Program Operating in the Amazon - Expedicionários da Saúde Health Crusaders Association
80th greatest access to specialized medicine in remote areas, disadvantaged by their distance from urban areas and poor access. This experience has also been used in Haiti during the earthquake to assist with complex surgeries. It is important to increase the dialogue with the whole society, especially the government, about the importance of Brazil having effective public policies to bring specialized medical care to remote areas. Another dream is the "disaster kit" for more flexibility in emergency humanitarian situations such as what happened in Haiti. A container with surgical instruments, equipment and medicines to be sent to any region where there is need for specialized medical care with a staff trained for this type of action. http://www.vimeo.com/22895859
About You
About You
First Name
SILVANA
Last Name
NADER
Facebook Profile
About Your Organization
Organization Name
Associação Expedicionários da Saúde
Organization Website
Organization Phone
(19) 32986033 /(19) 91795819
Organization Address
Av. José Bonifácio, 2656 Bairro: Jardim das Paineiras Cidade: Campinas
Organization Country
Brazil, SP
Country where this project is creating social impact
Brazil, AM
Is your organization a
Non‐profit/NGO/citizen sector organization
How long has your organization been operating?
More than 5 years
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Innovation
Entry Form title
Program Operating in the Amazon - Expedicionários da Saúde Health Crusaders Association
What change do you want to bring to the world?
80th greatest access to specialized medicine in remote areas, disadvantaged by their distance from urban areas and poor access. This experience has also been used in Haiti during the earthquake to assist with complex surgeries. It is important to increase the dialogue with the whole society, especially the government, about the importance of Brazil having effective public policies to bring specialized medical care to remote areas. Another dream is the "disaster kit" for more flexibility in emergency humanitarian situations such as what happened in Haiti. A container with surgical instruments, equipment and medicines to be sent to any region where there is need for specialized medical care with a staff trained for this type of action. http://www.vimeo.com/22895859
What are the primary activities of your project?
Our main goal is to contribute to the improvement of Indigenous Health in Brazil by making it possible for isolated indigenous populations of the Amazon to access clinical care and surgical expertise, with cutting edge technology. The medical specialties are linked to eye surgery (cataracts, pterygium) and general surgery (especially hernias). Gynecological and orthopedic surgery of low complexity is also performed. Consultations and appointments in the specialties of ophthalmology, general practice, pediatrics, gynecology, orthopedics and orthodonture round out the services. An expedition team consists of about 35 volunteers including physicians, nurses, and logistics. Initially, the program operated in hospitals in São Gabriel da Cachoeira, Amazonas. As the region has massive geographical size, the group realized that only a Mobile Surgical Center tailored to the population’s needs and structured with high-tech equipment would make the program more effective for the entire region—providing greater autonomy for the program. Under this new operating model, it was possible to perform a surgery twice in the same period of time and reach regions far from urban centers. To carry out the expeditions, there need to be partnerships with local health agencies, community support for adequate infrastructure for installation of the Mobile Surgical Center, support from private financial resources and material support of FUNAI, the Health Ministry and Special Indigenous Health Districts, participation of the Brazilian Air Force and the Military Command of the Amazon.
What is innovative about your initiative? How is it a new contribution to the field?
The implementation of doctors in remote regions of the country, is difficult for the health ministry due to the high complexity but the experience the Health Crusaders (EDS) proves that you can take high quality medicine to less favored regions that are far from major centers and have huge difficulties in accessing services. EDS believes it is important to increase the dialogue with the whole society, governments, communities, universities and other institutions on the importance of enacting effective public policies of health care in remote areas in Brazil. The work of EDS is a major contribution in this way. The program involves cross-sector partnerships (government, NGOs, businesses), participation from within the community benefited, an interdisciplinary technical team and highly specialized technology and strong social impact. EDS’s Program Operating in the Amazon developed the Mobile Surgical Center tailored to the needs of the group, structured with high-tech equipment. This is an innovative way of working, and the first time it has been used in Brazil in a NGO. It is a social technology that can be replicated and expanded to other regions. The DSEI professionals highlight three main principles of importance of partnership with the Health Crusaders: local action in the form of a surgical task force is the only way to deal with pent-up demand and slow referrals from the network, avoid displacement to urban centers, thereby preserving their culture and traditions, modern technology and high quality care by specialists attending the population.
