There are tragedies that should not exist. The death of little Benicio in Manaus is not just a mistake. It is a brutal picture of a system that tolerates improvisation and negligence and perpetuates a culture of irresponsibility. As a physician, FMUSP Emergency Department Professor, and General Manager, it is impossible not to feel angry. We must say it clearly: lives are being lost because Brazil has internalized the idea that “anyone” can play critical roles in the health sector without adequate preparation.
And this is the reality that no one wants to face: Brazil has more than 575,000 active doctors, but about 210 to 225,000, or nearly 40%, work without a medical residency. This means that nearly half of the professionals who care for emergency, pediatric, maternity hospitals, UPA units, emergency rooms and intensive care units have not received specialized training to deal with critical situations. It is the cruel embodiment of the “train more, train less” policy.
To make matters worse, the country already has 405 medical colleges, the largest number in the world after India. Some of them were opened not through health planning, but through judicial orders, without assessment of training capacity, without organized teaching hospitals, without experienced teachers, and without sufficient areas of practice. We set up courses in cities that had no beds, no intensive care unit, and no maternity ward; We allow degrees that do not provide adequate laboratories or real teaching supervision. This uncontrolled spread does not constitute democracy, but rather is recklessness. The results are already beginning to show in emergencies, in avoidable errors, and in the silent erosion of quality of care.
In Benicio’s case, this structural fragility took its toll. The doctor had no specialty; Did not monitor the preparation of the medication; Do not evaluate the patient during treatment. There was no clinical pharmacist present to verify dosage and dilution; The nursing technician was without residency or supervision; There was no active auditing; The security chain, which was supposed to be unbreakable, simply failed. None of this is an exception. It’s routine in thousands of services across Brazil.
We train 30-35 thousand doctors a year, but about 40% of them do not go into residency. It’s like being handed a pilot’s license with no flight hours. Who suffers? The patient, often cared for by a specialist who has never undergone extensive training, daily rounds, simulations, supervised shifts, case discussion, or formal assessment of competency. In an emergency, this is not a detail: it is the difference between life and death.
The numbers are enormous: hundreds of thousands of Brazilians are served every day by professionals without adequate training. This affects everything from the initial assessment to prescriptions, communication with nursing, interpretation of danger signs, and preparation of medications. When the system accepts this fragility as normal, tragedies cease to be accidents and become logical consequences.
It takes institutional courage to state the obvious: Brazil does not ask enough of those who care about people. Emergency is no place for amateurs; Pediatrics is no place for improvisation; Medicine cannot be given by trial and error. A hospital with no specialist doctor, no clinical pharmacist, no nursing supervision and no constant audit is not “rescue”: it puts people’s lives at risk.
Therefore, it is urgent to propose concrete changes. The first is to conduct the national examination to evaluate medical training, Enamed, which will be administered by the Middle East College to all fourth- and sixth-year undergraduate medical students. Obtaining a satisfactory evaluation in Enamed conducted in the last year of graduation and the requirement to fully practice medicine. Obtaining unsatisfactory grades in undergraduate medical courses at Enamed will result in the implementation of admission suspension or vacancy reduction measures, among other precautionary measures. If a student does not learn, the institution must respond. We also need mandatory clinical audits in all hospitals, with independent analysis of prescriptions, errors, adverse events and behaviour. It is necessary to create a transparent system so that every citizen can verify the real training of the professionals who will serve him, before choosing a hospital or service. Patient safety is not a luxury: it is a moral obligation.
The Ministry of Education and the Ministry of Health must present a joint plan to create places in medical residency programs to reach a ratio of one place per graduate within a few years, ensuring specialized training for newly graduated doctors.
Benicio’s story should mark a turning point. We can no longer live with hospitals operating without qualified teams, without safety processes, without clear protocols, and without accountability. The country needs public policies that expand accommodations, qualify choices, strengthen audits, and turn patient safety into a matter, not just a rhetoric.
Benicio is not coming back. But his memory should compel us to change what is wrong, quickly and courageously. Because every life lost due to an avoidable mistake is a collective failure. Brazil can no longer accept the unacceptable.