Google Cloud Speech-to-Text API (Chirp) + Gemini 2.5 Flash Non-Thinking. Treat it as a searchable index of what was broadcast, not a quotation record.
00:00:00with Herman José because I was thinking I have things to say and
00:00:04the world, I feel that the world wants to hear me
00:00:06immediately returns this Wednesday
00:00:10night on RTP Mundo.
00:00:39Hello, good evening, how are you at home? Once again, I come into
00:00:43your homes to talk about some topics that I consider interesting.
00:00:47Today's topic apparently has nothing to do with food, we will prove
00:00:51throughout the program that it does indeed have a lot to do with food and people's well-being,
00:00:55particularly in situations of illness. So today we're going to talk about
00:00:58home hospitalization.
00:01:00We will define throughout the program what that
00:01:02the sick family member, and now we are means, its objectives, to whom it is directed,
00:01:05this type of service provision,
00:01:09the implementation of the same here in Madeira which has been growing, also some
00:01:13numbers in terms of the country, to talk about this we have next to me,
00:01:16on my left, Dr. Marias, and more than
00:01:19anyone else, she is the face of home hospitalization, she has been the one
00:01:23who has fought for this service since the beginning, let's say, which is another
00:01:27hospital service for the population, next to me... we have Chef Jaime
00:01:31Cruz, more than well-known, no need to say
00:01:34anything, going to Jaime's restaurant is
00:01:38something that is always an experience of eating well,
00:01:41so his presence fits perfectly in this program, I would start
00:01:45by asking Maria da Luz, what, in your
00:01:48perspective, let's first define the object of this program, what do you
00:01:51define as home hospitalization? Well, first of all,
00:01:54I would like to greet the people at home, a good evening and thank
00:01:58them for thinking of... this topic, which is really what you
00:02:02say, it's a topic that for me is the apple of my eye, so it's a topic I've
00:02:05always fought for and that is finally implemented in the region. Now,
00:02:08allow, just like you saw the home hospitalization is, as the
00:02:11name implies, the provision of hospital-level healthcare
00:02:15at the patient's home, so
00:02:18it's an activity that we started, more
00:02:21precisely, in March 2023 here in
00:02:24Madeira and we practically take the hospital to the patient's
00:02:28home, so it's directed at acute or chronic
00:02:32acute patients who, having
00:02:35criteria to be admitted to the hospital, also meet criteria that allow them to
00:02:39be at home and be, in essence, daily observed by us,
00:02:43a multidisciplinary team and who goes daily to the patient's
00:02:46home. Your technical responsibility and your work
00:02:50team also implies a prior assessment of the total conditions of the home
00:02:53to suggest hospitalization. Some
00:02:56perspectives that you would like to highlight regarding this, is that it?
00:03:00That's why I said at the beginning that patients had to have clinical,
00:03:03geographical, social criteria,
00:03:06this is always done with informed consent, always with the patient's
00:03:10and their family's consent, so there are
00:03:14social criteria, from the moment they ask us to observe these patients,
00:03:17we have teams, two teams
00:03:21working daily, one that goes to the patient's home and another that stays at the hospital to
00:03:24recruit patients, in essence recruit patients, so whenever
00:03:28they ask us to observe... a patient who has an indication, we go to see if
00:03:32the patient has clinical criteria, an acute illness, so our
00:03:35intervention always goes to the acute phase, because then
00:03:39the patient is, in essence, this is, in essence, a continuity of care,
00:03:42then we will pass the patient to primary healthcare when they leave the acute phase,
00:03:46in essence, what we do in the hospital, the patient is then discharged, during the acute
00:03:50phase they are under our
00:03:52is it to tutelage, so we
00:03:54when we are called, so if there is a clinical criterion,
00:03:58then the social worker who also... is part of our team will also talk
00:04:02to the patient's family, the patient must have a family, must have living
00:04:05conditions and must have a phone to be in daily
00:04:09and permanent contact with us. Then we have
00:04:12a nutritionist, a pharmacist, we have the medical and nursing team
00:04:15and we have all the specialists from the hospital who give us incredible help,
00:04:19that is, whenever I need a patient, to contact a
00:04:23colleague from any specialty, they are always available to help us. In terms of IT, this
00:04:26home hospitalization service is linked to the entire hospital network, yes. And once
00:04:30the patient is chosen for this type of service, they can rest assured,
00:04:34because they will have everything they would have if they were
00:04:37within the walls of a hospital, and the same quality, right?
