In Brazil, a large portion of the population needs to travel to access healthcare, especially those more specialized and complex services. Vitor’s family, aged 9, left the small town of Tocantins, Brigino de Nazaré, in search of a diagnosis and treatment. First, they went to Palmas, where the little boy was diagnosed with chronic kidney failure. But there was no treatment for the children and the family ended up moving to Brasilia. In the nation’s capital, Vitor’s mother died of cancer. Today, Father Fernando Pereira takes care of his son alone, who accompanies him at the Children’s Hospital. If the attendant sends him anywhere, I will go. Father says: When there is better treatment, I will always be on his side. 
The presence of the referral hospital is a factor that attracts many immigrants to the city. In its Urban Impact Zones Survey, published in 2020, the International Institute of Quality (IBGE) mapped out the displacement of the Brazilian population in search of health services. The study listed, for example, 30 cities that a large number of people go to when they need highly specialized and complex care, for example, high-cost treatments that include hospitalization, surgeries, MRI, CT and cancer treatment. Among these thirty cities, there are capitals and references also in the interior of the country, such as Barretos, in São Paulo.
Barretos is a reference center for cancer care and receives people from all over the country. “Barretos is a mirror. It is an example that it is possible to treat it with SUS free of charge, of the best quality, with all possible complex tests”, says the medical director of the Infantile Hospital, Luiz Fernando Lopez. He explains that the hospital has many support homes for families who go to the city to receive some treatment in the hospital. Treatment, food and accommodation are free of charge.
Valreslin left Dos Santos Boa Vista, Roraima, and moved to Barretos with her daughter, Hannah, to treat a type of eye cancer called retinoblastoma. Hana was diagnosed at ages 1 and 8 months. They lived for nearly four years in a hospital support home. “I didn’t have anyone here. It was me and myself, you know? So, at the time, the family was sorely missing,” says Valrislene. Today, Hanaa is 9 years old, has already undergone 2 treatments at Infantojuvenil and is now being monitored every six months.
Distancing from the family is also a reality for Cristiano Abreu and Fabiana Pizera, who moved to São Paulo in search of a transplant. Cristiano left his hometown, Ilhéus, in Bahia, and went to the capital, São Paulo, six years ago for a heart transplant. Half of my life I was leading a normal life, half of it had cardiomyopathy. Now, for the rest of my life, I have a new heart so that I can have another way to live, ”he says. The harmonious heart arrived in February 2020. Now it continues to follow at Instituto do Coração (InCor) and cannot wait to return to Bahia.
Rafaela left the small town of Piqui, in Paraíba, to live in São Paulo in 2020, during the coronavirus pandemic, and is waiting in line for a lung transplant. To be close to the hospital in São Paulo and prepare for the surgery, Rafaela must be away from the family. She becomes emotional when she talks about her two children and the time you spend apart from them. “When I came, I said, ‘I’m going for them, for my kids’, because as much as it hurts to stay away, I have to be good to accompany them. That’s what moves me, ” he explains.
Fabiana’s family also had a split time. I left Venezuela in search of a better life in Manaus. But the father, who continued to reside in the neighboring country, had a stroke and was unable to undergo treatment. Fabiana had already moved with her father in Brazil, with him and her daughter to Brasilia, when she secured a place for him in the network of Sara Rehabilitation Hospitals.
The neuroscientist and president of the Sara Network, Lucia Willadino Braga, indicates that 34% of patients seen in Federal District hospitals are from abroad. Telemedicine is a possibility that a specialist brings into this healthy migration scenario. In order to cope with the pandemic, Sarah’s network saw the need to establish a call center, and according to her, research proved the tool was effective. “I believe that when we talk about medicine without borders and migration, the telemedicine tool contributes a lot, adds a lot to the quality of our care and enables better care for people coming from abroad,” she says. .
The head of the National Council of Municipal Health Secretariats (Konasyms), Welsh Freire, adds strategies that can be adopted in the country, such as promoting investments in health zones and macro health areas, so that they can solve and avoid regional problems. Families looking for highly sophisticated treatments should travel.
Ricardo Dantas, a public health researcher at the Oswaldo Cruz Foundation (Fiucruz), stresses that there is no point in expecting specialized care, such as an intensive care unit, in all municipalities. “It is imperative that the state government step in and mobilize its resources so that the population can access services,” he argues, emphasizing that it is imperative to support SUS and reduce the health inequalities that exist in Brazil.
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