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She waited for me in the meeting room, despite prior commitments that delayed me by half an hour. "The Professor is waiting for you over there," it was as if I had received a bouquet of flowers, unconventional, I know, but from the joy of the meeting, which I longed for, I greeted her with two kisses, instead of the handshake imposed on us by a certain social protocol.
"You know that the idea of working is something you can do anywhere. I did not waste my time, don't worry." In the hustle and bustle between the hectic schedule of new meetings and the discussion of how she should diplomatically manage a work matter, she did not dispense with her familiar gaze from one who knows how to see others on the inside. And yet, at no time does this look hurt whoever is observed by it.
Maria do Céu Machado, currently Chairwoman of Infarmed, is a Full Professor at the Faculty of Medicine of the University of Lisbon and Member of the National Council of Ethics for Life Sciences. She was High Commissioner for Health, Member of the School Council and Scientific Council of the Faculty of Medicine, Clinical Director of the North Lisbon Hospital Centre and Director of the Department of Paediatrics of Santa Maria. She had 8 Research Scholarships, 2 Bial Clinical Medicine Awards and the Amélia de Mello Quality Award. She has published 163 articles, 4 books and 667 scientific communications. Granted Grand Officer of the Order of Merit in 2010, she also received the Gold Medal from the Ministry of Health in 2012.
In a month in which we wanted to get to know the world of Paediatrics, the pretext for this was perfect.
As she told me of her childhood memories and how her two grandfathers made her connect with Medicine, I noticed the round gold wedding ring on her finger, that of her husband, João Lobo Antunes, who passed on in October 2016. Listening to her is like having a soft background melody that touches the most precious thing we have: affections. In the background, softly, Ennio Morricone sounded in my ears, with the soundtrack of Paradise Cinema, and I imagined Toto and his love for Alfredo, the "old man" who projected the forbidden scenes of the kisses of American films on screen, so I imagined a little Maria do Céu, full of worldly thirst.
Of the many afternoons she spent with the grandparents who lived at Guerra Junqueiro, she first learned to distinguish medicines when she was only five, when she began to read the names of the tablets that attempted to treat the heart of grandfather Armando. "I was spelling out syllables so I learned to read all those medicines."
But there was also grandfather Manuel, who told her his stories of medicine that influenced her from an early age. A Lieutenant-Colonel medic, he was taken prisoner in World War I (1914/1918), in the Battle of La Lys, with many other Portuguese officers in the battlefield at Rasttat, Germany. Each prisoner had a card that identified them, with the name, but luckily without a photograph. Lucky yes, because as someone no longer belonging to this time, he gave his word of honour that he would not run away and the card was proof of that. "My grandfather had given his word, and even when they were letting them go to the nearest village, the card remained in the field and no one fled. The value of one's word of honour! So do you know what they did? They exchanged the cards among themselves, and so, while my grandfather did not renege on his word, he managed to escape."
Although her parents had tried to convince her that a career in engineering was more appropriate than being a doctor, the obstinate teenager Maria do Céu at fourteen left them a note one night when they went out to dinner, "Mother, Father, I have already decided, I want to pursue Medicine." At the time her mother reinforced the error of the word, encouraging then that it was "medicine, if that is her will."
She laughed, relaxed as she told me the loose stories of her life. She let me know that we wouldn't have much more time to talk because she had commitments. I asked her if we could meet again. "Okay, but send me your questions and I'll think about them, will you?" I explained that I had no questions and that I just wanted to be a listener, I preferred to continue to know her spontaneous side of one who says exactly what she thinks and not what is conventional. I just dropped another topic on the table: Professor João Lobo Antunes.
Her bright eyes did not speak to me with sadness, they were only full of joy and a longing that time does not alleviate, a sign that there was still much love to live.
