By PAULO CAPEL NARVAI*

All the ills and iniquities of society, which mass produce health problems, fall on the SUS

A nursing professional was slapped in the face on the afternoon of March 21, 26 kilometers from the Planalto Palace. It happened at the Basic Health Unit (UBS) in Taguatinga. According to Union of Nursing Assistants and Technicians of the Federal District, a man entered the UBS demanding a prescription for a controlled drug, known as the “black box”. He was assisted by a nursing technician who informed him that she was not legally competent to supply the medication. He explained that to receive it through the SUS it was necessary to have a medical prescription and that there was a doctor on duty who could assist him.

Nonconformist, the man who said he was lawyer, got excited, claiming to “know his rights”. Fearing being attacked, the server asked the guy's wife for help, who instead of containing her husband, slapped the server. The next day, health professionals from the UBS paralyzed their activities, in protest, for half an hour. The posters read: “Health calls for peace”, “SUS belongs to everyone” and “Servers are here to serve, not to be a punching bag”. For Coren-DF, the aggression “it is disgusting and cannot go unpunished".

Episodes of verbal violence to deal with conflicts generated in social interrelationships in school environments and in health units are relatively commonplace, especially in metropolitan peripheries.

The day after the aggression at the UBS, on March 22, 43 kilometers away and 22 kilometers from the Planalto Palace, a student resolved a disagreement with her colleague by pointing a revolver at her head, in the middle of the school courtyard, the Centro Educacional São Francisco, known as CED Chicão, from São Sebastião.

What stands out in these two recent episodes, which express the trivialization of violence in everyday social interactions, is that they were not just verbal. From insults and disrespect for others, people have moved on to physical violence. In one case, there was a firearm.

Both cases took place, significantly, in the federal capital and less than 30 kilometers from the Palácio do Planalto, the maximum symbol of the Executive power of the Republic.

The presence of firearms and the substitution of dialogue for threats to life are signs that, currently, there is something more in the daily life of our cities, indicating that the degree of degeneration of sociability has been accentuated in Brazil.

It is not a question, it is worth pointing out, of that violence “over there”, in what Plínio Marcos used to characterize as “quebradas do mundaréu”, “where the wind bends” and where various types of violence are always preventing the full enjoyment of life, whose power, however, fortunately never fades, always feeding the hopes of that, yes, life can be different, even in the hoods. In many of these ravines there are what today are described as “stateless territories, under the control of drug traffickers or militiamen” – which, if not the same, means the same thing.

The aggressiveness that often leads to de facto, in environments where violence is intolerable, such as schools and health units, where life is preserved and valued, needs to be analyzed and understood, in order to be contained.

If it cannot be said that the Planalto Palace and, more specifically, the “hate office” that operates there under the approval of the first representative, is the cause of the trivialization of violence that spreads dangerously throughout the country – often guns in their hands and a lot of hatred in their hearts – it is impossible not to consider what the repeated apology for weapons and violence to resolve conflicts means for society. If, in objective or positive terms, the cause cannot be demonstrated, there is no doubt about the link between these facts for a dialectical perspective, whose law of universal connection evidences the nexus.

Messages whose values ​​are oriented towards understanding, dialogue and peaceful coexistence do not emanate from the highest office of the Republic, seeking to understand the reasons of those involved in quarrels.

Quite the contrary, what one sees and hears in the demonstrations that “come from above” is the apology for violence, the solution by force, including armed, of all kinds of social problems. The clear message is: arm yourselves and resolve your differences with a bullet or physical force. No talking, understanding, arguing, convincing. Dialogue? No. If there is a difference, the best thing to do would be to "fight each other", in the best "an eye for an eye, a tooth for a tooth" style, although it is known, to exhaustion, that this is the fastest way to a scenario in which, in the end , everyone will be blind and toothless, or worse: dead.

Sanitarians consensually point out that violence, in the most different forms, is a very serious public health problem in Brazil.

On this 7th of April, a date dedicated worldwide to health, most countries are still grappling with the effects of the covid-19 pandemic while the WHO organizes a plan to exit the emergency phase. However, the brutal inequality in access to vaccines remains unchanged.

In Brazil, concerns are directed towards the consequences, still little known, of the SARS-CoV-2 infection and, above all, the future of the SUS. All the ills and iniquities of Brazilian society affect our universal health system, producing mass health problems, which are expressed in UBS, outpatient clinics and hospitals, such as diseases, infections, pain, suffering and death. SUS professionals know that they are not “punching bags”, but that, somehow, they have to deal with much more than the consequences of the actions of viruses, bacteria and various dysfunctions.

