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Ji - JOURNAL OF THE
INTENSIVIST - INTERVIEW - MAY 2008 - BRAZIL
"WE GO TO CREATE A
NEW ICU"
President Founder of the
SOBRATI, Douglas Ferrari says that the biggest challenge is To Qualify, to
complet Humanization and Democratization of the Brazilianīs ICUs. That we
are advancing in the certain way.
More Informations or
contact: sobrati@sobrati.com.br
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This was the tonic of the
interview carried through with the intensivist doctor and President Founder of
the SOBRATI, Douglas Ferrari. Formed it has 22 years in the UNESP ( University
of State of Sao Paulo ), remembers the ICUs rudimentary, with Mark-7, without
oximetric and with limited monitors. One also remembers the high taxes of
death, around 50%, with limitation of qualified and specialized professionals.
Today it shows another scene where the national industry collaborated for
implementation technique and the concept to interdisciplinary and the
specialization initiated impact for reduction of the death of 50% for 20%. It
counts that the SOBRATI collaborated in the ideological change and inserted
vision contemporary with advanced formation for professionals of all the
entailed professions to the attendance of the critical patient, support the
national industry and integral opening of the ICUs for family. Ideas
Controversies, intend to collaborate for creation of a new ICU, Qualified,
Democratic Human being and. It understands that the biggest challenge of the
Society is to democratize the qualified and human intensive attendance,
transforming Intensive the Therapy National. Account despite the success of
the SOBRATI if of the one in virtue of its ideological clarity, in the respect
to the professions mainly in its autonomy and forms to practise its specific
science. As Douglas Ferrari the SOBRATI reestablished the concept of modern
Intensive Therapy and of the Intensivist of all the professions, changed the
acceptance of the national equipment in the ICU and created an educational
system of the solid and advanced Intensive Therapy, including the formation of
specialists and Intensivists Professors. It finished affirming that the future
of the ICU to go in the humanization and specialized training, generating
education and research.
JI - How appeared the SOBRATI
and which its objective and as it explains its success?
The SOBRATI translates
a great dream of all intensivist where all pledged in only intention, that is,
the welfare of the critical patient, its family and has team, transforms
intensive the attendance qualified where all inside make its part of the
professional limits of each one. The Society has clear and transparent
ideology, bringing a translated national model in its blazon where it
predominates the national flag and the EKG that if symbol became
technician of the monitorization. It has objective to support the two polar
regions, that is, the team and the patient, bringing the best possible ICU
inside of the reality of each place. It understands that we can make the best
ICU in any region of this country, since that it has persistence and
commitment of the team. In five years already we are the biggest society to
interdisciplinary in Brazil, this success is justified for our objective and
clear intentions where all are identified and attended to action effective.
JI- As in practical the
SOBRATI tries to change the Brazilian ICU?
All change is cultural.
It has difference between teaching and educating. To only transmit the
knowledge technician does not occur the transformation, is necessary to go
more beyond, that is, she is necessary to educate. Education is a long and
delayed process, where if it over all makes necessary the personal corrections
in the ethical and moral aspect of the people, therefore the knowledge without
ethical persistence does not translate the change, distorts the application of
knowing. In such a way it is that we intend to move, taking the responsibility
message, of the commitment, preventing the transference of the personal
problems or the Unit for third, if not interrupted this process, we will be
the life lamenting, looking at the stagnation and blaming the direction or the
SUS ( Public Sistem Health). It is basic that let us make quarrel of the ICU
for the least favored socially, as the child and the aged one of the periphery
that it needs and it needs the Public ICU. We have the conscience that the
ICUs private must establish a proper mechanism or auto-regulation, exerting
the quality even for requirements of the market. But which is the precursory
spring of the public service? It is to like and to commit itself to the idea
of the Health for all, is to exert the mission of the health in the relief of
pain and searchs of the cure for 50 million excluded socially in our country.
It sees, we do not observe quarrels in congresses of as to democratize the ICU
and of that it forms to make the ICU with Brazilians for Brazilians.
JI- What he means it Mr.
the concept to interdisciplinary?
He has confusion between
interdiscipliary and multiprofessional. The SOBRATI was created in the
concept to interdisciplinary, where each professional exerts its profession
of independent form and with application of its proper science. The ICU is a
great professional meeting where at least seven professions work together.
This is the concept of " INTENSIVE THERAPY; , breaching exclusividades and
fortifying the paper and professional autonomy. We are against any form to
delegate exclusive and inherent professional acts of each profession for an
only professional, exactly because the professions are established by law.
But of meeting the interdisciplinary, the basic concepts of the Intensive
Therapy, the joint protocols and that they meet, the agreement of the
physiopathology, of the emotional aspect, the politics of quality, basic the
ventilatory and haemodinamic monitorization, are basic and basic concepts "
to share". Responsible professional knows and recognizes its limit, and the
SOBRATI has collaborated with the Advice of Classroom to guide these works
that are inherent the modernity and evolution of the professions. We are
pro of all advance technician.
