No document made public last Friday and which has more than two hundred signatures, it can be read that these professionals “reject the way they have successively seen their technical autonomy run over, with arbitrary decisions by various entities (…) The situations in which the answer is questioned are multiplying, with the implementation of solutions, supposedly collaborative and expeditious, that go against what are the good practices and guidelines of Public Health Doctors (…). And whenever the units choose not to adhere to these ‘cosmetic’ solutions and ask for more resources to be able to meet their needs, they are denied “.
The first signatory to this open letter is Ricardo Mexia, President of the National Association of Public Health Doctors (ANMSP), who SAPO24 made some of these complaints concrete: “there have already been several episodes in which health authorities have not been allowed to intervene publicly because administrative supervision, ACES (groupings of health centers) or ARS (regional health administrations) do not allow it. Then, we are talking [de casos] of reversal of decisions by health authorities regarding prophylactic isolations that have been determined, “he says. To this is added” a wealth of issues that have to do with the technical organization on the ground, on which models have been imposed [aos médicos de saúde pública] with which they do not agree – and if they do not assume these models, they end up not seeing the resources they have been asking for months “.
These resources are mainly human, “to carry out epidemiological surveillance”, as well as “means to make calls. It is true that some have arrived on the ground, but they are not enough”. Hindering the fight is also the “lack of an information system” more robust that supports the collection, analysis and sharing of data, a claim that is not new.
This document signed by more than two hundred professionals also denounces the “lack of planning and long-term thinking”. Ricardo Mexia exemplifies with a word: “January”.
“Everything that happened in January [é reflexo da falta de planeamento]. We knew there was going to be an increase in the number of cases, because there were already experiences abroad, like Thanksgiving Day in the United States. Here, after parties [de Natal e Ano Novo] it was foreseeable that there would be an increase in the number of cases and nothing was done to reinforce the means of response – and this is true for public health, but also for hospitals “.
In addition to the liberalization of Christmas, he added, there was a communication problem – the promotion of public health is one of the areas of competence of public health doctors.
“[Houve uma] inversion of communication with the issue of vaccines, neglecting the fact that all other public health measures had to continue to be implemented for a long time. Vaccines have arrived, and it is excellent news, but until that has a population impact it will take a long time “.
In addition to changing the focus of communication, Ricardo Mexia criticizes the moment chosen to suspend the regular press conferences of the Directorate-General for Health. “We went from a scenario of a daily press conference, whose usefulness was realized early on that it was not so so significant, for this absence now. In the worst moment of the pandemic in Portugal it was important to explain to people what they should do to face it. It was certainly not the time to lower communication “, he defends.
For the president of ANMSP, it is essential “to keep the message that we are still far from overcoming the pandemic”. At the same time, it is imperative to “strengthen the means for epidemiological surveillance, both at the level of communications and at the level of human resources”, and it is necessary to be “more agile” in implementing solutions.
“What concerns us at the moment is to protect people and for that we need a strategy, we need leadership, we need things to be able to materialize more quickly and there is not such a long delay to implement solutions”.
When we question whether he considers that there has been a lack of leadership in the management of the pandemic, he says in the affirmative: “I think so, certainly more assertiveness is lacking in the approach. It is not clear why it took us so long to implement restrictions in January that were inevitable”.
200 hours of overtime “offered”
The document signed by more than 200 doctors and public health interns also addresses labor issues, starting with the payment of overtime.
The Minister of Health announced, in October last year, that she had approved an opinion from the Attorney General’s Office that gave the green light to the payment of the supplementary work carried out by public health doctors beyond 200 overtime hours.
Ricardo Mexia explains that “at the beginning [da pandemia] public health doctors were not even paid overtime, and hundreds worked. Then there was an understanding that these hours should be paid and that they were not [regime] Permanent Availability, but understood that [o pagamento] it would only take place after 200 hours. It is not understood why there are 200 hours ‘offered’ work. Trade unions should have been involved [nesta decisão] and they weren’t, “he laments.
The signatories of the document still “repudiate” the way in which the Health Authority supplement was regulated, included without negotiation in the State Budget and whose value, in its view, is “insulting”. There is also no provision, they point out, “the retroactive payment of this subsidy”, which “has been due for over a decade”.
Finally, public health physicians contest “the decision, albeit transitory, to no longer require ‘medical qualification’ to exercise the functions of Health Authority”.
Ricardo Mexia explained to SAPO24 what is at stake in this matter: “the problem lies in the way in which the proposal is written, which can lead to a change in the way health authorities are appointed. If the idea is that people who exercise unit coordination functions do not have to be consultants, a degree of differentiation in the medical career, that is what it should be written in. But if there are no people with that degree to nominate, it is because the competitions are never resolved. 2017 and 2019. This is simpler than saying that this requirement is not necessary after all [de qualificação médica para o exercício das funções de Autoridade de Saúde]”.
In the document, the professionals stress that “it is essential to remember that the Health Authorities practice medical acts and make medical decisions. Smoothing this requirement is yet another attack on the professional dignity of the Health Authorities, setting an unacceptable precedent, under the pretext of the pandemic situation that we crossed. It is a red line that cannot be crossed “, they defend.
Despite these demands, the signatories of the document reinforce “their absolute commitment in combating the covid-19 pandemic, alongside citizens, selflessly and in the face of the huge discrepancy between the growing needs and the available resources”.
–
