Luciano Duro is Professor and coordinator of the medical school at Univates (Universidade do Vale do Taquari), Rio Grande do Sul. There have been huge developments in medical education in Brazil creating major challenges against a background of social and political change.
“they are 18 or 19 years old and they have huge difficulty dealing with suffering, dealing with not knowing how to do things, and we have huge mental health issues with our medical students”
“We have the Left and we have Right… When the Left was in government, we had much more emphasis on public health. When Bolsonaro was in government…different ways to engage the private sector”
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Luciano Duro: The main challenge that I have, as coordinator of the medical school here at the university, a private university, is that the mindset, the mentality, the way we used to think in my generation, is now almost completely different.
It’s another way of facing problems, it’s another way of understanding how we need to teach in medical school. We have lots of technology but there is some discussion about how teachers of my age and older can use this technology to teach medical students. And, sometimes, in addressing these issues, we don’t agree.
Also, they (the students) are 18 or 19 years old and they have huge difficulties dealing with suffering, dealing with not knowing how to do things, and we have huge mental health issues with our medical students. I have done some research on mental health and the use of medication. My hypothesis is that more than 80 percent of our students are using some kind of antidepressant medicine, benzodiazepines, I don’t know what else. To deal with these problems in a private medical school, that demands payment out of pocket, is huge. But, I think this is a good challenge; to find a way to talk to them and find some way to make things more acceptable.
In our Health System, we don’t have students that use our national health system, the public health system. They pay out of pocket. They have used a different system to pay for healthcare all their lives, themselves and their families. The national system is therefore completely different from their life experience, and this is another challenge, to change this mindset.
DMacA: You’ve had a huge increase in the number of medical students in Brazil. When did that begin and how has that affected medical school?
LD: It became a reality, I think, 10 or 15 years ago. They thought that, by increasing the number of medical schools, our population could have more access to a medical professional, a doctor. But we have a huge territory and we have geographical difficulties. We have our Amazon. If we need to give medical advice, to have a medical consultation, we need to get in a boat and travel two days on a river. And, you see, our Indians are very are poorly cared for and our new doctors don’t think about going to the deprived areas. They are still looking for jobs around the big centres, the capitals, or more populated cities, that can offer more opportunities, job opportunities. Even with this government policy, it’s been the same for 10 to 15 years. Now we have another attempt to get doctors to those deprived areas, in order to get them better pay and work conditions. We don’t know (if it will work). The first attempt was not so good at all but they’re still trying.
DMacA: When I was in Brazil I was very impressed with the emphasis on primary care and the primary care centres throughout the country. Is this still the case, is there still the same emphasis on primary care?
LD: I can answer that as yes and no. Yes, because once you have introduced this idea, you never forget. But, no, in the way its being done. The government, our Minister of Health, tried ways to engage health professionals to promote the idea of primary care but we have lots of professionals working without thinking this way, or being trained, despite all the attempts to teach our medical students to focus on primary care. Despite this, we still don’t have the change towards working in Primary Care with longitudinality. They get one year and they fall off to do a residency in another specialty. But, as regards primary care, unfortunately, I’m not so optimistic about it. Unfortunately.
DMacA: I was also interested in the emphasis on public health. Is there still a lot of emphasis on public health?
LD: Yes. You see, it’s very dependent on the way of thinking of our government. We have the Left and we have Right. On the Right we have Bolsonaro and, on the Left, Lula. When the Left was in government, we had much more emphasis on public health. When Bolsonaro was in government, I saw some different ways to engage the private sector to get health care – in order to create a bigger market gain for the whole country growing economically. With this economic growth, all people could get more health (care). But, with the centre and Left government this is discussed more. For example, for the first time in the history of Brazil we have a Ministry of Indians, with an Indian as a Minister. Our Indians don’t have access to good health care for any problems. Its a battle between those ideologies, the Right and Left. Now, since January, we have a Ministry for Indians. We have a very substantial number of Indians in our country. They have been side-lined until now but I think we will now have a public health approach.
DMacA: Luciano, it’s been an absolute pleasure talking to you again. Thank you for your wonderful insights into healthcare in Brazil. One of my greatest memories is of the enthusiasm and the commitment of young doctors in Brazil. Luciano thank you very much indeed.