What stage is your project in?
Operating for more than 5 years
Tell us about the community that you engage? eg. economic conditions, political structures, norms and values, demographic trends, history, and experience with engagement efforts.
The Indigenous Health Districts of the Amazon that are responsible for preventive and curative medicine are facing operational difficulties due to the difficult access to communities. Serving serious cases and voluntary surgery depends on transfers to medical centers in the region that can take days. There is difficulty moving the patient and his indigenous family to urban centers. There is a lack of specialized care in health facilities, overcrowding and outdated technology. In equatorial regions there is a high incidence of degenerative eye diseases (cataracts, pterygium). In populations that do a lot of physical activity abdominal hernias are common. These cases would be referred to a medical center for surgery. But with all the difficulties, only the most severe cases can be attended. The fact remains there are hundreds of people drawn from the social and productive life because they lack access to simple surgical procedures. Health Crusaders believes it is possible to change this situation through surgical expeditions to serve the geographically isolated indigenous population through its annual Program Operating in Amazônia. Expeditions of volunteer doctors with the latest technology to perform surgery (pre and post-operative care), and special diagnostics referral of cases for when the team is not prepared to intervene with the local medical specialties involved. The medical areas addressed are ophthalmology, general surgery, pediatric care, general medical and relatively simple gynecological and orthopedic surgery.
Share the story of the founder and what inspired the founder to start this project
A group of friends, mostly doctors on a 2002 visit to the Pico da Neblina-AM, were deeply impacted by a Yanomami village. Faced with a reality of health care so different from the one they were living, they decided to change the focus of their leisure travel and try to do something to benefit the health of the indigenous population of the region, especially in surgical care as it was in highest demand. A question was, why have simple surgical procedures become so complex? If they can not be operated in large cities (eg Manaus.), where there is technology, let’s bring it to them! They sought the institutions responsible for indigenous health care to share the idea was born in 2003 and split responsibilities. The health crusaders association, registered as OSCIP in 2005, initially catered to patients with eye problems and hernias, diseases of high incidence in the local indigenous population. It was determined that the first expedition would happen in Sao Gabriel da Cachoeira. There they could count on the structure of Iauaretê hospital surgical center that was first used by the Health Crusaders team in February 2004. Doctors at the DSEI / RN took responsibility for the search of surgical cases in the region, transportation and lodging for patients and their families. The success of this first experience and the large number of cases raised by the active search for patients has boosted the program has expanded its staff of doctors, who have since then performed at least three expeditions a year with a Mobile Surgical Center.
Social Impact
This Entry is about (Issues)
Please describe how your project has been successful and how that success is measured
The biggest impact is on the patient, but the program benefits the entire indigenous health care system. The DSEIs (on-site health care) have difficulty training specialists for diagnosis in rural areas. There is a lack of specialists to perform surgeries: cases referred to Manaus take months to be attended. Training Indigenous Health Agents is fundamental to our work in communities. EDS promotes training for these professionals in the preparatory phase of the expedition so that they can identify potential surgical cases to be served by the NGO. A team that works directly during expedition also receives special training and safety standards and guidance post operation. There are classes to clarify the various questions and specialties. The DSEIs lists the importance of partnership with EDS: local action in the form of surgical task force is the only way to deal with pent-up demand and slowdowns in the network of referrals and references. Avoid a shift to urban centers, high-tech care, specialists and diagnostic equipment in the area of economic DSEI for the expedition because optimizing public resources increases the quality of indigenous community life. In terms of the patients, those who regain vision or get rid of a disabling hernia regain their self-esteem, get back to work, hunting and fishing. They return to be responsible for their family. If they have no role in the community group, they will feel alienated from the village. Initiatives to take better care of the family and the forest are the second best social impact of community leaders and health workers. Since February 2004 the organization has provided 14,687 medical consultations and performed 2,662 surgeries for indigenous peoples in the Brazilian Amazon. Also in the year 2011, after the earthquake in Haiti, EDS sent seven teams SOS Haiti performing 359 surgeries and1,407 outpatient visits.