We got together once again, this time at Infarmed, where she has taken on the role of Chairwoman of the Drug Authority since May 2017. In an exceptionally tidy space with a vanilla aroma, at the back you can see a painting that even any layman of art knows belongs to Paula Rego. "João gave me that painting because I said that that figure with the stethoscope is me (the wolf), with authority over everyone else. She laughs while looking at the computer and tells me that she receives an average of 300 e-mails per day and that a great deal of these entails opening file attachments, with long texts, and then she examines them. On top of the table, there is a photograph of Pope Benedict XVI, the only photograph that she has.
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I feel uncertain that I chose the right chair. She sits opposite me, "you did well to sit there, because this is usually my chair." When I ask her why she doesn't choose the chairs at the head of the table, she explains to me that she rarely likes to use them and that she usually gives them to the vice president, or executives, "it is less formal and everyone is more at ease."
And she was right.
She identifies herself as being "a schoolgirl." She studied at the "Sagrado Coração de Maria" (Sacred Heart of Mary), for eleven years, doing the 11th and 12th years at the Dona Filipa de Lencastre High School (current Secondary School). "I went to Filipa because at school I started doing exactly the opposite of what the sisters demanded, such as wearing tights, which was prohibited, and at fifteen we want to assert ourselves.
Always a good student, she joined the Faculty of Medicine of the University of Lisbon in 1966. Of the 700 students that entered that year, only 270 made it to the end. It was the lack of numerus clausus that allowed them all to enter, but natural selection took place in the first year, when they met the famous Chair of Anatomy, who, incidentally would accompany her as her Monitor, sometime later. She belonged to a golden year of Medicine where she made friends that she still meets today and dines with every 5 years. Eduardo Barroso (Medical surgeon), Francisco George (former Director-General of Health), Álvaro Carvalho (Psychiatrist and one of those responsible for the Mental Health Programme), José Gameiro (Psychiatrist), Benedita Barata da Rocha (Immunologist and research director of the French National Scientific Research Centre), António Rendas (former Dean at Nova), Luis Novais (Gastroenterologist), and Francisco Abecassis (Radiologist) are some of her friends that still remain to this day. "We were very united and cohesive. Can you believe that, in practical classes, by the sixth year, we were sixty students? I'm recalling a surgery class with Prof. Granate, and a patient on a stretcher in the middle of more than sixty students. We went on strike from classes, asking that they spread these practical classes across two semesters at least, and we succeeded."
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At that time, were students more proactive politically and socially?
Maria do Céu: It was different. Students now join the School and Pedagogical Board and are regularly heard. The current Student Association does a fantastic job of being proactive. At that time, we only had a course delegate, and there was a lot of solidarity amongst us. This is the group that remains cohesive and that meets for dinner. Now we are less happy because we're older. (She laughed)
Maria do Céu Machado is one of the few doctors who cover various places, alternating between Ministry and Hospital, never staying only limited to the hospital where she was trained. "We shouldn't be an opportunist, but we must make the most of opportunities and I was lucky in life and always liked being challenged."
Still in the 6th of the study programme, she decided that she wanted to get married. "I went to tell my father, who was really angry. I was his only daughter and I was always provoking him."
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But you got married?
Maria do Céu: I got married. But I made a bet with him, on the day after the wedding I promised that I would take an exam. And so I did. Wedding at 5pm, with 200 guests, the most nervous family and me studying Psychiatry. To tell you the truth, I didn't get a very good mark, but I did the exam.
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Do you mean to say that you never disregarded your professional life, even while getting married quite young?
Maria do Céu: I got married at 22, had a daughter at 23 and another at 24. They were difficult times to reconcile between personal life and professional life.
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When your daughters appeared, what implications did they have on your professional life?
Maria do Céu: The year after getting married, I started an internship in clinical practice, the current general internship, and my first child was born in April of 1973. At that time, doctors didn't get maternity leave or a single day of family support. So what we did was present a certificate of illness, up to a maximum of 30 days a year. At the end of two weeks, I was working and doing 24h emergencies, and was taking my daughter to my mother's house, who had a nanny who had already "raised" me and my brother. I should have asked for a couple of months of retroactive leave, since I'm no less of a mother than the others. (she laughs).
