Prevention of Traumatic Brain Injury In Brazil – The Pense Bem (“Think Well”) Program of Brazilian Society of Neurosurgery

Each year in Brazil, about 50.000 people lose their lives and 150.000 become invalids due to road traffic accidents.  The cost for neurotrauma treatment and rehabilitation on both public and private Brazilian institutions reaches nearly $US2.8 billion dollars each year.

In 1995 the Brazilian Society of Neurosurgery (BSN) started an educational program for the prevention of neurotrauma (traumatic brain injury and spinal cord injury), adapted from the American model “Think First” for the Brazilian environment, with a special effort devoted to young people and children.

In the first decade of Pense Bem, the BSN tried to build a foundation to support the program without success. Isolated neurosurgeons tried to develop Pense Bem in their regions, but no systematic study was verified.

Between 2004 and 2006, “Pense Bem” was systematically implemented and its impact measured for the first time in Brazil, revealing the effectiveness of the program in reducing neurotrauma severity in traffic accidents through public education. It presented a standardized model of implementation in a developing country. A summary of the project entitled “Impact of a program for the prevention of traffic accidents in a Southern Brazilian city: a model for implementation in a developing country” was published in Surgical Neurology (2009;72:6-13; discussion 13-4).

Since 2006, Pense Bem has grown consistently in Brazil through the work of the Pense Bem team of neurosurgeons:
-  A video of Pense Bem, in partnership with a big private TV network, was televised in the main cities of the country (São Paulo and Rio de Janeiro)
-  A campaign, during the summer vacation, has taken place on the roads of Brazilian southeast region
-  Interactive educational material was designed targeting children between 10 and 14 in the National Fundamental Instruction.

In June 2010, led by BSN, “The first national week for prevention of neurotrauma/Pense Bem” took place in the 57 most important cities of the 49 urban agglomerations in Brazil. Our country has 49 urban agglomerations with 379 cities where 47% of population live. The targeted public was children in public and private schools of National Fundamental Instruction. The actions were performed by volunteer neurosurgeons. This was the first major step for dissemination of Pense Bem amidst children in Brazil.

After 2 years, the Brazilian Federal Government (BFG) decided to support programs for prevention of violence and trauma, especially concerning children and women. The link to achieve a public/private partnership between BFG and BSN was Pense Bem. From the public side, there was interest to provide funds for educational materials (videos, CDs, labels, banners, and educational leaflets) and for logistic organization. From the BSN side, there was the recent experience of Pense Bem diffusion in several Brazilian cities and the intention to spread it further amongst children between 10 and 14 years old in National Fundamental Instruction in all national territories.

BSN produced all institutional materials for the education targets of Pense Bem; the materials were distributed all over the country. A huge intervention has been performed by neurosurgeons and medical students under the coordination of BSN over the last ten years. Despite the logistic difficulties of gathering of data due to our large country, the number of children targeted by Pense Bem is about 15 to 20 per cent of all Brazilian children registered on National Fundamental Instruction, i.e. about 4 million children.

In conclusion, Pense Bem has been built step by step, with public and private collaboration. I hope this experience in Brazil may motivate neurosurgeons around the world to develop preventive strategies to deal with the huge public health and social problem of neurotrauma.

Cármine Porcelli Salvarani, MD
Pense Bem Coordinator 2006-2016

August 2022