Legal abortion and transsexualism cannot be taboos in the SUS, says the new secretary – 06/01/2023 – Equilíbrio e Saúde

The new nationwide secretary of major well being care, physician Nesio Fernandez, 40, says the Ministry of Health should resume the “civilization agenda” and decentralize authorized abortion providers and the strategy of transsexualization in the SUS (Unified Health System), matters, in opposition to who fought Bolsonarist militancy.

“The legislation already says that any maternity hospital can carry out a authorized abortion. This isn’t a process overseas to their day by day life. But who will increase this difficulty, civil society? The nation,” Fernandez mentioned in an interview with Sheet.

For him, the strategy of transsexualization can be prolonged. Since 2008, SUS has supplied entry to hormones and physique and genital modification surgical procedure for trans ladies, and since 2013 additionally for trans males and transvestites.

He additionally argued that foreigners might return to the Mais Médicos program, particularly in distant cities, however with out the cooperation settlement that was beforehand signed with Cuba. The plan is to fill vacancies by opening public bulletins for individuals who graduated in the nation or studied overseas and did the Revalida (which validates the diplomas of medical doctors who graduated overseas and need to work in Brazil).

The secretary additionally prompt partnership with faculties and dialogue with spiritual establishments to strengthen the vaccination marketing campaign.

In 2020, Fernández was concerned in an effort to ship a ten-yr-outdated little one, pregnant after rape, to Pernambuco to carry out a authorized abortion, a state of affairs that led to protests by extremists and the actions of former minister Damares Alves.

What is the change in major care that ought to be famous in relation to the Bolsonaro authorities? The atmosphere we need to construct right here is one which characterizes SUS. These civilized applications focus on abortion, gender-primarily based violence, sexual reproductive well being, social determinants of well being together with race and shade, susceptible populations. These are all the time matters that first achieve nice significance and depth in SUS. You get HIV, the LGBTQIA+ agenda, we have to get well it quick.

All these superior applications ought to be in Saps [Secretaria de Atenção Primária à Saúde] an atmosphere of freedom of thought, criticism, improvement and proposal of public insurance policies, as a result of a Ministry of Health or secretariats that solely publish technical notes are of no use to us.

How can the authorities resume the ‘civilisational agenda’? It is critical to prepare a community that, from the second of attracting first help, permits, in case of suspicion of violence, the well being agent in the neighborhood, the physician, the nurse, everybody to acknowledge the state of affairs in order to stop it from reaching rape. If there’s rape, take away that little one from the state of affairs.

Then there ought to be integration with the Unified Social Assistance System, a guardian council, a direct hyperlink with the Ministry of Public Rights of every area. If this little one rape sufferer finally ends up pregnant, she must be recognized shortly so she will entry the lowest-threat authorized abortion.

There ought to be a decentralized maternity community that performs abortions. I needed to take a ten-yr-outdated woman from Espirito Santo to Pernambuco. I agreed with all silence, secrecy till I completed the process.

Because of the religiosity of public well being brokers, medical doctors, nurses, [eles] welcome the pregnant little one as a mom. “Hi mother, hearken to your coronary heart [do bebê].’ They naturalize the violence in this struggling, not permitting that little one to even be inspired to train his autonomy, his determination. And it does not repair the sufferer in phrases of psychological struggling.

So you want a NASF (household well being assist facilities) with a psychologist, with a social employee in all major care.

The legislation now says that any maternity hospital can carry out a authorized abortion. This isn’t a process overseas to their day by day life. But who will increase this difficulty, civil society? It has no normative pressure, no stimulating, financing pressure. Whoever has it’s the state. The Ministry of Health should compel the complete chain of public authority, state and municipal public authority, contracted personal suppliers, to ship providers and guarantee dignity and entry.

Will you create particular public coverage concerning authorized abortion? Will professionals be instructed that if a lady arrives with a declared case or seems pregnant from rape, to not deal with her as a “mother” however as a sufferer? No doubt. You want to determine insurance policies from norms to funding, monitoring, analysis. If not, it isn’t a coverage, it is a memorandum of intent, a protocol, it is a want primarily based on educational inspiration. Public coverage should have every part.

