Projects in Brazil

Current health situation in Brazil

Brazilian national health system (NHS) is composed of a large public, government managed system, the SUS (Sistema Único de Saúde), which serves the majority of the population, and a private sector, managed by health insurance funds and private entrepreneurs.
The public health system, SUS, was established in 1988 by the Brazilian Constitution, and sits on 3 basic principles of universality, comprehensiveness and equity. Universality states that all citizens must have access to health care services, without any form of discrimination, regarding skin color, income, social status, gender or any other variable.

The public system is still grossly underfunded and lacking quality, though that's been improving greatly in the last few years. Important legal issues, such as the regulation of Constitutional Amendment 29, are expected to minimize some of those problems. In 2006, the most notable health issues were infant mortality, child mortality, maternal mortality, mortality by non-transmissible illness and mortality caused by external causes (transportation, violence and suicide).

Private Health Insurance is widely available in Brazil and may be purchased on an individual-basis or obtained as a work benefit (major employers usually offer private health insurance benefits). Public health care is still accessible for those who choose to obtain private health insurance. As of March, 2007, more than 37 million Brazilians had some sort of private health insurance.

Specific health problems:

High child mortality rates
Situation in 2003: National rate of 25.1 children deaths per thousand live births, however in northeast region of Brazil, this rate reaches 37.7 children deaths per thousand live births.

High maternal mortality rates
Situation in 2003: National estimated rate of 73.1 maternal deaths per one hundred  thousand live birth children in 2002.

High mortality rates by non-transmissible illness
Situation in 2003: Mortality rate caused by heart and blood circulation problems of 151.1 deaths per one hundred thousand inhabitants. Mortality rate caused by cancer of 72.7 deaths per one hundred thousand inhabitants.

High mortality rates caused by external causes (transportation, violence and suicide)
Situation in 2003: National rate of 71.1 deaths per one hundred thousand inhabitants – 14.8% of deaths in 2002.

T@LEMED

T@LEMED has already established and operates a network of medical centres, which offer medical advice to remote doctors in Brazil. The system operates currently over terrestrial (phone) lines. This project introduces an e-health model to the provision of health services in strongly underserved regions in Colombia and Brazil.

The implementation of this model is supported on current telehealth technologies based on ultrasound and other imaging modalities as well as on evidence based medicine. The target clinical applications include typical infectious diseases for the region such as malaria and tuberculosis, and general ultrasound applications such as pregnancy control, urology and cardiovascular diagnosis.

The trial of this model, reflected in the deployment and pilot tests of telehealth stations, demonstrates to local health authorities the benefits of information technologies for health provision and social development. Corresponding health authorities are already involved in the project and monitor its results. As a result, it is expected that this model be incorporated into health services of both government health authorities and private health providers.

More information about T@lemedcan be found in at the extensive project website (www.alis-telemed.net) describing the project goals and the participating partners.Hence only a short overview will be given here. Within T@LEMED project, a network of hospitals has been established providingmedical services based on ultrasound imaging. The medical application used, is called TeleConsult, which is a commercial version of TeleInViVo software. TeleConsult is a stand-alone application running on Windows 2000/XP. The application is able to acquire medical images from any ultrasound device through a video grabber attached to the computer. Furthermore, DICOM based agents would store medical images from any DICOM compliant device.

The TeleConsult application is a combination of a 2D/3D DICOM Viewer, an image grabbing software, medical annotation tools and a medical telecommunication tool. All operations, a user of the software can operate can be assigned to following eight modules: The Database Interface menu, the Image View menu,the File I/O menu, the Geometry menu, the Greylevels/Colors menu, the Tools menu, the Cine menu and the Teleconsultation menu.

Two referral hospitals in Brazil provide telemedicine services making use of TeleConsult application.

• Santa Casa Hospital in Porto Alegre (South Brazil)
• FAHUCAM, in Vitoria (Middle-North Brazil)

The two centres are ca. 1.200 km apart. Each hospital centre is able to provide its edical services to 4 other periphery hospitals in its rural areas. Santa Casa hospital s formed by 7 hospitals, which creates a medical care network. In order to support his complex, there exists a data network communication connecting the 7 hospitals. The network uses a star topology, where the hospitals are connected to a central node. The Internet connection is released over a fiber optics channel with bandwidth of100 Mbps. FAHUCAM Hospital in Vit ´oria, is connected to the Internet via fiber optics 6 Mbps RNP (Embratel).

T@HIS

T@HIS is a telemedical network connecting physicians and hospitals over a new generation satellite network based on the recently launched AmerHis payload on the AMAZONAS satellite. Within the project three remote clinics in Amazonas, Para states in Brazil have been connected to a referral hospital in Bel´em, the capital city of Par´a. The dominant type of images transferred over the system is ultrasound images, acquired from portable or stationary ultrasound devices. The medical applications include general examinations as well as obstetric and gynecology. However the applied platform handles any imaging modality and particularly DICOM formatted data.

The state of Par´a presents the rate of general mortality of 3,65 deaths in 1.000 inhabitants. The main reasons are the blood circulation diseases and birth associated diseases. The aim of the current medical implementation was to improve the access to medical resources, available only to rural cities from the isolated areas in Amazon in Para prefecture.

MedNet

MedNET aims to establish a collaborative framework with counterparts in Latin America (Brazil & Peru) to promulgate access in underserved regions of Latin America to efficient, cost effective, high level and high quality medical resources. The proposed healthcare database andmedical platformwill directly impact on patient safety by enhancing clinical services and improving the primary healthcare in the pilot locations. This will be achieved through advanced diagnosis and treatment methods, efficient collection and sharing of data on treatment outcomes and patient demographics and collaborative medical research.

This system effectively embeds European medical protocol and standards for medical information exchange, storing and representation and, given the fledgling nature of electronic Health Records in the targeted regions, will support diffusion in the wider up-take of electronic European standards.

Counterparts from Latin America will be directly involved in the adaptation and customization of the medical platform. Additionally, MedNET will establish a collaboration framework conducive to the development of e-Health in the region through a dissemination and exploitation plan that sets out to identify and engage with stakeholders through a series of meetings, showcases, workshops and conferences.

The pilot study locations will be connected over satellite communication based on DVB-RCS protocol utilizing the European AmerHis system. This will both enhance the medical network, in terms of add-on components, scalability and reliability, and provide opportunities to exploit the network infrastructure by developing platforms for education and commerce.
The selected regions in Amazon have no access to broadband communications.