unfortunately, since zika and dengue have similar treatment options, they also share similar barriers to care resulting in poor monitoring and reporting of the disease. So the next question is, how do we improve surveillance of a disease when going to a doctor is more of a hassle than a solution?

What helped me the most in understanding the difference between collective and public health was the idea that public health prevents disease while collective health promotes health and like Professor Mota said, “to be happy is to be more than healthy.” Collective health encompasses a magnitude of research and policy areas. The first possible step would be listing zika and dengue in the notifiable diseases list, requiring doctors to report cases; however, sick patients would have to go to the doctor in order for their cases to be reported. An earlier step could be developing a community-based education aimed at educating people about mosquito breading and the dangers of standing water. A far off and expensive research option would be improving treatment option by developing a cure or anti-viral drugs to help patients after infection. Taking a collective health approach to improving surveillance of infectious diseases such as dengue and zika, would involve multiple areas of practice; political, ideological, social or economic.

The United States and Brazil differ greatly in certain areas but share many similar problems. I was surprised to learn that Brazil shares similarly high rates of elective caesarian sections during childbirth, organ transplants and electronic imaging usage as the US. I expected more natural births to occur in Brazil; however, Brazil has succumbed to the same over utilization of C-sections. It is not necessarily the mothers who elect for C-sections but the doctors who prefer scheduling births during business hours. The unnecessary and over use of electronic imaging software is a big cost concern in the US and Japan but again it surprised me to learn that it is also a problem here. I think one cause of the increase in unnecessary health care expenditures here in Brazil could be that SUS provides health care coverage to everyone in Brazil and doctors are going unchecked. Doctors get rich by performing procedures and charging SUS or private insurance companies (we have similar problems in the States). In a country of roughly 200 million people, providing universal coverage requires increased monitoring of procedures and payments in order to avoid excess spending.

While Brazil and the US share many of the same cost and care concerns, a major difference in access to care between our two countries is health insurance. Brazil has national health care visiting a doctor is free, however, queues can be incredibly long. The US has private bases insurance, which can be expensive, and still a high percentage of the population is without any form of health insurance making a doctor’s visit very expensive. The collective health options mentioned above are great prevention strategies but a big problem is still visiting a doctor once infected, there is not a whole lot a doctor can do and in Brazil it could take hours to see a doctor and in the US it could cost a lot of money; and for what, the doctor to tell you to go home, rest and drink lots of fluids…that hardly seems worth all the hassle in either country.

I think the US could adapt several aspects of the Brazilian national health care system into our health system. The US is struggling to find a happy medium between public health care coverage and private insurance, while Brazil successfully utilizes both. Private insurance in Brazil is voluntary and picks up where SUS leaves off, but SUS still provides health care coverage to every person in Brazil, citizens and visitors. I personally think a hybrid national health care system is the best option for us here in the US as well. Since private insurance currently covers most Americans, developing a national health care system would provide coverage to everyone but private insurance would still be available to those who want, need and can afford it further coverage. Of course that opens up the argument that health care provided to those with private insurance is better than those under the national health care system. There lies the next step for public health practitioners in the US, making sure access and quality of care is the same between those using public health care services and those who have private insurance, everyone has coverage and those who want or require more can have it as well. I would call that a win-win.

This was my first study abroad program and it wasn’t exactly what I imagined. I knew we would be taking classes at the Federal University but what I wasn’t expecting was to learn so much about Brazils national health care system and from my understanding of their health care system get a better understanding of national history and culture. My favorite part of the trip though was taking what I was learning in classes at UFBA and turning around and asking my host family what they thought about SUS and other government programs. Living with a host family definitely added to the overall experience. It allowed us to take knowledge learned in the classroom and directly apply and question it at home. I think I gained a good understanding of Brazil national health care because in class I learned the policy and good intentions of SUS and at home I was able to get a practical and personal understanding of the pros and cons of the system. Hearing the negative opinions from my host family was surprising because everything we learned in class about SUS sounded good and promising. Sometimes good intentions and policy can be lost during implementation and utilization of a program. This realization shows me the importance of program evaluation. Just like any program or policy implemented SUS the successfulness and positive/negative feedback for a national health care system needs to be evaluated. Only through evaluations can improvements be made resulting in a better and more successful program. The voice of the people is important when it comes to national health care. Everyone has different needs and wants; it is important that the government listens and makes corrections as necessary.

Public health aims to prevent disease while collective health wants to prevent disease and promote health together. Collective health is social movement that encompasses various practices including, political and policy, theory and ideology, social and economic context. The US can learn a lot from the Brazilian national health care system.

 

Police brutality is a newly publicized social issue in the States. I wanted to learn how Brazilians see their police force. I have always been interested in police culture in other countries. I travelled to Venezuela a few years ago and was told not to trust the police or the military, especially as an American. I was really interested to learn how Brazilians view police, if they trust them or fear them.

