Itinerant office makes dressing for stones on the head to test for Covid in those who live on the street

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With backpacks equipped with first-aid kits, a team with a nurse, two health agents and a social worker walks through the streets of the Santa Cecília neighborhood, in the central region of SP, to assess the health of people in vulnerable situations. Underneath the Elevado Presidente João Goulart, known as Minhocão, the work is intense with dressings, temperature measurement, rapid coronavirus test and monitoring of chronic diseases.

The work is part of the Consultório na Rua, a federal health care program that is in 120 municipalities in the country, according to the Ministry of Health. In São Paulo, the public initiative had to be expanded during the pandemic to account for the increase in the number of homeless people in the period: there were 19 teams before Covid-19 and, currently, there are 26 that work in all regions of the city. , according to Ricardo Nunes (MDB) management.

The effectiveness of the assistance action even has the blessings of Father Julio Lancellotti, from the Pastoral do Povo da Rua de São Paulo, one of the greatest authorities in the country in caring for people in situations of vulnerability.

“Today, this program is one of the most advanced things for the homeless population”, says the religious, who emphasizes, however, the need for advances in the number of teams.

Right at the beginning of the journey, which lasts about three hours in the afternoon, the team finds, in Minhocão, the baker Leandro Lozada, 45, sitting on a mattress, shirtless, with a bruise on his back and head. Nurse Renata Pontes, 43, puts on plastic gloves and then takes gauze and saline solution out of her backpack to clean the wounds.

“It’s a very good service, I can’t complain”, says Leandro. He says he was injured the day before after fighting with another homeless person at the Marechal Deodoro subway station.

Leandro still takes care of his wife, the housewife Andrea Francisco, 48, who suffered a stroke right there, under the elevator, just over a year ago, and still lives on the street, using a borrowed wheelchair. “They bring me ointments and I can get diapers at the post”, she says.

The teams are made up of professionals who carry out health monitoring with consultations, guidelines, dressings, medications, vaccinations and other procedures, according to André Contrucci, technical interlocutor of teams at Consultório na Rua in São Paulo.

“The objective is to insert the homeless population in the health care network. Part of a work of daily visits, including on holidays, registration and territorial mapping”, says the interlocutor.

On the streets for ten years, sales promoter Osías Monteiro do Nascimento, 51, carries his coronavirus vaccine receipts in a small bag that he takes with him wherever he goes.

Osías received the booster dose in Marechal Deodoro square, in Santa Cecília, as part of the assistance program. ​He is one of the 630 homeless people in the neighborhood who get health care wherever they are.

“I felt a lot of relief when I was immunized. I had a reaction, fever and tiredness, but it was worth it to avoid this virus. Now, we have to show the vaccine passport wherever we go”, says Osías, who is undergoing treatment against syphilis. with the healthcare team.

Until February 5, 2022, 53,783 doses of vaccine against Covid-19 were administered to homeless people in the capital of São Paulo, including booster doses, according to data from the Municipal Health Department.

The artisan Bel, 41, lives in a canvas house built under the overpass and is already immunized. She was recently diagnosed with tuberculosis with the intervention of the Consultório na Rua team. She receives treatment right there on the viaduct.

“I don’t know what I would have done without them, they were the best people with me, they care and bring me the medication to take every day.”

Bel has three children and will take advantage of the consultation with the gynecologist at the post, in March, to have a contraceptive implant in her skin.

Consultório na Rua has been in existence since 2004 in São Paulo, born as A Gente Na Rua. At the federal level, it was created in 2011 under Dilma Rousseff (PT), with the São Paulo project as a reference, informs Father Julio.

“It emerged within primary health care and is linked to UBSs [Unidades Básicas de Saúde]. Now, it is in the national policy decree, built with a thousand hands”, says the priest.

The religious highlights another feature of the program in São Paulo. “All health workers are former homeless people or residents of shelters who have already been in a situation of vulnerability.”

André Contrucci, the technical interlocutor of the teams, says that this allows a closer relationship with the homeless population. “Health agents use street codes, they know how to approach those who have a harsher attitude. On a day-to-day basis, it’s a fundamental job.”

Today many of them are university students or graduates, says the priest. “This feature of the program is very important because it welcomes and provides growth and professionalization for these people.”

Part of the team in Santa Cecília, health agent Daniel Cruz, 41, arrived in São Paulo in 2011. He came from the interior of the state to look for work opportunities, but soon moved to a reception center. He spent a period on the streets, much of that time in Praça 14 Bis, in Bela Vista, due to his addiction to narcotics.

Daniel’s story changed in 2019, when he started his treatment at the Psychosocial Care Center. “I found myself. From there, my life started to change.”

In 2020, Daniel received the invitation to work as a health agent in the Consultório na Rua program to strengthen the team in the pandemic and he has been there for two years. “I love what I do.”

But the former baker does not stand still and began studying journalism at a private university, with a 50% scholarship. “I intend to write a book about life on the streets.” He currently lives in a small apartment in Aclimação, central region.

Other professionals who can be part of the teams are a psychologist, social worker, dental surgeon, occupational therapist, social worker and doctor.

But the pandemic has changed some procedures on walks. Nurse Renata says that, since March 2020, two items have become part of her visiting routine: the thermometer and the oximeter.

“Patients who cannot leave the territory receive this attention on the street”, says the team nurse, who performs daily rounds to make dressings and make sure that the homeless are taking their continuous use medication for tuberculosis and HIV, for example. .

Renata also says that since December the coronavirus test has been carried out on the street. “Before, patients had to be referred to the UBS, and many did not want to go to avoid the risk of losing their belongings. So, with the tests in hand, it facilitated diagnosis and treatment.”

Consultório na Rua is also present in cities such as Porto Alegre (RS), Campo Grande (MS) and Recife (PE). In 2021, R$ 49 million were transferred to public policy that served, from January to August, more than 78 thousand people in the country, according to the management of Jair Bolsonaro (PL).

In January 2022, in the city of São Paulo alone, 18,666 approaches were carried out on the streets and 14,657 medical consultations were carried out, says the city hall.

Despite being only praise for the program, Father Julio makes a point. “Mental health coverage is still lacking. It is necessary to have a specific doctor and its own team.”

The priest also declares that the Consultório na Rua should reach more districts. According to the Municipality of SP, the program is expected to expand with six new teams over the next few months, from 26 to 32.

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