The Wolves' Playground E-Book

Henrique Prata

• Herausgeber: Editora Gente
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 224

Veröffentlichungsjahr: 2024

Beschreibung

HEALTHCARE IN BRAZIL BREATHES THROUGH VENTILATORS. BY HENRIQUE PRATA, president of the biggest oncology hospital network in Latin America Who are the people in control of healthcare in Brazil? To Henrique Prata, many of these people are truly wolves in sheep's clothing. Sparing no facts and names, the president of the Hospital of Love in Barretos denounces the subverted values he has seen in his many years working with cancer care, and shows the reality of a system that seems to close itself off when dealing with vulnerable people, exploiting them when they need it most, and getting more money in the process. With a hopeful spirit and a lot of faith in the future, the author also shows the other side of the coin, reporting inspirational tales of heroes who save lives daily. He calls all readers to form a chain of good, whose goal is to face the struggles that make public healthcare of excellence so much harder in Brazil. As you read, you will understand: - How money dominates public and private medicine, becoming patients' key to life or death; - How public medicine is used to defend and strengthen private medicine in Brazil; - The positive and negative sides of medicine and politics in the country, based on the real and transparent reports written by Henrique Prata; - The challenges Henrique Prata has faced and continues to face as the president of the Hospital of Love; - How society can unite to make public health better, creating healthcare that's corruption and discrimination-free.

Leseprobe

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HENRIQUE PRATA

President of the largest oncology care network in Latin America

THE WOLVES’PLAYGROUND

THE MONEY-ORIENTED PRIVATE MEDICAL SYSTEM THAT RESTRICTS PEOPLE’S ACCESS TO PUBLIC HEALTH

TranslationSally Tilelli

Director

Rosely Boschini

Senior Editorial Manager

Rosângela Araujo Pinheiro Barbosa

Editor

Juliana Rodrigues de Queiroz

Production Control

Fábio Esteves

Translation

Sally Tilelli

Graphic Design and Layout

Plinio Ricca

Proofreading

Valesca Giuriati e Lilian Queiroz | 2 estúdio gráfico

Images

Image archives of Hospital de Câncer de Barretos

eBook Production

Loope | www.loope.com.br

Copyright © 2023 by Henrique Prata

Original title: O parque dos lobos

All rights of this edition reserved to Editora Gente.

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São Paulo, SP – Postal Code 05435-000

Phone: [phone]

Website: www.editoragente.com.br

E-mail: [email protected]

Cataloging-in-Publication Data (CIP) Angélica Ilacqua CRB -8/7057

Prata, Henrique

The wolves' playground: the money-oriented private medical system that restricts people's access to public health. / Henrique Prata; tradução de Sally Tilelli. - São Paulo: Editora Gente, 2024.

ISBN 978-65-5544-449-0

Original title: O parque dos lobos

1. Public health – Brazil 2. Public policies – Health – Brazil I. Título II. Tilelli, Sally

23-2774CDD 362.10981

Index for Systematic Catalog

1. Public health – Brazil

Publisher’s Note

To speak of Henrique Prata is to speak of a man who is deeply focused on achieving his life mission: helping thousands of people who suffer with cancer. As the president of the Hospital do Cancer de Barretos – the Hospital of Love, as it is known –, he is a man of strategic vision, generous heart, and managerial capabilities, who holds the noble task of helping those in need, providing them daily with free, humanized, and high-quality professional health care.

However, by disclosing the hardships faced by patients with cancer, he also brings to light some facts that show the harsh reality behind the Brazilian public health system.

Despite the challenging nature of his mission, Henrique Prata believes that by sharing these stories, testimonies and evidence, Brazilian society will become more conscious of their own reality and, thus, devise solutions capable of transforming the situation of public health in the country. He struggles to create a “chain of good”, capable of surpassing obstacles that jeopardize people’s access to a high-quality health system.

With exceptional sensitivity, Henrique Prata struggles to touch readers’ hearts by sharing his daily experiences and his search for a deeper connection with the Divine. Committed to this belief, he fights tirelessly against the injustices present in the Brazilian public health system, which was devised to the less favored, working with love and selflessness.

This is a story about love and courage, so I strongly recommend this reading to all of those who wish for a more humane and fairer society.

Have a good reading!

Rosely BoschiniCEO and Publisher of Editora Gente

“Many people boast: I do not owe anything to anyone! A mistake, we owe a lot to everyone.”