In 1975, a very revolutionary and proactive group from our study programme, understanding that access to healthcare outside major centres was sorely lacking (there wasn't a network of Healthcare Centres or a National Health Service), promoted, together with the Secretary of State, what would later be known as the Medical Service to the Periphery. We were distributed nationwide. Those who had small children, like me, would stay closer to Lisbon. I chose to stay in the area of Benavente, Coruche and Salvaterra de Magos. When we got there, you can't imagine the differences we saw: in Salvaterra alone, there was only one doctor, who told us that we only had to go once a week to fulfil the emergency hours. We, with such revolutionary spirit (the "Hot Summer of 1975"), wanted to treat the population and always with the complete timetable and physical presence. People weren't used to being monitored. In an appointment, I asked a gentleman who complained about a cough to lift his shirt up so I could hear his breathing and heartbeat, and he nervously asked: Can I come back tomorrow so I can take a bath and wear a clean shirt??
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But after that period?
Maria do Céu: We took the speciality admission test and I had an opening in Paediatrics, which was exactly what I wanted. I still ended up doing surgery, but with two small daughters I understood that it meant not having the time to be a mother.
In the general internship, I had been placed at Curry Cabral Hospital, whose Director of the Paediatric Ward (infectious diseases) was José Mateus Marques. The service meetings were on Wednesday mornings and Saturday evenings; everyone went, nobody skipped or protested these timetables, which would nowadays be unthinkable. It was an extraordinary clinic, there was a cholera epidemic and another one of diptheria and there were many children, so many that we left them on the floor, and with the smallest ones, we took the office drawers and put them inside, with a small blanket and with milk; thus, the drawers served as cribs. We went through terrible times there. But Mateus Marques was so fantastic that our group (we were 6) all chose the Paediatrics speciality.
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Maria do Céu was always saying that she only wanted to be "a happy Paediatrician," but life was posing her challenges that would make her much more than a carer for the little ones. But that would be later. Now, convinced of her path, she submitted herself to the necessary tests and was placed at Estefânia, between 1976 and 1983.
She said that she never had a connection to new-borns, as she always preferred teenagers, having recently written a book about them: "Adolescentes." But for a few years, teenagers wouldn't be the focus of her studies, or in her clinical practice. A fighter and always willing to evolve to new levels, even if the path wasn't a straight line, she applied to the Alfredo da Costa Maternity. The public exams included a "face test," which meant making records, observing the child, and in front of a panel, without notes, having clinical discussion and giving therapeutic guidance. Of the thirty-three applicants, it was Paediatrician Maria do Céu who came in first place. She was at the Maternity for 13 years, where she pursued her PhD at the Nova University (where she was Assistant), on "Malformative Uropathy" in pre-natal diagnoses, that is, on the babies that were born with kidney and urinary tract problems. In that period, she interned in Cambridge and London, in pre-natal diagnoses and intensive care of new-borns.
A new phase of her life started in 1996. The Amadora-Sintra Hospital, despite being a public hospital, was managed by a private group (the José de Mello Health Group) and at that time they were looking for the right person to head the Paediatric department. "The hospital was completely new, the Paediatrics department was enormous and, after accepting the invite, they told me to submit a human resources, equipment and organisation plan in record time. I chose my heads of service: Gonçalo Cordeiro Ferreira (Paediatrics), Helena Carreiro (Neonatology) and Paulo Casela (Paediatric Surgery). We started in March and opened on June 1, with a paediatric emergency room, two intensive care units, one for neonatal care alone, the infirmary, and we had more than 90 beds in all."
Because it was a private group, it didn't need to be governed by public tenders, making the exact choices and justifying purchasing decisions like a manager that drives a business that exists to make profit. The profile of manager, which characterises her so well, was inherited from her time at the Maternity, where she decided to do a course backed by the European Union, "to be a manager is a mix of Psychology and Mathematics."
