Thursday, February 2, 2023

“Without the private effort, the Portuguese State would not have been able to face the pandemic”

Interview to José Germano de Sousa, President of the José Germano de Sousa Laboratory Medicine Centre


Sofia Arnaud

In an interview with PRÉMIO, Germano de Sousa, clinical pathologist and president of the josé Germano de Sousa Laboratory Medicine Centre, spoke about his career as a doctor, his former position as President of the Portuguese Doctors Association and the growth of his network of laboratories, operating in the field of clinical pathology laboratory trials and the main national player in this sector, currently performing 15 to 16% of Covid tests in Portugal.

He argues that the State cannot do without the private sector as regards the common objective of improving healthcare to the population and says he is proud to help the Portuguese in their fight against the pandemic.

You were born in island of São Miguel, in the Azores. From your childhood days in the Azores archipelago, your student days in Coimbra, the challenges of being a doctor during the war in Angola to taking important positions in society, such as President of Portuguese Doctors Association between 1999 and 2004, what are the most important moments of your life?

I have many memorable moments in my life. In particular the time as a student in Coimbra, which I long for, where I grew up as a Man and learned to be supportive, daring and to give more importance to people than to medals and where I learned also that freedom is worth more than anything. I was an academic leader and I was prevented by PIDE (the State Police during fascist rule) from doing internships in the hospitals of Coimbra and from being an assistant lecturer at the University.

Then I went to war, another striking period in my life. As a doctor, I started working at a hospital in the military front in a small town called Luso, later renamed Luena. These were very complicated times and I was working day and night under very difficult situations. But it was at the same time a great medical school. We were eleven doctors in total and we took care of everything.

However, I also have very good recollections of that time. My daughter Maria José was born in Angola I was the obstetrician. A day that will be forever in my mind.

Other important times followed, when I returned to Lisbon and I started my medical career at the Lisbon Civil Hospitals, which were by then the big medical school in the country. My son José was born in this period, one of the most remarkable and happy days of my life too.

Being President of the Portuguese Doctors Association was also very important, given all the work carried out not only as a doctor, but also as a leader of doctors. My role as President of this association was very important for the dignity of medicine.

Germano de Sousa Group is seen in the laboratory medicine field as a structure of experience, rigor and professionalism. How did you get here?

I made my career at the civil hospitals, but like all doctors I was underpaid. Then I was invited to become Associate Lecturer at the Faculty of Medical Sciences. When I completed my specialty in clinical pathology I started working in a laboratory with a colleague. Later I left this laboratory and moved to another lab with two colleagues. One day I spoke with my two children, Maria José, who had already completed her specialty, and José, who was in the last year of his university studies and we decided to move together. And we were able to grow always based on quality.

In 2003, when I was President of the Portuguese Doctor’s Association, I was “harassed” by foreign groups to sell the laboratory. These groups were buying large chunks of the medical sector in Portugal at the time. I called my two children and asked them if we should sell or if we should stand up to these large groups. The decision was obviously to move forward, we fastened our seat belts and moved on. Me and my partner parted ways and the three of us bought another laboratory. Always betting on quality, my colleagues realised that our laboratory was indeed a rightful medical laboratory. Whose main concern was the patient and that in addition to doing laboratory trials with the utmost rigor and quality it was, through our doctors, always there all the time for our colleagues from other specialties, acting as consultants.

All of this allowed us to grow and to start expanding. The space became small and seven years ago we moved to the Lisbon Telheiras neighbourhood, to the place where the Portuguese Design Centre once was, we renovated the space, equipped it with the latest technology, made a small museum at the hall and, at the moment, we are already expanding to the building next door.

Right now, in terms of laboratory trials in the field of clinical pathology, I believe we are the main national player in the sector, with a daily average of 7200 patients at national level, before Covid and an average of nine laboratory trials each.

How many laboratories are there currently in this network?

We have two central laboratories, one in Lisbon and another in Oporto. These central laboratories, in addition to clinical pathology, also have a genetic and molecular pathology laboratory, a bet we made five years ago and focused on the study of genetic changes and the research of genetics and genomics of cancer. We were pioneers in many of these diagnoses, we were able to identify the markers that allow us to suggest a better and more effective therapy.

In addition to these two central laboratories, we have 12 more laboratories and around 500 biological sample collection points spread across the country.

