‘Brazil under Constitution’: universal right to health is one of the greatest advances of the Charter of 88 | Brazil in Constitution

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My name is Maria. I’m from Bahia, from the Recôncavo, from São Francisco do Conde. Before, it was a very precarious place, we didn’t have a health center or transport. When the staff had to go to a hospital, my mother said that she was either riding a donkey or a macaw”, says housewife Maria Dias.

Graziela Azevedo: You even lost a child brother, right?
Maria: This this. There was no way to have a definite diagnosis of what he really had and that made her very, very sad.

Why did so many children die in the past in Brazil?

“What happened is that young children acquired infections, generally gastrointestinal. They had diarrhea, dehydrated and died. There was no medical assistance”, explains Dr. Drauzio Varella.

“The situation is more serious, desperate even in the Northeast. Today, the infant mortality rate is 122 children per thousand births, almost triple the rate tolerated by the WHO“, warned a report from 1988.

“It was common, it was normal to lose a child. Society accepted this as a fatality”, says Drauzio Varella.

Reporter in an interview in 1987: How many children have you had?
Pregnant: Sixteen children.
News reporter: And now how many do you have?
Pregnant: I have seven.
News reporter: With the one who will be born?
Pregnant: Yes ma’am. The first died at 10 months, with diarrhea.
News reporter: The second?
Pregnant: With diarrhea too.
News reporter: The third?
Pregnant: The third died at the age of five, the doctor didn’t even say what he died of. I took it and within 24 hours it died.

“Health was a favor. Nobody was obliged to attend. What happened? Those who had a formal contract were entitled to medical assistance through the former INPS, medical assistance through Inamps – which was the National Institute of Medical Assistance. Those who didn’t have a formal contract, which were all informal workers, especially all rural workers – and Brazil was a rural country at that time -, had no right to anything”, emphasizes Drauzio.

“Once I even had to sell a yoke of oxen to save my mistress. If I didn’t have this yoke of oxen, who knows, maybe even my boss would have died”, complained a farmer in a 1985 report.

Dissatisfaction with health care as a charity was growing in the country. “For the first time since 1941, the National Health Conference was open to civil society. In the audience are rural workers, housewives, in addition to doctors”, reported a March 1986 report.

A great movement began that would change the destiny of Health in the country.

“He took away the principles, the political bases of what would become the Health chapter of the Federal Constitution. I don’t even know how old I was, but I think I had a passion there, which is the same passion that I think I have until today for the SUS and for the strength with which Brazilian society was able to demonstrate to the world as a society that articulates itself , how we managed to achieve something very positive”, highlights doctor Paulo Marchiori Buss, from Fiocruz’s Center for International Relations.

The proposals of the Eighth National Health Conference were taken to the Constituent Assembly and approved. The text that sparked a revolution in care begins like this: “Article 196 – Health is everyone’s right and a duty of the State”. And it also says: “Guaranteed through social and economic policies aimed at reducing the risk of disease, and at universal and equal access to actions and services for its promotion, protection and recovery”.

To transform the law into a social impact practice, the SUS was created. The Unified Health System was born in the Constitution of 88. Regulation was necessary and came two years later.

“Health Minister Alceni Guerra launches, in Brasília, the Unified Health System. In the SUS, the municipalities receive directly the resources destined to the health area”, reported Cid Moreira in Jornal Nacional.

Other laws were created, but without departing from what is written in the Constitution, to detail the functioning of the health system and guarantee to any Brazilian, in any part of the country, the right to medical assistance, the right to health. The right, not the favor.

“Lucas was born like that, apparently everything was fine, but when he was 15 days old, it all started. He started to turn yellow. I never imagined that he would need a transplant”, recalls Maria.

“It’s just time for the teams to get ready in the operating room. As soon as the door closes, Maria realizes that a new battle is starting”, narrated a report from 2001 when Lucas underwent the procedure.

Mary, Luke’s mother, had faith, but also a lot of trust in a great human work. She gave her son’s life into the hands of health professionals at the Instituto da Criança at Hospital das Clínicas de São Paulo, one of the largest transplant centers in the world.

It was a long road, but the path already existed because it was traced in the Constitution of 1988. Lucas’ serious illness, when he was still a baby, was diagnosed at the Hospital das Clínicas in Salvador, but the family’s travels show that in a large country like Brazil, the promise of healing has to go far.

If the liver transplant worked, basic, routine care could take place at the health post in Recôncavo Baiano, in the land of the boy who was born between life and death.

“The victory is there, right? Full of life, thank God, thanks to health professionals. Many victories! Everything I thought was impossible, he actually achieved through SUS”, celebrates Maria.

