With teams missing by Covid, doctors threaten strike in São Paulo

With health units overcrowded, lack of medicines, exhausted and sick teams, doctors from APS (Primary Health Care), who work in basic units in São Paulo, will hold a meeting this Thursday (13), at 19:30, to decide if they go on strike.

The situation has worsened in recent weeks with the advancement of the ômicron variant and the influenza epidemic, which led to the dismissal of about 1,600 municipal health workers, an increase of 111% compared to the beginning of December. The state network is also experiencing a similar problem.

The removal of health professionals due to Covid or flu syndrome has become a dilemma across the country and also affects up to 10% of the workforce of private hospitals, according to Anahp (Association of Private Health Hospitals). The situation prompted the Ministry of Health to reduce the period of isolation of asymptomatic Covid patients from 10 to 5 days.

Among the demands of doctors in the municipal network of São Paulo are the hiring of more teams for care and payment of overtime. Many professionals say they are being called upon to work on Saturdays without additional pay.

“The only additional resource is overload. Employees are being called to work on Saturdays without knowing how they will be compensated. Some OSS [organizações sociais de saúde] are not paying as overtime, they offer as a bank of hours, but, in practice, nobody can take those hours”, says doctor Ana Paula Amorim, director of the Paulista Association of Family and Community Medicine and who also works in the municipal network.

According to doctor Vanessa Araújo, representative of Simesp (Sindicato dos Médicos de São Paulo), municipal health workers are completely exhausted and disrespected by the government. “The situation in the city of São Paulo is heading towards a collapse”, he says.

This Wednesday morning (12), for example, she says she visited UBS Santa Cecília, in downtown São Paulo. The unit was supposed to have eight doctors and was operating with just three. “Four doctors recently resigned due to exhaustion and because they were no longer able to do primary care work, to monitor the chronically ill, to prevent diseases. The demand is for emergency care all the time”, he says.

According to community leaders, at the UBS in Jardim Fontalis, in the north zone, there were only two doctors (a general practitioner and a gynecologist) to serve a region with a population of 60,000 people. The unit’s four family health teams were without doctors.

Araújo says that the situation of defrauded teams is the same in at least 50 UBSs visited in recent weeks. “The OSS allege difficulty in hiring doctors, but they also do not inform the reason for this. Is it low remuneration? Exhaustive workload? Misconfiguration of PHC? They do not assume responsibility.”

The doctor says that, since the beginning of the pandemic, many primary care professionals have left the municipal network due to discouragement and exhaustion. THE leaf found that many of them are being absorbed by the private network, which increasingly invests in primary care.

Araújo says that discontent increased at the end of the year, when doctors were warned on Christmas Eve that the optional points had been suspended and that health units would open on Saturdays to care for people with Covid and flu symptoms.

“At the beginning of the year, the situation became unsustainable because, in addition to the overload, many workers started to get sick from Covid and influenza.

Professionals also report that they are exposed to contagion by Covid due to the lack of EPIs (personal protective equipment), such as gloves and aprons, in addition to basic supplies. “There is no dipyrone, no stretcher sheets”, says family doctor Ana Amorim.

Retired nursing technician Maria Madalena Figueiredo, health counselor in the region of UBS Jardim Fontalis, in the north zone, says that the lack of medicines is widespread. “Lack of everything. Painkillers, anti-inflammatories. Patients are going from post to post and get nothing.”

She says that this Wednesday (12) she was looking for syrup for a couple of recyclable collectors and medicines to treat tuberculosis of a vulnerable patient in the region who is in a nursing home. “It’s sad. There’s always someone complaining,” she says.

In the east, Laura Araújo, a resident of Jardim Tietê, complained about the lack of medicines such as alenia, for bronchial asthma, and losartan, for hypertension. “Sometimes I get one, but not the other,” she says, after going through three health clinics, without success.

For the doctor Ana Amorim, the situation is worse than at any other time of the pandemic in relation to the large number of people with respiratory symptoms.

In addition to the exhaustion and frustration of not being able to provide adequate care to patients, Amorim says that there has been an increase in episodes of violence against health professionals by the population.

On Friday (7), for example, a man, irritated by the delay in care, invaded the medical office of a UPA (Emergency Care Unit) in Guarulhos and began to look at the patients’ records. A health professional tried to restrain him and was punched. A security camera recorded the assault.

In response to the demands of the doctors’ union, Sindhosfil (a union that represents the 14 social health organizations that currently manage primary care in the municipality) said that the doctors’ claims are the responsibility of the São Paulo City Hall and that there were no financial sources. to fund the claims.

The Municipal Health Department, in turn, informed the union that it authorized the payment of overtime to professionals who are working on Saturdays for the OSS. And that they have also been authorized to hire doctors and nursing teams to meet the increased demand.

As for the missing medicines, the secretary recognized the shortage and attributed it to problems with importing items and the cancellation of purchases already committed, due to the pandemic.

In a note to leaf on Wednesday night, the secretariat says that since the beginning of the vaccination against Covid, in January 2021, the ministry authorized the contracting by the partners [OSS] of nursing and administrative teams to assist in vaccination.

“At the present time, due to the ômicron variant, there are many cases in a short period of time, promoting an increase in attendance at the units and, therefore, the integration of services in the care network was necessary”, he explains.

Since last Saturday, January 8, the units began to open every Saturday until the decrease in cases of respiratory symptoms in the capital. SMS says that it has already authorized the payment of overtime for professionals by the OSS.

The SMS also emphasizes that it requested the presence of doctors in the UBSs on Saturdays, however, it did not oblige the teams to be from Primary Health Care.

“Partners will start the overtime payment schedule starting this month and, to those of the direct administration, who start attending Saturdays from this phase of the pandemic, SMS will be publishing concierge and payment on extra duty.”

Until Friday (14), SMS says that, together with the partners, it will be closing the amount of contracting to support the entrance door of the equipment, including expanding the schedule and schedule of some units to 22:00 or, until same, transforming 12h units into 24h.

“In relation to supplies, the Municipal Health Department (SMS), informs that it received, in December 2021, more than 867.5 million units of medicines and supplies, with a total investment of R$ 116 million. another R$ 28 million in medicines and medical supplies, in addition to another R$ 52 million that will be used to purchase supplies.”