Renê Patriota

This description of Renê Patriota's work was prepared when Renê Patriota was elected to the Ashoka Fellowship in 2001 .

Introduction

Renê Patriota is a physician who empowers consumers to demand and receive better health care from both the public health system and private health insurance and health plans. Her association resolves immediate problems that threaten patients' access to urgently needed medical attention and seeks long-term solutions to guarantee patients' access to quality health services. Renê's work enables individuals to become active citizens as they exercise their right to quality health care.

The New Idea

Renê is mobilizing citizens to demand their right to quality health services regardless of their illness, socio-economic background, or legal situation. She co-founded and now heads the Association for Users of Health Insurance, Health Plans, and Health Systems (ADUSEPS). The Association monitors and investigates the level of customer satisfaction with the governmental health system, private hospitals, and private clinics. Renê relies on a network of monitors comprised of Association members, church volunteers, and even prisoners completing community service obligations. Using the results of this monitoring, Renê's organization takes legal action against private health providers, insurance companies, and the state to gain immediate care for individuals with urgent health needs and pressure government decision makers and company owners to improve their services. Renê also conducts capacity-building courses and seminars to raise awareness about health rights for all sectors of society, including prisoners. Renê aims to improve health services by introducing greater accountability and transparency in the public and private health systems by giving voice to patients' concerns. Since access to quality health services is a national problem, Renê plans to form a network of associations modeled after ADUSEPS to implement the same course of action throughout Brazil.

The Problem

In Brazil, access to quality health care services is extremely unequal. Most people rely on the public health system. A small portion of the population pays for private health plans or health insurance. The common problem both groups face is the lack of guaranteed, quality health services. The most serious problems for those using these health services are: 1) inefficiency of public health services; 2) disregard for users' suffering; 3) misinformation on the part of public authorities; 4) lack of service for elderly and chronically-ill patients; 5) prejudice against and abandonment of sick prisoners in public hospitals; 6) customer passivity; and 7) abuse of power by some managers, service providers, doctors, nurses, assistants, servers, and others, given the patient's vulnerable situation. The common thread running through all these problems is the general population's lack of understanding about its right to quality health care. These realities are a problem for all citizens, since each and every person is a potential user of public health services. The state of Pernambuco has 7.9 million inhabitants, of whom 750,000 subscribe to private health plans. The rest of the population depends on the public health system, medical consultants, or private agreements. Middle and upper-class Brazilians who can afford private health plans generally seem to ignore the problems of those forced to use inadequate public services or who rely on the charity of employers, friends, and family.

The Strategy

Renê rallies public and private health care consumers on all socio-economic levels to exercise and fight for each and every citizen's right to quality health care. Renê excludes no one, not even the dead, suing on behalf of deceased family members who were denied appropriate health treatment. Her cases involve malpractice, negligence, inexperience, and failure to provide emergency aid. She currently has five civil suits in litigation, in addition to the nearly three hundred judicial and administrative actions against health plans and insurance companies. One of ADUSEPS' main instruments is its Social Control of Public Health Project. The Project's goal is to improve the efficiency of the government health system in order to guarantee each citizen's constitutional right to quality health care. The main lines of action include: 1) improving treatment in public hospitals; 2) developing monitoring actions in health units; 3) denouncing irregularities committed in the targeted health units; 4) educating health service users and their families about their rights and responsibilities regarding their health and the code of medical ethics; 5) sending representatives to pressure state and federal health ministries to fulfill their constitutional obligations in favor of public health; and 6) raising general awareness about the government health system by training monitors to promote the Project's importance in communities, neighborhood associations, public and private schools, mothers' organizations, condominiums, and similar associations.The Association, which is supported by contributions from its thirteen hundred members, is an active member of the National Forum of Organizations for the Defense of Consumer Rights (NFODCR). Renê plans to consolidate her projects in Recife by 2005. In five years, she intends to spread and adapt the model to other cities in the state of Pernambuco. In ten years, Renê intends to use the high visibility she has gained in the media and through NFODCR to expand her program to other cities throughout Brazil.

The Person

Renê's work in church groups and other volunteer organizations demonstrates a long commitment to justice issues. A graduate of the Federal University of Pernambuco Medical School, Renê provided free medical services to prisoners and other excluded populations. She treated patients from 8:00 a.m. to 10 p.m. in her obstetrics/gynecology private practice until one case changed her life. In 1996, her patient, Angélica Ricoy, who had been prescribed chemotherapy for breast cancer, was denied hospital treatment. Renê closely followed Angélica's fight for her rights to health care, but Angélica died due lack of adequate treatment. In a church meeting room, soon after Angélica's funeral, Renê and her peers created ADUSEPS. Angélica was admitted, in memoriam, as the first member. Since then, Renê has dedicated herself to fighting for all citizens' constitutionally-guaranteed right to health.