In the three weeks we have been here we have been exposed to several depictions and points of view regarding Brazilian police. Our tour guide, Freddy, lives in a favela and teaches Geography at a very poor, mostly black public school. I asked Freddy how he regarded the police in his neighborhood and his reply surprised me. He said, “as a Brazilian, I fear the police.” Freddy is a well-educated, well-dressed, law abiding citizen. What reason would he have to fear the people sworn to protect him? When we visited Bagunçaço, Joselito Crispim the director, explained that when neighborhood kids see police they either run in the opposite direction or towards the drug dealers because they feel safer with drug dealers than with police officers. He told us a story; one day he saw two police officers walking towards him and he was more afraid that they would arrest him than arrest the drug dealers standing on the corner dealing. Police corruption was vividly depicted in Cidade de Deus. Towards the end of the movie, opposing gangs were getting mass amounts of guns from a singular dealer; we the viewers didn’t know who was supplying the guns. It was eventually revealed that the supplier was a group of dirty cops. The corrupt cops arrested one of the gang leaders just to release him once he paid what he owed. After being shown so many examples of corrupt police, I began to assume that the whole Brazilian police force was corrupt and something to be feared.

A Police Lieutenant spoke to us about urban violence and community outreach programs sponsored by the police. This was the first time I had heard any positive actions by Brazilian police. He explained to us that programs, such as his, want to show communities that police shouldn’t be feared and their primary goal is to protect people. His program sponsors annual beauty pageants and this year’s winner received a full scholarship to ACBEU. On Mother’s Day, the program sponsored a barbeque. Mother’s Day is the second largest holiday, after Christmas, in Brazil; the program is smart to use this day to reach out and celebrate all mothers in the community. I believe it is important to reach out to mothers because they are instrumental in educating their children at home not to fear police. During our final presentations, Omenka spoke about all-women police stations, a program that started in São Paulo but has spread across all of Brazil. These stations provide a safe place for women to report sexual or abusive crimes without the fear of male bias or negative backlash. Woman collect statements and women investigate. It is an example of how Brazil is working to empower and protect women in the modern world. I see the development and further spread of such stations as a positive influence on how women and communities will see police.

There is still a long way to go till police officers are trusted and respected fully in Brazil. While touring a school in Calabar with the Police Lieutenant, he told us a saying known in Brazil, “the police are loved only by dogs, drunkards and children.” Targeting the way mothers and women see police, I think, is an important first step towards changing the way all of Brazil sees police. Women spend more time with children than men and changing the way the next generation sees police can lead to better candidates for recruitment and lower the amount of corruption.

It has been almost two weeks since arriving in Brazil. I have found that Brazil shares many of the same resource privileges as the United States, however, our appreciation towards these resources differ both collectively and individually. I have focused on the different usage and appreciation towards electricity and the common utilization of health care.

You don’t appreciate what you have till it’s gone. This idea is something I have experienced throughout many of my travels in other countries but it always takes me by surprise. Most people in Brazil have electricity but unlike Americans, I feel that Brazilians are still mindful of the fact that electricity is a privilege. Homes do not have air conditioning. Instead they open windows and turn on fans. Air conditioning is not viewed as a necessity (even in a country so close to the equator). While American’s switch on the AC the minute the seasons change. Hot water for showers is also not of major concern. Electronic showerheads heat the water slightly but the steaming hot water I use every morning in the US is not available to me here. Of course with temperatures in the 80’s most days I appreciate a slightly cooler shower when I get home. Lights are not left on when no one is in a room. Hotels control their electricity by requiring a key card to turn the electricity on in the rooms. The key cards are either the room key itself or attached to it, so to have electricity someone has to be in the room. While washing machines are a new common household appliance, dryers are not. Similar to AC, dryers are not viewed as necessary. Clothes are left hanging in front of a window to dry in the same breeze that cools down the home.

The wasting of resources is not something that I expect from Brazilians, at least in the homes. However, I was surprised to learn that Brazil shares similarly high rates of elective caesarian sections during childbirth, organ transplants and electronic imaging usage as the US. I was specifically surprised to hear that Brazil, a country where I expect more natural births, has succumbed to the same over utilization of C-sections. From what we have learned, it is not necessarily the mothers who elect for C-sections but the doctors who prefer scheduling births during business hours. The unnecessary and over use of electronic imaging software is a big cost concern in the US and Japan but again it surprised me to learn that it is also a problem here. I think one cause of the increase in unnecessary health care expenditures here in Brazil could be that SUS provides health care coverage to everyone in Brazil and doctors are going unchecked. Doctors get rich by performing procedures and charging SUS or private insurance companies (we have similar problems in the States). In a country of roughly 200 million people, providing universal coverage requires increased monitoring of procedures and payments in order to avoid excess spending.

It is not that Brazil is without access to many of the same resources as the US; it is that many Brazilians still appreciate what resources they do have, I think, more than American’s. This appreciation helps cut down on surplus spending; something the average American consumer fails to think about when flipping the switch on for AC, taking a hot shower or drying clothes. I’m not sure if I appreciate having unlimited electricity more or less after these two weeks and I wonder how quickly I will jump to turn on my AC, take a hot shower, or dry my clothes when I return to the States.