[ProCOR] Case for Prevention: Porto Alegre, Brazil

De: procor-bounces@healthnet.org [mailto:procor-bounces@healthnet.org] Em nome de Coleman, Catherine
Enviada em: quarta-feira, 1 de junho de 2005 09:38
Para: procor@healthnet.org
Assunto: [ProCOR] Case for Prevention: Porto Alegre, Brazil

Porto Alegre, Brazil demonstrates a model of multi-sectoral partnerships and multi-level approaches to promote cardiovascular health. Other cities and countries are encouraged to share their models through ProCOR in order to inform and inspire the efforts of others.

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Nurses and nutritionists, epidemiologists and neurologists, cardiologists and communicators, primary care physicians and public health professionals, government officials and staff of NGOs, recently convened in Porto Alegre, Brazil, to discuss the city's model of CVD prevention and control. The participants represented a microcosm of the sectors of society that contribute to health. In Porto Alegre, multi-sectoral partnerships bring together diverse groups to promote health in multidisciplinary ways and on multiple levels.
National policy, community interventions, and medical care-family medicine, primary care, specialists, and emergency-are working together to develop a range of innovative programs that serve the poorest pockets of Porto Alegre and the richest.

The International Meeting on Cardiovascular and Cerebrovascular Disorders Prevention and Control in Porto Alegre, Brazil on May 19 was convened by Dr. Aloyzio Achutti, Amicor, and Dr. Jefferson Gomes Fernandes, Director, Institute of Education and Prevention, Hospital Moinhos de Ventos. Participants from World Health Organization; Brazil's Ministry of Health; Hospital Moinhos de Ventos in Porto Alegre, the Institute of Research and Prevention, AMICOR, and ProCOR demonstrated the power of linking health care with social change.

Underlying Porto's Alegre's activities is the support of the Ministry of Health. On the national level, Brazil is putting in place legislation and policies that provide impetus to efforts to create healthy environments. Brazil has the largest public health system in the world. Brazil's national health policy is currently in final review by its Health Assembly, and free nicotine replacement therapy has just become become part of the public health system. On May 25, a national day promoting physical activity and nutrition was celebrated across the country.

A "quality of life" map of each of the more than 2300 census blocks in Porto Alegre guides the city's planning. Indicators such as age, literacy, employment, electricity, number of inhabitants, access to sewage disposal and garbage pickup, presence of health care facilities and their capacity to meet demand, are analyzed and assigned to each census block in values ranging from 1 (worst) to 5 (best). The census blocks can be reviewed individually, providing an immense amount of detail, or can be aggregated into clusters. Indicators also can be overlaid onto one another in various combinations.

The outcomes of this planning target the specific needs of each area of the city. For example:
* On an outlying island, programs to provide water treatment, sewage disposal, and electricity accompany a family medicine clinic's services, which include home visits to each resident by a trained member of the clinic staff.
* The hospital is building its new laundry facility in a poor area of the city. Although the facility is several miles away from the hospital, the location was chosen because it will create more than 300 jobs for nearby residents and the hospital realizes that health benefits will follow when more employment is available.
* A 24-hour emergency clinic recently was established in an empty building in an area of Porto Alegre that experiences a high incidence of violence and injuries. The Institute of Education and Prevention has developed a one-year program for individuals planning to enter medical school which includes an orientation to community health and a patient-focused approach to their future profession.
* Primary care, dental care, and a wellness clinic are available in a hospital branch located in an upscale shopping, increasing ease of access to preventive services by including health care among residents' everyday errands.
I was struck by the balance I saw at Hospital Moinhos de Vento between their successful strategy of creating a "hotel" atmosphere in their private hospital facility and their success in providing the same level of care at the public hospital. Many cardiologists with whom I spoke emphasized the importance of balancing an emphasis on the use of clinical skills and multi-disciplinary medical management of cardiovascular disease while incorporating the latest technology in appropriate ways. The "rush to refer" that is overtaking much of American medicine did not seem to dominate the model of care described at Hospital Moinhos de Vento. One physician asked, "Why should we prescribe the latest, more effective, most marketed drug when older medications work better, are cheaper, and have a longer track record." Another physician said, "We need to recognize the important role of non-physicians. And we need to learn in new areas that were not part of our training, like how to counsel a patient on physician activity or nutrition." While the philosophy and vision at this hospital is not representative of all medical institutions in the region or the country, I was told that it is not the only Brazilian example of successful
integration of clinical care and community, of technology and the "art of healing."

Prior to the conference, on May 17, I celebrated the 8th anniversary of AMICOR with Dr. Achutti and his wife, Dr. Valderes Robinson, also a cardiologist. Dr.Achutti founded AMICOR in 1997 to establish a network of cardiologists, physicians, and health workers from Brazil, Latin America, and other countries.
Daily he links them to locally relevant information from Latin American and international sources. Information is presented in Portuguese, Spanish, or English. Dr. Achutti is currently exploring the potential of blogs to transfer
information among networks and he maintains an extensive email distribution list. ProCOR and AMICOR are part of an increasingly linked "network of networks" around the globe, in which interpersonal, institutional, regional, national, and global networks intersect with each other at common points of interest to proliferate the sharing of knowledge and connections among people.

Thank you to the many Brazilian colleagues who made me feel welcome, patiently explained what was unfamiliar and enthusiastically explored what was possible. I especially thank Dr. Achutti for his faith in all kinds of connections and his ability to make them happen.
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