Cut of vacancies in hospital deepens crisis in pediatrics in BH – Gerais

  pediatrics of the S
With 34 beds, Pediatrics in So Lucas is responsible for 2,500 consultations per month, 500 surgeries per year that will have to be absorbed by other health units (photo: Edsio Ferreira/EM/DA Press)

With the closure of pediatric units in the private network, finding vacancies in ICUs and emergencies for babies and children in Belo Horizonte has become an increasingly difficult mission for mothers and fathers of small patients. On the 20th, Hospital São Lucas (HSL), in the Center-South Region, announced the end of pediatric care, which means the loss of 34 pediatric beds in the capital and 2,500 visits per month. The scenario puts even more burdens on the public system of BH, which is already facing problems to compose the pediatric staff in health centers and Emergency Care Units (UPAs).

The institution, managed by Grupo Santa Casa, sees an average of 80 children a day in the emergency room and performs around 500 surgeries a year. The HSL informed that pediatrics will still work for 90 days from the date of the announcement of the interruption of the service, that is, until mid-October, and then close the doors. But concern about the impacts of the closure of its activities was immediately established among medical entities and professionals in the area.

A member of the Minas Gerais Society of Pediatrics (SMP) and director of mobilization at the Minas Gerais State Physicians Union (Sinmed-MG), Cristiano Tlio Maciel Albuquerque says that the unit’s closure will have a strong impact. “The proposal was for immediate closure. The doctors turned to professional associations and we alerted to the assistance risks of the decision. Therefore, Santa Casa extended this service by 90 days”, he said.

For him, there will be no immediate assistance impact, but the agreements will need to prepare for the next year. “They need to analyze the numbers of patients who have been treated at the HSL and prepare for the next seasonal period (especially autumn and winter, when respiratory conditions are more common), as it will be impossible to face it without an increase in the number of on-call workers and beds in the various agreements that So Lucas attends”, he warned. According to him, the hospital makes an average of 2,500 visits per month.

The immediate impact, according to Albuquerque, will be on the quality of care in some specialties. He mentions the children’s oncology patients, who will lose the team that accompanies them in the treatment, for example. “There are children with a one-year treatment plan who will need to move and their families don’t even know where they are going yet.” The closure will also overload the SUS sites that are already congested, analyzes the pediatrician.

ECONOMIC QUESTION “The case of So Lucas is a continuation of the financial crisis in pediatrics. It is a low-complexity specialty, does not generate procedures, exams, works with low technology. basically professional knowledge and simple nursing care.”

The doctor says that the specialty is not valued from an economic point of view and that pediatric hospitals need to be subsidized. “There needs to be a review of the table and hospitals need to understand that pediatrics is not for profit. She can’t hurt. In Belo Horizonte, in the last 20 years, more than ten pediatric services were closed in hospitals.” The trend, according to him, is for large networks of agreements to open their own hospitals, as they are required by law to provide pediatric care. “That’s bad because it limits parental choice.”

NO WAY Children and parents suffer due to the lack of child care. Especially on weekends, they suffer from pilgrimages between hospitals and often face hours of waiting until they are finally received by the doctors. “ Chaos. I only consult privately and, even so, there is no pediatrician to attend to the children. I have to go from hospital to hospital until I get care”, says Cludia Regina Ribeiro, 56 years old.

On the 21st, she went to Hospital São Lucas for the first time with her grandchildren, Erick Miguel, 8, and Maria Clara, 5, after the eldest started complaining of a sore throat. “I spent hours with him in the hospital queue, when he was younger, and we only got care because he started to have a seizure”, she recalls. Like her autistic grandson, she says that Miguel suffers even more to get medical care, even though, according to the law, people with autism are entitled to a priority list. “With the pandemic, the situation became even more chaotic”, adds Cludia.

IT professional Wackson Abel Soares Silva, 36, does not know of another hospital, besides So Lucas, that accepts the health plan of his son Emanuel, 3, and says he is lost without knowing where to take him after the unit definitively close. “When I was coming here I was a little desperate. My wife commented that So Lucas closed pediatrics. I didn’t even know where to go,” he says. “I have to look at where I’m going to take him next, because I’ve always brought him here. It took me a while to receive care, but it never happened that I was not attended to,” he says.

