manaus.

Through the help of my institution at Fiocruz, ICICT, I was able to apply a part of my questionnaire of health workers in the city of Parintins, a city in the interior of the state of Amazonas.

The objective of the focus group was to gain a perspective on the types of health information sources used by residents, as well as access to these sources of health information. This information will be recorded and used when adapting the questionnaire I used for my Fulbright research project. Eight participants, all from different areas of the interior of the state, were selected to participate in a one-hour session, with me as the moderator.

It’s difficult to get a comprehensive look at how the public health system works in the Amazon, as well as how people access their health care information (and health care in general) there, but this focus group provided some interesting input to consider when adapting this questionnaire—what options to provide for the closed-ended questions, how to format the answer choices, etc.

Highlights from the conversation:

• Some places in the Amazon take 22 days to reach Manaus (by boat), the closest city with tertiary level health care.
• There are several communities with no SUS community health agents, and many communities with only one community health agent in a community of 3,000 people. This agent only goes once a month to Manaus to report to the public health workers there.
• Many of these communities have no public health infrastructure (family health clinics, UPA, etc.)
• There is a high trust in benzadores and midwives. This isn’t even considering the indigenous populations.
• Towns in the interior of the Amazon, including Parintins, have no access to printed information material, including newspapers and magazines.
• There are no libraries in the interior.
• Prior to Internet, residents received information through local radio (weak and not very good health information) and TV.
• The idea of passing information and medications from one person to the next is common in these areas. Using the medicine that was given to your aunt, heeding the advice of your grandmother’s sister—high frequency.
• The Internet has become their door to the world (the residents). All of a sudden, there is a huge overload of information. Many of these focus group participants stressed the need for filtration of information, and expressed concern about Internet literacy among the non-educated.
• Participants mentioned the use of books—an uncommon source among university students in the pilot study.
• The focus group participants tended to be more health information-seeking savvy, choosing scientific literature and websites like SCIELO versus random Google searches.
• Participants mentioned the use of family members for health information.
• Concept of family member as a health professional—asked what they consider first—them as a health professional or a family member. First they are health professional (how to consider this during a future questionnaire).
• Main health problems encountered in the interior are vector-borne diseases like malaria, as well as digestive problems and respiratory problems (from creating fires for homes and building).
• Participants mentioned the lack of UPA-24 hours, Family Health Clinics. Mention the North (Ceara) as the reference for good healthcare. (Cariocas/Rio mentions the south—Curitiba, Porto Alegre as references for good SUS/public health care).
• Same problems with rural health care in the US, the intensity is much greater. The US has telemedicine, incentives for medical students to work in rural healthcare, etc. These problems are becoming a focus in Brazil. (Side note: medical students going to Argentina, Bolivia to get their license and coming back to work in Brazil. No one wants to work in primary care.)
• My own observations. In addition to the lack of newspaper stands, I noticed some things about living in a small town that make it inherently healthy—people use their bikes everywhere, there are rickshaws… now it is changing, more people are using motorcycles. Wonder what this means for the future.