Cora Coralina

To my father, a man who really lived through Christ’s teachings of love for one’s neighbor and for those who are ill. In his own vulnerability, he was the object of this very love.

To my friend, José Luiz Cutrale (in memoriam), who, along our 61 years of existence, was the biggest example of love’s infinity.

Preface

I was deeply honored and happy to accept Henrique Prata’s invitation to write this book’s preface. I have read it twice, and I feel deeply emotional about it. There are three distinct realities that touched me along the reading.

First of all, because the author himself is a courageous and brave man, who holds this strong conviction that a even someone with no knowledge of medicine can still save lives! His entire life has been dedicated to helping the sick and poor, treating them – and everyone else – with dignity and equality. Modern and efficient, all the hospitals he runs represent great examples to the world – they are true symbols of humanization. And with a firm hand and a lot of energy, Henrique Prata enthusiastically manages the Hospital of Love, and I have never seen anything like it. I had the opportunity to visit the Hospital of Love, and I was simply enchanted. By meeting Henrique Prata in several important moments of my life, I realized he is a man of God – a real saint of our times. This book is worth reading, the same way this unique human being is worth meeting.

The second thing that really impressed me as I read this book was the courage, the clarity, and the honesty he demonstrates as he shows us the extreme inequity existing in our society. It’s the kind of medical practice that explores its patients even at their worst moments of vulnerability, showing no mercy for human suffering. With determination, he reveals the names of those in the political environment, whose only plight is towards money and power, and do not think twice before letting the poor ones die in hospital lines. I do not know of any other person that, with such strength, maturity, and firmness, shows us the dark side of politics and medicine in this country. Despite all that was mentioned, Henrique Prata does not lose hope. Quite the opposite, he takes the opportunity to show where are our real heroes inside politics and medicine – those who would give their own lives to help others in need. Those who turn their chosen profession into a vocation, giving their life to the cause. It is so beautiful to see the transparency and brightness by which he shows both sides of politics and medicine in Brazil.

The third thing that has equally impressed me in this book is the fact that it goes beyond the negative and reveals a future of great hope, which believes men can do good. It almost incites the desire to save lives in the reader and giving themselves to such ideals. In every difficult moment he had to face, Henrique Prata has always kept his faith in God and Providence – two believes that have guided his life. This book that is in your hands, dear reader, was written by someone who walked every step of the exhausting and challenging path to Santiago de Compostela, surpassing his worst fears and renovating his belief that, with God by our side, we can defeat any and every obstacle in life. Henrique Prata’s faith is a great example to all of us.

In fact, as I finished this reading, I suddenly felt like reading the first two books he wrote again. Inside me there is also the will to give this book to a million people – to everyone in the planet – to make every single reader feel the hope and the will to make a difference – to humanize our medicine.

May God bless each reader and give them the courage to follow Henrique Prata’s example. Peace and Goodness.

Friar Hans Stapel Ofm

Founder of Fazenda da Esperança (Hope Farm)

Presentation

“One is unique when stretching their hand, but when one withdraws it, one becomes ordinary. Selfishness unifies the insignificant.”

William Shakespeare

With this book I hope to deeply touch the hearts of all the readers, by narrating my daily routine and my continuous search for a perfect communion with God.

In the last thirty-three years I have been learning with Him, as I work as a manager in the health field. In my two previous boos, Love Above All and Providence, we could see how everything happened through Divine Mercy, especially because I have no academic education in the health area. I can thus state that my life history is not unique, for I know of many works with the same essence and the same God values.

To see people through the eyes of God is the best way to achieve success in our work. And He teaches us that we are all brothers and sisters, despite the context or situation we are in... we are all the same.

If the work is done with all this care and deep love, it grows and supports itself, for its own intimacy with God. His mercy is endless, and it’s the same for all His sons and daughters.

As a son of God, I feel I can please Him yet more, fighting and showing no fear of the injustice of the health system for the poor. This will become clear in this book.

Summary

Introduction

Chapter 1

A Look at the System and an Exception Among Public Men

Chapter 2

How Was the “Wolves in Sheep’s Clothing” Concept Born?

