CASO ABARÉ: audiência mediada pelo Ministério Público dá esperança para saúde dos ribeirinhos do tapajós

13 de junho de 2013 por Fábio Pena

Preocupado com a situação dos ribeirinhos do Tapajós, o Ministério Publico Estadual – MPE – vem acompanhando de perto o Caso Abaré, buscando esclarecimentos, agendando reuniões, convocando audiências, entre outras medidas que possam contribuir na busca de soluções para o impasse.

O promotor Túlio Chaves Novaes é quem está na linha de frente do processo. No mês passado, convocou uma primeira reunião com a atual Secretária de Saúde de Santarém, Dra. Valdenira Cunha, para esclarecimentos preliminares. Já nesta manhã do último dia 11 de junho, a audiência foi mais ampla. Além da atual titular da pasta de Saúde de Santarém, participaram também os representantes dos dois outros Municípios da área de abrangência do Abaré, como a Prefeita de Belterra, Sra. Dilma Serrão, e o Secretário Municipal de Saúde de Aveiro, Dr. Marco Aurélio Xavier. A reunião contou ainda com representantes da Secretaria Estadual de Saúde (SESPA) e de outras Instituições como o Projeto Saúde e Alegria (PSA), a Ordem dos Advogados do Brasil (OAB/Stm), além dos assessores técnicos e jurídicos dos Municípios.

Os principais assuntos giraram em torno do cumprimento da Portaria 2.191 do Ministério da Saúde para região do Tapajós, que credenciou o Abaré I em dezembro de 2010 como a primeira Unidade de Saúde da Família Fluvial para atender as duas margens do rio, zonas rurais dos três municípios: Santarém (proponente da Portaria), Belterra e Aveiro, sendo que os ribeirinhos destes dois últimos se encontram sem atendimentos desde o ano passado, foco de insatisfação dos gestores presentes. O outro assunto tratado foi sobre a perspectiva aberta pelo Ministério da Saúde para aquisição em definitivo do Abaré – ainda de propriedade da ONG holandesa Terre Des Hommes, o que gera insegurança na continuidade dos serviços no médio-longo prazos.

Túlio Novaes informou que “a atuação do MPE nesse caso não se resume às reuniões, mas que o Órgão está mergulhado na busca de uma solução para esse problema. O MPE está colocando em prática várias ações visando contribuir nessa discussão da permanência da embarcação em Santarém, e do atendimento eficiente às populações ribeirinhas da região”.

Na audiência, os representantes das organizações presentes puderam apresentar seus posicionamentos e documentações para fundamentar o MPE na condução desse processo de mediação.  A Prefeita de Belterra, Dilma Serrão, comentou que “cerca de 740 famílias ribeirinhas da margem direita do Tapajós dependem do atendimento prestado pelo Abaré e que no período que deixou de fazer a assistência àquela população, a situação de saúde ficou precária”.

O mesmo tem acontecido com os ribeirinhos de Aveiro, segundo Marco Aurélio Xavier, Secretário de Saúde daquele município. “Sem o Abaré, nós não temos condições de oferecer um atendimento adequado para a população. As comunidades estão nos cobrando, com razão, uma solução para a volta do Abaré ao nosso município”.

Desde que assumiu a atual gestão de Santarém em 2013, os serviços prestados à bordo do Abaré I vem enfrentando dificuldades. A Secretária de Saúde, Valdenira da Cunha, argumenta que “em nenhum momento a SEMSA aventou a possibilidade de ficar sem o atendimento do Abaré I. Desde janeiro, não estamos medindo esforços na manutenção do serviço. Não tem nenhuma possibilidade de ficarmos sem essa embarcação na nossa região ribeirinha”. Porém, a própria secretária informou que desde o começo do ano apenas duas viagens foram realizadas. “O atendimento da população ribeirinha está sendo feito. Houve uma viagem em maio, está tendo outra viagem agora, saindo dia 3 com previsão de retornar dia 13, fazendo toda a Resex” [zona rural de Santarém].

Na audiência, a Dra. Valdenira confirmou o acordo de aluguel do Abaré com validade de um ano [2013] com a organização TDH, como uma forma de assegurar a embarcação no Município, e que os holandeses não estavam cobrando os pagamentos. Confirmou também que o Abaré estava atendendo somente as comunidades de Santarém, pois legalmente a Prefeitura não podia realizar gastos com os demais municípios. No entanto, foi informada pelo Dr. Fábio Tozzi, que acompanhou todo o processo de construção da política pública ainda como coordenador de Saúde do PSA, que já havia instrumento legal estabelecido desde 2010 junto à CIB [Comissão Intergestores Bipartite], que ampara legalmente o arranjo intermunicipal, caso contrário o Ministério da Saúde não estaria repassando mensalmente as verbas federais há mais de dois anos para Santarém, que por ser o Município-polo é o responsável em administrar os recursos recebidos. E que na ocasião foi inclusive assinado um Termo de Cooperação entre os parceiros que define a responsabilidade de cada um.