00:04:40Right. Jaime, what do you have to say about this? I mean, for
00:04:44me, the advantage of this in technical terms of the patient being
00:04:48at home, with the involvement of the family, in their own space, all these
00:04:51things, is an important aspect, but for me, another perspective joins this,
00:04:55which is the food, which, being healthy, is their
00:04:59own food. It's not hospital food, clinic food, or whatever, it's their
00:05:02own food. What do you think of this perspective? I think it's very interesting because I think it's
00:05:06an extraordinary idea, that is, nowadays, as we
00:05:09know, and you more than anyone, the overcrowding that exists... in hospitals,
00:05:13people don't have beds, they're on stretchers,
00:05:16they can be in their homes
00:05:20with the comfort of their home, and on top of that, supervised by
00:05:24such a good technical and medical team. In terms of
00:05:27food, even better, because they can, with the
00:05:30nutritionists and with the
00:05:33doctors, say what they should eat and what they can't
00:05:36eat, it has a very big advantage, and even
00:05:40more so, the comfort of the family. I've already been hospitalized, I've been in the hospital too,
00:05:44and I know that I think that from the comfort of the family, it's already
00:05:47a natural comfort, it's
00:05:50an extra pill, isn't it?
00:05:53This also, in my perspective, I'm sometimes exotic in my
00:05:57ways of thinking, this is a bit of a step back in relation to the
00:06:01family's responsibility in the family's illness, that is, for a long time,
00:06:04particularly in rural environments, the patient
00:06:08was cared for in their family environment, then it moved to hospitals and the family
00:06:12almost... divorced themselves from the patient, from
00:06:15returning a little to the origins, don't you think? So it's a
00:06:19question, it's an increase in the responsibility of the family environment towards a
00:06:22sick family member who has the good fortune of being sick, it's also an increase in
00:06:25responsibility, don't you think? I usually say that this type of care provision
00:06:29is true humanization in health, we actually
00:06:32take the hospital to the patient's home, we are available for that
00:06:35patient, the patient feels that they have the
00:06:39family feels that and you said something very important, which is
00:06:42regarding the family's involvement in
00:06:46the illness and we do that, that health literacy, we educate
00:06:49the patient in their own place, they have their things, we explain what
00:06:53kind of food they have to eat, we do a very important thing, which is
00:06:56therapeutic reconciliation, that's why we also have a pharmacist who goes and sees
00:07:00patients what medication, many times we have
00:07:03surprises, we have patients with the same medication
00:07:07with several names, but the patient doesn't know it's the same and, therefore,
00:07:10they may even run the risk of... taking the same medication twice and therefore
00:07:14and we, on site, we will know where things are
00:07:18and in reality that's it, the family also feels more
00:07:21supported, because the family also has some fear of all this
00:07:24and if they feel supported and you said something that also
00:07:28calmed me down a bit, that's what I think, from the moment they are with us and are at home, they have to be
00:07:32safe, they have to feel safe, then they also feel that they can treat
00:07:36their family member, that's it, and many times when we discharge them, they say, "Oh, if
00:07:40anything happens, they'll contact us," and we say, "Don't worry."
00:07:48hospital, just a call from you if necessary, I think it's a huge
00:07:51added value, uh, the political management of health has also
00:07:54cherished this a lot, particularly in recent times to the point of wanting to
00:07:58extend it to more geographical areas, particularly the south, the south
00:08:02of the island, uh, this
00:08:05expansion of the area of influence also implies an increase in resources, obviously, this has to be
00:08:09thought out and prepared in advance, not only the resources, but also the... number of
00:08:12cars available and all that, right? So there is a certain
00:08:15programming.
00:08:17I think this is one of the important bets here from our
00:08:21superiors hierarchically in political terms, I think everyone
00:08:24agrees and I feel it, I feel that they are with us and that
00:08:28they are concerned and that they really want to and because it was also
00:08:32realized that this is really an important way to bring
00:08:35health to the patient and and there is national
00:08:39and already worldwide data, this has not existed since... now
00:08:43do we have an idea of how much availability or installed capacity at
00:08:46a national level exists at this moment? At this moment we have a hospital
00:08:50without walls with 362 beds at this moment there are, these are recent data
00:08:54from our SNS, 36 home hospitalization units in the
00:08:58country. I haven't quite understood yet, I have a question and you do
00:09:01the triage and
00:09:04urgency first or is it like that?