We currently cover all possible areas of laboratory medicine, clinical pathology in the fields of haemato-oncology, haematology, chemical pathology, endocrinology and microbiology in all its aspects, including virology, where we are doing more than 7000 Covid tests per day all over the country. We work 24 hours a day, there are no weekends or holidays. It has been an overwhelming effort.

It is worth mentioning that without our efforts and the efforts of the private companies, the Portuguese State would not have been able to face the pandemic. Especially because, as the director general of the World Health Organization said, it was necessary to test, test and test and only by testing was it possible to track and identify the outbreaks, without this it would be impossible to control it and, in this respect, we have been playing a fundamental role. Our Group alone represents about 15 to 16% of all Covid tests carried out in Portugal.

About three years ago, you opened a centre in the Azores. What has led you to make this decision? Links to your roots?

Yes, in Ponta Delgada. Links to the origins, obviously, and also because it was a region with little resources in this this field and needed our support. We already had an excellent relationship with a local laboratory and that laboratory wanted to become part of our Group and we are currently able to provide all the care that under normal circumstances would be more difficult in the Azores.

How do you explain the fact that Germano de Sousa Laboratories are in charge of performing most of Covid-19 tests at national level and with ever greater demand?

Whether we like it or not, the second wave has arrived and I’m afraid we are facing the beginning of a third. This represents a great effort and our participation in this process is fundamental. Some politicians don’t like to acknowledge it, but our collaboration has been crucial not only in this Covid problem, but also when it comes to “open doors” and to receive patients from the different provenances, through conventions, from the National Health Service (SNS), from private sector, ADSE, Police Forces and several insurers and has been paramount to prevent setbacks as to the healthcare provided daily in Portugal, thanks to our contribution and that of other laboratories that have signed also agreements with the Health Ministry to cater for all NHS patients at fair prices

I recall that it was this concept of convention that allowed in 1978/79, when the NHS was approved, to give the Portuguese what they didn’t have. Such healthcare that “tending to become increasingly free” was only possible because we, laboratory, radiology, cardiology and gastroenterology people from all specialties and with private doctor’s offices stated our availability to work with the Government so that the NHS could become a reality and not just something that exists only on paper. The NHS only succeeded in implementing itself because we, the doctors, through the Doctor’s Association, signed a convention with the State whereby we committed to provide healthcare services at “socially fair” prices, far from the prices charged in the private sector.

The NHS was clearly one of the excellent works of Democracy, but it must be fair to those who helped building it.

Currently, our Group of Laboratories and others with agreements reach 22 thousand people daily from local healthcare centres.

It would be unfair to say that they can do without privates and, focusing on a different area, I would like to recall that the NHS exists because there are private entities and Charities.

In Portugal 45% of people are covered by another health system, in addition to the right to receive NHS care. If these systems ceased to exist, the NHS would not have the capacity for so many people.

We exist because they need us so much! We are extremely useful, and without us the State would fail. From this perspective, I am very happy to be able to help the Portuguese.

Could you tell us what kind of tests are currently available for Covid-19 and under what circumstances should each particular test be performed?

The first diagnosis test recommended by the General Health Directorate (GHD) and its standards is the molecular test (RT-PCR).

In the absence of this, and only if there are symptoms, the so-called rapid antigen test should then be performed. This test is only effective if performed in the first 5 or 6 days of symptoms. These tests don’t work in pre-symptomatic or asymptomatic cases, and may lead to false negatives.

The measures adopted by the Government and the General Health Directorate (GHD) made any sense throughout the pandemic?

In general terms yes. We are faced with a new, complex situation that emerged overnight. What happened in Portugal also happened in other European countries, the measures were taken recommended by the GHD, with some setbacks and advances along the way. There were some errors and some measures took too long to be adopted, but it is easy to put the blame after.

In my opinion, when the first wave started, there should have been a more careful and monitoring action by the authorities in some problem areas, poorer neighbourhoods where infected people live as where some of these people could not stop going to work or did not comply with basic safety rules. It is worth remembering that right after that outbreaks started appearing in civil construction, for example.

At Christmas there should also have been stricter rules, to avoid a third wave in January or February.

Many people are not following some basic rules to prevent the spread of the virus, especially the younger strata. The current President of the Portuguese Doctors Association, Miguel Guimarães, argues that there must be “a simple, short, clear and always true communication”. Do you think communication should have been more assertive?

I think we started thinking about communication later in the process. Things are different now as we realised that we need to communicate differently and to different audiences.

A 25-year-old boy does not listen to GHD press conferences daily. It would work better if they used Youtubers that are in vogue or even Ronaldo or the comedian Ricardo Araújo Pereira to get the message across.