Chapter 3

Porto Velho, Rondônia

Chapter 4

São José do Rio Preto, São Paulo

Chapter 5

Santa Casa de Barretos

Chapter 6

Work Team

Chapter 7

Bebedouro, São Paulo

Chapter 8

Palmas, Tocantins

Chapter 9

Araguaína, Tocantins

Chapter 10

Aracaju, Sergipe

Chapter 11

State Governments

Chapter 12

The Federal Government

Chapter 13

Philanthropic Hospitals

Chapter 14

Man of Faith and Love

Conclusion

Introduction

The stories I am about to tell you in this new book aim to denounce, clarify and, at the same time, summon people of good will to form a chain to face the obstacles that challenge the existence of quality public health system in Brazil.

I’d never imagined this struggle would be so cruel and demanding. The stories I’m about to share, supported by witnesses and proof – and no other way would do it – will make us more conscious of all we can do as a society to change the tragedy of public health in Brazil, which, in the end, may be the difference between life and death to so many people.

I was certainly very happy as I wrote my first book, when I walked the path to Santiago de Compostela for the first time, ten years ago. I was undoubtedly inspired by the Holy Spirit as I lived through moments of introspection and remembrances, which made it possible for me to share, in a clear way, the stories of my father and my family, as well as my own, so that people could understand a project that has existed successfully for sixty years, even with so many obstacles and such a monstruous deficit in resources. The Hospital of Love is more than a building. It’s a mission. Many of those who learned its history were touched by it and felt motivated to act with the same goal. I can say I feel fulfilled because of that. So many people, who are as lay as I am, understood that despite not being doctors, they could still save people’s lives.

This story must be told from the perspective of a family that has been living through this experience for more than a hundred years. In my second book, I had the opportunity to say that my great-grandmother used to shelter patients in her own house, and that’s how everything started. After that she built a Santa Casa (holy houses of mercy hospitals) in Lagarto, in the countryside of Sergipe, which was inaugurated in 1919. As she had no experience in the field, she had to deal with the same troubles I have nowadays, which means tirelessly searching for the donation of resources among people in our society, and thus giving quality medical service to the highest number of unassisted poor people in our country, so that they would escape the claws of our country’s failed, broken and dishonest system. There has never been justice in the public medical service offered in Brazil, so much so that nobody from the three powers of our federal government has ever used the public system. All of them have access to health insurance and other benefits, while an inefficient service is provided to the poor, who still must be admitted in institutions that survive with outrageous resources, even when coping with high complexity cases.

Thus, the first book was an inspiration from the Holy Spirit, which cleared my mind and refreshed my memory and my feelings along the 500 kilometers walk from Burgos to Santiago. There is no doubt that book was a huge success. It sold more than 260 thousand copies and allowed us to start building a hospital in Porto Velho, Rondônia. Entrepreneurs and businessmen who have read it – and still read it – have been contributing with more that 50 million in the last ten years, to improve the ICU installations, the surgical center, the chemotherapy and radiotherapy rooms and the outpatient’s ward (infirmary). The initial part of the project was born from people who had read the book prior to knowing about the Hospital of Love in Barretos (in São Paulo), the one in Jales (São Paulo), and before knowing me. That’s why I feel quite motivated to write this third book.

Chapter 1

A Look at the System and an Exception Among Public Men

This book presents readers with both denunciation and nonconformity towards the disarrayed values in both politics and medicine. I will obviously exclude from this list all the good men in those areas – who unfortunately are not many. The most powerful are the ones fed by the power of money, and those whose political and financial interests are all they care about. That’s something I have seen happen for more than thirty years in our Ministry of Health. As incredible as it may seem, and despite the good men who have served there, their attitudes have always been first oriented by politics.

The only exception I make concerns Minister José Serra, whose administration was efficient and based on technical principles, both ahead of the Ministry as in the Senate. He devised one of the most significative social justice acts, prioritizing laws that facilitated the use of resources in public health with the security of fiscal responsibility. He created laws that forced cities, states and the Union to respect a thirty-day limit after invoice to pay their debts, and did not allow the budget to be postponed from one year to the next.

That was a fair and obvious solution, which, unbelievably, took a long time to be implemented. My father, who was the owner of the hospital, for example, went bankrupt when inflation galloped (20%, 30%, 40%, extrapolating 50% a month) as, without the fiscal responsibility law, the situation became unsustainable. Besides that, it was necessary to wait months to receive the amount invoiced, and by the time it happened, the amount was insufficient to cover even one day of interest. It was an abomination, a disaster, and José Serra was the man who found a solution to this problem.