00:09:08The triage for the unit is done in several ways, we are
00:09:11contacted. And we are contacted how? Either through the
00:09:14emergency room, a patient who goes to the emergency room and has an indication to be hospitalized and who meets these
00:09:18criteria, the emergency doctor asks us to go see them.
00:09:21Hospitalized patients who are hospitalized and who can continue, so they have been there
00:09:25for 5 days, maybe they would have stayed there for 10 days, but they can already go home
00:09:29because they can finish their treatment at home and we go home,
00:09:33special care units, excuse me but they're getting me in order
00:09:36regarding the program. I'll stick to the routine anyway,
00:09:40one of the first interviews you did with the patients at home, you asked if they were
00:09:44well impressed with it and he said with
00:09:47a lot of humor, "If I'm well impressed, then here I have a doctor just for me,
00:09:51if I were in the hospital it would be one doctor for so many people." So just this
00:13:45clarified butter, loves, let's give Jane a little break so he doesn't get
00:13:49flustered, so continue. The Madeiran
00:13:52health care has an increasing variety of available
00:13:56home health services, yes.
00:13:59All of a sudden, there are so many, all with different characteristics and
00:14:03objectives in terms of treatment
00:14:07and coverage of different health needs. Home hospitalization, I would say,
00:14:11is top-tier among all this, no, no, all
00:14:14care is important, okay? All care is important, okay? But the last conclusion
00:14:18then there are the home visits from general and
00:14:21family medicine colleagues, then there are the home visits. From
00:14:25pain therapy too, sometimes they have equipment that needs revision,
00:14:28then finally there are the home visits from palliative
00:14:32care, so all of this is a resource for
00:14:35home assistance, so I think this is spectacular, I mean, the patient
00:14:39less and less has to worry about their illness,
00:14:42knowing that they are well at home and will have everything they need at home, of course, there
00:14:46has been throughout this implementation of HD,
00:14:49a good relationship and articulation with all these
00:14:53support visits for the home.
00:14:55And it's essential that this happens, because in reality, patients have
00:14:58to have continuity in their trajectory through
00:15:02the services. There's no
00:15:05overlap of the functions from my point of
00:15:09view, no, no, because in reality our patient is our
00:15:12patient, our activity is limited to the acute phase, it's an acute
00:15:16or acute chronic patient, right? Who, in essence, has a pathology
00:15:20that indicates hospital admission, so these patients
00:15:23would be hospitalized. From our services, I'm asking this
00:15:27because I also know, and I witnessed some of your conversations at an initial
00:15:30stage, some friction in the relationship with
00:15:34other specialties, namely family medicine. But
00:15:37this has all been diluted over time, I think it's only by talking
00:15:41that one understands, in reality, everyone understands
00:15:45that in your daily activity you have a, we are all important, you have a
00:15:48briefing, you have a briefing every day with that work team in order
00:15:52to plan the work day. We plan before leaving, we
00:15:56always have contact, we are always in contact, all of us know the patients who are at home,
00:16:00anyone from my team at this moment knows who the patients are, we have a way of
00:16:03communicating with each other and that we have, sorry
00:16:06for interrupting. It is fundamental because we are
00:16:08permanently with these patients while they are at
00:16:12home in HD, as it is called,
00:16:15hospitalization, the patients are with us. In terms of
00:16:19costs and sustainability of the system, which is something that managers really like
00:16:23and that we also have to pay attention to,
00:16:26it is advantageous. So the costs are advantageous, they show that
00:16:30there is really a reduction in costs because daily costs become
00:16:33lower. We start by seeing that the patient's bed is at home, exactly.
00:16:37So the hospital part, so the bed is at home, so, but
00:16:41but more important here is really a thing that Jaime
00:16:45talked about there, which is really the comfort for the patient, being at their
00:16:48home, with their own things, we notice in elderly people often when they are
00:16:52hospitalized in the first few days, I don't know if you also had that in your
00:16:55service and you have, they get confused, hospitalization is always a
00:16:59critical phase, it's a lack of reference, being at home there's no possible confusion,
00:17:02they're in their own place, it's a lack of references not only human but also of physical
00:17:06spaces, that is, it's their bathroom, their kitchen, their car.