There is, however, a part of society that, on the one hand, wants “the government” to guarantee “FIFA-standard hospitals” to all, but, on the other hand, does not even want to hear about a State Career for SUS workers. "Not that. No way! Brazil doesn't have the money for that. The State is broke and does not have the resources to support a bunch of civil servants!” At the same time, this part of society considers it normal and ethically acceptable to evade taxes, enjoy tax exemptions, keep social inequalities unchanged, mock rights and democracy and those who defend them. Not to mention the unlimited tolerance with the precariousness of work and, in some cases, even with work analogous to slavery.

Despite the enormous contribution that our universal health system made to the fight against the pandemic in many states and municipalities – even though it was underutilized by a large number of incompetent and subservient managers – and despite the federal government, whose actions and above all omissions helped the most coronavirus than the population, the effects of the underfunding of the SUS are drastic, the worsening of which has been compromising actions and health programs of national scope. According to economists Bruno Moretti, Carlos Ocké-Reis, Francisco Funcia and Rodrigo Benevides, in the article 'Bleeding the SUS', adding up the effects of Constitutional Amendments 95/2016 and 109/2020, around BRL 48 billion were withdrawn from the SUS in the period from 2018 to 2022. It really is bloodletting. It is aggravated, as it occurs in an already very debilitated organism.

Brazilian society has been reacting as best it can to the trivialization of violence and the scrapping of the SUS, which it has learned it can count on, under any circumstances.

In addition to initiatives at the base of society to face the consequences of the pandemic in communities, entities and social movements organized the front for life, with the objective of confronting the genocide also at the political-institutional level.

The Front brings together more than 550 entities and movements and, this April 7th, in addition to acts and manifestations in several cities, which will take place throughout the day, it will start, at 17 pm, the “National Free, Democratic and Popular Health Conference”, with closing scheduled for August 5, in Brasilia.

But if the Frente pela Vida is keeping an eye on the pandemic and the SUS, defending life is not at all easy in Brazil, which coexists with chronic problems of trivializing violence and disregard for life, aggravated even more in the current situation by the poor command of the front of the Republic.

The fight for life, the defense of life, requires much more than containing the current genocide and needs to include the permanent fight against violence and its trivialization. This means, therefore, that there is a lot of struggle ahead, many and diverse clashes to be waged.

In the book SUS: a revolutionary reform, which I am launching this April 2022, by Editora Autêntica, I record at a certain point the account made by Darcy Ribeiro, according to which “Brazil has always been a mill for spending people: it ground six million Indians and liquidated twelve million blacks Africans to sweeten the mouths of Europeans with sugar and to enrich themselves with the gold of Minas Gerais”.

In the first decades of the XNUMXst century, the country continues to kill, in different ways. In work environments and processes, in social struggles for rights, for land, housing, the environment… “The country”, in terms, certainly, as I am referring to the owners of the country, the main stakeholders in maintaining the status quo, where violence against women and the LGBTQIA+ population is also trivialized.

In Piracicaba, about 900 kilometers from the Planalto Palace, an employee of the University of São Paulo (USP) was killed by her ex-husband, with a knife in broad daylight, in front of her daughter's school. It happened on March 24th.

There is a dialectical link between the Planalto Palace and the femicide in Piracicaba, according to the Union of Workers of the University of São Paulo (Sintusp). In Weighing Note for the death of Carolina Dini Jorge, a public servant at USP, the entity states that “in the Brazil of Bolsonaro and Damares, hatred of women is preached by the State itself. Every seven hours a woman is a victim of femicide. Every ten minutes a rape happens. This sad statistic shows that tragedies like this are no exception. They are part of a policy of submission of our bodies, our sweat and our conscience. A death like this, so absurd and unnatural, should make us rise with such indignation and cry out for justice. We cannot be silent victims of society's oppression and exploitation of women. Our hatred needs to be the fuel to organize our fight. If Carolina was not the first woman to suffer feminicide, we demand that she be the last”.

In this social context, whose everyday relationships are marked by the cult of violence and death to resolve conflicts, ignorance, stupidity and brute force parade their folly with the typical arrogance of "good people" who feel they are fighting "against the evil” making it, paradoxically, in the name of freedom, precisely its first victim. Ignorance destroys freedom by presuming to defend it.

The “Free, Democratic and Popular National Conference on Health”, which begins on World Health Day, is a valuable opportunity to deepen our understanding that the trivialization of violence means a serious threat to health. This, as a synonym for living well, points in another direction and indicates the path of a full life for everyone.

For this reason, all strength to the Front for Life and that the National Free, Democratic and Popular Health Conference indicate the best course for Brazil to guarantee the maintenance and deepening of our still fragile democracy and, also, for the strengthening of the SUS .

Democracy needs SUS and SUS needs democracy. Both SUS and democracy need the strength and commitment of organized citizenship, actively participating in social organizations and movements, to contain the trivialization of violence and deter all those who promote it.

*Paulo Capel Narvai is Senior Professor of Public Health at USP.