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Economy & Energy
No 39: August-September 2003 
ISSN 1518-2932

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Utopia in the Health Area


Carlos Feu Alvim

 When Celso Furtado recently received the title of Doctor Honoris Causa at the Federal University of Rio de Janeiro he told the new generations not to be afraid of building a New Utopia. The expression New Utopia has been used in several situations and we sometimes have already used it here.

To build a new utopia is not an easy task and should this utopia be inspiring it must be connected with our reality. In the health sector, Dr. Campos da Paz considers in his book “Tratando Doentes e Não Doenças” (Treating Sick People and not Sicknesses) considers that “one reaches reality only when one is in quest for utopia”. This is what he is trying to do in the health area.

Coherently with the book’s title and faithful to his working philosophy, the author describes in the book case examples or – before he should correct us [1]  - sick people examples. He describes as well his exemplary medical and public service manager career.

The journalist Roberto Pompeu de Toledo in this book’s preface calls attention to what Sarah represents in the health utopia in Brazil. He says that in this area Brazil is confronted with the option: an integrating model like that of Sarah and a model that could be called a society “disintegrating” model. In the integrating model there exists the real possibility of Brazilian citizens from different economical classes to get the same type (and the good one) of medical treatment in the same public institution.

In the disintegrating model we would perpetuate the frame that fixes inequalities. Unfortunately, it seems that this frame is already established in the primary education that is public and of bad quality for the poor and private, with quality depending on the price, for the rich and for the middle class. Its most bizarre expression is the voluminous and inefficient expenditure on private security testified by the fences around closed condominiums that try to establish a physical boundary between the two “brazils”. Incidentally, it is inside such a fence that I am writing these observations.

Much could be said about the public health utopia of Sarah. In his book, Dr. Campos da Paz tells how he concieved his dream of public health. Among the interesting details, we learn that it started in a time and place where other dreamers like Juscelino Kubitcheck and Professor Celso Furtado tried to make their utopia come true. The Sarah utopia for health was born in the new Brazil that emerged in the Central Plateau.

I undestand that in order to build a new utopia for Brazil we will have to be revolutionary in the methods and conservative in what concerns seeds that have already produced good fruits. It is dangerously pretentious to say that it is only possible to sow in flatten land. I was always intrigued by the admirable ingenuosity of the Chinese who are building the new from the millennial roots of their culture. Japan and Korea are other eloquent examples of countries that built the new by purifying and renewing old seeds. In my recent visit to these countries I could better understand this bridge that in these countries links the new with their history.

In Brazil there are several islands of competence in the Public Service and in the Private Sector. In many cases, they proclaim themselves as exceptions and they don’t directly menace the dominating system. Others like Sarah have the pretension of being case examples. They are tested seeds for building a new utopia. That is why they are attacked by the system.

Sarah has successfully transferred a unit system to a network. The difficulty of a system of excellence is to prove that the model can be applied in an ample scale. The first objection is comparison of costs that many times is reduced to the price of a specific operation no matter what the results are. The book offers eloquent examples of the impossibility of comparing a procedure that transforms the victim of an accident into a cripple with another one that returns him/her to a productive life by using the mechanism of “medical assistance prices”.

In order not to restrict ourselves to the magnificent examples of the book, we could emphasize the impossibility of comparing via price a primary education that suplies to the society a functional illiterate with another one that gives to the future citizen the base to become an individual capable of integrating himself into the society and give it his best working capacity.

In the case of Sarah, Dr. Campos da Paz sometimes permits it to slip out that he has dreamed (probably he still dreams) with the day when this example can be extended to the whole Public Network. However, his present position seems to be that of preserving the conquered terrain. Our institutions are fragile and there is always the danger of extinguishing – inclusive on grounds that the model is not economical viable – the kind of public institution that is a promissing one.

I really think that it should be organized a campaign for preserving the public institution that is an endangered species. The objective would be to preserve the bio-diversity of the institutions. This is valid even when there are doubts about the generalization of its model in the present economical conjuncture since they should be considered essential elements for building a better Brazil[2]

We know already the disastrous experience of the public education when it was decided - in a no explicit way - that it should only serve the poor. For example, it was estinguished the qualified secondary school to which belonged the Pedro II and the Minas Gerais State College (I am honoured to have attendend it) and so many others. The names have remained but apparently the species has disappeared. There is always the hope – as some animal species that were considered extinct but of which some surviving individuals could be found – that in Brazil there still exists a primary public school where the genetic material of the good public primary education is preserved[3].

The country lives a moment of hope and changes. Sarah is an example of public institution of excellence and in order to remain a qualified institution it cannot “focus” on serving the poor layers of society. It would be ironic that when there is the hope of a more fraternal and just society, its better symbol in the health area should not be expanded – or at least preserved.

The construction of a new utopia for Brazil should include the observation of the “acomplished utopias” present in these islands of competence that were established in the country. It is usual that they are built around exceptional people like the case of Sarah, of the Oswaldo Cruz Foundation or Butantã Institute. It is not easy to acknowledge the qualities of our contemporaries. Even though it seems paradoxal, to learn from the success of institutions or mainly the people of the present is more difficult than learning from past failures.

[1]  It is well illustrated by a photo where a medical team in the background is concentrated on examining an x-ray while a saddened sick person is alone in the foreground. Dr. Campos da Paz took this photo at Sarah’s installations in order to correct the medical attitude that he condemns.

[2]  It is not rare that the worry is about institutions that are using well theit money rather than with institutions that don’t and where it is not difficult do find examples of doctors that do not work even 50% of their assigned time.

[3] I always challenge my friends who are for privatization to indicate a large developed country where primary education is not public.

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