Cristián Gallardo interviews Guilherme Pagin São Julião, colorectal surgeon from São Paulo, about the current reality facing surgeons in Brazil with the COVID-19 crisis. #SouthAmericaWeek

Short bio: Guilherme Pagin São Julião

  • Medical graduate: Faculdade de Medicina da Universidade de São Paulo, Brazil (2008)
  • General surgery residency: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (2009-11)
  • Colorectal surgery residency: Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil (2011-13)
  • Clinical fellowship in laparoscopic surgery: Colchester Hospital University, NHS Foundation Trust, Colchester, England (2013-14)
  • Clinical fellowship in colorectal surgery: Instituto Angelita e Joaquim Gama, São Paulo, Brazil (2014-15)
  • Currently: Colorectal surgeon at Instituto Angelita e Joaquim Gama, Hospital Alemão Oswaldo Cruz and Beneficência Portuguesa de São Paulo


Guilherme Pagin São Julião and Cristián Gallardo

Cristián Gallardo: Dr Guilherme, thank you for agreeing to speak with us about the current reality Brazil is facing with the COVID-19 crisis. The pandemic’s devastating impact worldwide is well-known. So I’d like to start by asking what was the major impact for surgical patients in Brazil?

Guilherme Pagin São Julião: The major impact on surgical patients was the fact that some examinations (such as colonoscopies, MRIs) and some surgeries, were postponed because of the pandemic. That probably will mean that many patients will be diagnosed and operated in a more advanced state of their disease, with worse prognoses.

CG: In what way do you think the situation in Brazil differs from the other South American countries?

GP: The situation in Brazil is different from the other South American countries. There are a few reasons for that: Brazil is a huge country with a huge population. Because of that, there are big differences in terms of healthcare services among the different states. Furthermore, the persistent political fights between the federal and states governments have produced a lack of reliable information among the Brazilian citizens who do not feel confident in what information to believe.

CG: You have an impressive CV, and have dedicated yourself to colorectal surgery and rectal cancer in particuluar. Regarding watch and wait patients for example, have you faced delays on the beginning of chemotherapy protocols, or on magnetic resonance and endoscopy schedules during this pandemic? How did you manage to cope with these scenarios?

GP: Things have changed since the start of COVID-19 infection. In my opinion, delays at the beginning of chemotherapy or radiotherapy, or MRI and endoscopic studies, have not been because of lack of health facilities but because patients were afraid of getting COVID-19. In relation to watch and wait patients who require an intensive follow up, we have had to change the procedures like rectoscopy or MRI, that were routinely performed in an outpatient manner to an inpatient manner, as outpatient services were shut down.

CG: Concerning surgery postponement in general, was this also an initial approach in Brazil? What are the main concerns at this moment, and in the long term, and how can we optimise our future response?

GP: Yes, in March, when the first patient was diagnosed with COVID in Brazil, at the beginning of the pandemic, all elective surgeries were postponed. Shortly after, in April, hospitals allowed us to operate on what was called semi-elective surgeries - most of these were oncological cases. We did not face a very long period of time without being able to schedule these cases.

CG: At this moment, patients with benign diseases such as haemorrhoids, anal fissures or fistulas do not wish to be operated because they are afraid of being infected by COVID. Hopefully this situation will allow us to have more available operation room time to operate on malignant disease. I think the problem will be the patients who were not diagnosed in due time due to the pandemic who will have to be operated in a more advanced stage of their diseases.

Do you feel your government or healthcare system is aware of surgical postponement consequences?

GP: I do not think political authorities are aware of the consequences of surgical postponement. They are more worried about their political fights. To illustrate this is the fact that Brazil had three different health ministers between March and June.

CG: Are these entities in your country advocating any solutions for these issues?

GP: No, as far as I am aware the government authorities are not advocating any solution for these issues. They seem more interested in not being considered guilty because of the high death rate.

CG: Were your residents or any of you senior surgeons redeployed to other services during the pandemic?

GP: The answer is yes, some colleagues, mainly residents, were redeployed at Hospital Das Clinicas at Sao Paulo, which is the biggest public hospital in Brazil, to treat COVID-19 patients. However, I do not believe the situation will continue like this. Many patients, including COVID-19 patients, will have surgical complaints and they will need surgeons to treat them.

CG: How has the current situation affected your own practice, and are you taking any precautions in your social life?

GP: Absolutely - it has affected my entire life. I have a little baby who was born in December 2019, just a few days from the first case of COVID-19 reported in China. Every time I come back home I feel scared of bringing the virus home so I take all the precautions needed. However, I am sure in the near future we will come back to a 'new normality' where we will increase the hygiene habits we used to have, but it will not be a nightmare like these days.

CG: That brings us to the end of the interview! I would like to thank you for giving us the local insight on the COVID-19 pandemic in Brazil, and I would like to ask you a final question. What is the main lesson we can take from this pandemic so far?

GP: COVID-19 will not disappear. I don’t think that in 2-3 months we are going to be free of it. I believe, from now on, we will constantly take care of not being infected during medical appointments and operations. We will use PPE more strictly. Until an effective vaccine is discovered, all measures to avoid dissemination of the virus will have to continue.

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