Mônica Bergamo: Our talents from USP are going to private medicine, says Eloisa Bonfá

For the first time in 110 years of existence, the USP School of Medicine will be headed by a woman: rheumatologist Eloisa Bonfá, 64, took office on Thursday (10), for a four-year term.

It is not the first time that she has broken paradigms at the institution to which she has dedicated her entire professional life: at age 40, the doctor was the first full professor at the Department of Internal Medicine at USP. In 2011, she was the first woman to head the clinical board of the Hospital das Clínicas of the Faculty of Medicine of USP, the HC.

In office, he faced Covid-19, and treated more than 12,000 patients who were victims of the biggest pandemic in recent history.

In this conversation with the column, she reveals the fear that the same thing will happen with Brazilian public universities that happened with the rest of education, which, without investments, was emptied in favor of private institutions.

She also talks about the machismo that is “in the walls” of the institution, the elitization of medical education and the need for the college to be “a place of transformation”:

THE PIONEER

Medicine in Brazil began more as a man’s profession. But there’s been a balance for a long time, if today there aren’t even more women [trabalhando na área]🇧🇷 In the gym, this took longer to happen. I was the third female professor at the institution. And that only happened in 1998. I was also the first woman to be a department head, the first to be a clinical director, at the age of 70. It is an institution that took a long time to make this opening. And so, the longer it took for us to arrive [a posições de comando]🇧🇷

At the same time, it is an institution that highly values ​​merit. So the question of there being barriers [para mulheres] is not very clear. You do not realize. It is hidden somehow. But that the barrier exists, it exists. ‘Cause there’s no point in taking this long to happen [de uma mulher virar diretora da faculdade]🇧🇷 The important thing is that it happened. It’s an honor to be here right now. And we hope it will be an opening for this to happen again and again.

THE MACHISM

There was never a time when people [na faculdade] say “you can’t because you’re a woman”. It was never explicit. can’t identify [fatos em que foi vítima de machismo]🇧🇷 But it is in the institutions, in the walls, in the way of doing things. Exists. You feel it in the air. “I’m not going to tell this joke because Eloisa is here”, or “ah, I’ll tell you later”.

It is something very diluted, because here [na Faculdade de Medicina], as I said, it has to be worth the merit. But [o machismo] existed. I am really happy [de ser eleita diretora]but I’m even sad because we “lost” Poli [Escola Politécnica da Universidade de São Paulo]which teaches a highly masculine profession [engenharia]🇧🇷 And they had a female director before us [Liedi Bernucci, que foi eleita diretora da Poli em 2018]🇧🇷 But we’re getting there.

PAID COLLEGE

The Faculty of Medicine already has 50% of [estudantes que ingressam nela pelas] quotas. So this issue that it is a college only for the rich is being corrected. It’s important to have that inclusiveness and maintain that diversity because you attract talent seeking a higher level of competence.

I’m against charging students tuition, because that’s not a solution. The solution is to try to change a concept that this college is not free. She’s well paid, and she’s expensive. And we have to get this into the heads of the people who are here, that it is an investment that is being made in them, in their family.

And that they are being privileged and therefore should do as abroad: you pay, in the sense of donation. You participate in the process.

Let’s make it clear to our students, with or without quotas, that this is an extremely expensive investment that society makes in them. And that we have to be accountable.

We saw in the pandemic that, when this happens, society realizes where the investment is going and contributes, supports. We were only able to do what we did in Covid-19 because society was with us. What are we doing that makes a difference to society? We have to show. But we only speak in scientific journals.

ELITE DOCTOR

I want to tell students what the cost of a medical course is, so they know they didn’t study for free. Someone paid for it. Each year 180 students enter the entrance exam, and in total we currently have around 1,300 students. Increasing vacancies is difficult because it requires more resources.

I will even ask to collect this data because I want to know how much a medical student costs. We’ll fall on our backs when we find out, because it’s too expensive. Let’s work on cultural change. We did a humanization management at Hospital das Clínicas [da Faculdade de Medicina da USP, o HC]🇧🇷

It is an effort for people to learn to look at something other than just success in the profession. The look at why to be a doctor, what you need to value, the way you relate. Let’s bring this center to the college. There will be a specific discipline for that.

As I said, 50% of our students entered through quotas, and often they come from abroad and arrive in a city like São Paulo and we don’t have any reception for them.

