Uma visita notável

Abstract

I visited Brazil for the first time in 2006, and was struck by three things. First, I was welcomed with so much warmth and enthusiasm that my affection for the country was immediately assured. Second, the sheer size of the country seemed overwhelming, to a native of the comparatively tiny British isles. Third, perhaps reflecting this vastness, the extent of health inequalities was both more immediate and more apparent than any I have encountered before, despite the familiarity of this problem. This led me to reflect on the similarities and differences between our two health systems, on the needs of the populations, and how nurses might provide services themselves, or influence service provision to meet those needs. I visited a family health unit in São Paulo, and was interested to meet the nurse leading a team of community workers, and to note the similarities with our UK primary health care teams. These usually include doctors and nurses, and sometimes pharmacists and other health professionals, all working from the same base and serving a population registered on the practice list. Until 1974, community nurses and midwives all worked in bases separately from the doctors, and covered a caseload that was geographically defined. People can choose which family doctor's list to register on, so their practices, and associated primary care teams, do not relate to a specific local community. Also, in the UK, we distinguish between the professionals who deal with clinical health care needs (mainly district and practice nurses), and those whose primary responsibility is to promote and improve health (mainly health visitors and school nurses). Close and frequent collaboration between family doctors, nurses and others who provide clinical care to people who need medical treatment helps to promote multi-disciplinarity and best practice. Generally, for this group, the practice list system works very well. However, it is less effective in supporting work for health improvement: the health promotion aspects of community public health. As a result, we are trying to redevelop the geographical links once more, so that health visitors and school nurses are better able to liaise with local residents and communities.