Everytime I think that Iīve learned as much as Iīm going to learn about EM in Brasil, something else surprises me. The problem with researching the development of a specialty in a country this large is that sometimes even people within a country arenīt aware of the efforts going on just a few hundred miles north of them…and so Iīve started to feel a bit like the country is made up of bits and pieces that should fit together relatively well, if only they knew where the others were, or even that they’re parts of a greater effort. After 3 months of visiting hospitals and talking to various societies involved in EM development (in Rio, Porto Alegre, Curitiba, Campinas, Sao Paulo), I finally met a doctor today who told me point blank they think that theyīll organize a specialty here within a year…. surprising after 3 months of being told that EM will take about 10 years to develop, will take forever to develop, will never develop. Technically, theyīve already gotten approval from the AMB (the Brazilian Medical Association), step one of three involved in setting up a specialty. Yet, depending on who you ask, this step is a false one– a poorly set up move done to keep EM under the guard of Internal Medicine. Itīll be interesting to see who ends up correct. In the meantime, Iīve been doing my part, collecting email addresses and phone numbers of those interested in the development of EM in Brasil and trying to put them all in touch with one another.
The research is actually going much better here than it did in any other country Iīve been to this year. I spent a decent amount of time in the trauma bays and ERs of the hospitals in Campinas and Porto Alegre, and was able to tour and observe a bit in Rio, Curitiba and Sao Paulo. In Campinas, I spent a day shadowing the SAMU ambulance service on its rounds and then spent a day with the second year med students, who were coincidentally in the middle on learning about pre-hospital services in their city. Consisted of 6 stations set up with various parts of the system– the ambulance service on the highways (www.autoban.com.br), the regular ambulance service, the firefighters (they provide first response services here in Brasil), different doctors and paramedics involved, and a really gory slideshow of the īībest everīī of the Autoban rescue services. Iīve seen a lot of interesting things this year, but that may have won the award for most shocking 15 minutes of my life 
!
Thatīs the other interesting part- as doctors work on ambulances here, I wonder if there may be more room for the development of a specialty for ambulance doctors, even if itīs difficult to organize a specialty within the hospital. There is already a residency in EM here in Porto Alegre, even though there is no specialty for these physicians to work in….and I feel like there might be a home here. Iīm not sure if itīs what they want, but, maybe itīll be a start….then again, maybe thereīll be a specialty in a year. Who knows.
Anyway, off to buy a plane ticket home…eek.
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