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Global Health
Brazil: Working toward equal health care
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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
globalhealthnews@musc.edu.
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.
Announcements
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
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