|Hospital Municipal Sebastião Martins Alves, Lençóis, Bahia|
Hospital Municipal Sebastião Martins Alves is not a historically significant hospital. It is not well equipped, nor particularly clean (though it is not particularly dirty, either). It is not well staffed, nor is it on the cutting edge of any medical advances. (There are few cutting edges at all in Hospital Municipal Sebastião Martins Alves, and if there are, you probably want to avoid them.) But the hospital in the little town of Lençóis in the Chapada Diamantina region of Northeast Brazil is of utmost significance to the residents of the area, and in many ways symptomatic of much what ails the health care system in Brazil.
On a Sunday morning the waiting room of the hospital is uncharacteristically slow. Seven or eight people sit on the two benches lining the whitewashed walls. A small television above the desk replays last night’s World Cup game. On the reception counter, a stainless steel tray contains samples of various bodily fluids.
“Come,” says Elisângela. “I’ll show you around.” Elisângela is a nurse in her late twenties, with a round, caramel-colored face and a sweet smile. Her white medical coat has a crocheted trim. “So you’re researching midwifery and childbirth?”
She hurries me past the curtained exam room, where I hear someone moaning. “This is the delivery room,” she says proudly, opening the door to a sparse room featuring a bed that looks vaguely like torture equipment.
“And here is the labor room.” She shows me the adjacent windowless closet that barely fits a narrow cot.
“You should meet Maria Aúrea,” she says, calling over an older, dour-faced woman with a plastic shower cap over hair. “She sometimes helps with the deliveries.”
“Is she a nurse?”
“Actually, she works in the kitchen. But she’s a parteira, a traditional midwife.”
Maria Aúrea’s eyes dart around the hallway, as though she is looking for a way out.
“I’d love to talk to you sometime, Senhora,” I say to Maria Aúrea. “I’m researching midwifery—”
“I have to go.” Maria Aúrea cuts me off, and hurries away down the corridor.
Actually, there are two healthcare systems in Brazil. There is the public system or the private system, which about a quarter of the population is lucky enough to have access to, either by paying into it individually or through an employer.
Most people depend on the universal publicly funded Sistema Único de Saúde, or SUS. Since its creation in 1988 this has made enormous strides, reducing maternal and infant mortality by half and raising life expectancy from 66 in 1990 to 74 today, but it is still a vastly overstressed and uneven system. At a national level, for example, there are two hospital beds for every thousand patients. It is common to wait months for basic tests such as an X-ray.1
And everyone in Lençóis is depends on SUS, at least to some degree. Even if they can pay for a private doctor or hospital (which most cannot), the nearest city where such care is available is at least a six-hour drive away.
“I thought you didn’t deliver babies here,” I say, turning back to Elisângela.
“We’re not supposed to. But if a woman comes in practically pushing already, well, we have no choice.”
“Does that happen a lot?”
“More than you might think. We try to get them in an ambulance and take them to Itaberaba, though.”
“Do a lot of women give birth in the ambulance?”
“Oh, yes. That happens all the time, too.”
There are no doctors living in Lençóis, so they rotate in: a different doctor every day of the week. Most come from several hours away. On the Sunday I was there it was Doctor Pedro, a paunchy, fiftyish man with thinning hair and even thinner patience. “I can talk to you for just a minute,” he said brusquely, waving me into the small office with peeling paint. Behind him, a fan made his comb-over rise and fall distractingly.
I asked what he thought about the C-section epidemic in Brazil. “That’s not a problem here,” he said wearily. “We don’t do C-sections. We really aren’t equipped to deliver babies at all.” Doctor Pedro looked tired, slightly beaten down. He had probably driven several hours to get here, I thought, to tend to a long line of people with diabetes and hypertension and other ailments—who needed more than he could give them—then drive several more hours home. No wonder he had little patience. “I do have an ultrasound machine in my car, though,” he said, perking up.
I thanked Doctor Pedro and Elisângela for their time and headed out into the hot midday sun, into the pulse of reggae music, the squawking of chickens, and the yelling of children. Hospital Municipal Sebastião Martins Alves faces cobbled street called Rua Vai Quem Quer—“Go If You Dare” Street.
The name is a holdover from the town’s history, more than a hundred years ago, when Lençóis was a boomtown in Brazil’s diamond mining Wild West, when jagunços, soldiers for hire, hid among the rocky escarpments and shot at each other.
Now children play soccer and hide and seek on Rua Vai Quem Quer in front of the hospital and sit on stoops licking popsicles. Women hang laundry in the median dividing one side of the street from the other.
But perhaps, I thought—walking slowly home down Go-If-You-Dare Street, hoping fiercely that no one in my family would need the services of Hospital Municipal Sebastião Martins Alves—the name is not entirely without resonance, even today.
- “What the U.S. Can Learn from Brazil’s Healthcare Mess,” Olga Khazan, The Atlantic Monthly, May 8, 2014