Being Sick in Brazil: My Venture into The Public Health System

Libby Parker-Simkin - Brazil


January 6, 2014

Just before Christmas, I got quite sick. It started with a sniffle and sore throat and escalated to a nasty upper respiratory infection. After a few days of being miserable, my host family took me to a Pronto Atendimento, Brazil’s version of an urgent care center. I went through the triage process, got my forms filled out and my vital signs read, and took a seat in the waiting area with everyone else. It was a Sunday evening, so there were other patients, but the place wasn’t ridiculously crowded.

I waited. I looked around. The place smelled like a hospital: Harsh disinfectant, disease, medicine, and people. The arm of my chair was inexplicably covered in bite marks. The guy next to me looked like he was dying. He was doubled over in his seat with a hand wrapped around his face, squeezing his temples like he was trying to keep his head from exploding. Every so often he shuddered. He might have been crying. Across from me, a mom smoothed her daughter’s hair out of her face. The girl was no older than four, wearing an IV that looked huge on her tiny wrist. As I waited, another man hobbled in, wincing with every step he took. It was both familiar and unlike any waiting area I’d ever been in. Everyone got a wristband with their triage level, from blue for not that bad, to red for emergency. Above orange, an ambulance took people to the nearest public hospital, São José, about ten minutes away. My color was green. The headache man had a yellow wristband. So did the girl with the IV. Eventually, my name was called and I went into one of the examination rooms.

My doctor was very nice. He muddled through my lack of Portuguese medical terms as I described coughing and having “stuff” in my sinuses and my lungs. He listened to my breathing, and told me he was going to order a chest X-ray, “just to make sure it isn’t pneumonia.” I swore internally, thinking about the difficulty of getting one. I would probably have to go to the hospital, X-rays are expensive, and I would probably have to wait a few days for any sort of diagnosis or treatment. He wrote his X-ray prescription on a slip of paper and told me to take it to the front desk. I did, reluctantly, thinking that the man there would probably give me a list of places I could go to get it done. Instead, he told me to go down a hallway and wait by the door marked “Raio-X.”

The chest X-ray was quick and easy, and I took it back to the doctor, who read it and told me I wasn’t dying and it wasn’t pneumonia. He wrote me several prescriptions, and told me to drink lots of fluids and eat my vegetables. He even let me keep my X-ray film.

In two hours, I saw a doctor twice, got a chest X-ray, had it read, and got a diagnosis and prescriptions. I went to the public health post, so all of the care was paid for by the Brazilian government. (Thanks, Brazil!) In the US I would have gone to see my GP, she would have listened to my lungs, and probably prescribed a nebulizer treatment and antibiotics. If she had asked for the X-ray, I would have had to go to the hospital, get the X-ray, and then wait several days for a radiologist to read it and tell my doctor the results. My doctor’s office would then call me and tell me what to do next. The whole process would take several days and cost a significant amount of money (Chest X-rays in the US cost an average of $370).

The difference between the American and Brazilian healthcare systems is that Brazil considers access to healthcare to be a constitutional right. Under the national healthcare system, the Sistema Único de Saúde, anyone can go to the public hospitals or urgent care enters and get free or discounted medical treatment for everything from illness to injuries to cancer. “Breaking Bad” type stories about people who can’t afford their medical treatments don’t happen here. Brazil’s public health system also encourages prenatal care and child vaccinations, which has helped decrease the under five mortality rate from 94 per 1000 in 1980 to 14 per 1000 today. The system is not without problems. There are long waits. The quality of care varies significantly from place to place. Much of the specialized healthcare infrastructure is privatized and inaccessible to those without private insurance. Brazil doesn’t have a unified standard for things like emergency procedure or ambulance attendance, and there are only 17.6 physicians for every 10,000 people. It isn’t perfect, but everyone has access to a basic level of care and no one worries about going to the doctor when they are sick.

Brazil is a democracy that’s less that thirty years old. It’s known for its disorganization and corruption. It’s ranked number 85 on the Human Development Index, with a score of 0.73. It also has a national healthcare system that provides a minimum standard for everyone while still allowing the option of private insurance. Why can’t we have that in the US?

Libby Parker-Simkin