How many people have been impacted by your project?
More than 10,000
How many people could be impacted by your project in the next three years?
More than 10,000
Winning entries present a strong plan for how they will achieve growth. Identify your six-month milestone for growing your impact
Institutional improvement, management, communication and fundraising aimed at long-term sustainability
Task 1
Set long term action plan and expand the team of medical volunteers to have two teams that can operate simultaneously, if necessary in several regions
Task 2
Set long term action plan and expand the team of medical volunteers to have two teams that can operate simultaneously, if necessary in several regions
Task 3
Formation of Advisory Board for improving the governance of the organization. Development of a code of ethics and conduct in order to consolidate practices defended by the organization today.
Identify your 12-month impact milestone
In conjunction with public bodies that address indigenous health care, identify new areas with high demand for specialized medicine.
Task 1
Develop diagnostic methodology and analyze existing data that could contribute to a more efficient way to identify demands for service
Task 2
Expand training of local health workers. Structure a second medical and logistics staff to act simultaneously on two expeditions or timely meet situations of humanitarian assistance.
Task 3
Improve the mechanisms of cross-sector alliances so that the responsibilities and counterparts will be clearer and so that there are more efficient mechanisms for monitoring the process
How will your project evolve over the next three years?
Develop a proposal in conjunction with government partners so that the EDS social technology becomes public policy and may benefit patients in all regions of the country and increase access in remote areas to specialized, low complexity medical and surgical care.
Sustainability
What barriers might hinder the success of your project and how do you plan to overcome them?
The biggest challenge is the lack of financial resources to maintain the structure of logistics, expenses for meetings to establish or strengthen institutional relationships and travel, maintenance of medical equipment and computers, as well as other operational expenses. The organization receives some services and material resources from partners and implements its work with volunteer doctors. But preparing each expedition involves investments that are not fully covered by the partnership or the current donations from taxpayers to partner organizations.
We received donations of high-tech equipment, infrastructure equipment (tents and mobile), medicines and other surgical supplies that ensure the technical feasibility of each expedition. Due to the beneficial impact on communities in professional and respectful ways that work in partnership with local health providers, EDS has the credibility and trust of major institutional partners such as FUNAI and the Ministry of Health and Ministry of Defense.
The best way to address these challenges is to leverage resources that enable the hiring of consultants or industry professionals who will help us to structure the management and sustainability of the organization.
Tell us about your partnerships
Partnerships with local staff trained to perform the triage process (selection of surgical cases and consultations), transportation and accommodation of patients and postoperative follow-up.
Partnerships with local agents and institutions that support the mobility of doctors in the area and transport of equipment and supplies. Community support for adequate infrastructure for the installation of the Mobile Surgical Center or the existence of a local surgical center in good condition. Support from the private sector through donations of equipment, medicines, supplies, transportation and mainly the sponsoring of the logistics of each expedition which takes about four months to be organized.
The partnerships with health professionals working in the region where the program is implemented are essential to the planning and execution of our program: defining the scope of service on every trip, looking for diagnoses and patients, determination of necessary medical areas, support for infrastructure -structure, logistics and care after surgery. Finally, ensuring the inclusion of the Health Crusaders team in the local community. Local professionals are responsible for lodging, transportation, food and act as translators interfacing with the medical patient. A partnership with regional hospitals allows for surgeries to be transferred to the hospital when certain risk factors are identified.
