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Cloudy and gloomy times that we are living. At the time of publication of this article, Covid-19 will have already taken more than 210 thousand lives worldwide and more than 6 thousand lives in Brazil. Not to mention the huge underreporting that is beginning to unfold, especially in emerging and poorer countries. National health systems are being tested to their limits. The entire world is in a challenging moment. The current crisis promotes the perverse combination between the violent coronavirus pandemic and the specter of an unprecedented and devastating economic crisis.
Fortunately, in health, with all the ailments and problems, SUS is a unified and coordinated national system, with capillarity and decentralization of actions. He always suffers from the chronic problem of lack of resources, but heroically resists and faces the epidemic. Complementary health complements public actions that serve 47 million Brazilians. But the health system can collapse. The result is not only worse thanks to the correct policy of social isolation led by the former team of the Ministry of Health, by governors and mayors.
I could dedicate myself, in these lines, to discussing the political crisis resulting from the departure of Minister Sérgio Moro, the permanent conflicts, rekindled in recent days, between the powers of the Republic, the lack of leadership in health and economy, as a result of the internal problems of the federal government, the geometric expansion of the epidemic among us. But I preferred to honor the thousands of health professionals and managers who at this moment defend, with great difficulty and with enormous sacrifices, our lives, in the people of two great protagonists in the history of SUS: the great sanitary Eugênio Villaça and former Minister Luiz Henrique Mandetta. After all, SUS’s mission is to take care of people and their actions are carried out by people, and among them, some have an outstanding leadership role.
Eugênio Villaça completed, in the last 24, eighty years. Coming from his Pará de Minas and inspired by the experience of his father, who developed social work in a childcare position, he made the explicit commitment in the thanks in his book “As Redes de Atendimento a Saúde”, one of his main publications among young people. dozens more: “health projects demand love from their subjects, especially from the most humble people.” He graduated in Dentistry from UFMG and became a recognized surgeon in Belo Horizonte and professor at the university. A turning point in his life came from the course he took at the National School of Public Health, specializing in health planning. He abandoned his promising career as a dental surgeon, who would give him a much more peaceful material life, to dedicate himself body and soul to public health.
Practice without good theory is blind. Theory without transformative action is sterile. Eugênio became one of the most important toilets in Brazil, one of the authors most read by SUS managers and professionals, and worked in hundreds of Brazilian municipalities and in notable experiences in Paraná, Ceará and Minas Gerais. Eugênio Villaça concentrates a rare combination of qualities: rigor and intellectual quality, existential concern, public spirit, accumulated experience, creativity, personal integrity, acute critical sense, social commitment, militant spirit and capacity for work and leadership.
It has always been a reference for multilateral organizations such as WHO, PAHO, IBRD, IDB, and international cooperation agreements. At 80 years old, he continues to be the main consultant to the National Council of Secretaries of State (Conass) and contributes to the evolution and to overcome the bottlenecks of this victorious public health policy called SUS.
I always knew that SUS was a collective work in permanent construction, as in the choice of João Cabral de Melo Neto’s poem to open one of his books that “a rooster alone is not woven in the morning, he will always need other roosters … so that the morning, from a fine network, is woven between all the cocks. ”SUS is the work of thousands and has influenced and qualified many of them.
He fought and fought for the primacy of primary care as a center of gravity that regulates comprehensive health care networks and warned, not by theoretical intention or preciousness, about the imprecision of some concepts, such as low, medium and high complexity or the Basic care, as if The primary level of care was not central and could be dismissed as trivial, simple and unimportant. I remember him questioning our team in Minas Gerais: “What is more complex about a transplant or making a person stop smoking or drinking excessively?” And he added: “Neither of them are complex. One dense in technology, the other in cognition and human relationship ”.
In his focused optimism, he coined a phrase that became a mantra in Conass: “SUS is a problem solution and not a problem without a solution.” In Eugenio Villaça’s eighty years, the tribute to all the health workers who promoted with their ideas the construction of the Brazilian public health system, which heroically defends us from Covid-19.
Luiz Henrique Mandetta is an orthopedist, born in Mato Grosso do Sul, trained in pediatric orthopedics in the United States. He was the municipal secretary of Campo Grande, director of Unimed there, federal deputy from 2011 to 2018. I shared with him for eight years on Wednesday mornings at the Chamber of Deputies Commission on Social Security, Health and Family. I was the most “caxias” in the whole class, and look, I was also very applied. But he was the only one, the only one, who studied all the projects on the agenda the day before. Serious, dedicated, intelligent, experienced, studious, competent and enthusiastic about the struggles for health. At 54, in 2019, he was appointed Minister of Health.
We had great health ministers such as Adib Jatene José Serra, among others. Mandetta became part of the list of the best ministers in all of our history. Crises shape great leaders. During the coronavirus confrontation, Mandetta became a reference for the Brazilian population. With his charisma, professionalism, seriousness and communication skills, he managed to mobilize the country around the only available strategy to face the pandemic: social isolation. He earned the trust and admiration of millions of Brazilians. He left a great void with his departure.
There are no simple solutions to complex problems. Building a public system of universal access and comprehensive medical care is not easy in a country that has public investment per capita three times less than Portugal, four times less than Spain, seven to nine times less than Italy, Canada and the United Kingdom. United and France. If it is true that SUS has serious limitations, mainly financial, it would be impossible to imagine defending life against the aggressive Covid-19 pandemic without the existence of SUS.
These 31 years of SUS construction are the work of thousands of managers, health professionals, and health advisers, spread anonymously in each of the Brazilian municipalities. But its relative success is largely due to the ideas and actions of people with Eugenio Villaça Mendes and Luiz Henrique Mandetta. To them our tribute and gratitude.
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