At her new hospital, she conducted an exhaustive analysis on the pathologies of the paediatric population of that area and evaluated the need for an adequate response. "You cannot imagine how the absence of bureaucracy avoids waste."
She stayed for 11 years with the Mello Group, which she summarised as an "extraordinary time, and one of great learning." The optimisation of human resources and techniques provided Maria do Céu Machado with macro vision that helped to strengthen Medicine. She served as Clinical Director between 2015 and 2016, always with Amadora-Sintra with private management, but the first turbulence began to appear, with winds of change sweeping through the Hospital. It was then that she received the invite from then-Minister of Health, Luís Filipe Pereira, to be Chairwoman of the National Child and Teenage Health Commission. She accepted and developed various initiatives in conjunction with the Ministry's institutions. Already with the successor in the Health Ministry, Minister António Correia de Campos, she was invited to serve as High Commissioner of Health, a post she first held in November 2006, thus accepting another challenge. "I asked the Minister what this position entailed, and he responded that it was a kind of Big Brother for Health, because it was necessary to coordinate the National Health Plan and the various entities involved."
She was responsible for planning strategies, covering very different areas, such as mental illnesses, AIDS, cancers and heart diseases, as well as international areas: European Union, World Health Organisation and Cooperation and Development. From the microenvironment of the hospital, she crossed over to the global scale. "It was a brutal change that I wasn't used to. I had a tough time with it, but from the Public Health standpoint, it was as if I were doing a new speciality.
She received a new invitation from Adalberto Campos Fernandes (then-Chairman of CHLN's Board of Directors), and then after four and a half years as High Commissioner, she returned to Santa Maria, where she says, "she had come full circle after such a long time."
The return to Santa Maria and to Paediatrics, however, was not easy. Thirty-eight years later, she was aware of the closed and conservative environment and of the difference between the worlds she had travelled through. "The Department at Santa Maria is great and the people are very special and competent, but they were used to a Director that was chosen internally and someone from outside was hard to for them accept."
Too entrepreneurial to not create change wherever she goes, she managed to have refurbishing work done in Paediatrics and to improve some units, with other done at various Services, giving them greater responsibility. For all this, she drew up a three-year plan. Once again, it involved all the people under her management. While being demanding, she still enjoys seeing her teams feel satisfied and useful but expects the same commitment from them. From the balance between the private experience and then the public one, she says that the major challenge was that "in the public sector, everyone tries not to comply, even if they agree with the policies undertaken, but it's a way of being that has been internalised."
She has gone through all levels of teaching, saying that she loves the role of Teacher because she needs to get to know the younger people, "because of the drive and because they are increasingly demanding and eager for knowledge." She ended up reaching the top with the aggregation tests, becoming Full Invited Professor at the Faculty. At that point, she was already Clinical Director of Santa Maria, between February 2013 and September 2014.
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What were these two years as Clinical Director like?
Maria do Céu: It was very difficult because Santa Maria is a large university hospital that is complicated to manage. I often heard this: "it's been like this for thirty years, why change it now?" It seems that some customs have become habits. An example of this includes stretchers in the internment corridors! I had very good assistants, established the regular Clinical Board with all services the directors and in which I made them aware of the strategic evolution that was required of us, to control the Hospital's debt. I listened to the complaints and problems. I'm going to tell you a secret (she laughs). João (Lobo Antunes) was very nervous in the first meetings at my Clinical Directorate. He said, "you're going to be there in front of forty directors, they're going to kill you and I'm going to have to stand up for you." And I laughed and guaranteed that I had the experience to run the more complicated meetings. I served at the Portuguese Medical Association and I ran for Chairwoman but, luckily (!) I lost. But the Clinical Board went well because we only wanted to uphold the good name of the hospital and the Faculty and it was useful, for whoever directed the services, to know what was happening and to be able to speak about their problems which were often transversal to everyone.
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Do you make enemies when implementing such changes?
Maria do Ceú: Of course, but not many, only some. Power is said to be isolating. Those with power and wanting to change something can't give in to pressures and that's not easy.
