Legal abortion and transsexualization cannot be taboos in the SUS, says new secretary

New national secretary of Primary Health Care, physician Nésio Fernandes, 40, says that the Ministry of Health needs to resume the “civilizing agenda” and decentralize legal abortion services and the transsexualization process in the SUS (Unified Health System), themes fought by Bolsonarist militancy.

“The law already says that any maternity hospital can have a legal abortion. It is not a procedure alien to their daily lives. But who is going to raise this issue, civil society? the State,” said Fernandes in an interview with Sheet.

For him, the process of transsexualization can be expanded. Since 2008, SUS has offered access to hormones and body and genital modification surgeries for trans women and, as of 2013, also for trans men and transvestites.

He also claims that foreigners can return to the Mais Médicos program, especially in distant cities, but without the cooperation agreement that was previously signed with Cuba. The plan is to occupy vacancies by opening public notices for those who graduated in the country, or studied abroad and did the Revalida (which endorses the diplomas of doctors who graduated abroad and want to work in Brazil).

The secretary also proposes partnership with schools and dialogue with religious institutions to reinforce the vaccination campaign.

In 2020, Fernandes participated in an undertaking to send a ten-year-old child, pregnant after rape, to Pernambuco to perform a legal abortion — a situation that led to protests by extremists and the actions of former minister Damares Alves.

What is the change in primary care that should be noticed in relation to the Bolsonaro government? The environment that we want to build here is the one that characterizes the SUS. These civilizing agendas discuss abortion, gender violence, sexual reproductive health, social determinants of health involving the issue of race and color, vulnerable populations. These are always subjects that gain great prominence and depth in the SUS first. You get HIV, the LGBTQIA+ agenda, we need to recover this quickly.

All these advanced agendas must have in Saps [Secretaria de Atenção Primária à Saúde] an environment of freedom of thought, criticism, elaboration and proposition of public policies, because a Ministry of Health or secretariats that only publish technical notes are of no use to us.

How can the government resume the “civilizing agendas”? It is necessary to organize a network that, from the moment of attracting primary care, allows, in case of suspicion of violence, that the community health agent, the doctor, the nurse, everyone recognizes the situation, to prevent it from reaching rape. If there is a rape, get that child out of the situation.

Then there has to be integration with the Unified Social Assistance System, tutelary council, a direct relationship with the Public Ministry of each region. If that child victim of rape ends up developing a pregnancy, she has to be diagnosed quickly to access, with the lowest risk, legal abortion.

There needs to be a maternal network that performs abortion, decentralized. I had to take a ten-year-old girl from Espírito Santo to Pernambuco. I agreed with everyone a silence, the secret, until I completed the procedure.

Due to the religiosity of community health agents, doctors, nurses, [eles] welcome the pregnant child as a mother. ‘Hi mommy, listen to your heart [do bebê].’ They naturalize the violence in that suffering, preventing that child from even being encouraged to exercise his autonomy, his decision. And it does not repair the victim from the point of view of psychological suffering.

So you need NASFs (family health support centers) with a psychologist, with a social worker in all primary care.

The law already says that any maternity hospital can perform a legal abortion. It is not a procedure alien to their daily lives. But who will raise this issue, civil society? It has no normative power, no inducing, financing power. Who has this is the State. It is up to the Ministry of Health to coerce the entire chain of public power, state and municipal public power, contracted private providers, to provide services and guarantee dignity and access.

Are you going to design a specific public policy on legal abortion? Will the professionals be instructed, if a woman arrives with a declared case or who seems to be pregnant due to rape, not to treat her as a “little mother”, but as a victim? No doubt. You need to establish policies from norms to funding, monitoring, evaluation. If not, it’s not politics, it’s a note of intentions, protocol, it’s a desire based on academic inspiration. Public policy has to have everything.

I’m not saying I’m going to do it next month. It is something within the scope of that debate of discussing themes that in this recent period were protected. We need to preserve the Ministry of Health institution, so that it can lead, with advanced positions, any and all complex discussions.

So, in general, the Ministry of Health cannot deny debates such as legal abortion… …process of transsexualization of the population.

For the transsexualization process, does any new procedure or structure need to be created in the SUS? We already have some services in Brazil, so they can be enhanced, others need to be created, we have states that do not have any services, not even the outpatient service.

Is it an idea of ​​the government to decentralize this type of service? Of course, because the trans population is not that big. How much these people suffer, how much they can resignify themselves, have another quality of life if they can go through a transsexualizing process, from psychological treatment, psychiatric support, medication, to surgical procedure, if they have access to the civil right to be able to modify the Name. There is no way that all states do not have a service like this implemented and consolidated.

How does this kind of issue advance under a conservative Congress? You don’t need it. This is already at the discretion of the public power, it can now open [o serviço], has resources from the Ministry of Health, has funding channels. You don’t need Congress for that. This is pacified. I’m just discussing legal abortion, already pacified abortion.

What is the proposal on vaccination? It is not enough today just the audiovisual campaign, just the mobilization campaign. You need to have a mobilization with the schools. The older the age, the lower the vaccination coverage. Especially from three and four years old, coverage is lower. Where are the 3, 4 year olds? At Schools. Either we mobilize education in this agenda or we cannot carry out this campaign.

Lula spoke in dialogue with the churches for vaccination. I am Baptist, my dialogue with believers is very good. In Espírito Santo, we managed to get the Pentecostal bishops, the Assembly of God, rabbi, priest, everyone vaccinated on the same day.

It’s not everyone who is a denialist, Bolsonarist, there’s a good crowd there. This group can talk. I think vaccination is an agenda to help resume dialogue with religion.

Can foreign doctors, including Cubans, reinforce Mais Médicos? When the public notice opens for non-revalidated foreigners, they can apply. The first stage will be for professionals registered in Brazil, Brazilians or foreigners. The second is for Brazilians trained abroad, and the third for foreigners. [sem diploma validado].

As long as there is a deep Brazil, the periphery, and we don’t change much the content of values, training, profile, medicine class, we will need for decades to recruit doctors on a compulsory basis, and one of the best ways is the temporary registration .

What is the proposal to accommodate the Mais Médicos and Médicos Pelo Brasil programs? The path is the unification of programs. Both will be part of a single strategy. You have a shortage of doctors, but you also have a shortage of other professionals. You can’t put the psychologist in the inside of the inside of the inside [do Brasil]. There is a shortage of speech therapists in large centers. Everything is missing.

What should be the future of ADAPS [Agência para o Desenvolvimento da Atenção Primária à Saúde, criada no governo Bolsonaro para administrar o Médicos Pelo Brasil]? The agency is about to undergo a reformulation and improvement process in which other competences and responsibilities can be incorporated. It is a topic that will take months to mature. It may also be an instrument to implement telemedicine. Or it can be an experience that consolidates other hiring milestones in the public sector.

A large portion of the budget for primary care is directed by parliamentary amendments to municipal funds, without following criteria of regional priority. Amendments are decided in December. Those that we are going to execute [em 2023] already passed. The challenge is to be able to assemble a good portfolio [de ações para as emendas], make a mature and republican debate with Congress, to qualify the application next year. We are not going to put an end to the parliamentary amendment, this is an objective phenomenon, this is part of the Brazilian political culture, very difficult.

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Nesio Fernandes, 40

Evangelical, PCdoB member and doctor trained in Cuba, he was Secretary of Health of Espírito Santo, from 2019 to 2022, and president of Conass (National Council of Health Secretaries).