Is Brazil a bad country


Klaus Hart

has been working as a Brazil correspondent for media in Germany, Austria and Switzerland since 1986. He has written more than 30 volumes of reports and travel books about Brazil. He lives in Sao Paulo.

The public health system in Brazil

The public health system in Brazil is inefficient and bad. Only those who can afford it go to the doctor. Or straight to the cosmetic surgeon. There is hardly any other country where more cosmetic operations are performed

A child stands in front of the emergency room of the Pedro Ernesto University Hospital in the Brazilian city of Rio de Janeiro. (& copy picture alliance / landov)

It could hardly be more contradictory: every day, the media in Brazil castigate the catastrophic conditions in the country's hospitals and health facilities, where noticeably poorly trained doctors and nurses work under desolate conditions. At the same time, the press is full of advertisements for expensive plastic surgery in private clinics that promote an unrealistic ideal of beauty.

According to many experts, the health situation of Brazilians has deteriorated in recent years. The tropical country currently ranks only 85th out of 187 in the United Nations Human Development Index. But despite its incomparably lower average income, Brazil ranks right behind the United States in terms of the number of cosmetic surgeries. In 2009 the number of interventions was over 1,200 a day; although the official figures are certainly not complete here. In 2014 there are already more than 1,700 operations per day. In contrast to the USA, because of the extreme differences in income in Brazil, the vast majority of operations are only performed by around 20 to 30 percent of the population, i.e. the middle and upper classes.

The highest rates of increase have been recorded in recent years. As recently as 2008, only a few thousand women in Brazil underwent this costly operation. It is now over 20,000 a year, but not 6,000 in the USA. "Unlike in Europe, our women show everyone after the procedure what cosmetic surgery has changed on their bodies," says Dr. Luiz Carlos Martins, President of the Brazilian Association for Plastic and Aesthetic Surgery. "That is strange and belongs to the Brazilian culture. Every culture has a predominant aesthetic characteristic. In very cosmopolitan Brazil there are many women with larger buttocks. But the many Brazilian and Asian women of Spanish and Italian descent look different." A buttock augmentation costs between $ 3,000 and $ 10,000, depending on the level of difficulty.

Anyone who is considered ugly in Brazil is hard to find a job

His colleague Dr. Persio de Freitas goes one step further and challenges Brazil's "Ditadura da Beleza", the beauty dictatorship. "The media in Brazil exert pressure to be beautiful. Anyone who watches Brazilian telenovelas might think that in our country there are only people who conform to a certain ideal of beauty. But that is the minority." Those who do not meet the pre-cut beauty standards in Brazil suffer from inferiority complexes, says Dr. Freitas.

Brazilian men have long been affected. "The younger managers think that a fresher appearance is necessary in today's job. Plastic surgery makes you more accepted on the market. This is why demand is increasing significantly, especially in the executive floors in Brazil," explains Dr. Freitas.

Valcinir Bedin, President of the Brazilian Society for Aesthetic Medicine in Sao Paulo, also attacks the excesses of plastic surgery. "Important basic values ​​such as knowledge, ability and professional competence are of secondary importance to something as transitory as external appearance. In the job market, the professional skills of an applicant are only of secondary importance. Those who do not meet the given aesthetic standards or are classified as ugly will not get any Job."

90 percent of 50-year-old middle class women in Brazil have at least one "cirurgia plàstica" behind them. More and more lower-class women are trying to follow suit and are surrendering themselves to cheap bunglers. The results show every year Rio's carnival photographers: completely deformed breasts and buttocks, enlarged by the injection of dangerous substances such as methacrylic.

Another phenomenon is causing headaches for cosmetic surgeons' associations: since 2010, operations on minors have more than doubled. Today, even girls under the age of 16 want bigger breasts. Since the body is still in the growth phase, reputable doctors advise against such operations. There is a lack of everything: medicines, doctors, hygiene

But most Brazilians could never raise the money for an operation in their lifetime. Almost every day, people die in the queue in front of the run-down public hospitals. "Health care for the common people is totally neglected," said the president of the Brazilian Society of Aesthetic Medicine. "As a cosmetic surgeon, that throws me into an inner conflict. I feel insignificant, silly, insignificant - because I only deal with people who worry about silly, insignificant things."