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She was letting out some of the details of her personal life. She told me that she had a very conservative family. Was it difficult to go through a divorce?
Maria do Céu: It was difficult. When you have children, it is always much more difficult, but we went through the empty nest syndrome. I would always tell my daughters that the bed, table and clean laundry were only up to age 25, and , it's funny, because they both got married at 25. Then I was a grandmother from 2000 onwards. Now I do some lovely theatre with my 7 grandchildren (she showed me a Christmas video with all the grandchildren, where they recreated the birth of Jesus) and I took my oldest grandchildren to London to take an English course, we went to a pub and everything. But looking back, I got married very young (which I don't regret) and after 28 years of marriage, and with the kids away, I found it difficult to continue. Afterwards, I was re-married fifteen years to a very interesting person, but with a special temper. And they were fantastic years of companionship... We travelled a lot, toured a lot.
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Some time ago I read an interview with one of Professor Lobo Antunes' daughters and she said that everyone asks her to speak about her father, but that recalling him causes in her a sense of longing and is an invasion of her feelings. Do I have the right to ask you to recall it and tell me about it?
Maria do Céu: (It's the first time she closes her expression) There were some months where it was very difficult to talk about it. The image that I had was the final image, sick and I was also unable to listen to music. Now I listen to music and have fond memories. He was very precise, with a fabulous memory. He read really quickly and quoted, knowing which book and the exact page. He was incredibly knowledgeable.
We worked a lot, but always had our formal dinner at home. We spent hours talking about everything, I remember and miss it a lot. We laughed a lot, he had a great sense of humour. We travelled a lot, we toured the world. I forced him to ride a bicycle in Vietnam, through the rice paddy fields. I told him that only then would we get to know their culture and we were invited to enter some houses, as they are such a sweet people. We also went to the Quirimbas Islands, in Mozambique, the best beach in the world; we went to Brazil on numerous occasions and rode horses. We went on several safaris, in South Africa and Tanzania. Those who got to know him couldn't imagine everything that we did, but I have photographs to prove it! (She laughs)
Long before he got ill, he told me: "we have to make the most of it, since we don't have a lot of time. Incredible, isn't it? And we had time for family, his four kids and my two and then we got grandchildren competing with each other, but he beat me because he had nine grandchildren and I had seven. (She laughs)
And you have some daughters with a strong personality, because one of them said to you, on a day when everything seemed to be going wrong, that if you didn't feel sorry for yourself you would be able to solve all the problems.
Maria do Céu: It's true. My eldest daughter was eighteen and we decided to give her a dog. The maid, when she saw the dog (who had diarrhoea), quit. That day there was dinner for the whole family and I had work to submit the next day, with handwritten notes (different times). When the youngest (16) arrived, I was drenched in tears, because everything was going wrong and she told me "if you didn't feel sorry for yourself, you'd be organising yourself and getting everything done." And I've never ever forgotten that. I remember the advice and organise myself. That day, there was dinner, I finished work and the dog stayed there.
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Perhaps alone in the professional role that she occupies, she knows that she has to decide for herself, whether or not she makes friends. She has two Epagnaul Bretons that she walks at the end of the day. Sometimes, she gets her grandchildren together, writes a script and makes films. Accompanied by memories, she draws on them through the music of Bach, one of her husband's favourite composers, and through photographs. These are all the ways that continue to keep her company when she "needs" her husband João.
On the meeting table in her Infarmed office, I noticed the book, Cronicas de Vida y de Muerte Memorias de Un Neurocirujano , by João Lobo Antunes. The book is the compilation of his best essays on ways to confront death. Maybe because it was intrusive, maybe because I hadn't read it, I didn't open the book.
Despite not being on top of that table, I know that the last book by João Lobo Antunes, Ouvir com Outros Olhos, has a message of gratitude that repays company and love which don't die: "to Maria do Céu, who made me better, when I thought that I was a finished work."
Maria do Céu Machado is an unforgettable woman that you don't want to stop listening to, like a symphony played live, only once.