As Health Minister, he tried to stablish social justice. Some types of medicine for treating cancer, for example, underwent no regulation and could be altered to contain just part of the necessary components. Then, he created the Brazilian Health Regulatory Agency (Anvisa – Agência Nacional de Vigilância Sanitária), and from that point on the prices of medicine became fair, and their quality, unsuspected.

José Serra was also the mentor of the Incentive Law for generic products, something that lowered drug prices. He also broke the protocol for the treatment of patients with HIV, which revolutionized the treatment of this illness in our country. But if I were to talk about José Serra in the Ministry of Health, I would probably spend the entire book doing so. I’ll sum it up by simply highlighting his honesty and efficiency with public health. When he was our Health Minister, we already had prevention protocols, treatment, university teaching, research, and rehabilitation programs for patients with cancer, however, he was the one who stablished that all services should be compulsorily executed by a specialist doctor, on-site. He also stablished a pricing policy that allowed people to pay the bills and still have access to adequate medicine – both basic items, which were always denied. Those were good times for everyone that used public health services.

Then, when he became the governor of São Paulo, in another crucial moment for public health, he determined that the state covered 75% of the total amount the Union invested in high complexity healthcare; in just 60 days in office he created more hospitals like Santa Casa, one of them in Barretos. He realized our city had a bigger deficit compared to a tenth of other cancer care oriented services in São Paulo, and he also knew we had always practiced health care of excellence, despite the resources we had – and we did that with absolute honesty.

When this happened, it was possible for the state to offer the same rights to patients. Until then, the state had never invested money in public health of high complexity, for it only invested in the management of its own services (which were poorly administered). Upon the creation of the Medical Specialties Outpatient’s Clinics (Ambulatórios Médicos de Especialidades – AMEs), the centers for medium complexity, the situation improved, but that was not enough. The state does not administer more than 40% of public service. José Serra gave us the possibility to do it and we reached the highest level at that moment.

Despite the problems in a few hospitals, which were not acting accordingly, José Serra was the only one who made justice. It’s been many years since José Serra has left the government, but the prices paid continue the same, both in São Paulo and in Brazil.

After twenty years, the amount paid for procedures in the Unified Health System (Sistema Único de Saúde – SUS) continues the same. Some of them were adjusted in 20% or 30%, but most of them are still frozen and we are facing now one of the most tragic moments in public health. The Federal Government is paying 21% of the amounts paid by José Serra during his administration. Now, there is no justice. No one can raise the huge sum of money that most of the high complexity services and Santa Casas require to provide treatment – and justice – to all.

That was the only moment we did receive the honest money we needed. Nothing they say or promise is true, neither in the Ministry of Health nor in the state Health Secretariats (Secretarias de Saúde), thus we have reached the end of the road.

The situation was already difficult when I became the CEO of Santa Casa de Barretos, five years ago, but today it is even worse. I have been speaking up and fighting for change, but we have been going through an unbelievable experience, with huge problems, maybe unsolvable ones, that nobody seems to see – or pretends not to see. I know it’s difficult to believe what I’m saying, but I have proof of that, and I’ll reveal them right here. They include the changes I’ve made in Santa Casa de Misericórdia de Barretos, which testify what I’m saying and make evident that the decrease in mortality rates are due to some of the approaches implemented there.

I am sure that, after I took control of Santa Casa de Barretos, about 25% of the patients who died there at least had a chance of surviving. I’m talking about more than 200 patients, who had access to a specialized doctor and onsite appointments, as well as taking medicine the institution was not able to provide before, because it was in debt – totally broke, indeed.

Besides, the “medicine mafia” that used to control the Santa Casa left it idle and allowed the offices to be used by doctors who attended to their paying patients without an appointment before the other ones, who had made their appointment via public service. The doctors, on the other hand, earned peanuts for their procedures – a cesarean section, for example, cost R$ 120 (that is, less than US$ 25), which made it impossible for doctors to make their living.

Chapter 2

How Was the “Wolves in Sheep’s Clothing” Concept Born?

The kind of medicine I want to offer my patients goes through all sorts of hindrances and obstacles in Brazil. This situation will become much more tangible for our readers in this third book, where I expose not only what really happens with the Brazilian public health service, but also the difficulties faced by governors to fight this system.

I have a lot to share with you in the following chapters. I will disclose several things that happened both in Santa Casa de Barretos and in other parts of the country. I will expose the money-oriented medical policy that prevails in the public service, which makes medical care far more expensive than it should be.

