Translator: Christi Yaghi Reviewer: Claudia Sander I'm an expert in people. I'm a family and community doctor and my job is basically taking care of people. But I don't take care of the illnesses, I take care of the person who's sick, and this makes all the difference.
I work at the Brazilian health system, SUS, since I've graduated; I can tell you that the reality of the health system is far more complex and challenging than what they tell us in college. Since my first day at work, I've realized how poorly I was prepared. I thought technical knowledge, purely scientifical, was above everything else, including people.
I've failed countless times trying to impose on my patients what I thought was right and good for them, but I'd do that without listening to them, without considering them, not understanding their expectations in the face of diagnosis and treatment. Surely it didn't work out. It was at SUS that I've found myself as a doctor.
Many of you don't remember or don't know because you're really young, but before SUS, health was charity. Millions of Brazilians didn't have access to a health system. SUS started at the end of the '80s and caused a revolution.
It transformed health into a legal right. It brought dignity to those millions of people. At SUS, no one needed charity or pity to be treated by a doctor, a nurse, a psychologist.
That has fascinated me to this day. SUS is the biggest public health system in the world. And in it I've found myself as a doctor, especially when I experienced family and community medicine.
At medical residency, I've learned that ethics, empathy and communication skills can be trained, that we can learn to be ethical, that we can improve our communication skills. More than that, I've learned that prescribing the best medication is as important as me, myself, being the best medication for my patient. Balint, a Hungarian therapist born at the end of the 19th century, used to say that the doctor himself is the first medicine that is administered to the patient.
Our personality, our empathy, our ability to mobilize ourselves in taking care of others. Everything I've learned at college started to make sense. In health care, that is to humanize.
It is to qualify our attitude towards others. It's an intention, a moral and ethical improvement that makes us look at others in their entirety. About five years ago, I started writing texts about my encounters with patients at the primary healthcare unit which I work in, at SUS.
They were quite unpretentious texts and I began to publish them on social media, and their reach has quickly gotten out of control. Hundreds of thousands of people began to read and share what I wrote, and many texts gained national and even international exposure, and I began to receive, from many people in Brazil and from around the world, messages congratulating me for my work. I found it rather interesting because I didn't understand what I was doing that was so incredible to deserve compliments, since it was all but a report of my daily life at a primary healthcare unit in the outskirts of a big city.
And I asked myself all the time, "What is so incredible about it anyway? " A very close cousin of mine answered that question, saying, "Júlia, do you realize how difficult it is to be heard at a visit to a healthcare professional? Do you realize how much in need people are of the care that you say you give?
" It was overwhelming for me to hear those things, because we're talking about people who studied and specialized in taking care of people's health, to be in touch with people's most acute suffering. And these people who are totally disconnected with other people's pain are the ones who've lost the ability to connect themselves with other people's suffering, with their patients' suffering. And when did we, doctors, lose that ability?
Was it because of extra work, physical and mental exhaustion? Was it because of long shifts? Was it because of flaws in our training?
I don't have an answer for that. But I'm quite sure that we are distancing ourselves more and more from what is key in our work as healthcare professionals: genuine care. I know that at SUS, the reality is not exactly how I picture it.
Lately, it has become farther away from my dreams. But I'm not here today to talk about what's still lacking. I'd like to talk to you about what can be done with what we already have.
If we have a door in our office, we can close the door and ensure our patient's privacy, so why do we keep it open? If we have bed sheets, why haven't we covered the naked woman who's to be examined? We can call them by name.
We can call them by the name they want to be called. We can give them autonomy or we can respect the patient's autonomy. We can understand that the person's path is their own, that they have an incredible ability to put new meaning into their story, their existence.
About three years ago, I was at my office, and it was a typical morning at a SUS primary healthcare unit, the reception loaded with people. It was almost lunch time, and there were still so many people to attend to. And I called a patient, not knowing that she'd change the way I saw my work, the way I saw life.
She transformed me, as a doctor and as a human being. Her name is Helena. I came to the office door to call her and when I called, "Ms.
Helena," a black, sad woman got up, and her countenance was so glum that I was sure, myself, that she was there to talk about that sadness. And then, in my arrogance, I said, "How nice! I've studied depression yesterday!
It's all very fresh here in my mind, I'm sure. Ms. Helena, come with me, it'll be all right.
" "Ms. Helena, good morning, sit down. How can I help you?
" She answered, "Doctor, I came because of a sore shoulder. " Then I sank into my chair, all my training had vanished. I closed the depression drawer, because many times we treat patients like that, we put the illnesses in boxes that don't communicate, don't interact, don't talk to each other.
