What a British doctor learned in Pernambuco – 06/08/2023 – Health

English physician Matthew Harris is currently working in London on a project inspired by what he learned from the Brazilian Unified Health System (SUS) more than 20 years ago.

A year after graduating in medicine in the United Kingdom, he moved to Pernambuco in 1999 and, after passing the tests to revalidate his diploma in the country, he began to work as a general practitioner at a health unit in the municipality of Camaragibe, in the region metropolitan area of ​​Recife.

Harris remained at the clinic for four years. At the time, he had no idea that the experience would change his career – and even spark transformations in the UK’s National Health Service (NHS) two decades later.

He is currently a researcher at the School of Public Health at Imperial College London and leads a project that aims to implement community health agents, something that has existed in the SUS for decades, in British territory.

The doctor does not hesitate to say that this initiative is 100% inspired by the Family Health Strategy (ESF), a program created by the Brazilian Ministry of Health in the 1990s that remains active until today – and brings results that are highly celebrated by specialists in the field. .

Harris received the BBC News Brasil team in a room in the Department of Primary Care and Public Health at the university, located in the west of the capital of England, to share a little of his professional history and the British initiative inspired by the SUS.

the first steps

The general practitioner says that conditions in Camaragibe were not the best back in 1999. “I worked in a rural area with about 5,000 residents”, he contextualizes.

Harris classifies the first practical experiences he had in Medicine as “challenging”.

“I had just left university, I didn’t have the confidence to speak Portuguese and I had to do my work in a very poor community in the Brazilian Northeast”, he recalls.

“The clinic only had a few medicines sent by the council. It was a very different situation to what I was used to in the UK.”

Despite all the difficulties, Harris quickly realized something paramount. “Despite all the challenges and the lack of resources, we can still do extraordinary things in primary health care,” he says.

And, in his view, the link in this Brazilian public health chain is a professional called a community agent.

These individuals represent the cornerstone of the ESF (Family Health Strategy). Created in the 1990s, the program is based on the premise that such agents visit the homes of people in a specific region, neighborhood or city.

The objective is to understand and monitor the main health problems that affect those individuals – and, of course, to take this information to the nurses, nursing assistants, family doctors and general practitioners who are in the Basic Health Unit responsible for that location.

Contacted by the report, the Ministry of Health reported that the country currently has 49,172 Family Health teams, which are responsible for serving 167 million registered citizens (or 79% of the total population) in primary care services, which are considered by the government as “the gateway to the SUS”.

“When I arrived, I had no idea how the public health system in Brazil was based on these community agents”, admits Harris.

The English doctor gradually noticed how the information obtained by these professionals was useful in everyday life. “They know and understand the place where they work deeply, down to the smallest detail”, he points out.

“The community agents are the first to know about any changes that happen. And this information is used intelligently, before the problems become too big”, he adds.

Community agents undergo technical training courses organized by city halls and other bodies in which they learn about health promotion and disease prevention.

They will use this information during interviews and conversations during home visits. If they are trained and supervised by a nurse or doctor, they can also carry out simple tests, such as measuring people’s body temperature, blood glucose and blood pressure, or finding out whether drug treatments for chronic diseases, such as hypertension and diabetes, are in place. being taken.

Lives saved by information

Asked by BBC News Brasil about specific episodes that marked his career, Harris remembers the story of an 11-year-old boy who ended up in the emergency room.

“He had been complaining of a headache for several days. Unfortunately, the emergency service could only offer paracetamol and ‘hope’ for him to get better”, he reports.

But the work of a community agent changed that story. “During a routine visit, the professional noticed that the boy was still unwell and alerted us. His eyes swelled and he looked worse and worse”, he says.

When the boy was brought in for an appointment, Harris noticed two things: the blood pressure was abnormal and the child had a sore foot.

“By putting all these pieces together, I was able to make the diagnosis of post-streptococcal glomerulonephritis”, adds Harris.

This disease with a strange name is a complication that affects the kidneys of patients who have had an infection with the bacteria. Streptococcus.

In the case of this episode in Pernambuco, the doctor suspected the condition when adding the clues of the cut on the foot (an indication of bacterial infection) with low blood pressure and headache (which suggest something wrong with the kidneys).

“If he wasn’t diagnosed in time, he would probably have kidney failure and eventually die,” says Harris. “But the rapid detection from the community worker’s work literally saved that boy’s life.”