We want to set up a website and mobilize students who would be volunteer tutors to receive them. So what we’re looking for is that medical students don’t just focus on learning and what they’re going to gain in the future. We want them to have a broader view, and for the college to be a place of transformation.

SCRATCHING

We all have to think about whether what happened to elementary education in Brazil is not already happening with very good public universities. A teaching that was public and of excellence, in which investment was falling and people were withdrawing from public schools and were looking for private schools. We are already seeing this in Medicine.

For example, our talents are going to the [Hospital Israelita] Albert Einstein, the teachers [que vão dar aulas na faculdade do hospital], are much better paid there. It is a reality. You can’t stop it. It’s the market. We cannot, therefore, depend more exclusively on public resources and investment. The ideal world does not exist.

We have to look for other sources [de financiamento].The equipment we use is dollarized, the medicines and maintenance too, they charge an absurd amount just to get here. With all the locks that exist in the public service, how can this work? So you can’t give up the public resource, but you can’t stop thinking about alternatives to be able to support yourself.

Today, with 5% of what we raise from private patient resources [no Hospital das Clínicas da Faculdade de Medicina da USP], we get 40% of what we need to run the hospital. It’s money used to fix the MRI, to buy medicine. we just do [atendimentos privados] to maintain SUS.

THE MONEY

We have a permanent education school here that is accredited by the MEC. It is training and capacity building in all areas of health. We can take our collaborators to give courses of interest to the whole society. They can earn a little more and stay here. We can already do that, but we weren’t investing. Our focus was always on public resources.

Einstein’s main revenues today are in education and clinical research, did you know? Third comes assistance. There is a huge investment in research. And what happens today is that my assistants [da USP] do research on [hospital] Oswaldo Cruz, at Einstein, at [hospital] Syrian-Lebanese.

The industry pays very well. He [médico] receives reasonably well [nos outros hospitais], for him. It settles there. and come here [no HC da USP] clock and do much less than he does there [nos outros hospitais]🇧🇷 We want them to stay here.

That’s why I want to do a Clinical Research Institute in college. We have already won a government building and the USP rectory for this purpose.

It will start operating in the first half of next year, and will be a source of funds for the institution. Industry funds research. The professors who participate in them receive, stay here, teach our students — and generate additional resources for the institution.

Clinical research is currently the main source of revenue in several universities around the world, because the investment is very large. In the US, universities have a fund for improving infrastructure and salaries and for hiring people.

For many years the money [da faculdade] comes from the government, and that helps us a lot. But we also want to be proactive in getting both splicing resources [parlamentares] as well as private donations.

long live SUS

The first thing I wanted to say is that SUS was fantastic during the pandemic. If there was any doubt whether SUS is worth it, [a pandemia] completely removed that doubt.

The hierarchy of the SUS, with primary, secondary and tertiary care, worked like a charm. Without it, we would not have been able to serve more than 10,000 patients as we do. ‘Cause if everybody with the flu came to our door [do Hospital das Clínicas de São Paulo], we would not be able to care for the most seriously ill patient. The right patient at the right door is what makes public health cheaper, because you don’t occupy such an expensive place. [como o HC] to deal with something less complex. It’s him [o SUS] really gives access.

A former student of ours who coordinated Covid care in the Bronx, USA, visited us and was impressed with Brazil. Because there, yes, a lot of people died. People were placed on the floor of the parking lot and they chose to treat whoever had the best chance of surviving. So, except in Manaus, where we had terrible failures, we didn’t have street deaths like New York did. The SUS worked, yes. And we have to be proud.

On the other hand, SUS is underpriced. He pays less for surgery than I spend on that surgery. No gear works like that. After the pandemic, we have to rescue and correct the course.

Let’s think about the vaccine. Our system is an example to the world. But in recent years immunization rates have been decreasing. Imagine having polio again? That is inadmissible. So, in deference to what the SUS did in the pandemic, we have to invest in it and correct the disparities.

Management is also an issue. She makes all the difference. The person who enters here [no Hospital das Clínicas], which is SUS, and most of the time she is delighted with the service. So it doesn’t matter if the structure is the best or not. If it works here, it has to work elsewhere.

But there is indeed a disparity in terms of management, cash flow and priorities. you have to have [atendimento de] high complexity. But you need to invest in the base. And with that, it prevents people from going to this other part of the chain. With prevention, with vaccine.

You can’t admit that vaccination is falling. That’s management. It’s propaganda, it’s a way of approaching. It’s distribution. So the SUS needs a new impulse, a new look at it.