The manicurist Ana Cludia Camilo Maia, 24, also has the same problem. “It’s going to be bad, because I’m used to it here. I have no idea where I’m going to take him if it’s not here,” she said. Despite the delay in care, she praises the work of the doctors in the unit. “When you get here, it takes a while, but then it’s quiet. I like the service. very nice,” she comments her.

MORE PRESSURE In the opinion of the director of professional defense of the Brazilian Society of Pediatrics (SBP), Fbio Guerra, the closure of pediatric units is worrying and will bring great harm to patients. “We have seen a continuous practice of reducing pediatric services. This reduces the possibility of supporting the population and overloads those who remain in the service. When units close, you are sure to overload others. I don’t understand that it’s for lack of professionals. This goes through administrative issues,” he says.

The entity denies that there is a shortage of pediatricians in the country and that professionals are not interested in the area. “It’s not that doctors don’t want to be pediatricians, but that institutions only want to hire when the situation is already emergency, in precarious situations. We have a very interesting contingent of professionals. Today, there are more than 44,000 pediatricians in Brazil, which would provide a sufficient distribution of care”, he says.

PLANNING The representative of SMP and Sinmed-MG, Cristiano Albuquerque, agrees. For him, there is no lack of professionals, but of structure and planning policy to face seasonality. “Pediatrics teams are sufficient for eight months of the year. From mid-autumn and throughout the winter there is a very large increase in demand, up to 200%. We noticed a planning difficulty for large hospitals to set up a reversible structure, which we see in other countries. what the union proposes. At the time of seasonality, open service as a fast track, using sorting systems, with teams that can implement protocols. Allow doctors to work longer for a premium.”

Guerra also believes that the problem is the result of a lack of planning and adequate working conditions. “We need more appropriate opportunities, which include the type of contract, work relationship and structural conditions, which can favor the establishment and maintenance of a team for assistance”, he says. According to him, institutions only hire professionals in times of crisis. “We see offers for precarious contracts, which are not of interest to professionals. It turns out that hiring in this scenario is not always easy,” he says.

The SBP director also assesses that the situation is the same in the public network. “A chain reaction. Trying to resolve this immediately is more difficult. If you plan ahead, if you have a service organization, it becomes easier to go through these crises. planning is needed to hire professionals more effectively,” he said.

Overload in cascade effect

With the collapse knocking the door of UPAs and health centers in the capital, the closing of units in the private network ends up further overloading the service in public facilities. Since June, the City of Belo Horizonte has been reinforcing childcare on weekends, but the pressure persists. Recent reports of requests for dismissal of pediatricians in health units and difficulties in hiring new specialist doctors in the area worry parents even more. According to Sinmed-MG, professionals approved in a public contest are reconsidering whether they will take up the position due to precarious working conditions.

Representative of the entity, Cristiano Albuquerque says that the state public network has a deficit of 100 pediatricians, while in the municipal network the number rises to 200. “The problem is that the state does not invest heavily. The doctor does not feel stimulated, he knows he will enter a scrapped institution, with a bad infrastructure to fulfill a failure of the scale working with a minimal team.”

He states that the union, together with the SMP, presented to the state and municipal health secretaries a set of actions to improve the scales: public tender, with the call for a greater number of vacancies at a time, greater flexibility in working hours, improvements in career plans, working conditions, in addition to the creation of a seasonal bonus.

Today, the health units in the capital have 287 pediatricians to serve 152 health centers and nine UPAs. The Municipal Health Department of BH (SMS) has previously confirmed that pediatric scales are lacking due to lack of professionals.

Through a note, SMS says that it is studying alternatives to minimize the possible impacts on the SUS-BH network and works incessantly to ensure full assistance to the population. The Municipality of Belo Horizonte (PBH) informs that, as a measure to guarantee the population’s service, the municipality granted an increase in the value of extra plants of 35% in all units of the SUS network in the city. The curriculum bank for the immediate hiring of doctors is still active. Interested parties must access the city’s portal to register.

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