It was after watching the documentary Who cares?which tells stories of social entrepreneursthat Adriana Mallet and Sabine Zink decided to contribute to the improvement of the access to health in Brazil. “We studied at the same college, a public university, we are from privileged families and we wanted to repay that privilege. I think that desire was dormant”, says Sabine, graduated in Physical Education with a master’s degree in Pedagogy.
They came out of the cinema, hugged each other and cried for an hour. That feeling was renewed and they had to do something. In the trajectory of Adriana, who is now a doctor, access to healthcare is an old issue. Of four aunts with breast cancer, three received a late diagnosis due to lack of specialized care. When she was 10 years old, she saw one of them die from the disease. “I went to medicine a lot with this access vision, because if my aunts had found out earlier, maybe they would be alive.”
With a newly purchased 4×4 car and a desire to travel through the Brazilian countryside, the two were inspired by the Saúde e Alegria Project, one of the cases presented in the documentary, which operates in the Amazon, and founded SAS Brasil in 2013. I project what was best in each one: health on the part of Adriana and joy on the part of Sabine. “I did a few months of residency in anesthesiology and I joke that I was leaving the hospital. I left the operating room for the emergency room, from the emergency room to Samu and from Samu to the expeditions”, recalls the doctor.
Today, the social startup provides free access to specialized doctors, most of them volunteers, such as ophthalmologists and gynecologists, to people who are on the waiting list of the Unified Health System, relieving a saturated network. In partnership with health departments, the institution provides virtual or face-to-face services, offering more than 20 medical specialties in six areas. It also has an online service platform that can be used from anywhere in Brazil.
“We understood that the lack of access is often more a geographic issue than an income issue”, says Adriana. “It is in this bottleneck that we understood that our performance would be more impactful”, completes Sabine. With a model called Health 1.5, the entity operates between primary care, which provides consultation with general practitioners, for example, and secondary care, focused on outpatient clinics that refer patients to more complex procedures at the tertiary level.
Many people find the term “social startup” strange, says Adriana, but she discards the NGO nomenclature and justifies that the idea of a startup is to learn fast and adapt for a purpose. “We know we have to start small, because it’s a huge problem that we can’t solve with old solutions. And no new solution is born ready-made and on a large scale. So the mindset was to test models.”
The company started by making expeditions with tents that were set up and dismantled every day in the cities they passed through, at first in the Northeast. People were informed about the care on the day, whose focus was to identify and treat skin cancer, but not all of them had a real need. To optimize the work, the entity sought the health departments to find out who was already on the SUS waiting list for a specialized consultation. The effectiveness extended to the structure and they adopted containers and then carts to house the meetings between doctor and patient.
Another step was to test telemedicine, since 2018, to previously identify which people needed minor surgeries, which would be performed during the expedition period. Before this resource, of every 100 patients previously selected for care, about 12 had a serious problem that required a surgical procedure. Afterwards, the screening became more accurate and, of the 100 selected, 67 needed surgery. This optimized the structure needed for each expedition.
Technology for innovation
So that the action is not punctual, Sabine explains that cities are selected according to the needs to receive advanced telemedicine units (ATU), another tested product. Currently, there are four installed in the cities of Cavalcante (GO), Santo Amaro (MA), Cruz and Acaraú (CE). “She stays in the city for at least a year so that we can have a greater continuity process within the municipal model. The expedition serves as a first assessment of which cities will receive.”
The startup has invested in technology and also has its own platform for serving anyone, and the first contact can be made by a WhatsApp number. For those who do not have a cell phone or internet access, SAS Brasil works with call centers, where a health professional with a telephone can mediate the consultation.
These structures, equipped with monitors, an automatic disinfection system and devices for measuring vital signs, were used in the first year of the pandemic in communities in Rio de Janeiro and São Paulo and won the Dasa & Abril Medical Innovation Award in 2020, in the category Innovation in Social Medicine.
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Another resource is a software that allows performing image exams with distance monitoring in real time. For example: a pregnant woman who lives in the countryside of Ceará can go to an UTA for an ultrasound, which will be seen on the screen by a gynecologist in Rio de Janeiro. The tool is used in cervical screening and should soon be reinforced with another innovation: an algorithm that analyzes results and indicates which ones are most likely to indicate cancer.
“Only a woman who, in fact, has an alteration will travel. We do more than 300,000 exams. It should do three times more to make an early diagnosis of women, who wait a year in line just to see their laps and 60% of them have nothing. the idea is won
Financial resources is the biggest challenge
In the first two years, SAS Brasil maintained itself with crowdfunding on an online platform and investing from its own pocket (staff and volunteers) when necessary. In the third year, pharmaceutical Roche entered as the first sponsor and remains until today, with the proposal that the company’s employees participate as volunteers in the startup’s actions.
“We believe that the partnership with SAS Brasil strengthens our mission to bring more health and quality of life to society. We are aware of the enormous challenges that Brazil faces in serving the population, which becomes even more complex given the geographic difficulties of our country”, says Sarah Chaia, director of the legal department, Sustainable Partnerships, Social Responsibility and Sustainability & Compliance Officer. from Roche Pharma Brazil.
In 2017, Hospital Albert Einstein joined as a supporter and, since then, other companies have joined the list of financial providers, which allowed the startup to hire doctors to coordinate areas and other professionals for different functions. “Sustaining a team of 50 people with a donation is not easy,” says Sabine, who has realized that having large donors as the main source of funding is unsustainable. In addition, she states that the operational cost of moving teams across Brazil is very high and it would be efficient to have support from airlines or car rental companies, for example.
“Today, we work with individuals. Having a base of 50 thousand people donating BRL 100 and reaching BRL 5 million is much more sustainable than having five big supporters of BRL 1 million. If from one year to the next a supporter cancels, it’s a budget leak.”
As the founders understood that income is not always the biggest problem for those who do not have access to healthcare, one of SAS’s plans is to create a format in which some people pay for care and, consequently, pay for the consultation or examination of those who cannot invest in this care.