Back home

After four years in Pernambuco, Harris returned to the United Kingdom in 2003 with at least one certainty in his luggage: it was necessary to replicate the ESF in the British public health service.

And a task of this magnitude carries a series of symbolisms and meanings.

One of the main ones is the fact that the creation of the SUS in Brazil at the end of the 1980s was inspired by the NHS in the United Kingdom – and now these roles are inverted.

“Even before returning, I already knew immediately that I had learned something from the Brazilians and needed to share it. I needed to share and open the eyes of specialists about community agents”, he points out.

“Everyone needs to know Brazil’s successful model”, recommends the researcher.

But the mission proved to be more arduous than he imagined.

“Unfortunately, it took me between 10 and 15 years to explain the importance of a system like the ESF because people here are not used to the Brazilian reality and have wrong representations about the country”, he laments.

“But the truth is that the realities of Brazil and the United Kingdom are closer than one imagines. There are more things that unite us than elements that separate us”, believes the doctor.

“Of course, we don’t have diseases like leptospirosis, schistosomiasis and dengue here. But we also suffer from diabetes, tuberculosis, hypertension, depression, asthma, diarrhea…”, he compares.

Harris assesses that one of the factors that helped speed up processes and allowed the installation of a preliminary British ESF was the Covid-19 pandemic.

“We argued that we needed a system of community health agents like the one in Brazil to monitor people closely”, he highlights.

And so the initiative came to life: the pilot project began at Churchill Gardens Estate, a housing estate in Westminster, central London.

the first results

According to Harris, the initial idea was to check whether people would be willing to open the doors of their homes to talk to health agents.

“And in the first six months we realized that this was not only possible, but also that the residents accepted the approach very well”, he informs.

The doctor calculates that, in the first year and a half of the project, around 70% of the houses in the neighborhood received at least one visit from health professionals.

“The agents are able to establish a relationship with people and really understand what their needs are. The important point is that they themselves live there, so they see themselves as part of that community”, he highlights.

Harris says the team did some studies to measure the practical results of the experiment.

“When we compare the homes that received the visits with those that are not part of the pilot project, we noticed that the first group participated more in vaccination campaigns and underwent routine tests more frequently”, he says.

“Of course, we cannot prove that this change is totally related to health agents. But it is at least suggestive that this has occurred since the beginning of the work of these professionals”, he adds.

According to the expert, the program’s employees are trained to identify and even solve the main health problems that are affecting each family.

From this, individuals feel freer and more empowered to take care of other important aspects, but which were neglected, such as updating the vaccination card or taking the tests that detect cancer at an early stage.

Incidentally, the training offered to British community agents was basically the same as that given to Brazilian professionals.

But Harris believes that the practical effects of a project like the ESF go beyond increasing the rate of immunizations or checkups.

“On Churchill Gardens Estate, for example, we observed that people had lived in the same houses for many years, but did not know their neighbors or speak to each other. Residents began to talk more and schedule programs together, such as a coffee”, he adds.

The doctor understands that the strategy created a kind of “social cohesion” – something very similar to what happened in Brazil itself in the regions served by the ESF for decades.

The pilot project has already been expanded to other areas of London and should start to be applied in neighborhoods in places like Yorkshire and Liverpool.

Low cost, high value

Harris points out that more developed countries, like the UK itself, don’t pay much attention to what is done in developing nations.

“Our tendency is to closely follow what happens in places like the United States, Germany, Australia or New Zealand and practically ignore the policies of countries in Latin America, Africa and Southeast Asia. But there is no good reason for this to be the case. like that,” he protests.

For him, the work of community health agents is an example of this scenario.

“Brazil’s ESF is a highly cost-effective program and helps solve the most common problems by accompanying families in a holistic way in the most important place of all: their home,” says Harris.

The expert estimates that around 40% of people’s health needs can be met by community agents during conversations and home visits.

“They can talk about vaccines, be aware of symptoms of chronic diseases [como hipertensão e diabetes]dealing with wounds, suggesting routine exams or simply checking if the person is taking the medication correctly”, he exemplifies.

Finally, the Imperial College researcher highlights how, in certain situations, simple and inexpensive health solutions can bring extraordinary results.

“It is clear that we have room for sophisticated technologies, which expand the frontiers of Medicine”, he opines.

“But sometimes I feel that we go beyond what is necessary and forget that the most basic interventions can make all the difference,” he concludes.