Rural Brazil: Healthcare to go

Twenty years ago the Brazilian Government decreed that health services should be available to all of the country’s inhabitants. In Southern Brazil, the wealthier, more developed and heavily populated part of the country, this pledge was comparatively easy to address. In the dense rainforest of the Amazon its fulfilment is altogether more difficult.

There the communities are remote, and separated from one another by great distances.

There are four people to every square kilometre if you set the overall population against the overall geographical area. When you consider that vast swathes of the region are uninhabited, the difficulty of providing blanket healthcare to the population starts to become clear. The people that live in the Amazon are still largely dependent on barter economies— and on catching and cultivating their own food.

“The final challenge of healthcare in Brazil is delivering care to the riverside communities where there are no roads and no money,” says Fabio Tozzi, a medical doctor who leads the team on the Abaré, a hospital boat that travels up and down the waterways of a section of the Para region in the Amazonian rainforest, taking medical services to the people who live in these isolated villages.

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The Abaré—which in the indigenous Tupi language means ‘care-giving friend’ (the boat was named by the villagers)—has been bringing healthcare services to 15,000 people in 73 villages and small towns for six years. In total there are more than six million people living in the Brazilian Amazon’s riverside communities, including some 60 tribes with which contact has not yet been established.

The Abaré works on a cycle of 20-day voyages around its coverage area, each trip focusing on a different medical issue. These range from vaccination, dentistry and gynaecology to child develop or hypertension (a particular problem in a region that, lacking refrigeration, relies heavily on salt curing). The boat has a fully equipped surgical theatre and emergency room and its team are able to resolve 93 per cent of the medical problems they encounter. The remainder are referred to the nearest city, Santarém.

In the municipal region covered by Santarém there are 150 doctors responsible for 1.5 million people. “This is the reality for the whole of the Amazon,” says Tozzi. “There are no doctors.”

Connectivity is essential to the success of the project. The Abaré is 3G-enabled, linking to masts in the small town of Belterra and the riverside village of Suruacá. It also has signal amplifiers that allow remote dwellers to access communications services when it visits their community. “Connectivity is very important,” says Tozzi. “The doctors can ask for help, for second opinions or specialist analysis of blood tests or x-rays and remote diagnoses. They have access to vital information from the internet.”

One Of The Medical Rooms On The Abaré

But a link to the world beyond the rainforest is important for more than medical information, he says. “It is very difficult to get qualified doctors and nurses to come and work on the boat. Having connectivity stops them feeling so isolated.” As well as remaining in contact with friends and family, he says, doctors are able to check their fears that, so far from the advanced environment of the cities where they trained, they might make a wrong decision.

A visit to the Abaré, and the communities that it serves, is an effective illustration of the benefits of the connected world. People living in these remote communities are not keen to visit the city for medical attention, because of the amount of time they inevitably have to stay away from their community and their responsibilities.

There are two boats a week available to these people if they want to go to the city.

When they get there they have to find somewhere to stay and, if they have to have medical tests, they must wait until the results are available.

It is not uncommon, Fabio Tozzi says, for people who make the trip to the city for medical reasons to be away for a month. Part of the problem is that they will often delay seeking help until the problem becomes so acute that lengthy hospitalisation is necessary. Sometimes they are too late even for this.

The boat was purpose built with funding from Dutch non-profit organisation Terre des Hommes and is operated by Brazilian NGO Projet Sáudi e Alegria (which translates as Health and Happiness). But funding is in the process of being moved over to the state, which has judged the project sufficiently successful to want to replicate it.

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The Abaré

The boat runs at an annual cost of around US$500,000, 80 per cent of which is now provided by a combination of federal and local government. There are now plans to introduce a further 100 boats to deliver services to riverside communities throughout the region. Public funding has been secured for 32 of them and the challenge now will be to see how the project can scale.

The team working on the Abaré is fortunate enough to have reliable 3G access but boats servicing even more remote communities will have to depend on satellite connectivity. Eugenio Scannavino, who leads Projet Sáudi e Alegria, says the NGO hopes that, as services are delivered to ever more communities, Brazil’s mobile operators will be motivated to provide cellular connectivity more widely across the region.