‘There was a lack of a human side’, says Teich about Bolsonaro’s administration – 12/09/2023 – Balance and Health

At 66 years old, oncologist Nelson Teich is trying to separate himself from the image he became known for during the Covid pandemic, when he was Minister of Health for the shortest time in history: 28 days.

Now, he seeks to appear more as a health manager, focused mainly on providing consultancy and helping with the management of hospitals and health policies in the public and private sector. “Although I am a person focused on health management, my focus is on public management. Despite this, I understand that the Ministry of Health needs to look at health as a whole, not just the SUS [Sistema Único de Saúde]”, it says.

He states that he is not a member of any party, nor was he a member when he accepted the invitation from Jair Bolsonaro (PL) to head the Health department. Therefore, he does not regret having accepted the invitation, but he also does not regret leaving the position.

“I left because there was a lack of a humanized look. There was a human side there, of showing concern for people and showing that you suffered with them, which was fundamental, and it was missing,” said Teich, in an interview with Sheet in Rio de Janeiro, during the XXIV Brazilian Congress of Clinical Oncology, in November. The doctor received the Ronaldo Ribeiro Career Award in Clinical Oncology on the occasion.

Unlike other former ministers who passed through the Bolsonaro administration, Teich did not seek to launch himself into any political position after —Eduardo Pazuello, elected federal deputy for the PL; Luiz Henrique Mandetta, from União Brasil, ran for senator for Mato Grosso do Sul, but lost to Tereza Cristina, from Progressistas, while Marcelo Queiroga was elected senator for Paraíba, also for PL. Teich has already been working to help implement the Cancer Prevention and Control Law, which was approved by the Senate on the 22nd.

What is the lesson that remains, looking back now, from the period that you were part of Health? And how do you evaluate the current management?
It was a very difficult period [da pandemia]. There was a lack of a more technical, scientific vision in driving. That was a deadly mistake [da ex-gestão]. In all senses [se referindo aos mais de 700 mil mortos pela pandemia no Brasil].

The current administration has more focus on health than the previous one, which is also a consequence of the previous government focusing more on ideological issues above anything else.

Mr. Do you regret accepting the invitation?
No way.

And do you regret leaving?
No way. My departure was not due to chloroquine; chloroquine only showed what the government’s approach would be. My departure was because I couldn’t lead and lead as I should.

What, subsequently with the other ministers, became clear…
Exactly. It was clear. Unfortunately, there was this accumulation of deaths largely because of this too. This probably occurred in other areas [a interferência na condução], but we didn’t see it, while health is very evident, especially in the middle of a pandemic. There was a human side there, of showing concern for people and showing that you suffered with them, which was fundamental, and it was missing.

What is the outlook for cancer in Brazil?
Our health management cannot keep up with the evolution of complexity [nos tratamentos], innovation and cost. The government spends, per patient, around R$2,000 per year for the SUS, if you look at the United Kingdom, it spends around R$21,000 (equivalent to £3,500). Therefore, it is not possible to think only from the perspective of public health, because we also need supplementary healthcare, which is, in itself, very heterogeneous.

So one thing I’ve been discussing today is that the government cannot position itself as the ‘Ministry of SUS’. It has to be from the country, it is a mistake to assume that just because someone has health insurance they are well valued, or that they will not depend on the public at some point. We saw this in the pandemic.

It is clear that those who depend exclusively on the SUS need more support, and we have a large number of municipalities in Brazil whose GDP per capita is below the poverty line. But these people depend on the State in all spheres, not just health.

That’s why I’m working on the Cancer Prevention and Control law, because it’s important to get something to happen in practice, to get off the ground. What you have most today are laws that are on paper, but do not happen in practice, in relation to cancer prevention.

Nowadays, there is no average Brazil. You have to work regionally.

What remains to be done when we talk about prevention and health promotion policy?
When we talk about prevention, we need to define what we mean. Because if you take primary prevention, which is preventing the person from having the disease, it’s one thing. Now, when we talk about early diagnosis, that’s another matter, and the SUS needs to move towards this.

There is no point in saying that people have to eat well, exercise, rest, when the reality is that we have 21 million people going hungry and more than 70 million are food insecure, they don’t know if they will be able to eat. Around 15% do not have drinking water. If you want to ask how many portions of fruits and vegetables a person is eating, if they don’t even have money to buy natural foods, how are we going to make this change?

What I think is that this prevention, in theory, is perfect, but as a public policy, the possibility of it working is almost zero. You have to worry about taking care of people who today are already demanding access to healthcare and can’t get it.

Is the biggest bottleneck that patients arrive very advanced? How to get around this problem?
Brazil has a prominent position in health in several areas, but it is difficult to maintain this. You have to be able to deliver that health management. Because when you carry out an early diagnosis program, there’s no point in launching it if you don’t prepare the system to take care of the person as a whole. So you carry out a mammography effort, but there are no surgeons to operate, you create a bottleneck. And there is also the issue of technology, whether there are the most suitable machines to carry out the exams, whether there are professionals who know how to use them, all of that. It’s not simple. There is a lack of doctors, a lack of health professionals, but there is also a lack of organization in the system.

When we discuss public policy, if you start to get into the details, there are so many things that you have to work on at the same time. And what I see today is that the discussions are a bit superstitious. They do not work with the necessary complexity. Covid came to show the weaknesses of the system, but this already existed for other diseases. However, as this information was not available [para a população]that wasn’t shocking.

_{The journalist traveled to Rio de Janeiro at the invitation of Sboc.}