In October 2019 she will turn 70. She hopes to say goodbye to the role of Full Professor and give her last class at the Faculty of Medicine. It will be difficult to stop there because the energy that moves her has not yet run out of plans.
The daughter was right: with little self-pity, Maria do Céu Machado doesn't have time to waste on regrets. There is still something to do.
So be it.
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Joana Sousa
Editorial Team
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She waited for me in the meeting room, despite prior commitments that delayed me by half an hour. "The Professor is waiting for you over there," it was as if I had received a bouquet of flowers, unconventional, I know, but from the joy of the meeting, which I longed for, I greeted her with two kisses, instead of the handshake imposed on us by a certain social protocol.
"You know that the idea of working is something you can do anywhere. I did not waste my time, don't worry." In the hustle and bustle between the hectic schedule of new meetings and the discussion of how she should diplomatically manage a work matter, she did not dispense with her familiar gaze from one who knows how to see others on the inside. And yet, at no time does this look hurt whoever is observed by it.
Maria do Céu Machado, currently Chairwoman of Infarmed, is a Full Professor at the Faculty of Medicine of the University of Lisbon and Member of the National Council of Ethics for Life Sciences. She was High Commissioner for Health, Member of the School Council and Scientific Council of the Faculty of Medicine, Clinical Director of the North Lisbon Hospital Centre and Director of the Department of Paediatrics of Santa Maria. She had 8 Research Scholarships, 2 Bial Clinical Medicine Awards and the Amélia de Mello Quality Award. She has published 163 articles, 4 books and 667 scientific communications. Granted Grand Officer of the Order of Merit in 2010, she also received the Gold Medal from the Ministry of Health in 2012.
In a month in which we wanted to get to know the world of Paediatrics, the pretext for this was perfect.
As she told me of her childhood memories and how her two grandfathers made her connect with Medicine, I noticed the round gold wedding ring on her finger, that of her husband, João Lobo Antunes, who passed on in October 2016. Listening to her is like having a soft background melody that touches the most precious thing we have: affections. In the background, softly, Ennio Morricone sounded in my ears, with the soundtrack of Paradise Cinema, and I imagined Toto and his love for Alfredo, the "old man" who projected the forbidden scenes of the kisses of American films on screen, so I imagined a little Maria do Céu, full of worldly thirst.
Of the many afternoons she spent with the grandparents who lived at Guerra Junqueiro, she first learned to distinguish medicines when she was only five, when she began to read the names of the tablets that attempted to treat the heart of grandfather Armando. "I was spelling out syllables so I learned to read all those medicines."
But there was also grandfather Manuel, who told her his stories of medicine that influenced her from an early age. A Lieutenant-Colonel medic, he was taken prisoner in World War I (1914/1918), in the Battle of La Lys, with many other Portuguese officers in the battlefield at Rasttat, Germany. Each prisoner had a card that identified them, with the name, but luckily without a photograph. Lucky yes, because as someone no longer belonging to this time, he gave his word of honour that he would not run away and the card was proof of that. "My grandfather had given his word, and even when they were letting them go to the nearest village, the card remained in the field and no one fled. The value of one's word of honour! So do you know what they did? They exchanged the cards among themselves, and so, while my grandfather did not renege on his word, he managed to escape."
Although her parents had tried to convince her that a career in engineering was more appropriate than being a doctor, the obstinate teenager Maria do Céu at fourteen left them a note one night when they went out to dinner, "Mother, Father, I have already decided, I want to pursue Medicine." At the time her mother reinforced the error of the word, encouraging then that it was "medicine, if that is her will."
She laughed, relaxed as she told me the loose stories of her life. She let me know that we wouldn't have much more time to talk because she had commitments. I asked her if we could meet again. "Okay, but send me your questions and I'll think about them, will you?" I explained that I had no questions and that I just wanted to be a listener, I preferred to continue to know her spontaneous side of one who says exactly what she thinks and not what is conventional. I just dropped another topic on the table: Professor João Lobo Antunes.
