[Applause]
today almost 50% of the world resides in
rural
but only 24% of physicians decided
work in these rural areas
but as I discovered this in 2014 I went
science without frontiers for the
Ireland
and there I got an internship with
family physician and community in a
community on an island in the
archipelago
The first time I went there I
I boarded a bus from downtown
the city that was living
and went towards the countryside
every kilometer was greener and greener
and fewer and fewer cars
when I arrived at the bus stop and
yes
I was very worried I caught my
cell phone had no signal had not
Internet
Then I sat down and waited for a doctor.
in search until he arrives
I had already made a thousand plans for
to go back to the city but still well
I waited for him to arrive and boarded the
and when I boarded I was
embarking on one of the best experiences
of my life
I soon started to talk to him that
I was working for 30 years in the same
community
I thought it was incredible how much he
knew the patients had already taken care of
of generations five generations of one
family had pre christmas
Grandmother’s mother accompanied her grandson
and then I would ask in the beginning
because I did not believe he knew
Everyone who lives there
Who lives there who lives in that house?
he is incredibly familiar with all the
houses of the archipelago and a very
in rural health is the
need for creativity
sometimes we needed to call the
ambulance in emergency cases
and then he had colorful bags that
We were hanging on the fences.
the sax and then we knew the way to
indicate the driver when you have
such bags and fold there continental only
that the dollar
need this creativity to deal with
When you have more adversity to
distance and time throughout the treatment
adequate in the rural area is much higher in
regarding urban area care
arrive the delay more and we need
be prepared as
health will deal with these situations and
often even having a system of
appropriate reference
the professionals the patients will choose
for not staying right or for being
care for not going to the hospital and
being cared for in your rural area
so we need to be more
prepared to deal with these
situations and of course that after
I discovered and knew the hands of
rural workers in ireland and
he would never be able to let go of
family medicine and rural community
rural health is so different
of the urban that when you open the door
to call a patient
I do not know what’s going to come in can be
a snakebite can be a
accident can be a serious
intoxication can be
a depression diabetes hypertension
It could be a fantastic story and I
I would like to share two stories
those already in the Brazil living in
one of those doors that the oab was
talking with the family doctor and
community that works inside the
Brazil
I ask we were commenting
He spoke but won when I was
Young woman working in the field I planted
smoke and during the time of passing poison
I smoke and I spent the whole day
poison the whole night so much the day
whole passing poison all night
spewing
unfortunately this is not a reality
that only he lives today 70 thousand people
die every year from the use of pesticides and
at least 7 million have toxic
acute or chronic and suffer from diseases
by these intoxications actions and today
this doctor thankfully lacked the right
work on land with rural health and
before he planted fun
today it helps people to stop
smoking but not for there
Another day I was attending a patient.
structuring his hand he had
cut with the machete on the fourth of the palace
and I had been holding it was
telling him that he had to wear gloves
he had to use equipment of
individual protection and talking there
in the end my preceptor nor the teacher
said so but mere be short or brief
and you’ve already cut folder using glove on
If not, then he said it because it is
I tried to deploy the folder and cut and
impossible to use the glove on the
two hands
today I try to at least negotiate with the
patient to wear on the glove that most
suffer cuts and I think that empathy
to put yourself in the next place
of these people living a reality
very different from our life in general
is fundamental
Good, coming back to me, it ‘s history.
Ireland
I arrived in Brazil very well, thanks.
I started to talk to my
colleagues on rural health
teachers were people me
They looked so there is no rural health
some people have such
more comprehensible approach than you
You know, it hit my back.
How cool is that experience in Ireland?
But there’s no such thing here.
that focusing on the case was losing my
focus is good
while I could not find the doctors
professionals working with
rural health in Brazil because, as soon as
I arrived I felt a bit orphaned that
I was not meeting my peers.
I started talking to professionals.
around the world and in 2015 see
idea of creating a project called hope
and medium in coffee
dubbed the rural coffee in a
world platform on which people connect
around the world through
youtube facebook and twitter
we have a meeting live on
youtube connects on facebook and one
son on twitter you have an idea
today we are in the 26th edition
then with two years of project over
100 people participated more than 40
countries and this project that it
practically created that initially did not
Brazil will be at the next meeting in
next conference of the organization
the global health system on
health work and we will be
there doing an edition of rural health
in a few weeks to discuss the
health professionals in rural areas
Then I arrived in Brazil and finally
I found a working group of the
Brazilian society of
family and community and wanted to
my feet on the ground doing a chilam
by the interiors of the Brazilian countryside
it was my turn to put my feet in a
journey through my interiors and through
interiors of brazil
I started with the place of my training
in rio grande going to visit the community
the hottie and then he would pick it up
also left the cd in the center of the city
She’s living a kettle because she’s not
had lunch
I went there to eat lunch at the time of the
and stay at home to take care of
patients and will even have lunch at the
of some patients learning about the
medicinal plants knowing that
community
and then I took my backpack and went
for caruaru pernambuco in the drought
I ‘ll never forget a story
that I lived there I was with the patient
and we are making a list one
list of things that were
disturbing him and had hypertension
diabetes family conflicts of
unemployment and I asked him
on this list that bothers you the most
he looked deep into my eyes and
told the drought
I could not make it rain, it’s no use.
