Five months after I moved to Rio de Janeiro, on a Monday at around ten at night while doing the washing up, I managed to cut my hand deeply and bloodily on a chipped plate.
Since moving to the city, I had been taking a protracted and somewhat useless tour through the labyrinths of a serious bureaucracy. Among other things, this meant that after all this time I still hadn’t penetrated the inner workings of medical care. I had discovered some basic facts; for instance, there is no such thing as a GP in Brazil, only a series of specialists and lists of practises that will or will not accept you depending on your level of health insurance. And of course there is free health care for those who can’t afford insurance. Only I had been warned many times not to fall into the hands of those doctors in Rio, since the story goes that decades of corruption and neglect have left their services seriously holey.
So, what to do with a hand spurting dark gouts worthy of the Psycho shower scene and me with two minutes before I faint (I can’t stand the sight of blood, anybody’s, but my own is the worst)? My husband bundled me downstairs, our doorman found a taxi and I was on my way to the public hospital before I could summon the Portuguese to protest ‘I have health insurance’. It should have been on my list of key phrases to memorise.
There was a bouncer at the door to the A&E; there’s no other term for a heavy in a nylon suit who stands to attention excluding people by means of sheer body mass, is there? But it seemed my hand was the appropriate passport: one look at the bloody bundle and I was in. Another large gentleman, this one all dressed in white, heaved me into a basic wheelchair and took charge. Things began to move fast. Faster and faster in fact, as he realised that I didn’t mind whizzing down corridors and into and out of lifts, that actually it was cheering me up, even when he swung me round and I found myself zooming backwards. This lovely guy’s enthusiasm was almost matched by the efficiency of the doctors who saw me. Within about half an hour I was lying on an operating mattress screaming horribly as the doctor injected anaesthetic and then calming down as he stitched up the gash: four stitches. He bandaged up my hand and advised me not to come back to the hospital to have the stitches taken out in a week’s time, but to go to a posto de saúde, a ‘health centre’. He said I would be seen much more quickly that way. Looking down as I was wheeled away again, I saw, poking out from under his long white coat, the doctor’s Osklen shoes; that’s a bit like your doctor wearing Alexander McQueen to work.
After a week of holding my hand out of the shower and being unable to twist the peppermill, it was Monday once more and time to get my stitches out. In my Ruas streetguide, I couldn’t seem to find any postos de saúde. I tried looking online but the websites were too confusing. So I thought I’d play safe and head for the nearest building marked with a red cross that wasn’t the public hospital I’d been to before. I began to walk into a beautiful leafy neighbourhood where the cars turned into mercs, black faces grew fewer, sweet-sellers vanished. . . I should have picked up the signs, especially when the road to the medical centre began to twist steeply, unendingly upwards. As I neared the top, sweating, I realised that no one walks up here ever – they are driven. This would be a private medical centre.
So it proved. The nice people at reception said yes they could take out my stitches straight away but it would cost, err, they couldn’t tell me exactly but somewhere in the region of 2-300 Reais (£80-£120). Too much for my budget, and even on principle, a crazy amount simply to take stitches out. They wouldn’t even use up any thread on me. They were nice enough, however, to call the nearest posto de saúde and offer to taxi me there, but it turned out that my local place had not filled in some form and due to protocol was not performing this kind of operation at the moment. The receptionists said that my alternatives were to go back to the hospital where the stitches had been put in and wait – they said it would be long, perhaps all day – or go into Copacabana to another, larger posto de saúde where they would probably see me sooner. I chose the Copacabana option.
A twenty minute taxi-ride later, I was in central Copacabana at the door of a concrete place with a big red cross sticking out of the roof. There were lots of people in there: charity workers trying to get signatures and money for an unfathomable cause, several queues for the in-house pharmacy, lots of people on stairways and occupying three floors worth of outer corridors, mostly waiting patiently sitting or standing in scrambled lines. No signs anywhere. I caught the elbow of a uniformed woman clearly trying to perfect that waiter’s technique of not catching anyone’s eye. She told me a door number. I knocked and waited, knocked and waited again. An elderly lady came up beside me and did the same. Twenty minutes, half an hour; there was clearly no one behind that door. I knocked at another door and the lady there said I should go back to the first and I would be seen. Ten minutes later, there was the same lady leaning out of our door and welcoming us both in.
As at the hospital, amidst all this chaos, my treatment could not be faulted. My stitches were taken out, I was given gauze and plasters and advised about future care for my half-healed cut. I was sent out, once more having paid nothing.
Two weeks ago I decided at last to see an ordinary doctor, to have a check-up, establish a relationship, the things one does with a GP in England. I got an appointment with a guy in my list of permissible general medics but when I went along, the sign on his door said cardiologista. I asked the receptionist: the doutor is a general doctor isn’t he? She reassured me. The doctor himself was friendly but with imperfect English. I showed him my hand, which he gave a perfunctory glance. He asked about my eating habits, then had me lie down on a couch and began untangling some wires. He fixed dragon clips to my ankles and wrists and suckered about six more electrodes to key places on my chest. He asked me to lie still as he looked into the middle distance and a machine behind my head made whirring and scratching noises. Then the doctor detached all his clips and suckers and let me sit up. With a flourish he pulled out a long print-out full of graphs of red and green waves. He smiled for the first time on telling me that my heart was ‘very good’ and gave me my cardiogram to take home.
Photograph by Chris Acos