JI- As would classify the
Intensive Therapy in the aspect technician, scientific and of Research?
The Intensive Therapy is
very including. It results of the work and devotion of innumerable
professionals of diverse professions. It agglutinates multiple sciences as
the intensive medicine, intensive nursing, intensive physiotherapy among
others. Therefore it represents a science without limits, of linked
practical concepts and. The SOBRATI, as it is related in its proper
assignment, came to strengthen this concept, to extend and to enclose of
systematic form all content and searches of this technological universe. We
initiate a new age, where it has distinguiz necessity it as new science and
having new formation of professors born in this objective and intention. It
congregates all professionals in a new concept.
JI- As were the ICUs and what
it moved?
In our research, three ages
had been important: It was Florence (1855), Dandy (1926) and To Safar (1950).
Each one had its contribution. The creation of the SCCM, that is, American
Society of Intensive Therapy in 1970, was an important and great world-wide
advance. In Brazil, 1980 the Association of Brazilian Intensive Medicine,
initiates a program of certifications for doctors, this tied AMB ( Brazilian
Medical Association ) and CFM ( Federal Medical Council ). Brazil had a delay
very important it to absorb the world-wide technology, having as parameter the
oximetric of pulse was developed in 1974 in Japan, but in 1990 we only start
to see oximeters in the Emergenciais Units. The volumetric fans had delayed 20
years for the use " populary" for the Brazilian intensivists. Everything the
very high price. Again we have the presence of the national industry that
pressured the market and was gradual diminishing the final price. Bird Mark-7,
absence of oximetric, bombs of infusion as rarity, scarce, plantonists stream
beds inexperienced, absence of physiotherapy, limited absence of protective
strategy, antibiotics, summarized the death in 50% opposing down current 20%
or until less. Today we have Ministerial Resolution that it regulates the ICUs,
the culture of the specialty is present in all the professions, the protocols
go if unifying and the national technology it goes well, very well.
JI- Which its vision of
future for the ICUs?
The ICU of the future
will be the ICU human being, opened where the patient can exert its autonomy,
to decide with the intensivists which its better same treatment or if desires
to be in the ICU. We will leave the automatism, we will have a harmonic place
where it will be invigorating the ethics of the person human being and all
exerting the feeling of the great family that we are and that we must offer
the affection, love and the devotion with the next one in the hospital stream
bed. This change will fit the new generation of intensivists, abandoning the
conflicts of the modern society when it will be inside of the environment-ICU,
the intensivist must be "Plated" in relation to the daily aggressions, it must
exert its profession of other people's form to the life each harder and cold
time. In relation the technology we advance in an extreme limit, I believe
more portable equipment each time, with interaction and independence of the
patient, either in ventilations, infusions or sedations. The computerization
of the ICU already is obligator. The nursing will be each time more the main
link, having only nurses (), having the Intensive Societies to be worried in
supplying and favoring to the " nurse- technician " the possibility to become
nurse, since they contribute of spectacular and dedicated form the critical
patient. I believe that the great Hospitals will be UTIs, Centers of
Whitewashing, in the presence of the Intensive physiotherapy effective
moving the quality of life of the critical patient. Psychology will be
obligator, with professional educated in the specific knowledge of the
universe-ICU. The phonoaudiology, the nutrition and the odontology can and
must mainly contribute of basic form for recovery and quality of life in the
emergencial environment.
JI- Why many consider these
ideas controversies?
They are not many, are
minorities. We respect the democratic space and quarrels of ideas. To
perhaps breach concepts and " prejudice" it is part of the social evolution.
Today what he is true, tomorrow could not be. We must be beyond our time,
since in Brazil we make the Intensive Therapy of high quality, an
international model. The question is not if we must move, but that we must
and we need to move and of that it forms to move. The SOBRATI has a proposal,
unites already innumerable times open the quarrel with all society and the
Brazilian and international Intensivists Societies. Already in we present
all presidents of the American South Societies, argue our intentions and we
had one feed-back amazing in the positive direction. In 2008 already we are
being invited for international quarrels, over all European.
JI- As is the paper of the
doctor in the current ICU?
The Federal Council of
Medicine has been exemplary in its performance in the direction to favor the
qualification professional, since he does not have autonomy to hinder
advance of not qualified courses of graduation. It acts fortifying the
dedicated professionalizing specialization, emission and recognition of
Headings of Specialists to the doctors, support the creation of the AMB,
Brazilian Medical Association, magnifying of presence and supervised
practical professional period of training in the Hospital, is factors that
characterize the doctor who has the responsibility legal and ministerial
technique in relation the ICUs. I see in the intensivist doctor a great
manager of team in work with coordinators of the professional teams. It does
not have as, invasive procedures, drogs decision among others prerogatives
are exclusive of the doctor. This aspect is consensual enters the Advice of
Classroom. What we must is to evolve in quarrels techniques in sectorial
chambers between the Advice each time more to "pro" the free inherent
exercise professional and consensual of each profession. This function fits
to the Advice. The SOBRATI must guide and differentiate ethical aspects of
the legal ones, and ratify decisions of the Advice in the professional
regulating aspect. Therefore the intensivist doctor must have ample
knowledge for taking of decisions, must respect the too much professions and
accept the professionals with high degree of knowledge and that he
collaborates in the joint decision. The subject is so delicate, that the
intensivist doctor only can take not emergency if authorized and shared
decisions with doctor assistant, that is, does not have this total autonomy.