On the media side there was also an unnecessary panic. I think it was exaggerated, people no longer wanted to see the news and lived in permanent anxiety.

In an open letter, published in Público newspaper, addressed to the Minister of Health, Marta Temido, and to the relevant authorities, doctors stress that the NHS “alone cannot help all patients” and that it will go into “disruption” if nothing is done quickly. In your opinion, do you think that privates should have more intervention in fighting the pandemic?

About three or four months ago the Members of the Doctors Association, headed by Dr. Miguel Guimarães, wrote a letter to the Minister of Health recommending her to quickly allow the private sector and the social sector to be hired, at “socially fair” prices, in order to become part of the entire support network to fight the Covid-19 pandemic . This letter was highly criticized and the Minister said that the NHS was not there to support private initiative.

At this moment, the reality is different and the NHS was forced to resort to Charities and privates, such as the José de Mello Group and others.

From the beginning, there was always the willingness of the private sector and the Charities to participate in this struggle with the Ministry of Health at the helm.

The much-desired vaccine against Covid-19 has already arrived in Portugal. Do you agree with the vaccination plan outlined?

The plan outlined seems ok for me. I would include however in the first phase, in addition to people over the age of 50 with associated pathologies, residents and professionals in homes and long-term care units, health professionals, armed forces, security forces and critical services professionals and also people over 65 years of age. Information is still a bit confusing.

The vaccine is free, optional and administered in the NHS. Many Portuguese are afraid to take it and a lot say that they will not take it out of insecurity as to its reliability. Are there reasons to be afraid?

There are no reasons to be afraid. As far as we know as regards these vaccines there is no need to be afraid, either when it comes to vaccines that use messenger RNA or vaccines that use attenuated viruses. However, it is clear that there may be side effects, such as fever, body aches, just like with the flu vaccine or any other vaccine.

Will you get the vaccine?

I will take it with great pleasure, as soon as my turn comes.

Is it possible to eradicate viruses with the vaccine or will we have to live with the virus for the rest of our lives?

This vaccine, just like the flu vaccine, is not a sterilizing vaccine. As with the flu vaccine, this vaccine will work for a number of months, maybe a year, which is already very good. We will probably have to take it every year.

It is believed that with more than 65% of people vaccinated there will be group immunity, but I am afraid that this immunity won’t last. Proof of this are the four coronaviruses that are there since the late 1960s of the last century, benign ones, and that come back every year causing colds, cough, etc. The benign coronaviruses that exist did not create lasting immunity.

We will have to live with this virus among us and we will have to vaccinate against it every year, but we are not going to eradicate it.

In your opinion, will masks disappear in 2021? When will we get back to normality?

From the moment when there is a large number of people vaccinated, it is worth leaving the masks. I think that by the end of the year we will be able to leave masks, if we all get vaccinated.

Finally, we know that you wrote a book on Portuguese Medicine during the expansion and that you are one of the promoters of the Health Museum in Lisbon. Will Covid-19 be covered in any of your books? And will there be an area dedicated to this disease in the Museum?

One of my hobbies is the history of medicine, I have done a lot in this area, including the dictionary of the History of Medicine.

Regarding Covid I already wrote about it, a book was recently published by Don Quixote publishing house together with contributions from experts in many areas talking on this issue and I also gave my testimony about what Covid is and what the future has in store. But it is still too early to write the Covid-19 story, there are not enough data.

To give you an idea, some time ago I was invited to present a book on Pneumonic, a pandemic that spread 100 years ago. Even so, there are still missing data to write its definitive story.

I was appointed, by the Minister of Health Adalberto Fernandes at the time, as High Commissioner for the Museum. I managed, together with Helena Rebelo de Andrade, the coordinator of the Museum, and with the support of Fernando de Almeida, the president of the National Institute of Health Dr. Ricardo Jorge (INSA), to open this space, where the exhibition “800 Years of Health in Portugal” is now being shown. The National Health Museum will certainly have an area dedicated to Covid one day.

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“Without the private effort, the Portuguese State would not have been able to face the pandemic”

In an interview with PRÉMIO, Germano de Sousa, clinical pathologist and president of the josé Germano de Sousa Laboratory Medicine Centre, spoke about his career as a doctor, his former position as President of the Portuguese Doctors Association and the growth of his network of laboratories, operating in the field of clinical pathology laboratory trials and the main national player in this sector, currently performing 15 to 16% of Covid tests in Portugal.

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