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Primary Health Care is Care First, Health Second

The Story of Dr Vera Cordeiro and Saúde Criança in Brazil

In the modern day of doctor-patient confidentiality and the computerization of medical records, there is little chance of a whole family visiting a practice for advice, or the merrygo-round of doctors being able to spot and act upon a root cause from people who live in the same place. The ‘sticking plaster’ solution gets people back on their feet again and allows them to get on with their life until the next illness crops up, but does nothing to provide or promote an environment that makes these illnesses less likely. In many parts of the world, especially the poorer parts, there has to be a sea change in how medicine is administered. This is where pioneers like Vera Cordeiro come in.

Saúde Criança Association (ASC), is an independent social organization founded by Dr. Vera Cordeiro in 1991 in Rio de Janeiro, Brazil that pioneered an innovative methodology to assist poor families that have a sick child undergoing treatment at a public health facility. The crisis becomes real when the pre-existing challenges of poverty worsen with the need to care for the child’s health, threatening the family’s integrity even further. ASC promotes self-sufficiency of Brazilian families with children suffering from acute and chronic disease typically linked with poverty. Saúde Criança’s program, the ‘Family Action Plan’ (FAP), adopts an innovative methodology: it is based on the principle that poverty is one of the important causes of disease. The causes of poverty and illness are multidimensional. The plan, which consists of a multidisciplinary team exerts integrated actions in the areas of health, education, citizenship, housing, and income, and is built based on each family’s needs. Besides overcoming the immediate difficulties inherent to the child’s post-hospitalization phase, the entity’s goal is to offer orientation and opportunities so that the family unit has its rights guaranteed and can enjoy a reasonable quality of life.

Saúde Criança fights for social inclusion by promoting human development. The crucial element of the methodology and one of the keys to its success is the family’s active participation elaborating the plan, objectives, and goals to be met during each phase over the two years in which it is part of the program. Every family is assisted individually, according to their needs and potential, during a period of approximately two years. The family’s progress is tracked during regular meetings with the Saúde Criança team with the objective of helping the family achieve dignity and autonomy.

In alignment with the World Health Organization’s definition of health, Dr. Vera feels that, ‘Healthcare is the promotion, prevention and maintenance of health as well as the diagnosis and treatment of diseases that can affect the human being. In this field of knowledge, it is very important to promote biopsychosocial well-being. And for this to happen, it is not only necessary that the patient is extensively analyzed as per traditional medical knowledge, but also through a lens that allows various levels of diagnosis and treatment including spiritual and psychological development, and knowledge of the conditions of life to which the patient and their families are submitted. Therefore, housing, income generation, education and citizenship are some of the crucial areas that should be integral to the patient’s treatment and diagnosis.’

And it is the words ‘dignity’ and ‘autonomy’ from the description of what Saude Crianca stand for, from earlier in the chapter, that ring out the loudest when you read on. Being well used to be something that was handed down from one generation to another with the health of the family being considered highly important by the elders
as those, that followed would be looking after them in their old age. We now expect specialists to do this for us.

The pressures on the budgets of modern medicinal practices mean that the simpler ailments to treat should be a matter of public knowledge, rather than kept a deep and dark secret by the medical community or leaving people to take a chance on the internet and hope the advice they read works.

Dr. Vera Cordeiro worked for nearly 20 years as a doctor in one of the largest public hospitals in Rio de Janeiro and she was upset and annoyed that much of her hard work was going to waste. She would attend to young children and get them out of a critical situation. Many would present to the hospital she worked in with infectious diseases and through her arduous work and the team around her, she would be in a position to send them home with the disease in check. But then often, far too often for this modern world, she would see them return with the same disease or find out that they had died from that disease at home. She couldn’t keep working along the same lines of fix and fail. She could no longer stand back and watch a system that didn’t provide long-lasting results for people. She knew a change had to come. In fact, she knew that she would have to enact this change from outside the current system to stand any chance of making a difference in the life of the kids she treated.
So, with a sense of adventure and the never-say-die spirit she still has today, Dr. Cordeiro sold many of her belongings and set up the not-for-profit organization that is Saude Crianca today. She recruited volunteers and trained them to work with families that needed the extra help and support that would take them away from the cycle of
illness-treatment-illness that was widely prevalent. They provided basic supplies that were not present before and built people up enabling them to gain a better control of their own medical destiny.

Putting families in control of what they do, where they live, what they eat and other factors based on education means they know what they want for themselves and feel confident to go out and get it. The feeling of helplessness is all-consuming in the world that Dr. Cordeiro knew before the program she built was rolled out to the masses. Families just lurched from one disaster to another with
the support of the medical community to bandage them and send them back to their prevalent circumstances. No more.

As many diseases are caused by poverty, and poverty is a multidimensional issue, the multidisciplinary work of Saúde Criança is at the heart of social inclusion and the promotion of human development.

Read more about Saúde Criança and other innovators in “The Healthcare Gamechangers, 12 innovators around the world reimagining healthcare”

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