And I can say that because I deal with it every single day. All my anguish comes from the fact that, apparently, nothing will ever change, despite anything I did in the past, and anything I still do. I realize that in every job, in every occupation, in any society, there is always a “wolf in sheep’s clothing”, just lurking. I must confess that when I was younger I myself played the wolf in sheep’s clothing, and in various moments of my life as a businessman. Maybe that happened out of pure ambition, or simply because I didn’t know better. However, as time goes by, human beings tend to grow smarter and realize that maybe what they did was wrong; perhaps in the efforts to conquer more and more, they acted improperly, and then one day they end up regretting their deeds and wishing things had been different.

Perhaps many of those who are wolves would rather not look in the mirror and realize that their ambition and greed turned them into selfish creatures, capable of “selling difficulties” to “obtain facilitations”, and harming others in the process.

When facing difficulties, the poorer are the first to sell whatever they have – a house, a car, a bike – to cope with health-related problems. They have no one to help them, such as a lawyer, for example, so they deal with the situation as they can.

When it comes to medical practice, this hurts me deeply. For this reason, and because of all the experience I have in this field, I can only feel in peace by doing my share. And that’s the reason why I fight against the status quo. But that is not an easy task. It’s hard for me to realize that I’m not capable of running more than one hospital, and, despite saving lots of patients, many of them still lose their lives.

I run almost the entire public health hospital chain in Barretos – I am responsible for cancer treatment management, medium and high complexity cases, AMEs and basic health care, which means catering to thousands of patients per day. And with all my experience in – and knowledge of – health management, I can definitely expose how the wolves in sheep’s clothing work.

The Holy Spirit was extremely attentive and considerate with me when I wrote my first book, so I hope He continues to illuminate me, so that I can share these facts with absolute transparency and honesty. Then, maybe we will be able to work together, join our forces, and demand that a new mindset is implemented among politicians; perhaps we can do something that will set us on the right path to social justice, and allow us to move further. I still have hope, but I’m not sure I’m not being far too ingenuous.

I’m aware of the fact that despite doing what I can, that’s still not enough. Even with the amount of patients we cater to, I still feel the anguish of not doing more to avoid so much suffering among them. But I continue to fight this monstruous system. I advise you that the content of this book is difficult to digest, but it will show readers how bad the situation is, and how evil things can become.

About twenty years ago, when we started the Cancer Prevention Mobile Units project, our aim was to visit the outskirts of cities and help women who had no access to information. The plan was to teach women with no access to information the importance to prevent breast and cervical cancer.

The idea of mobile units was born in Barretos, the city where the Hospital of Love is located, and the first cancer prevention tracking program was implemented and carried out successfully.

At the beginning, we implemented only one of these programs, and we used a bike – one bike – to reach all the low-income population. By doing that, 95% of the women adhered to the cause! The nurse in charge of the program, Creuza Saure, would ride the bike with a foldable stretcher attached to the back, going from house to house, from community center to community center, and she would collect samples for Pap Smears, which is a preventive exam for cervical cancer, and bring them back for analysis. For this job nurse Creuza was given the Unicef “woman of the year” award. This pilot program was a huge success, and the bike was replaced by truck units.

Nurse Creuza Saure and her bike, ready to perform preventive cancer exams in the outskirts of Brazilian cities.

Nurse Creuza Saure visiting a family to perform the exam.

At the time, this project was anchored in the profound respect everyone had for the Hospital of Love in Barretos. However, when we tried to implement it in other cities – such as Fernandópolis, near São José do Rio Preto, which used to send us many patients with advanced breast and cervical cancer (to whom this prevention would be essential) – we noticed total detachment and indifference. We were unable to get permission from local Health Secretariats to work both in São José do Rio Preto and Araçatuba, big cities in the countryside of São Paulo state. At this moment I started to realize there was a “market exclusivity” clause in those places. The private health sector had already invested a lot of money in clinics and medical offices there; the medical class was powerful and posed as a big obstacle to our program.

Doctor Raphael Haikel Junior, responsible for the mobile units from Hospital of Love, confirmed it would be impossible for us to reach the big centers without the approval of the local health secretariats. Nevertheless, in small cities our project was still welcomed, for this kind of exam was only provided by private prevention units, and it was expensive. We offered it with good quality and for free.