00:17:09A great advantage and the other is the reduction of infections, at home
00:17:13there are fewer infections, patients are proven to recover more
00:17:17quickly, that's an important aspect, lower mortality, that's an important aspect,
00:17:20infections are always a drama for a patient, for a surgical patient much
00:17:23more than for a medical patient, but for a medical patient, infections and
00:17:27superinfections are increasingly common, if they can be avoided or
00:17:30minimized in the home situation, I think it's excellent, but look,
00:18:57uh, let's suppose a patient has a respiratory
00:19:00infection that causes some motor incapacity,
00:19:03uh, you also have in this
00:19:07rehabilitation and kinesiotherapy programs also rehabilitation that goes to the patient's
00:19:11home, yes, that's an important aspect, we do kinesiotherapy at home, yes,
00:19:14yes, every patient who is at home has the same conditions as a patient who is
00:20:15season. One thing that patients often do when they are in a
00:20:18hospital environment is if they have alcoholic or tobacco
00:20:22habits, they go to the balcony to smoke. Do you have
00:20:25any restrictions on those things for the patient who is
00:20:29at home? It's out of our control, so they can have a respiratory
00:20:32infection, first of all, just to tell you that one of the exclusion
00:20:36criteria is alcohol.
00:20:39Ah, we cannot have a patient with active alcoholism safely at home.
00:20:42That's unthinkable. A patient who is at home is
00:20:45safe because they met all the criteria to go home.
00:20:49And so they are
00:23:50An important aspect, Luz, in these things of delivering the patient home,
00:23:54unfortunately, we have to be attentive to something that sometimes
00:23:58afflicts families without us realizing that there is family violence at
00:24:01home, sometimes we can have a patient who doesn't report it because they are afraid to
00:24:05report it, man or woman, it doesn't matter, and in the meantime, you
00:24:08put the patient in the lion's den, so to
00:24:11speak. There are prospects of care, relationship, that's why
00:24:15the patient goes home with the patient's consent from the
00:24:17family, yes, there is a term. And we
00:24:21go home daily, if we feel that, there was a
00:24:25there was a ready person feels that, if they feel it, we
00:24:28talk to the family and sometimes a conversation helps a lot because sometimes
00:24:32that, I even think in that aspect we even helped the
00:24:36family a little bit in that, to heal a little bit that violence because in the end they
00:24:40and then they feel completely involved
00:24:43they think they are doing something very important for the
00:29:43as another one says taste it
00:29:46to see if we need salt or not. When you send a patient for home hospitalization,
00:29:50you predict a certain period of hospitalization, but sometimes things
00:29:54don't go as linearly and it's always an unknown
00:29:57exactly, the hospitalization has to be prolonged.
00:29:59entreinamento.
00:30:02of selection, so what, what? The time, no, it won't
00:30:06be necessary, we have patients receiving antibiotic therapy, for example,
00:34:13us to come back to the dish later, but I wanted now, at this almost
00:34:17final stage of the program, for you to express what you felt in this program and
00:34:20if you were indeed useful to those at home,
00:34:24if you were useful in terms of disseminating, on the one hand, home
00:34:28hospitalization, a great advantage for those who are sick at
00:34:31home, and on the other hand, in transferring some food
00:34:35information to those on the other side to also innovate. I am
00:34:39radiant, firstly, for this
00:34:42novelty, which is something extraordinary, isn't it? I think
00:34:46I, as a patient that I have been and
00:34:49will certainly be because we all
00:34:52get sick, absolutely, we can't escape it unless we are a super
00:34:56sum, eh, to have that advantage, a divine
00:34:59advantage, to be in the hospital, hospitalized, at the end
00:35:03of the fifth or sixth day to say look, you're going home and
00:35:07you'll continue with this, with this, with this, with this, and man, I think it's extraordinary,
00:35:11extraordinary, I, I, I have to say thank
00:35:14you, thank you, it's commendable, that's something divine, when
00:35:18I thought about talking about auxiliary hospitalization in this program,
00:35:21it made so many things clear in my head, so many things that can be
00:35:24associated with it, talking about food as we are doing
00:35:28here, I'm happy that we achieved that, what do you think? Were you able
00:35:32to pass information about your HD at
00:35:35the same time we talked about food that can
00:35:39be implemented in the homes of the elements that you them to be
00:35:43above all two things. To understand that everyone has the right to
00:35:47this type of, this type of, it's not quality of life, unfortunately at
00:35:50this moment we only have a capacity of five beds because we only have
00:35:54one van, right, but fortunately we will have
00:35:57soon, I think still this month, it's starting now, we
00:36:01will have two, and therefore we can increase the sum of the
00:36:04profitability of these five beds to this date. How many patients, since you just completed
00:36:08a year, five? Ah, we with one, with one
00:36:11van, five beds at home, we treated
00:36:15145 patients, 145 patients, so there were 145
00:36:18citizens of our land who, in a terrible phase of
00:36:21illness, which for all of us is always a hassle, had the possibility of at
00:36:25least half of the treatment done
00:36:27in their home, in their home environment, with their home food, with their
00:36:31smells, I think that's spectacular. The
00:36:34incentive for more island coverage will imply more human resources,
00:36:38but things are being prepared, I think it's perfectly possible.