Her bright eyes did not speak to me with sadness, they were only full of joy and a longing that time does not alleviate, a sign that there was still much love to live.
We got together once again, this time at Infarmed, where she has taken on the role of Chairwoman of the Drug Authority since May 2017. In an exceptionally tidy space with a vanilla aroma, at the back you can see a painting that even any layman of art knows belongs to Paula Rego. "João gave me that painting because I said that that figure with the stethoscope is me (the wolf), with authority over everyone else. She laughs while looking at the computer and tells me that she receives an average of 300 e-mails per day and that a great deal of these entails opening file attachments, with long texts, and then she examines them. On top of the table, there is a photograph of Pope Benedict XVI, the only photograph that she has.
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I feel uncertain that I chose the right chair. She sits opposite me, "you did well to sit there, because this is usually my chair." When I ask her why she doesn't choose the chairs at the head of the table, she explains to me that she rarely likes to use them and that she usually gives them to the vice president, or executives, "it is less formal and everyone is more at ease."
And she was right.
She identifies herself as being "a schoolgirl." She studied at the "Sagrado Coração de Maria" (Sacred Heart of Mary), for eleven years, doing the 11th and 12th years at the Dona Filipa de Lencastre High School (current Secondary School). "I went to Filipa because at school I started doing exactly the opposite of what the sisters demanded, such as wearing tights, which was prohibited, and at fifteen we want to assert ourselves.
Always a good student, she joined the Faculty of Medicine of the University of Lisbon in 1966. Of the 700 students that entered that year, only 270 made it to the end. It was the lack of numerus clausus that allowed them all to enter, but natural selection took place in the first year, when they met the famous Chair of Anatomy, who, incidentally would accompany her as her Monitor, sometime later. She belonged to a golden year of Medicine where she made friends that she still meets today and dines with every 5 years. Eduardo Barroso (Medical surgeon), Francisco George (former Director-General of Health), Álvaro Carvalho (Psychiatrist and one of those responsible for the Mental Health Programme), José Gameiro (Psychiatrist), Benedita Barata da Rocha (Immunologist and research director of the French National Scientific Research Centre), António Rendas (former Dean at Nova), Luis Novais (Gastroenterologist), and Francisco Abecassis (Radiologist) are some of her friends that still remain to this day. "We were very united and cohesive. Can you believe that, in practical classes, by the sixth year, we were sixty students? I'm recalling a surgery class with Prof. Granate, and a patient on a stretcher in the middle of more than sixty students. We went on strike from classes, asking that they spread these practical classes across two semesters at least, and we succeeded."
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At that time, were students more proactive politically and socially?
Maria do Céu: It was different. Students now join the School and Pedagogical Board and are regularly heard. The current Student Association does a fantastic job of being proactive. At that time, we only had a course delegate, and there was a lot of solidarity amongst us. This is the group that remains cohesive and that meets for dinner. Now we are less happy because we're older. (She laughed)
Maria do Céu Machado is one of the few doctors who cover various places, alternating between Ministry and Hospital, never staying only limited to the hospital where she was trained. "We shouldn't be an opportunist, but we must make the most of opportunities and I was lucky in life and always liked being challenged."
Still in the 6th of the study programme, she decided that she wanted to get married. "I went to tell my father, who was really angry. I was his only daughter and I was always provoking him."
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But you got married?
Maria do Céu: I got married. But I made a bet with him, on the day after the wedding I promised that I would take an exam. And so I did. Wedding at 5pm, with 200 guests, the most nervous family and me studying Psychiatry. To tell you the truth, I didn't get a very good mark, but I did the exam.
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Do you mean to say that you never disregarded your professional life, even while getting married quite young?
Maria do Céu: I got married at 22, had a daughter at 23 and another at 24. They were difficult times to reconcile between personal life and professional life.
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When your daughters appeared, what implications did they have on your professional life?
