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Global Health

Brazil: Working toward equal health care

Editor's note: Welcome to the Global Health page. The purpose of this feature is to raise awareness of global health issues with an academic spirit to help improve the quality of care provided to patients. E-mail

by Marcelo Reyes, Ph.D.
Department of Neurosciences
Like the United States, Brazil developed as a big melting pot combining Portuguese colonists, native Indians, Africans and immigrants from European countries as well as others from Japan, Poland, and the Middle East. This multi-ethnicity can be observed not only in people’s appearance, but also in cultural aspects such as religion, music, cuisine, dance and other arts.
According to the Brazilian constitution, the state must provide free universal health care equally to all citizens and residents. A national health system was created to decentralize and break health care down into different levels. Primary care, the basis of the system, is offered directly to the local population, while more complex or specialized treatments are referred to better equipped hospitals.
Although Brazil has taken big steps to expand health care and reach nearly all of the population, it needs some improvement in terms of long waits to be seen by a doctor, disproportionate services throughout the country, and remuneration for professionals. Because of this, approximately 30 percent of the population can afford it and are covered by private health insurance and do not utilize the public health system. Paradoxically, in the case of rare or very complex diseases, several public hospitals offer state-of-the-art treatments.
When it comes to AIDS, Brazil has adopted a pioneering policy that sometimes is cited as an example for developing countries. The policy involves prevention, with massive educational campaigns and local distribution of condoms; diagnosis, with distribution of HIV test kits; and treatment, with free provision of antiretroviral drugs and psychological support.

Blindness, eye diseases an issue

by Antonio Carlos Rodrigues, M.D.
Botucatu Medical School, São Paulo State University
The eradication of blindness in children is one of five actions prioritized from the World Health Organization and inserted in the program VISION 20/20, aimed at blindness prevention and global eye health promotion.
An estimated 1.5 million of the world's children are blind and of these, 100,000 live in Latin America.   The two major causes of blindness in the world are cataracts and glaucoma. The prevalence of blindness for every 1,000 children (below 15 years old) is: 0.3 in rich countries, 0.6 in intermediary countries, 0.9 in poor countries and 1.2 in very poor countries. Among the most frequent causes of blindness in children are corneal scars in very poor countries, congenital cataracts and retinopathy of prematurity (ROP) in intermediate and poor countries, and genetic causes in rich countries.
Brazil has 30,600 blind children, 20 percent of them due to ROP and 20 percent due to congenital cataracts. Considered preventable and treatable diseases, the country has concentrated efforts on eradication of these diseases through the establishment of the Group ROP Brazil. Priority actions for this group range from efforts to prevent blindness in premature children, promoting immunization against rubella as well as the red reflex test on infants in all regions, and structuring centers for congenital cataract treatment.
Christ the Redeemer is a statue of Jesus Christ in Rio de Janeiro, Brazil. The statue stands 120 feet tall, weighs 700 tons, and is located at the peak of the Corcovado mountain in the Tijuca Forest National Park overlooking the city. It is the tallest of its kind in the world.

Botucatu Medical School, São Paulo State University (UNESP), and through funding from São Paulo State Research Support Foundation (FAPESP), conducted the dissemination, training and distribution of equipment for the red reflex test in the region’s cities. This hospital also is better structured with the purchase of equipment and staff training for the treatment and rehabilitation of children with cataracts.  
Within that training, we spent September through December in the MUSC Storm Eye Institute, for a Visiting Scholar Fellowship, following M. Edward Wilson Jr., M.D. [Storm Eye Institute director], pediatric ophthalmologist and researcher, dedicated to the treatment of pediatric cataracts.

Brazil facts
  • Brazil is the largest country in South America, the third of the Americas and fifth in the world.
  • Brazil is the only country in the Americas to speak Portuguese and has the largest population of Portuguese speaking people in the world.
  • 61 percent of the Amazon forest is situated in Brazilian territory.
  • Sao Paulo (the largest city in the country) has the second largest helicopter fleet in the world.


International Tax Seminar from 5 to 7 p.m. Feb. 12 at the Harper Student Center Auditorium.
Find the best way to file your taxes and get the most money back. Margaret West from Pinnacle 1 will share updates on international tax information. A 25 percent discount is offered to all MUSC ID holders. All MUSC internationals are invited. Light dinner will be served.

New Intermediate English Classes offered from 10 to 11:45 a.m. each Saturday at the Harper Student Center (across from the Office of Student Programs).
In addition to the Saturday advanced conversation classes with Dr. Bob Koepper,
an intermediate class has been added. The focus will be learning to understand American idioms and American speakers, grammar review and outings around Charleston to practice every day speaking. The classes will be taught by Mason Boyd.

Clinician’s corner

During a routine newborn exam, a patient is noted to have an absent bilateral red reflex. The mother is from the northeast region of Brazil, she has not been immunized against rubella and she has a history of contact with persons infected by the disease during pregnancy. The more likely eye diagnosis is:
A.  Corneal opacities because avitaminosis A   
B.  Retinopathy of Prematurity (ROP)
C.  Congenital Cataract      
D.  Bilateral Retinoblastoma

The correct answer C.
A congenital cataract may be caused by metabolic changes, associated with syndromes genetically transmitted, sporadic, or induced by intra-uterine infections such as rubella (most common), chicken pox, CMV, influenza, and syphilis. Vaccination of the population and prenatal care prevents infectious etiology of congenital cataracts.
The other causes of congenital cataract can not be prevented, but if the cataract is treated adequately blindness will be prevented. The early diagnosis through examination of the red reflex in newborns has a paramount importance. A child with bilateral congenital cataract should have surgery done between the fourth and tenth week of life otherwise his/her optical ways will not have proper development and the child will be doomed to low vision. In addition to surgical treatment, postoperative monitoring (especially in the first six years of life) is fundamental for a good visual development.
Prior to 2002, newborns in Brazil were not routinely screened for the red reflex. Since 2002 through the joint efforts of the Brazilian ophthalmologists, the red reflex examination is being circulated and is already required by law in many Brazilian states.

Friday, Jan. 30, 2009

The Catalyst Online is published weekly by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. The Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, Editorial copy can be submitted to The Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to To place an ad in The Catalyst hardcopy, call Island Publications at 849-1778, ext. 201.