Primary Care and universal health care dreams in ‘Soccer’s Country’

Marcelo_Garcia_imageDr Marcelo Garcia Kolling is a GP and primary care academic in Curitiba, Brazil

As Brazil prepared for the FIFA World Cup, its people were conflicted between football and needs of the country.   We have always called ourselves the Soccer’s Country (although we did not invent it, do not have the wealthiest national championship and, as is now clear, do not have the best team), Brazil is currently struggling to develop in other important areas as we strive to improve public services, whether in education, safety and health. In recent years its people have gone on the streets to call for the end of the military government and for direct elections. We fought for a Universal Health System and have tried to implement it for the past 30 years.

“Every Brazilian is a soccer coach” we say. Soccer is the topic of conversation in in every bar, and every media outlet, newspaper and blog is full of analysis of the game, its system and tactics. Everyone can name the iconic past soccer players or coaches, with Pele, Garrincha, Ademir da Ghia, and we had Tele Santana and Zagallo, with, more recently, Ronaldo, Rivaldo, and Ronaldinho Gaúcho.

But in the past two years, people have been concerned with other issues. Massive popular demonstrations ask how public money is spent and question tax exemptions in our essentially poor and uneven country. For primary care physicians, it is clear that, while everyone has the answers for our soccer team, we do not have solutions in other areas, notably in the Health System. We lack examples of past successful public health initiatives almost as much as we have a wealth of past players and coaches. Unfortunately, we seem unable to look outside our borders and learn from others. Maybe we think that because foreigners have learned from our soccer, and how it has adapted and evolved, we can create our own Health System from scratch, ignoring or blind to the trends worldwide.

The voices on the streets argue that, instead of, or in addition to, our “FIFA pattern” stadiums, we should have… more hospitals! “FIFA pattern” hospitals! At the same time, primary care is limited with little access, poor continuity and almost no coordination of care, and with just 1,5% of physicians specialized for general primary care (community family physicians). People simply don’t know that, rather than more hospitals, we need more quality primary care, offering timely and comprehensive care as is delivered in the more organized services of Europe or Canada.

While Neymar goes to the “top notch” hospital, to receive “top notch” diagnostic imaging technology, my next patient tells me that his chronic lumbar pain is not, after all, related to his obesity and sedentarism as I had told him, but the result of an injury “just like Neymar’s” that he had years ago, and he asks for a CT and/or MRI. As I prepare myself to discuss the correct management, defending my patient from harmful health propaganda, I just wonder when we will have our McWhinney to inspire the physicians and patients to a better understanding of what we need - just as Pelé always reminds us how the game should be played!

 

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