“Today, the Única Center started to operate, which aims to shorten the suffering of people waiting for a transplant throughout Brazil”, announced Fátima Bernardes, in Jornal Nacional, in 1998.

There is only one queue for those who wait, with equal chances in public or private hospitals. It is the largest free transplant program in the world.

The open door of the SUS is the same, the nurse too, but the visit of the patient who left the Hospital das Clínicas de São Paulo as a child, made the memory of a past of distress mix with immense joy.

Nurse: Is it Lucas? Look at the size!
Maria: Grown up. Our boy is huge.
Nurse: I changed his diapers.
Lucas: I won.
Nurse: What are you doing?
Lucas: I finished my studies. Now I think about becoming a nursing technician.
Nurse: Look at this!

“SUS works with islands of excellence. The AIDS program that revolutionized the treatment, the fight against AIDS in the world. So many people died that, by joining my clinic with the patients of Carandiru, I lost 10 to 15 patients a week at that time. And Brazil started to fight with the multinationals to reduce the price of medication and started to treat everyone. And that’s how the free distribution of medication had an impact on the spread of the epidemic”, explains Drauzio Varella.

Another impact was the creation of the family health strategy. “To assist a farmer who lives in that house, 40 kilometers from the Quixadá Center, the doctor arrives on horseback”, said a 1994 report.

The arrival of posts and agents where there was nothing before has also changed destinations. “An important advance in Brazil in the fight against infant mortality. The rate has dropped 75% in the country since 1990”, reported Bonner in 2013.

“SUS has solved primary care very well. Now, the problem lies in this intermediary assistance, between high complexity and family health care”, believes Paulo Muss.

“When we need it, we are not served. He is treated like an animal. It seems like they are doing us an obligation”, denounced a man this year.

When the people suffer in the queues and despair with the disease that is aggravated by the delay, it is also the SUS that cries out for help.

“Brazil has a public health system that is exemplary. Few advanced countries in the world have such a system. And this is an achievement that we must preserve, we must fight for it to remain. Of course we need more money, right? Pay professionals well, equip public hospitals well, don’t run out of medicines, vaccines”, points out STF Minister Ricardo Lewandowski.

SUS belongs to all Brazilians and more than 150 million people depend exclusively on it. The remedies to keep the single system alive and healthy are funds and management.

“The population has a role, every four years, in deciding a destination. Those who vote on the budget are congressmen and senators. So, we are going to choose deputies and senators in the October elections who are in favor of improving SUS funding”, says Paulo Muss.

“Brazilians have to be proud of the SUS, and try to participate in the correction. Imagine what would have happened if the SUS had not existed at this time of so many people needing hospitalization, at the height of the epidemic. And we had a National Immunization Program that is cited as an example in the world. With all this structure, when a vaccine appeared, we were going to get ahead of the world, we were going to vaccinate at an incomparable speed in Brazil. But, unfortunately, all this expectation was frustrated, right?”, says Drauzio Varella.

“In August, Pfizer BioNTech offered the Brazilian government 70 million doses to be delivered starting in December. Brazil had passed 100,000 deaths. The federal government did not respond to the pharmaceutical”, reported a 2020 news.

Despite the delay in purchasing vaccines, the SUS did an exemplary job. “The moment of receiving the dose of immunizing has been very special for Brazilians”, said William Bonner in 2021.

There were many records of happiness:I waited a long time for this moment”; “Very happy, the cry is really happy”; “Thank you so much, see!”; “I’m vaccinated, I’m vaccinated”; “What a thrill! Oh my God”; “Long live the SUS! Long live Fiocruz! Long live Butantan! Thank you so much, guys!”

“We saw how important the SUS was in controlling this disease, in accessing the vaccine. The exquisite care that those who took the vaccine had. This can happen in all care”, says Paulo Muss.

“The Constitution establishes a right and a duty: the right that every citizen has to health and the duty that the State has to provide health care. So, even if a person does not have health insurance, even if a person has never been to any hospital, the day they need it, the State must be available to provide their health care”, explains the STF minister. Luiz Fux.

Maria lost a brother in the past, has a son who has recovered his health. She is a witness and advocate of the changes that were necessity and dream until they became law.

“It’s in article 196. Health is everyone’s right and a duty of the State. So that all people, like me, who cannot afford it, can have the right to be healthy, to seek treatment. Just as we have duties, we also have rights, because it’s the law and it’s here”, points out Maria.

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She's our PC girl, so anything is up to her. She is also responsible for the videos of Play Crazy Game, as well as giving a leg in the news.

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