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REVISTA HISTÓRIA VIVA - EDIÇÃO 03
By the mids, Brazil's healthcare model for cervical cancer had only allowed for prevention and early detection measures in the form of isolated, sporadic, non-nationwide initiatives carried out by certain institutions -generally philanthropic ones- or by health departments, usually municipal. In , on the eve of formalizing the principles of the Public Health Reform contained in the new Brazilian Constitution issued in 18 the Pro-Onco Oncology Program was created; its projects included the "Expansion of the Prevention and Control of Cervical and Uterine Cancer" Its by-product was a series of technical recommendations that became part of the approach endorsed by the Ministry of Health -for example, a target age range of 25 to 60 and a three-year screening interval after two negative results By the end of the s, Brazilian women were enjoying greater citizenship status and much had been achieved in the production of scientific and epidemiological knowledge.
Combined with various local and national experiences, this stimulated the demand for cervical cancer to be addressed in an organized fashion and at a nationwide level. In addition, Brazilian health services had undergone a structural change. This new environment promoted the changes observed in the control of cervical cancer during the course of the s.
Pilot project The aforementioned context aside, Brazil had no prior experience implementing a national program for secondary prevention of any type of disease prior to the s. Moreover, Brazil's sharp regional differences in terms of socioeconomics, geography, climate, and epidemiology tend to discourage attempts to set up a nationwide program with any singularly defined, rigid features. The program's target population was women aged 35 to 49; and a total of , women received care, of which 3.
In technical terms, it was vital that the project spawn intermediary products with a view to the future structuring of a country-wide program.
Generally speaking, Viva Mulher's main contributions were the establishment of a model of decentralized action, the standardization of all stages of procedures including adoption of the nomenclature that since had been endorsed by the Ministry of Health and by the Brazilian Society of Cytopathology , geographic expansion, and the definition of the recommended periodicity for Pap smears By conducting qualitative surveys among health professionals and the female populations in question, the pilot project sought to devise communication strategies that would overcome cultural and regional resistance.
One of its greatest successes was probably the incorporation of the technique known as "See and Treat" "Ver e Tratar" , under which women with precursor lesions of cancer were treated with high-frequency surgery At the same time, the pilot project also revealed some critical obstacles that would have to be addressed if a national program were to be launched.
It was noted, for example, that guaranteeing the quality of test results would depend on the monitoring of external laboratories; software would have to be more user-friendly and, primarily, compatible with SUS systems; funding mechanisms would have to be found for ambulatory procedures; and managers would have to be recruited for a task of this magnitude However, in August , before the pilot project was concluded and its results analyzed, the Ministry of Health took over responsibility for the control of cervical cancer in Brazil, through a broad national campaign that became known as the "intensification phase" -a move that constituted a kind of surreptitious intrusion.
Perhaps the euphemism "intensification phase" was meant to suggest that this action had been planned all along and that a new phase had already been in the making, aimed at geographic expansion of the Viva Mulher pilot project.
If such were the case, the initiative should not have come at a moment when most of the pilot activities had been underway for a little more than one year and, in the case of the state of Sergipe the last to implement the Viva Mulher program , for only seven months.
Arguments against the idea were raised during subsequent discussions. There was concern that ground might be lost in the effort to enforce a paradigm of integral health care for women, since the Ministry would go back to working towards the solution of one specific problem, as well as a fear that the SUS would be unable to handle the expected large influx of women, who would then find themselves without treatment Among the matters discussed at its August meeting, the CNS expressed its apprehension about the infrastructure that the Ministry of Health would be relying on to conduct the national campaign At that time, the Seventeenth International Cancer Congress was taking place in Brazil, under the sponsorship of the Union Internationale Contre le Cancer UICC , the main worldwide NGO devoted to the fight against cancer founded in , at present with member organizations from countries.
It was not only the leadership of INCA -the institute that coordinated the pilot project- but also the majority of the experts attending the congress who felt the Brazilian government had precipitated itself and who condemned the ministerial decision.
We're very concerned about this mass campaign, undertaken without our recommendation. Sometimes governments do things like this" I know that the government has the money. But I think there'll be trouble with infrastructure" In addition to these opinions from specialists, the newspaper wrote that sources said "the ministry also had allegedly received a PAHO report criticizing the launching of the campaign".
According to him, the prevention campaign will only help and will take the problem [of cervical cancer] to women: "This can in no way hurt". The ministry said it would "be entirely able to" finalize all stages of the prevention program.
According to him, "the ministry has mapped out a number of regions in the country for organizing the campaign" These blatant disagreements over the campaign execution were cut short by a show of strength on the part of the Health Minister, who, a few days later, dismissed the director of INCA, leading to the resignation of his appointed staff.
In counterpart -and the misgivings cited earlier notwithstanding- the ministry received the support of the National Health Council First campaign or first intensification phase The Health Ministry's intervention in the Viva Mulher pilot project does not appear to have stemmed from any criticism about the work INCA had done on the project up until then or from any technical discrepancies.