00:36:42Another important aspect is that we have to captivate
00:36:45on the other side, obviously, the citizen who has the right to this benefit, we are
00:36:49talking about the difficulties of implementation on this side, technical, cars, human
00:36:52resources, and who is part of your team, I'm thinking of the
00:36:56doctors, you feel the...
00:36:59Initially there was some resistance, people hesitated, and today, after
00:37:02a year of treating 140 patients under this regime, do you feel that people are increasingly
00:37:06committed to it? In fact, they almost almost make a point of
00:37:10getting into this type of treatment, people, people like it
00:37:13very much because this, as I say, has benefits for patients,
00:37:17so it's associated with greater satisfaction of patients
00:37:20and families, but also ours. I notice that my
00:37:23team is all committed, everyone is happy,
00:37:26for sure, very important because this is something different, it's, it's
00:37:30basically something outside the box that we, in the hospital
00:37:34box, we are at the patient's home and we take it to the patient,
00:37:37we notice that the patients eh have
00:37:40affection for us and we have that moment, we spend about 20 to
00:37:4340 minutes with each patient at home every day, it is
00:37:47indeed a personalization there and in the 24 hours, that's what I want to make clear
00:37:50here, in the 24 hours of the day we are available for those patients
00:37:54and therefore they know that, they feel safe, that's what we want them to... so
00:37:57safe, we have something very spectacular here in Medari, we have to
00:38:01really thank them because we had that privilege that
00:38:05initially not all units in the country had telemonitoring, that is,
00:38:08we can remotely see the patient at home,
00:38:12know at every moment what they have, it's even possible to do an electrocardiogram
00:38:16remotely, it's possible to know the patient's attention, it's necessary to know everything for
00:38:19us to know, it's very important, this is very reassuring,
00:38:23we, we worry a lot about patient safety, the patient also feels that.
00:38:27More secure too. HD at this moment is having new
00:38:30structures in the hospital or the prospect of new structures that will
00:38:36control room here, there is a control room for monitoring patients who are at home, there are
00:38:40telemetry data that are transmitted there, the person is seeing the pulse, the
00:38:43electrocardiogram, I think this is spectacular, we just have to increase and
00:38:47increase our availability. Well,
00:38:50unfortunately we are reaching the end of the program, we had conversation for much
00:38:53longer, I wanted to thank your availability, Luz, and
00:38:56to give... regarding your initiative, the resilience, which
00:39:00is a very modern word now, that you had throughout this time, I think it was
00:39:04spectacular. As for you, Jaime, the usual, you are always
00:39:07with us, always, always together, not only for friendship, but also for
00:39:11these initiatives. And for those at
00:39:13home, I wanted and you must always feel
00:39:17a little sadness on my face when I'm saying goodbye, because in fact this is something
00:39:21I have to admit I do with pleasure, with availability, without
00:39:24any kind of stress, so it always gives me great pleasure
00:39:28to talk about these topics. I hope for those at home that the treatment of this topic was useful
00:39:31for you in terms of information about what
00:39:35HD is, what it can bring into your lives when you have the misfortune of
00:39:39illness, and now also to add the pleasure of eating well even during
00:39:43illness, this time at home, in your kitchen, in your
00:39:46corners, on your couch. Thank you very much for your presence, eh, we will have
00:39:50more programs next with other topics, thank you very much and good night, thank you, very good
00:42:19I've been working on this street for 57 years
00:42:23and, therefore, I came here to
00:42:26a shoe store I had up here, which is no longer a
00:42:29shoe store, and now I come here to this store,
00:42:32so at that time there was a vacant space
00:42:36and now I've been in this store for 40
00:42:40and... 2 years, 42 years this September,
00:42:42so my life is this, isn't it? So
00:42:46let's keep going here and see, let's survive, so
00:42:50I'm going to enter here, I
00:42:53have to straighten these shoes, man, there are many
00:42:56and some older ones, aren't they, they're quite?