I opened my little drawer of sore shoulders and said, "Wow. I know how to treat a sore shoulder. I've studied it so much at residency, everything will be fine, Ms.
Helena. Just pretend I didn't speculate about your case. " I opened the sore shoulders drawer, put all books and articles on the table, and Ms.
Helena began to tell me . . .
I said, "Speak up, Ms. Helena. Tell me, explain to me how that pain is.
" She replied, "Doctor Júlia, I've felt that pain for about two years. " And with each fact that she reported, I sank a bit more into my chair. "I've tried ice, heat, physiotherapy, stretching, yoga, acupuncture.
" What was left for me, huh? "Also, some months ago, I was referred to an orthopedist. He said I had to have surgery, I even had my shoulder operated on.
" I said, "Gee, why didn't you come here before? I could've done something. " "But I didn't come because of that shoulder.
It's hurting like hell, but now the pain is moving to this one. " Me, "Man! This woman has done all that medicine had to give her.
What am I going to do? How can I help her? " I didn't know, I didn't have the answer.
And I decided to follow my intuition, and I went back to the beginning, when I saw that sad lady coming in. I looked at her and said, "Is it really just the shoulder? Is there anything else you'd like to tell me?
" Then Ms. Helena started to cry heavily. We know that visits at SUS get interrupted many times.
Sometimes we are the only doctors at the unit, someone arrives urgently, someone needs to talk to us, and Ms. Helena couldn't be interrupted in that moment. That's when I decided to get up and lock the door.
I sat down in the companion's chair - she had come alone - I sat facing her and said, "Would you like to talk it out? " As I was holding her hands, she told me this: "Dr Júlia, it's been two years and two months today since I lost my daughter; she was burned alive by her husband - (Sigh) It has been really sad, because this sadness consumes me and I don't have anyone to talk about it. I try to talk with my husband, but he says, 'I cant' handle it, I can't live with that suffering anymore and each time you talk to me, all that sadness of the moment of her passing returns.
' I try to talk to my son, but he can't handle the pain. That's made me very sick. I take care of my grandson, whom she has left, and I look at him and see her, running around the house.
Dr Júlia, it's so much sadness, I miss so much when she'd get home and we'd open a cold beer, she'd make a snack while I'd do the laundry. I don't know what to do, how will I live with this. " I looked into her eyes and said, "Ms.
Helena, pretend I'm your daughter. What would you like to tell me, mom? " She closed her eyes, touched my face with her hands and started patting me, with eyes closed and said, "Oh, my daughter, how I missed you, kid.
Good to see you again, mommy has so much to tell you. Mommy is feeling so nostalgic, I missed so much when you'd get home on Friday and we'd drink our beer. Oh, it's so hard taking care of your son.
So hard to take care of him without you. " Surely, I couldn't help myself, I cried with her, for that's what I should've done. It's not in the books, but I wasn't a doctor anymore then.
I held and squeezed her hands and said, "Mom. I'm okay. I'm all right, be reassured, I'm OK.
We will meet again. I need you to find balance, to search for it, to keep on taking care of our family like you've always done. But I'm fine.
I'm waiting for you here, where I am. I'm peaceful. God bless you.
" (Sigh) We hugged for a long time, wiped our tears together, I returned to my chair, and took care of her shoulder - remember that she had a sore shoulder? After some referrals, prescribing medication, she said, "Doctor, every time when it's one more month from my daughter's passing, I visit the grave where she's buried so I can feel closer to her. And today I wasn't sure if I'd come here or go there, but I'm happy I came here, because, since she passed, I'd never felt so close to her.
Thank you very much for being the bridge, I needed that shoulder so much. " This is to humanize. Simply put, to humanize is to be a human being caring for another human being.
To humanize is not about the destination. It is about the journey, Where I come from, other men and women are graduating, improving their communication skills, their technical and scientific abilities, to become agents of transformation at SUS, which we believe in and fight for. Currently, I work at a primary healthcare unit amidst an extremely violent community in a city near Belo Horizonte.
It's 15,000 people under the care of five health teams. Back at residency, when I was touched by the idea that humanization was possible, I began to be an agent of transformation in the places I worked at. And other people were touched by that idea of humanization.
The impact of this is that every team that's transformed also transforms the life of 3,000 people. It's 3,000 who'll get to be listened to and looked at in their demands in health. We're able to build the SUS that we believe in.
Humanization is not the destination. It is the journey. Thank you very much.
