Surgical treatment in the Amazon Md phd Fabio Tozzi.

Apresentação em tema: "Surgical treatment in the Amazon Md phd Fabio Tozzi."— Transcrição da apresentação:

1 Surgical treatment in the Amazon Md phd Fabio Tozzi

2 SUS universality equity Whole/Completeness Amazon / Indigenous Health

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4 Context - summary Low population density Great distances - scarce transport routes Difficulty of internalization - medical staff - low physician / inhabitant ratio Small investment in health ($/ inhab.) Small supplemental coverage (private health insurance) low currency circulation health services ill-equipped Injuries resulting from lack of access to health services and infrastructure / sanitation Microregion - aggravated indices

5 Live by hunting, fishing, collection of forest, and regional crops, being very low currency circulation; Framework of Social Exclusion and Lack of Policies minor illnesses become serious lack of effective intervention, with high rates of malnutrition and infant mortality; low coverage in basic health Only 7.5% with access to high school education; 47.5% of the population is under 15. No longer able to secure their livelihood due to deforestation;

6 Roads in North region-Logic of by the river health

7 different laws and rules for territories

8 v v Percentage of municipalities in terms of number inhabitants. IBGE-senso 2010

9 Distribuição de médicos (coorte 1990 a 1999), segundo local de domicílio ou trabalho – Brasil, 2013 Distribuição de médicos (coorte 1990 a 1999), segundo local de domicílio ou trabalho – Brasil, 2013 Fonte: CFM; Pesquisa Demografia Médica no Brasil, 2013. inside of Pará, there is a higher average ratio of the country (1/4466 inhab.), performance results from the fact that 73.3% of the active state doctors are concentrated in the capital Belém, which meets only 20.4% of the state population doctor / population ratio

10 HDI (Human Development Index) States density Demographi c household head Not literate(%) house with sanitation (%) House with / supply water(%) HDI – M Acre3,6529,0419,5036,090,692 Amapá3,3318,076,1550,750,751 Amazonas1,7922,1520,0060,030,717 Pará4,9623,117,4042,640,720 Rondônia5,8016,173,6930,750,729 Roraima1,4517,5810,7179,240,749 Tocantins4,1722,432,7566,260,721 Maranhão17,0032,009,2152,950,647 MatoGrosso 2,7714,9515,6663,670,767 Amazônia Legal4,9921,7210,5653,600,721 Brasil19,9216,7347,2477,820,764

11 Government spending on health UF FederalstateMunicipialityTotal Por habitante Total Por habitante Total Por habitante Total Por habitante RO 186118,95179114,3910869,17473302,50 AC 149240,86133213,933758,86319513,65 AM 362115,01702222,8922069,781.284407,68 RR 66172,6385221,402976,79180470,82 PA 704102,7343663,7030544,551.445210,98 AP 77140,90142259,632850,65247451,18 TO 187148,47186147,4611288,34485384,27 MA 636105,6037462,0823138,341.241206,02 MT 354128,68345125,35293106,42991360,45 Amazônia Legal2.721110,992.580105,261.36155,536.664271,78 BRASIL33.703180,1016.03288,3016.36990,1565.105358,55 Total expenditure in million; expenditure per capita real. Fonte: MS/SCTIE/DES/SIOPS/SPO/SE/FNS/IBGE

12 UFBeneficiáriosPopulação % Cobertur a Rondônia84.4501.590.0015,31 Acre41.381703.4325,88 Amazonas496.7923.389.07214,66 Roraima9.633415.2812,32 Pará658.4497.249.1609,08 Amapá57.584636.6549,04 Tocantins50.3531.358.9223,71 Maranhão285.2376.265.0774,55 Mato Grosso286.2952.910.2649,84 Amazônia Legal1.970.17424.517.8638,04 Brasil46.225.819189.335.18724,41 Fonte: ANS/ Período:Jun/2007 Health supplemental coverage (private health insurance)

13 Low complexity medium complexity low investment High Number users 900admissions/250surg/month 800.000hab 300,000 + / 3.5M.R$/month per capita investment $$ Trauma/Emergency/Diabetic foot High complexity Santarém City- case report 240 doctors/300.000hab/1.200.00 high investment low coverage few beds (130) Only400admissions/350 surg. / Month Difficulty of access 1.200.000hab / $ 9M.R$/month percapta investment $$$$$$ Cancer surgery / neurosurgery general Trauma orthopedic complex surgery ultra low investment low coverage 30% 30 Family health teams 300.000hab / 1.5 M.R$/ month per capita Investment $ 14 +Doctors-3provab only 1 medical consultation/year/inhab HAS/Diabetes/parasitose / mal nutricion Water born diseases 1US=2.25Real

14 Surgery Suppressed Demand Media-STM Rural areas = NO ACESS Orthopedic surgeries Cholecystectomies / Hernias / Varices -vascular Ophthalmic surgery 5.000

15 Strategies knowledge Technology Research 1-Abaré 2-Use of technology for special areas 3-Surgery journey/Task force 4-New therapies How to solve this problem?? public health policies

16 The Abare in Primary Health Care for People of the Forest PUBLIC POLICY 2010 - ministerial decree 2191- ESF Fluvial 2014 Ministry of Health resources transformation into a Teaching Hospital

17 -Region of Western Pará - 3 Municipalities - 150 Communities - 30,000 beneficiaries DEFINED TERRITORIALITY MOBILE HEALTH UNITS ABARÉ: since 2006 / Tapajós New boat: 2009-10 / Arapiuns

18 ABARÉ – Fluvial Family Health Team Results Fonte: Brasil, Norte, Pará – DATASUS (2007) Abaré – Sosniski, Cristina (2008), Pesquisa Socioeconômica e de Saúde, e Relatórios do Abaré

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20 We We need preserve and help them ! ZOÉ laparoscopic colecistectomy one day 6 surg.

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22 Pilot study to evaluate the treatment of varicose vein with polidocanol treatment of choice for inland areas: Task force/Journey to eradicate varicose vein in Municipio de Juriti -Pará (April 9 Hospital and City Hospital Juriti) Fabio L. Tozzi FL, Campos W jr, AzevedoER,Pedrosa A. Ana Marcia. ONE DAY 130pacientes 5US$/each one

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24 ! Obrigado! Thanks 240Medical students 10 courses of medical residency

25 The important thing is not to give the fish but teach to fish!