Healthcare Runs Underwater in Rio Grande do Sul

The Brazilian state of Rio Grande do Sul is still struggling with the devastating floods that struck in early May. Schools, businesses, and other services remain halted. The healthcare sector faces enormous challenges as its services must continue, even under such extreme conditions.

In this interview with Outra Saúde, Paula Suseli, director of the Municipal Health Foundation managing the Unified Health System (SUS) in São Leopoldo, discusses the health sector’s daily struggles, three weeks after the floods hit. By that point, the city, part of the Porto Alegre metropolitan area, had lost 11 health units, forcing primary care services to relocate to 115 shelters housing thousands of displaced people.

Although the main hospital was unaffected, a new healthcare strategy is urgently needed amid significant material challenges. Many health professionals are stranded, trying to salvage their own homes.

Suseli warns of an impending wave of mental health issues in the state, with collective trauma expected to have long-lasting effects. She emphasizes that no health issue will be resolved without strong public investment for material and psychological recovery.

Outra Saúde: First of all, what impact has the climate tragedy had on the health structure in your city and state?

Paula Suseli: The impact was enormous. In many areas of Rio Grande do Sul, entire hospitals, health units, and pharmacies were evacuated due to flooding. While we don’t yet have comprehensive data on the public health impact, we know the disruption in access to healthcare services and medicines, exposure to contaminated water, and the psychological toll on those who lost homes, family members, or pets will lead to a rise in various diseases and illnesses.

OS: How are these health services working at the moment?

PS: In São Leopoldo, 11 health units remain closed due to the flooding, along with municipal and state pharmacies that lost medication and supplies. The Specialized Care Service (SAE) and the Capilé Health Center resumed activities on May 21 after 18 days of closure due to power outages and flooding. Many supplies and medications were lost, so we had to build the pharmacy from scratch, using donations.

In shelters with the largest populations (such as the events center with 1,000 people, Bigornão with 600, and Unisinos with 2,000), a health team (doctor, nurse, and nursing technician) works 12-hour shifts, including weekends and holidays. In some shelters, we don’t have a full team but have designated professionals mapping health needs and identifying vulnerable populations, such as children, the elderly, pregnant women, and people with comorbidities. Currently, we have health point people in 11 of the 115 shelters in São Leopoldo.

At the moment, we are developing a project focusing on health promotion and prevention to avoid unnecessary medical interventions, going beyond treatment interventions. To provide care in smaller shelters, we have mobile teams consisting of a doctor, a nurse, and a nursing technician, traveling with medication and vital signs kits. These teams make daily trips organized by proximity and stay in contact via WhatsApp with health and volunteer point people in the shelters for emergencies. There are currently seven mobile teams.

The Emergency Care Unit was closed for 12 days due to power outages and resumed activities on May 17. The city’s main hospital was not affected by the flooding and continued to provide care.

We are working to reopen health units: 13 are operational, along with two field hospitals set up with help from the army and the SUS national task-force team. We currently have around 14,000 sheltered people and more than 100 shelters.

OS: What are the main demands on the SUS at the moment? Are infections and diseases associated with the floods already on the rise in the population?

PS: At the moment, we have outbreaks of gastroenteritis, scabies and pediculosis [an infestation of body or clothing with the eggs, larvae or adults of lice] in the shelters. Now, with the change in temperature, colds and flu are starting. The municipality was facing a dengue epidemic, we still have cases, but with less intensity with the drop in temperature. We already have records of leptospirosis [infection transmitted between animals and humans], but nothing significant at the moment.

OS: What can we expect in terms of mental health? Will we have a long-term epidemic in this area?

PS: I believe so. The trauma of losing their homes and loved ones, and their personal histories will leave significant marks on people. Additionally, the trauma from the speed of the flooding and delays in rescues will have a lasting impact. This will further destabilize those already receiving care from mental health services.

Our Network of Psychosocial Care (RAPS) services were all affected. Of the three Community Psychosocial Centers (CAPS) in the municipality, only one has resumed operations this week with mixed teams (adult, alcohol-drugs, and children/young people). The situation, already challenging after the COVID pandemic, is now even more difficult.

OS: Is there an imminent risk of the health system in Rio Grande do Sul collapsing?

PS: Yes. Without significant social investment, including public policies on housing and food security, we will face serious problems in the medium and long term.

OS: How can we rebuild everything, prioritizing collective health?

PS: We need to rebuild the health units and specialized care services that were affected. This requires investment from the federal government and civil society. In the future, we’ll need to look again at the affected areas to understand the population’s needs. There is no doubt that the reference points we had for planning health services and care have all changed.

What will we do? We don’t have that answer yet. We must approach collective health from an intersectoral perspective, there’s no other way. And this is a huge challenge.

The interview with Paula Suseli was conducted by Gabriel Brito, and published in Portuguese on Outra Saúde at the end of May.

The following are personal accounts from health workers in Rio Grande do Sul:

Paula Suseli, director of the Municipal Health Foundation in São Leopoldo

We began mobilizing health teams as soon as the first shelter was set up, initially relocating the base of the SAMU Basic Support Unit there. Later, we opened the Municipal Gymnasium, which had housed cyclone victims in 2023, but it was flooded and evacuated within two days.

That Saturday, I stayed until midnight, with around 500 people sheltering there. The mayor ordered all rescue teams to evacuate the building, which also housed the municipal and state pharmacy, including stock. Panic was all around, but also a feeling of disbelief: nobody imagined that the water would overflow the dam, we thought it was a precautionary measure.

The next day, water spread through neighborhoods and downtown, shelters began to multiply and despair spread around. We worked around 20 hours a day with limited resources. SAMU [emergency services] began rescuing people, and the immediate health needs were related to panic and anxiety.

Today, the intensity of the situation continues, with plans made on a daily basis and changing needs. The hardest thing is not knowing when we will return to “normality”. Our workforce has been significantly reduced. Our primary focus has been to address the immediate needs of the homeless by setting up fixed teams in three shelters. Then, reopening unaffected services, and facilitating communication with shelters via a 24-hour number and the ZAP platform [e-Health platform].

Savannah Carvalho, Nursing Manager at the Municipal Health Foundation

As the technical nursing manager in the municipal administration, my work routine has been exhausting. Since May 3, I’ve only been home a few days. Even when home, I stay connected to my phone, adjusting schedules and responding to workers. Personal life, physical activity, and leisure have taken a back seat.

Due to the difficulty of commuting from my hometown to São Leopoldo, I stayed in accommodation in the city, far from my family. Each day is unpredictable, with new demands arising all the time.

The responsibility of organizing workers daily is intense, especially since some of my co-workers cannot be in town due to their homes being flooded. Everyone is fragile, and management ends up being the support system for many of them, requiring me to be strong enough to support those who need it.

Materially, I haven’t suffered damage, so I’ve taken on more responsibility to allow other colleagues to reorganize. Emotionally, I am tired and often more stressed than usual.

People’s Health Dispatch is a fortnightly bulletin published by the People’s Health Movement and Peoples Dispatch. For more articles and subscriptions to People’s Health Dispatch, click here.