As suggested earlier, the reasons behind it seem instead related to matters of a more general political nature and to a logic lying outside the field of cancer control. Present at the event were governments and over 5, representatives of 2, NGOs from around the world.
For two years, the women's movement in Brazil had worked with over women's groups in preparation for the event, and the country proved an active participant. The main topics addressed in Beijing were: advances in human rights for women; women and poverty; women and decision-making; female children; and violence against women.
There were two health priorities: the prevention and promptly treatment of gynecological cancers, and family planning.
The head of the Brazilian delegation committed the nation to working to change the reality of cervical cancer. The personal and intense involvement of the wife of the President of Brazil strengthened the links between the federal government and the women's movement, fueling an expectation for greater female participation in public policy making in Brazil, including the health area She wanted a strong cervical cancer control program because she had taken on this commitment at the International Women's Conference in China.
She herself was under pressure from the organized women's movement, and passed this pressure along upon her return to Brazil.
The project was born, but not, it doesn't seem to me, at the pace the government had hoped for. In a nation this size, it's very hard to lay a solid foundation across the whole country.
CARVALHO, Marcus - Os Protagonistas
I think that at some point, [there came] the realization that the natural course of the Viva Mulher program, the way it was being conducted, would take longer than expected. So it was decided to wage a major national initiative to mobilize women and municipal and state governments to join in the process" In -the year Brazil's president was on the campaign trail, taking advantage of the new right to re-election within the executive branch that had been granted under a Constitutional amendment- the Ministry of Health apparently decided to use the opportunity to respond loud and clear to the pledge made in Beijing.
This decision -besides eliciting the reaction by foreign experts mentioned earlier- also generated controversy among Brazilian health professionals and academics, especially in the public health field. All warned about the weak efficacy of temporary actions and the need to create an ongoing, standardized program to control cervical cancer in Brazil It should be taken into account that the SUS was only ten years old at the time and that this was the country's first major nationwide experience in mobilizing public institutions and civil society According to a Health Ministry's report, In addition to repeating the pilot project's successful strategies, and in view of its national character, this campaign or intensification phase sought to enact other initiatives as well, yielding positive results for the overall process Among them were the implementation of a specific electronic system for monitoring activities Siscolo and the consolidation of the decentralization process initiated under the pilot project, which included expansion of laboratory coverage for slide reading, the establishment of centers around the country where high-frequency surgery was available, and the formation of a regional tertiary healthcare network.
Considering the main factors behind disease vulnerability, the intensification phase met important goals: The campaign let Brazilian women know that they had a major commitment in August and September of that year: to have a cervical cancer prevention test.
A number of operational glitches kept the campaign from running smoothly and impeded the achievement of the planned objectives. The establishment of the electronic Siscolo system was disorganized, leading to inconsistencies in the inclusion of data by laboratories.
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Two weeks after the activities commenced, the proposal to focus on the age range had to be tabled under heavy and spontaneous pressure from women seeking Pap smears at health posts: "Two weeks into the campaign, the guideline had to be thrown out and the test opened up to everyone, because women were out on the streets demonstrating.
During the second campaign [to be addressed next in this article], we expanded the age range to 25 to 59 and advised the states and municipalities that we visited not to deny women the test" Since the health system was not prepared for an initiative of this magnitude, many women who responded to the campaign could not get tested, one reason being a shortage of doctors. An attempt was made to solve this problem by extending the campaign for 15 more days The biggest problems, however, had to do with reading the slides and dealing with women whose results were positive.
Painted architecture was not approximate, as in the Middle Ages, but 'possible', measured and proportionate to man's height. In view of the imminent celebrations for the five hundredth anniversary of the death of Raphael - one of the greatest painter-architects of the Modern age - this dossier proposes a deepening of the architectural culture of painters in order to highlight the levels of knowledge, the theoretical sources, the practical knowledge, the relationships of collaboration between painters and architects, the elements that allow us to recognize in the diffusion of linear perspective a strong element of cultural renewal of the pictorial profession.
Without forgetting that in some cases, like in the famous ideal cities or in wooden inlayed panels, architecture is the only subject of pictorial composition. Proposals will be evaluated and accepted according to quality, but also spread and variety. Please circulate this Call for Papers widely.
Once you have registered and consulted the submission guidelines, please send your proposal on our online journal platform:. References Agamben, Giorgio. State of exception.
Translated by Kevin Attell. Mario da Gama Kury. Brasilia: Editora UNB, Google Scholar Benjamin, Walter.
Revista do curso de Letras da Uniabeu. Rio de Janeiro, v.Portaria n. El abrumador aroma picante de Hunan. On this research, we work with Peter Seixas aiming to perceive what is the place of history education in the knowledge production inside the school and in historical thought formation, creating a strategy of treating data along with the theoretical conceptions and the speech of the subjects we have analyzed.
This thesis is treated, in history theory, as the narrativist paradigm.
Preventive strikes: women, precancer, and prophylactic surgery. A total of 70 surveys were answered.