JI- the SOBRATI already took off it sleep?
Everything in this life has a price. I am
very happy and carried through. We believe that we are in the certain way,
we have a very great support of the Brazilian professionals. Each time more
we surprise in them at innumerable supports. It is not easy, mainly in
regards to not favoring the shunting line ideological, not leaving that
wills or weaknesses human beings intervene with the Society. Already we
attend many Societies to crush in virtue of manipulations and internal
interests. We do not hide that we are little malleable in our direction of
the works. We do not accept shunting lines ideological, we accept the
dialogue integrally, however I exert the responsible paper of and the
founding one and have the responsibility to lead as a father its son for
optimum way. I understand that who creates, knows its it creates, and it
knows to guide the way in the direction of its proposal.
JI- What the SOBRATI already reached?
First it reestablished the idea and
concept of " Intensive Therapy "; in Brazil. It works to create the
ICU made for Brazilians for Brazilians, being abandoned international
protocols many packed times that do not reflect our reality. It recognizes
the importance of the world-wide technology, the external experiences. But
translating the SOBRATI, we have as main mission the educational change,
emphasizing this main mission. Already we more than form 1000 intensivists
between specialists and professors. We create the Intensive Basic Support
that gave the possibility of many professionals to have access inside the
current concepts of CPR and DEA of the Brazilian reality and with
accessible or gratuitous cost for public Institutions. We are important
link interlocutor with the society, was very clearly our paper in the
episode of the TAM where we receive alls family, we comfort parents and
brothers, and demons answers to the journalists waiting for professionals
technician for the explanations. We could play our role, since we train
the INFRAERO of Congonhas gratuitously two months before, in qualifying
for this noble mission. That is the SOBRATI, is the presence, the
immediate reply, the tiring long trip that it rewards with it I hug fort
of the distant colleague that the same shares with intention to make ICU
of Quality, Democratic and Human being. Innumerable trips, lectures,
congresses, meetings, training, interviews, Magazines, TV and much more.
We are pure energy.
JI- Which its your plans for the future?
To delegate each time more the Society
the serious people, ethical, without personal interest and that they can
guide the Society in the principles that was created. To direct a Society
of the transport of the SOBRATI is not easy, still has ideological
quarrels, questions prompt politics that, at the certain moment, I will be
co-ordinating the works not so of close, for this has the statutory
important figure of President Founder who is heard, takes decisions and
has the function of the ideological maintenance. Today, the SOBRATI has
dedicated and serious young, a new generation or " New Generation" ,
management is quality and not amount.
JI- accuse many times to It with
egocentricidad.
Id, ego and superego are structures of
our psychic skeleton. I assume my ego as motor force. The ego without
the use of intelligence is empty. To watch, to prevent ego-trip, and to
search the recognition of the ideas are personal goals. We have a
culture that it favors to many critical ones and few compliments. Brazil
enslaved millions of human beings per 500 years, perhaps either the
civilized country that more perpetuated the slavery in the world. We
have the pseudo-elite created in this model, that is not imported
with the slum quarter, with the child of street, the favored suffering
of less in the corridor of the hospital waits in it of days to have
access to a stream bed that can save its life. In this different and
unjust process, we have many connivent people. When we make strike in
the emergencial and essential service, where our children are taken care
of? In private plans of health. To argue egocentricidad is one "
pormenor" ahead of the amplitude of our responsibility.
JI- the SOBRATI created the CNI (
Intensivist National Council ), which the purpose?
The CNI is an agency only of
support to involved with the ICU and the Emergencys Units, is
professional or academics, since the professional and prescribed ethical
support fits to the Advice. It collaborates in the support to the
development of education and of the Research, it fortifies the work
environment and it looks for to guide works in agreement lines of
direction of the SOBRATI. It is an important perhaps pioneering
initiative and. Search to approach and to create an identity between the
intensivists, is a control point, since the function of the Society is
ampler.
JI- Which would be its finish
considerations for the Journal of the Intensivist and ours internauts or
cybernauts?
The SOBRATI has in its date of
foundation, 25 of December, our official Day, " Day of the Brazilian
Intensivist " , a moment of the remembrance of the humility, the
suffering of the people, the hope, the life, solidarity and the peace.
Before professionals we are parents, husbands and wives, brothers and
sisters, friends and friends. The profession is a complement in our
lives, professional being or professor is to exert inside before
everything the practical one of our homes. As the great Gonzaguinha (
brazilian singer ) musician would say: "Each one knows the pain and the
delight of being what it is". Either you completely, search what she has
of better in you, she makes optimum of itself, you look at for and
search its happiness in simplicity and the people love who you. The life
this above of of this everything.