today we have the best
professionals
the best consultants the best
equipments
care has not yet arrived in the
the rural population estimates the
International Labor estimates that the
global health deficit is 2.5 times
rural areas in relation to
urban areas of at least 10 million
there is a shortage of 10
millions of health professionals today
the areas they most need and the
prediction is that in 2030 we have a
estimate of having to need 40
millions of health professionals
but they will focus on where
most developed areas in the country
developed countries and middle-
low and low income countries still
shortage of 18 million professionals
of health
so let’s look at some maps
together the dark green areas are the
areas that correspond to the most
of the world
coincidentally what you think
are low- and low-middle-income countries
income
these are the 70% of the world’s
live in extreme poverty
lives in rural areas then why
people do not train professionals to
working in rural areas should be
Wonder what good to stop for?
think
looking maybe this is not a
Brazil problem because Brazil is
very light andré dark green the people
does not have a very rural population
big
according to the official census 15% of the
Brazil resides in rural areas, which
equivalent to around 30 million
people
because the definition of rural in the
Brazil started at no during the state
where rural was considered as an area
outside the urban perimeter
then all that was and all
cities would be categorized the
its center as cities as urban and
everything outside that would be rural
but then it ends up making a
overestimate where the parent number
small municipalities
demographics end up being very
overestimated because they are considered
all as urban beauty
Now you look at this image here, you
think he’s talking about an area
urban or rural
sure we are talking about a
urban area
by the definitions of Brazilian laws
this place has
electrical lighting networks beyond
of it is less than three
kilometers of a health unit and
This is the door and the health command.
Let’s put some history
in these data
after all history is given with soul
one day a very bad patient arrived and
he needed the medical person to do the
the heart massage to start the
resuscitation maneuvers and then she
asked for pro in team
please call the ambulance there
team or her but doctor does not have
urban phone that does not have
do not call me
Thank God the pros
Brazilians have dealt with a lot of
a lot of creativity
fluvial health units are
ways to reach people
composed of mobile health and
reach these communities
I’ll never forget the agent
community health system which is a
to expand access to rural health
showing the scars on the legs of the
dog bites
are community agents who
gates to get them to
people’s house walks miles
horse bike bike spent the
sole of walking shoes
It’s my homage to them here but I
wanted to share a story with
I also went to Minas Gerais
inside mines general
and there I was as I was following a
young lady a young woman at the end
with palliative care and the already
was resolute with death
I asked her everything she
did before the illness she liked
She told me milk pudding.
quickly
I wrote down recipe I got organized
is getting a house with organized
a neighbor making the pudding
The milk I was going to take her came
milk people a few days later I arrived
for her a milk pudding
I showed her on the edge of the bed she said it ‘s a
pudding and I asked
It’s a piece she looked at me and said
no, I was a bit taken aback
with that one, right?
I did what I could and such but she spoke to
me like you and the doctor there in the kitchen
We obeyed that it was there.
we ate a piece of pudding and went to see
the other patients of the day when the
people came in for about a couple of
hours later she called to warn that
she had died
We arrived at the house again to do
the death certificate prepare the body
we got into the kitchen, it was pudding
on the kitchen table and the relatives
were eating pudding
I went to the room to help
prepare the body to finally gain access
and then I was closing her mouth and
I realized she was smiling
because it’s important to count this
story to you guys because
probably a doctor who works in the
rural area will be the only professional
and the whole team will be not to be the
professionals within a radius of
km seek that community
and need to be prepared to deal
with this kind of situation
in 2016 we created street alcides or
rural seeds with this idea of the rural
popping up inside me and talking
with several people
we wanted with worldwide to create a
group that was to integrate young doctors
young health professionals with
experienced professionals with
academics and that it was going to be a
It is democratic that everyone could
then hear talk we created this
Street group alcides
we identified that mainly
in developing countries there
a lack of mentoring is often the
and was isolated in
certain places did not have a
teacher did not have a mentor to
help guide those people so
we created a project called monitor
mind that global mentoring is the
first map of mentors that people
has been launched this year this project
and these are this is the mentoring map
world, for example a doctor
in Nigeria can be
accompanied by a mentor from a distance
from Australia
the newly formed doctor of the states
may be accompanied by a motor
experienced with Uruguayan rural health
or a Nepalese doctor with the doctor of the
Neon Neon A Health Professional
that of Rwanda with a professional
health of australia then we
is decreasing the distances and
idea is not to take care of the
people but will respond to their own
people to carry out their care
finally I wanted to ask you
How many of you already bought one?
potato, what will it be?
I want you to think with me on this one.
which was the way that
She made it to get here.
What land was it planted on?
will this potato go from Ireland or
from Brazil it’s more
will it be that the farmer planting this
potato that harvested this potato has pain
back at the end of the day by harvesting
this potato will be that the person who
this potato has been poisoned by
agrotoxic
finally, that person has
access to a health service such as the
your right
I’ll tell you that health
is not a simple comparison
with urban and is not just about
potatoes but that will keep me restless
until you can not get health for everyone
throughout the world, including in
rural
thank you very much
[Applause]
”
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