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With an outstanding performance throughout the pandemic, Margareth Dalholm criticizes Rio’s management in the face of the crisis and values that the public network should have been used more efficiently. According to the researcher, who defends technical criteria for the appointment of hospital administrators, the last few months also show the importance of the capillarity of SUS and primary care, since most health problems can be solved with care. simple.
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I can’t help but talk about the pandemic in our early days, Margareth. How do you analyze that we are going through the crisis in Rio and what are the steps for the future?
I think we were in very bad shape compared to São Paulo. We have paid the price for the dismantling of the SUS in Rio in recent years. I usually say that we have a vocation for tragedy, because they are absolutely disastrous governments, one after another. Health is a sector that has shown inefficiency in the provision of public services, in addition to an enormous level of corruption. This mismanagement, especially in the field hospitals, was a scandal. Deviation in health or school meals, Gabeira, let’s agree that there is no way to forgive or justify. There is no forgiveness. This is just a hoax, there is nothing else.
Even the legislation should be more severe in these types of situations …
This is a heinous crime. On the other hand, not only to mention the negative aspects, we also had two very important moments in the crisis. First, a great recognition from the academic community of Rio. Then we have Coppe / Ufrj respirators that produce and patent respirators at low cost. We have the Oswaldo Cruz Foundation (Fiocruz), which is also here in Rio, producing millions of PCR tests. Second, a new fact that my generation has never experienced is the creation of new volunteers. In other words, we were clear that it was not possible to leave mass participation to control the epidemic in the hands of government agencies. The private sector would have to attend. And she attended. Perhaps not the size that social inequality and exclusion in Brazil require, but she attended.
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But, what do you think the epidemic teaches us to face the problems that already existed in health?
Rio has its own network of services, mainly of installed hospitals, which could have been much better used and used in the pandemic. But many of these units were municipalized, state-owned, and later scrapped. What we hope is the recognition of the error, since the network can be better used. See the Bonsucesso Hospital, recently affected by a fire. It is huge, with several beds and always underused. On the other hand, it is clear that it is necessary to recover the capillarity of the SUS. It is possible to solve 80% of health problems with unsophisticated care, that is, in the so-called primary care. And be attentive to the control of endemic diseases. In the case of tuberculosis, for example, Rio has one of the highest rates in Brazil.
Rocinha has a great impact, right?
Rocinha has an incidence of tuberculosis equal to that of Bangladesh. About 300 cases per 100 thousand inhabitants.
We know that health facilities offer spaces for political indications. How to deal with this problem?
I think there has to be transparency in administrations. The hospital director, or any kind of expense manager, cannot be chosen for purely political reasons. It has to have some merit, a proven scientific experience, a curriculum that fits that role. The criteria end up being totally wrong, there is no meritocracy in the process. Someone may be an excellent doctor, but not understand anything about public administration.
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To this political issue I add the provincial rivalry, which makes the relationship between municipal, state and federal entities too difficult, a fundamental factor for the functioning of health..
Political greatness is often lacking. Bahia is today an example of a paradigm. The governor is from PT (Rui Costa) and the mayor is from DEM (ACM Neto). They are political enemies, right? Even so, they acted articulate in the area, regardless of any divergence. It is an example of civility in this scenario of wild animosity in which we live.
The next mayor will have to face the issue of vaccination. How do you imagine the year 2021 on this issue and the issue of priority when it comes to immunizing people?
The vaccine will come out. Fiocruz will deliver the first batch of 30 million doses in January. The first group to be vaccinated includes people who have taken placebo in clinical studies. This is group 1. This is a human rights issue, it is legislated by international mechanisms. Then there will be the obvious groups, health professionals, everyone who works in the public and private network, and people with more fragile diseases. Later, the elderly and those with diseases called comorbidities. Groups that we call special vulnerability will also come, among them pilots, flight attendants, sailors, all those people who are capable of carrying the disease. I think this vaccination logic is not the problem, we know how it should be. The complexity lies in the need to vaccinate in two doses. That is, whoever gets vaccinated has to receive the second dose again between three and four weeks later. This requires the public to understand that vaccines are important. We, doctors, you, journalists and opinion formers, must neutralize this absurd, prejudiced discussion, which preaches ignorance, about not vaccinating.
We, as a society, owe a great debt to the issue of basic sanitation. An overdue public debt. To what extent can the promotion of basic sanitation help us in this field?
I gave an interview to “Forbes” magazine, and the journalist found it curious that a doctor said that the biggest problem in Brazil is basic sanitation. I explained that 40% of Brazilian schools do not have sanitation and that is exactly where our children are. I said that there are health services without sanitation. An example of attention to this issue is on the other side of the Guanabara Bay: Niterói detected that there were viruses in the city’s sewers. With a crisis diagnosis, capillarity and tests, he managed to control the numbers. Investing in sanitation in slums results in children not dying from leptospirosis.
How much better communication from opinion leaders can help public health?
Many doctors are prejudiced against the press, but the pandemic has shown that there is serious journalism. We have evolved, and the press too, today knows exactly who to ask in the sector. We need to be transparent in our communication with the public. If we can do it with firmness and a little sweetness, the better.
