by Doris Cikopana 18C
My first shadowing experience in Brazil occurred in the streets of Bom Retiro. It was my third day in São Paulo, my second official research day in the city, and my first day of shadowing Dr. Alessandro at the UBS, a primary health clinic in Bom Retiro, a neighborhood known for its large immigrant population. Usually, there is an UBS assigned to each neighborhood in Brazil. Though I had shadowed other doctors in Chicago and Atlanta on various occasions before, I had always done so within the context of a hospital–usually in a clinic, and in other instances in the Operating Room. Numerous patients stopped Dr. Alessandro as we walked to visit other patients in their homes to ask for general medical advice. Alexandra, another pre-medicine student from the US, and I met Dr. Alessandro at the clinic around eight in the morning, and soon after that, we started walking and headed on home visits with him and a community agent. Being pre-medicine students coming from a country with a very different healthcare system, my research colleague and I were in awe of what we perceived to be a different way of practicing medicine. We were struck by the fact that confidential medical information was being mentioned to the doctor on the street. At the same time, we were surprised to see the close-knit relationship between Dr. Alessandro and his patients. We were very interested in learning more about home visits and other aspects of the healthcare system in Brazil.UBS Bom Retiro: Photo Exposition created by Emory student Sara Kauko on the walls of the UBS Bom Retiro
UBS Bom Retiro: Hallway where usually patients wait to be seen by the doctor. Usually this space was always crowded with patients and medical professionals during my time at the UBS
The Sistema Único de Saúde (SUS), the Brazilian Healthcare System, offers health services to the population free of charge. All of the services offered by the UBS Bom Retiro, including home visits, doctor’s appointments, medications, etc. are free of charge independent on the status of the patient. Anyone who resides in Brazil, whether the person is a Brazilian citizen, a legal or illegal immigrant, has the right to access medical services.
My experience conducting research at the UBS Bom Retiro was enlightening for a variety of reasons. I was able to see a holistic approach to practicing medicine. At the UBS Bom Retiro, this meant that the medical team treated patients based on their emotional responses and psychological conditions instead of solely evaluating their physical wellbeing. An UBS is comprised of different teams made up of a doctor, a nurse, nurse technicians and community agents. The UBS also has a team of specialized professionals such as a psychologist, a psychiatrist, a physical therapist, a social worker, etc.UBS Bom Retiro: Meeting of one of the teams at the UBS
What struck me the most about the UBS in Bom Retiro was the time and attention that the professionals allocated to each patient. Throughout my time at the UBS, I never saw any of them give up on one of their patients. I had never seen more dedicated professionals than the team that I worked with (I had the opportunity to observe their weekly meetings and hear about each of their cases). Although many times the patients would not go to their doctor appointments regularly because of lack of time or other problems that would arise, one of the community agents would go to their home to make sure everything was going well with the patient. The community agents consistently encouraged the patients to attend consultations and make sure they were taking their medications. Based on my observations, I determined that Dr. Alessandro really valued the importance of explaining the medical conditions to his patients. He made sure to communicate with his patients in a way that they could easily understand. After having a conversation about this with him, he told me that the patients are more likely to follow his instructions if they understand their condition. During this experience, I witnessed a humanistic approach to the practice of medicine where medical professionals take into account and value many emotional, situational, and psychological factors other than just physical conditions. This did not only lead me to write my honors thesis, which explores the access to health services by those who do not speak Portuguese as a first language in Brazil, but it also inspired me to think about the kind of doctor I want to become in the future.UBS Bom Retiro: One of the consultation rooms (Dr. Alessandro’s usual consultation room)
Activity organized by UBS Bom Retiro: Community agent on the left and Physical Educator on the right are teaching Lian Gong to a group of young children at their school near the Luz Park
Doris Cikopana is a senior in the pre-medicine track, double majoring in International Studies and Spanish and Portuguese. She is currently writing an honors thesis on the inequality of access to healthcare in Brazil. Doris conducted her research during the summer of 2016 in a clinic based in Bom Retiro, São Paulo, traditionally recognized as a diverse neighborhood with a high population of immigrants. Her thesis explores access to government services in Brazil from the slave trade in the 18th century through the time of the military dictatorship, the creation of Brazil’s current healthcare system (SUS), and access to health services in Bom Retiro for immigrants.