RESUMO
PIP: For the past 15 years, the Fundac Esperanca, a private organization founded in Santarem by a North American Franciscan priest, has been working to provide the widely scattered rural residents in the mid-Amazon region of Brazil with effective health care. Early efforts focused on Esperanca's hospital boat, which traveled up and down the river to reach the remote settlements. During the 1st decade of operation, Esperanca vaccinated some 150,000 people and provided general medical and surgical services to countless others. Yet, by the late 1970s, the program's staff were beginning to question the longterm effectiveness of their efforts. In 1979, Esperanca decided it could have a longer lasting impact on health in the mid-Amazon region if it could mobilize rural communities to improve family diets and sanitary practices and carry out comprehensive vaccination campaigns. Supported by a grant from Private Agencies Collaborating Together (PACT), it launched its own primary health care program. This initiative began with a health survey of the region. The studies revealed that 1/3 of the children under age 6 were malnourished, 90% had untreated cavities, and 2/3 of the 10,000 people tested showed evidence of parasitosis. There were higher than normal incidences of malaria, anemia, tuberculosis, diphtheria, uterine cancer in women, smallpox, and visual problems. The social, cultural, and demographic characteristics of the region also were discouraging. Most people lived in widely scattered river villages and were illiterate, with little understanding of hygiene, nutrition, or public health. None of the settlements had formal health care systems. Esperanca chose to make the community paramedic the keystone of its program, stating clearly that the outreach worker is the conduit to clinical services in Santarem. In time, it was decided to phase out the hospital boat's activities. It had come to signal the wrong message, i.e., the doctors were coming and good health was on the way. Instead, Esperanca decided to help communities solve their own health problems. The relationship between the paramedic and the local health committee is the most obvious symbol of this new power to change the conditions of community life. Esperanca also has had a special project; it introduced wells, the benefits of clean water, in its 12 participating communities. Once they became available, the prospect of the wells started a minirevolution in the communities. After the wells were opened, parasitic diseases declined markedly. Esperanca's program continues to evolve. there are several hopeful signs of its success: the training program for paramedics is an ongoing effort; sensitization of medical professionals to the reality of rural health care and the need for alternative strategies; and the development of relationships with a whole range of public agencies.^ieng
Assuntos
Pessoal Técnico de Saúde , Agentes Comunitários de Saúde , Participação da Comunidade , Atenção à Saúde , Pessoal de Saúde , Administração de Serviços de Saúde , Serviços de Saúde , Medicina , Organização e Administração , Características da População , População , Medicina Preventiva , Atenção Primária à Saúde , População Rural , América , Brasil , Conservação dos Recursos Naturais , Demografia , Países Desenvolvidos , Países em Desenvolvimento , Educação , Saúde , Higiene , América Latina , Saúde Pública , América do Sul , Abastecimento de ÁguaRESUMO
PIP: The Hope Foundation, a private organization founded in the Amazon town of Santarem, Brazil, by the American Franciscan Father Luke Tupper,has provided health services to be dispersed population of the rural zones of the central Amazon basin for 15 years. The 1st activities were centered on a hospital ship. In its 1st decade the foundation vaccinated 150,000 persons and provided medical and surgical services to countless others, but in the late 1970s the program personnel began to doubt whether the program was having lasting effects. In 1979 the foundation decided that the health of the population could be improved if rural communities could be induced to improve their nutritional and sanitary practices and if extensive vaccinations campaigns were carried out. A preliminary health survey indicated that 1/3 of children under 6 in the area were malnourished, 2/3 of the 10,000 inhabitants examined showed evidence of parasite infection, and the infant mortality rate was very high. The predominantly illiterate population tended to live in isolated river communities without potable water or sewage systems, and with no regular access to medical care. The foundation sent health auxiliaries from their office in Santarem to visit the rural settlements, organize local health committees, plan vaccination campaigns, and plant small communal gardens. The hospital ship continued to make periodic trips for more specialized problems. Very soon, however, the program encountered difficulties because of the remoteness of the villages, the difficult access, and the problems of organizing and motivating local health committees among persons with little relevant experience. It was decided that literate persons from each community should be trained to carry out basic treatments and to launch public health campaigns. The strategy would provide a number of paramedics disposed to remain in their communities and would assure close working relationships with the local health committee. The health workers were given intensive courses over 12 weeks in the dispensary in Santarem, where they learned to do basic laboratory examinations to identify the 9 most common intestinal parasites in the region, to organize vaccination campaigns including record keeping, to provide prenatal care and attend deliveries, to recognize a variety of diseases, and to refer doubtful cases to the dispensary in Santarem along with complete medical histories. They also provided follow-up care for surgical patients. A program to dig wells provided the benefits of clean water, a reduction of parasite infections, increased prestige for the health workers who were active in the campaign, and more free time for the women and children who had previously carried water from the rivers. The Hope Foundation cooperated with the medical faculty of a nearby university to train medical personnel for community health in the Amazon basin, but found little interest among new graduates. The foundation recently contracted to train health promoters to serve other regions of the state of Para.^ieng