Brazil's high-quality media report hair-raising things every day from public hospitals and health facilities, and by no means only those that are in the severely underdeveloped regions in the north and northeast of Brazil, but also in the leading economic centers of Rio de Janeiro and Sao Paulo: sick people wait there for months a doctor's appointment, even for years on the planned operation. In the emergency rooms, the seriously injured often lie on the clinic floors for days in the stench and heat. In many places there is a lack of medication and medical supplies, so that doctors sometimes have to use cardboard as splints in the case of broken bones. But often there is a lack of staff alone. Injured people with gunshot wounds are turned away in the emergency rooms because no doctor is available.

In addition, many doctors are poorly trained. In 2014, studies in Sao Paulo came to the conclusion that 59 percent of the newly trained medical graduates did not have the necessary basic knowledge. For example, 64 percent did not know that prolonged coughing could be an indication of tuberculosis, a very common disease in Brazil.

More than half of Brazilians today are overweight or obese, making them particularly at risk of developing cardiovascular diseases, diabetes and cancer. Breast and uterine cancers are "increasing dramatically" in Brazil, according to the latest statistics. AIDS is still an epidemic in Brazil and is by no means under control. Brazil was downgraded from the group of countries that best cared for people infected with AIDS. Instead of the leprosy elimination promised to the WHO up to now, the government is now only aiming at "controlling" the medieval disease. The tropical country still has the highest density of leprosy worldwide, with over 30,000 new cases registered annually and a high number of unreported cases. Even in Latin America's richest metropolis Sao Paulo, with over 2,500 slums, leprosy is a problem, as is tuberculosis and malaria.

With a view to the 2014 World Cup and the 2016 Olympic Games, European tropical medicine experts are also warning of the insidious dengue fever, which is transmitted by mosquito bites and can be fatal. In 2013, around 1.5 million Brazilians fell ill, and according to the World Health Organization, more than 500 died. The fact that mosquitoes can spread so rapidly is also due to the poor hygienic conditions in the country. For example, over 50 percent of the meat produced and sold in Brazil is not subject to any food controls. One example of many: In the megacity of Fortaleza in northeastern Brazil, 74-year-old Carlos Oliveira has severe circulatory problems. Since there are no ambulances, the family takes him to the clinic in a neighbor's car. Several hundred patients are already crowding the corridors there. Oliveira is packed on a stretcher by the nurses - with the information that unfortunately there are currently no treating doctors. After four days, the family carers advise taking Oliveira home with them. The family follows the advice. Two days later the man is dead.

Anyone who has money can get medical treatment in court

The family belongs to the Brazilian lower class and has neither the knowledge nor the financial means to file a lawsuit against the hospital. Anyone who can do this has the opportunity in Brazil to legally enforce medical treatment. Those who can get away with it, all too often save their own life or that of their family members, are harming all those people who have been waiting for treatment for a long time. And that in a country that has the highest violence and murder rates in the world. Heavily armed gangs attacked and even rob hospitals and their patients in Brazil. The World Health Organization confirms that violence and crime can also make people mentally ill. According to expert studies, over 20 percent of the Brazilian population is physically or mentally disabled, in countries like Germany it is only about 1 percent. In view of this misery in the health system, many Brazilians are outraged by the billions in spending on the 2014 World Cup and the 2016 Summer Olympics. That is one of the reasons for the civil protests all over the country. As early as 2010, José Temporao, Brazil's Minister of Health from 2007 to 2010, agreed with them when he said: "Our model of the health system does not work. It does not guarantee quality in the hospitals. It shouldn't be a year and a half before I get an appointment with Neurosurgeons get. More resources are needed. "

Faced with this situation, the Brazilian government has started to recruit foreign doctors. At the beginning of 2014, President Dilma Rousseff announced that over 7,000 Cuban doctors were already practicing in Brazil, mainly in slums in large cities and other poor regions. Another 6,000 doctors are expected to join this year. This is perhaps a start to remedy the worst grievances in the Brazilian health system.