I’ve never really had any interest in public health. I didn’t know anything about it—I knew that functional systems were in place in numerous countries but that they ran the risk of providing poor care or not having enough capacity. And so, while I marveled at the idea of free health care, the little I knew about it I associated with inefficient bureaucracy.
The first things I learned about public health in Brazil were through our university classes the first month in Salvador. The name of the system here is SUS—Sistema Único de Saúde—and it’s considered to be a pretty groundbreaking system of universal health care.
My past three months living with an Agente Communitario de Saude (ACS), or Community Health Agent, as my host mom, have both challenged and confirmed my preconceptions.
Let me first explain the role of an ACS—Raquel’s role in her community—because it’s fascinating, really. She is essentially a form of communication between the local health post, the Secretary of Health in Santo Amaro, and her area of work, which includes Nova Suica, Sito Camacari (the community next door to this), and Bela Vista (another MST settlement up the road). This means delivering exam solicitations, making monthly domestic visits, and counseling people who come with health concerns. She’s the one who makes sure people get to the hospital when they need to, who takes someone’s blood pressure if they’re concerned, and keeps detailed records of the whole community.
Then there’s the local health post. About three years old, this serves Nova Suica, Sitio Camacari, Bela Vista, and another community across the road, with what is basically a first-come, first-serve system, though you can come and make an appointment as well. There’s a dentist, nurse, and doctor, and they provide medicine and vaccines—all for free. I’ve seen pregnant women with pre-natal tracking cards, and mothers with baby growth tracking cards. The staff of about 4 women keep diligent handwritten records of everything, and in general everything seems to run smoothly.
But I’ve seen problems. Sometimes Raquel doesn’t get the chance to visit everyone in person, or at all. At the health post, the doctor, dentist, and nurse only come certain days for certain purposes, and one day my host aunt walked the 20 minutes to get to the health post for the dentist, only to find out that the dentist hadn’t come that day because there wasn’t any water.
Joel Segre made a great point to me when he came to visit: “Not being interested in public health is like not being interested in people. And sure, ‘public health’ might not spark any kind of interest, but if you zoom in on specific topics, suddenly you’re hooked.”
Seeing all these things first-hand has sparked in me an interest in health that I didn’t know I had—especially when I watch Raquel consulting the members of the community who come to the house for advice. She’s the local record office that keeps track of your vaccines, the caring aunt checking in on your progress after you fall sick, and the nagging grandma telling you to go to the doctor to take care of that. But her records, her advice and her reminders are all absolutely essential.