Current annual budget of project, in US dollars
$500,001‐1 million
Explain your selections
Exchange Rate: 1 USD$ = 1.70 Br R$
1.Pre-Expedition:
1.1 Exploratory trip to identify surgery needs, train local health agents and identify surgery cases in the community (active search) Total: R$ 33.850,00 /USD 19.911,76
1.2 Preparation of the community to receive an expedition (infrastructure material and labor), communication and publicity in the community, acquisition of medicines and medical supplies.
Total: R$205.800,00 USD 121.058,82
2. Mobilization: Cargo transport, air transportation, food and lodging for the medical and logistical team, charters and miscellaneous expenses, communications infrastructure. Total R$ 59.050,00/USD 34.735,29
3. Operations: Operação: Rent sea planes, rental boats, boats and generators, Fuel, Food to support local staff and patients, labor, local support, emergency reserves.Total R$132.665,00/USD 78.038,24
4. Demobilization: Transport of cargo air transport team, food and lodging, and miscellaneous Charters Total R$59.050,00/
USD 34.735,29
TOTAL per expedition :R$ 490.415,00 /USD 288.479,41.Value invested by the partners alongside EDS:U$D 402,352 costs for medicines, supplies and high-tech equipment provided by the NGO for each expedition.
Partners involved
SESAI, FUNAI, Indigenous Health Districts, local governments, Ministry of Defense, Brazilian Air Force, Military Command of the Amazon, Indigenous leaders from the Community benefited. All these partners contribute directly to facilitate the care provided in the community.
How do you plan to strengthen your project in the next three years?
Increase fundraising with individuals and companies to fund the logistics and administrative aspects of the program. Grow existing partnerships for the donation of medicines, equipment and supplies. Grow the number of volunteer medical professionals and other volunteers in the areas of management, projects and resources. Generate a more successful relationship with the press as a way to broaden the dissemination of the organization, and to strengthen its reputation.
Challenges
Which barriers to health and well-being does your innovation address?
Please select up to three in order of relevancy to your project.
PRIMARY
Other (Specify Below)
SECONDARY
Lack of physical access to care/lack of facilities
TERTIARY
Limited diagnosis/detection of diseases
Please describe how your innovation specifically tackles the barriers listed above.
To meet people who live far from operating rooms EDS developed the Mobile Surgical Center, tailored to people’s needs, transported and assembled anywhere for action. It is an innovative way of working, the first of its kind for an NGO in Brazil. Methodology: mapped and processes that can be replicated in a systematized way. The expeditions take place in communities where government and residents are mobilizing to make all necessary adjustments in terms of infrastructure to receive a surgical expedition. There are specific coordination needs: Medical, logistics, specialty ophthalmology, general surgery, pediatric surgery and orthopedics. There is training of local health teams supported by the University of Campinas. Evaluation both during and after each expedition.
How are you growing the impact of your organization or initiative?
Please select up to three potential pathways in order of relevancy to you.
PRIMARY
Enhanced existing impact through addition of complementary services
SECONDARY
Influenced other organizations and institutions through the spread of best practices
TERTIARY
Grown geographic reach: Within host country
Please describe which of your growth activities are current or planned for the immediate future.
Strategic planning for institutional strengthening and improvement of strategies for raising financial and material resources. Public relations actions to strengthen the organization's reputation and constantly improve its relationship with key stakeholders that affect or are effected by the Health Crusaders activities.
Do you collaborate with any of the following: (Check all that apply)
Technology providers, NGOs/Nonprofits, For profit companies, Academia/universities.
If yes, how have these collaborations helped your innovation to succeed?
Partnership: local staff trained to conduct screening of surgical cases, transportation and accommodation of patients and postoperative follow-up. Local agents and institutions assist in the movement of doctors in the area and transport of equipment and supplies. Communities provide the adequate infrastructure. Corporate donations: equipment, medicines, supplies, transportation.
The partnership with health professionals working in the region where the program is implemented it is ensures the successful implementation of the Health Crusaders team in the local community. They are responsible for lodging, transportation, food and act as translators in the doctor-patient interface. Partnerships with regional hospitals mean that surgeries can be transferred to the hospital in the event that
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