I’m not saying I’ll do it subsequent month. It is one thing inside this debate to debate matters that in this current interval have been protected. We should protect the establishment of the Ministry of Health, in order that it may lead any advanced discussions from a excessive place.

So, in basic, the Department of Health cannot deny debates akin to authorized abortion… …a strategy of transsexualization of the inhabitants.

For the transsexualization course of, ought to some new process or construction be created in SUS? We have already got some providers in Brazil, to allow them to be improved, others must be created, we’ve states that shouldn’t have any providers, not even the ambulatory service.

Is it the authorities’s concept to decentralize one of these service? Of course, as a result of the transpopulation isn’t that huge. How a lot these folks endure, how a lot they’ll reconcile, have a special high quality of life, if they’ll undergo a strategy of transsexuality, from psychological remedy, psychiatric assist, remedy to a surgical process, if they’ve entry to the civil proper to be a possibility for change of the title. There isn’t any approach that each one nations is not going to have a service like this applied and consolidated.

How do these sorts of points progress in a conservative Congress? You don’t want it. This is already at the discretion of the public authority, it may now be opened [o serviço], there’s a useful resource from the Ministry of Health, there are funding channels. You do not want Congress for that. It’s pacified. I’m simply discussing authorized abortion, already pacified abortion.

What is the vaccination provide? Today, solely the audiovisual marketing campaign isn’t sufficient, solely the mobilizing marketing campaign. You should have mobilization with the faculties. The older the age, the decrease the vaccination protection. Especially from three and 4 years the protection is decrease. Where are the 3-4 yr olds? In faculties. Either we mobilize schooling in this program or we cannot run this marketing campaign.

Lula speaks in dialogue with church buildings on vaccination. I’m a Baptist, my dialogue with believers is excellent. In Espirito Santo, we had been capable of vaccinate the Pentecostal bishops, the Assembly of God, the rabbi, the priest, all on the similar day.

Not everyone seems to be a denialist, Bolsonarist, there is a good crowd on the market. This group can speak. I feel vaccination is a program to assist re-open the dialogue with faith.

Can overseas medical doctors, together with Cubans, strengthen Mais Médicos? When the public announcement opens for undocumented aliens, they’ll apply. The first stage will be for professionals registered in Brazil, Brazilians or foreigners. The second is for Brazilians finding out overseas and the third for foreigners. [sem diploma validado].

As lengthy as there’s a deep Brazil, the periphery, and we don’t change a lot the content material of the values, the coaching, the profile, the class of medication, we should recruit medical doctors on a compulsory foundation for many years, and certainly one of the greatest methods is short-term registration.

What is the proposal for the inclusion of Mais Médicos and Médicos Pelo Brasil applications? The approach is to unify the applications. Both will be a part of one technique. You have a scarcity of medical doctors, however you even have a scarcity of different specialists. You cannot put the psychologist inside the inside the inside [do Brasil]. There is a scarcity of speech therapists in giant facilities. Everything is lacking.

What ought to be the way forward for ADAPS [Agência para o Desenvolvimento da Atenção Primária à Saúde, criada no governo Bolsonaro para administrar o Médicos Pelo Brasil]? The company is about to bear a strategy of reformulation and enchancment, in which different competences and tasks could be included. This is a subject that has been brewing for months. It also can be a device for implementing telemedicine. Or it may be expertise that consolidates different levels of public sector employment.

A big a part of the price range for major medical care is directed by parliamentary modifications in municipal funds, with out respecting standards for regional precedence. Corrections are determined in December. The ones we’ll fulfill [em 2023] already handed. The problem is to be capable of put collectively a great portfolio [de ações para as emendas], made a mature and Republican debate with Congress to qualify subsequent yr’s candidacy. We is not going to finish the parliamentary modification, it’s an goal phenomenon, it’s a part of the Brazilian political tradition, very troublesome.


Nesio Fernandez, 40

An evangelist, PCdoB member and Cuban-trained doctor, he was Minister of Health of Espirito Santo from 2019 to 2022 and President of Conass (National Council of Health Secretaries).


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