SÃO PAULO – Although they have a centuries-long presence in Brazil, many Catholic hospitals have been struggling in recent years with financial problems and poor infrastructure.

The COVID-19 pandemic came as many Catholic medical institutions were in the middle of a modernization program which better integrated them with the public sector, which may have helped prepared them for this unprecedented crisis; however their dependence on the weakened Brazilian public healthcare system may now be a problem.

The first Brazilian hospitals in colonial times – Portugal ruled the territory 1500-1808 – were part of the Portuguese system of Holy Houses of Mercy, Catholic charitable institutions that have assisted the poor, disabled and sick since the 15th century. Such hospitals were managed by lay Catholic fraternities. With the establishment of a public healthcare system in Brazil in the second half of the 20th century, the Catholic institutions began to receive government support and today they meet more than half of total public demand.

Only some of the Holy Houses of Mercy are currently managed by the Church – as has happened in the United States, many have been taken over by non-Catholic organizations in mergers. However, several Catholic congregations have formed healthcare organizations over the past few decades in order to make sure the Church kept a presence in the Brazilian healthcare sector. Some of these offer private healthcare services; others operate with resources from the governmental system, which is free of cost for all citizens.

“Ninety-three percent of our services are provided as part of the public system,” said Father Francisco Belotti, founder of Associação e Fraternidade São Francisco de Assis na Providência de Deus, a Franciscan-inspired institute which manages 74 healthcare institutions in Brazil.

This mean’s Belotti’s association is primarily concerned with assisting the poor – given that most middle-class Brazilians prefer to pay for healthcare providers and have access to private hospitals – at the same time it creates economic difficulties.

“The government’s refunds correspond to only 40-60 percent of our costs. The rest is on us,” he told Crux.

“Not only Catholic hospitals, but most of the publicly funded hospitals aren’t prepared for COVID-19. These institutions have been burdened with the weakening of the public healthcare system in Brazil over the past decades,” Alex Motta, national coordinator of the Bishops’ Conference’s Health Pastoral Commission, told Crux.

Insufficient governmental resources left many Catholic hospitals partially broken. “Budget cuts in healthcare created this situation. This can, one way or another, affected the services they can provide now,” Motta added.

In some cases, the Church has taken back institutions that had become dysfunctional and in order to restore them to health. That’s what happened in the city of Sorocaba, in São Paulo State. Over 200-years-old, the local Holy House of Mercy was put into debt by the previous administrators, who were not affiliated with the Church. In 2016 – after the arrest of the hospital’s director – the local archdiocese offered to take over the hospital.

“The hospital lacked everything, even pillows. We’ve been using the rent from some properties to pay those debts,” Father Flávio Miguel Júnior, who managed the takeover, told Crux.

Donations have been transforming the deteriorated building in a modern hospital – 40 out of 70 rooms have been recently been refurbished with resources given by local businessmen. “But we still need much help,” said Miguel said.

With the COVID-19 pandemic on the horizon, in January Miguel rented more than 20 ventilators. The hospital now has 60 intensive care beds.

“We can use up to 40 of them with COVID-19 patients if needed,” he said, adding that 10 coronavirus patients are currently in the ICU.

“The peak of the demand has not been reached yet. We’ll certainly have difficulties, but not bad as the ones we can already see in other parts of Brazil,” Miguel said.

Media reports showed that in different cities, such as Manaus, in the Amazonas State, the healthcare system is already collapsing under the weight of COVID-19 cases.

“We’re not experiencing too many problems now because we take care of several hospitals and we’re able to transfer resources from one to another, if needed. But many congregations manage only one hospital and are facing terrible hardships with the pandemic,” Belotti said.

“Ones lack beds, others lack ventilators, and others lack professionals. The federal and state administrations have never prepared to deal with something like that,” he added.

For the Catholic healthcare institutions, the solution might be to improve their level of association and the communication between different religious communities. During the current crisis, steps in this direction are being taken with a sudden urgency, Bishop Joel Portella Amado, secretary-general of the National Conference of Bishops of Brazil, told Crux.

“We don’t have the cultural habit of sharing our resources. There are, for example, many institutions which lack a building but have professionals. It’s very important in a moment like that to connect such things,” the bishop said.

Amado said Catholic institutions and government facilities are now trying to work together to handle the pandemic in Brazil.

“The Church has been offering buildings to receive hospital equipments and beds where it’s necessary. Through agreements with local administrations, it’s also dedicating its hospitals to the general healthcare demand, while a local public hospital gets only the COVID-19 cases,” he said.

That’s the case of the Pope Francis Hospital Boat, created and managed by Belotti’s fraternity. Since the outbreak reached the Amazon region, the boat has been meeting the general demand while a larger local hospital focused on COVID-19 patients, Amado said.

“Many problems had been taking a longtime to be solved have suddenly been looked at. Communities are reacting in a positive way to this overwhelming pandemic and are donating money, medicines, and food to Catholic hospitals,” Amado added.

The pandemic caught Brazilian Catholic healthcare institutions in the middle of a process of transformation. In 2018, many of them – representing more than 300 hospitals in the country – gathered in a national congress for the first time and discussed their situation and their needs.

An association of Catholic hospitals was founded at the event, with the goal of improving solidarity and cooperation.

“We plan to pool our purchases, for instance, getting better prices for every institution. We also want to share our structures and knowledge,” Belotti explained.

“The healthcare reality has changed a lot in the past few decades. We used to organize a campaign and a street festivity to collect funds for a hospital and that was okay. Nowadays, it’s impossible to solve things like that. We need to find new ways,” the priest said.