Caetano Scannavino, coordenador do PSA, fez críticas não ao acordo em si com os holandeses, mas à forma com que ele se deu, pois teria sido mais prudente se Santarém tivesse se municiado antes das informações e documentações, conversado com Belterra e Aveiro, além do Ministério da Saúde tendo em vista as boas perspectivas oferecidas por Brasília.   “Sabemos das dificuldades de inicio de mandato, mas teríamos evitado todo este desgaste, o risco de bloqueio das verbas federais, assim como a interrupção dos atendimentos junto a esses 5 mil ribeirinhos da margem direita do Tapajós se o acordo estivesse em conformidade com a Portaria Ministerial do Tapajós. Mas antes tarde do que nunca, passado quase meio ano, temos que reconhecer alguns avanços no últimos dias e agora é pensar para frente”.

Para isso, um dos encaminhamentos da audiência foi o resgate dessa documentação comprobatória –  sobretudo a resolução da CIB – e ao mesmo tempo, o restabelecimento do diálogo entre os três municípios para a repactuação de suas responsabilidades.  A Prefeita de Belterra, por exemplo, confirmou o interesse e manter a parceria com Santarém. “Mesmo que nós não tenhamos sido informados sobre o porquê da paralisação dos atendimentos do Abaré em Belterra, nós viemos aqui manifestar nosso interesse no diálogo para continuidade desse serviço, que é fundamental pra nossa população”.

“Estamos verificando de que maneira, pactuando via CIB, o Abaré possa estar prestando serviço a esses dois municípios [Belterra e Aveiro], com cada um com sua responsabilidade fiscal e jurídica, cada um em sua área de atuação”, informou a Dra. Valdenira Cunha.

Quanto à propriedade do barco, visando garantir sua permanência como patrimônio municipal, após  as recomendações do Conselho Municipal de Saúde, bem como das manifestações públicas do Ministério da Saúde sobre o interesse na compra da embarcação, houve um importante progresso que foi a retomada do diálogo entre Santarém e Brasília sobre o tema. “Nós estivemos dia 6 de junho no Ministério da Saúde para avaliar a possibilidade de compra ou manutenção da parceria com Fundação Terre Des Hommes. O Ministério vai entrar em contato diretamente com eles para verificar a isso. Havendo interesse, o Ministério tem o recurso para comprar o Abaré e continuarmos prestando o serviço à população ribeirinha”, disse Valdenira.

Para o promotor Túlio Chaves Novaes, “as reuniões tem caminhado muito bem, estamos conseguindo estabelecer um diálogo entre todos os atores envolvidos, os interessados, e eu penso que quem tem a ganhar com isso realmente é a população que é a ponta dessa cadeia toda. O enfoque não é só a garantia do atendimento em saúde aos ribeirinhos, mas também o aprimoramento desse serviço. Que possamos ter uma medicina de ponta prestada na região amazônica para a população carente”.

O coordenador do PSA disse que saiu satisfeito da reunião. “Fico feliz porque instituições como o Ministério Público funcionam nesse país, e esta audiência deu um sinal de esperança. Sabemos que ainda tem muita coisa para acontecer, é importante que as comunidades se mantenham mobilizadas, mas estamos mais otimistas para que o Abaré possa guinar novamente para a saúde ribeirinha nas duas margens do rio Tapajós. Esperamos o restabelecimento imediato dos atendimentos na Flona Tapajós [margem direita] e o início das tratativas junto ao Ministério da Saúde para a aquisição em definitivo do Abaré para que este permaneça na região à serviço dos ribeirinhos, que ajudaram na construção desse modelo, que merecem e tem direito à saúde como qualquer outro brasileiro”.

Outra audiência está agendada para o dia 16 de julho. Até lá, espera-se que os encaminhamentos tomados surtam efeitos positivos para sacramentar o modelo de Saúde da Família Fluvial do Tapajós, por meio do Abaré, não só no atendimento das populações locais, mas também como inspiração para as demais Unidades que estão começando a ser construídas por toda a Amazônia.

Atualização:

Ainda na tarde do dia 11, como previsto na ata da reunião de forma de agilizar a retomada dos atendimentos nas duas margens dos rios, o Projeto Saúde e Alegria encaminhou ao MPE a Resolução 214 da CIB que aprova a parceria  intermunicipal entre Santarém, Belterra e Aveiro, datada de 29 de novembro de 2010.

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    Fico feliz por ler boas notícias. Até então só surgiam informações desanimadoras. Acho que diferenças políticas não justificam esta falta de ação dos responsáveis no município. Continuo na torcida.

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