Maria do Céu: The year after getting married, I started an internship in clinical practice, the current general internship, and my first child was born in April of 1973. At that time, doctors didn't get maternity leave or a single day of family support. So what we did was present a certificate of illness, up to a maximum of 30 days a year. At the end of two weeks, I was working and doing 24h emergencies, and was taking my daughter to my mother's house, who had a nanny who had already "raised" me and my brother. I should have asked for a couple of months of retroactive leave, since I'm no less of a mother than the others. (she laughs).
In 1975, a very revolutionary and proactive group from our study programme, understanding that access to healthcare outside major centres was sorely lacking (there wasn't a network of Healthcare Centres or a National Health Service), promoted, together with the Secretary of State, what would later be known as the Medical Service to the Periphery. We were distributed nationwide. Those who had small children, like me, would stay closer to Lisbon. I chose to stay in the area of Benavente, Coruche and Salvaterra de Magos. When we got there, you can't imagine the differences we saw: in Salvaterra alone, there was only one doctor, who told us that we only had to go once a week to fulfil the emergency hours. We, with such revolutionary spirit (the "Hot Summer of 1975"), wanted to treat the population and always with the complete timetable and physical presence. People weren't used to being monitored. In an appointment, I asked a gentleman who complained about a cough to lift his shirt up so I could hear his breathing and heartbeat, and he nervously asked: Can I come back tomorrow so I can take a bath and wear a clean shirt??
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But after that period?
Maria do Céu: We took the speciality admission test and I had an opening in Paediatrics, which was exactly what I wanted. I still ended up doing surgery, but with two small daughters I understood that it meant not having the time to be a mother.
In the general internship, I had been placed at Curry Cabral Hospital, whose Director of the Paediatric Ward (infectious diseases) was José Mateus Marques. The service meetings were on Wednesday mornings and Saturday evenings; everyone went, nobody skipped or protested these timetables, which would nowadays be unthinkable. It was an extraordinary clinic, there was a cholera epidemic and another one of diptheria and there were many children, so many that we left them on the floor, and with the smallest ones, we took the office drawers and put them inside, with a small blanket and with milk; thus, the drawers served as cribs. We went through terrible times there. But Mateus Marques was so fantastic that our group (we were 6) all chose the Paediatrics speciality.
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Maria do Céu was always saying that she only wanted to be "a happy Paediatrician," but life was posing her challenges that would make her much more than a carer for the little ones. But that would be later. Now, convinced of her path, she submitted herself to the necessary tests and was placed at Estefânia, between 1976 and 1983.
She said that she never had a connection to new-borns, as she always preferred teenagers, having recently written a book about them: "Adolescentes." But for a few years, teenagers wouldn't be the focus of her studies, or in her clinical practice. A fighter and always willing to evolve to new levels, even if the path wasn't a straight line, she applied to the Alfredo da Costa Maternity. The public exams included a "face test," which meant making records, observing the child, and in front of a panel, without notes, having clinical discussion and giving therapeutic guidance. Of the thirty-three applicants, it was Paediatrician Maria do Céu who came in first place. She was at the Maternity for 13 years, where she pursued her PhD at the Nova University (where she was Assistant), on "Malformative Uropathy" in pre-natal diagnoses, that is, on the babies that were born with kidney and urinary tract problems. In that period, she interned in Cambridge and London, in pre-natal diagnoses and intensive care of new-borns.
A new phase of her life started in 1996. The Amadora-Sintra Hospital, despite being a public hospital, was managed by a private group (the José de Mello Health Group) and at that time they were looking for the right person to head the Paediatric department. "The hospital was completely new, the Paediatrics department was enormous and, after accepting the invite, they told me to submit a human resources, equipment and organisation plan in record time. I chose my heads of service: Gonçalo Cordeiro Ferreira (Paediatrics), Helena Carreiro (Neonatology) and Paulo Casela (Paediatric Surgery). We started in March and opened on June 1, with a paediatric emergency room, two intensive care units, one for neonatal care alone, the infirmary, and we had more than 90 beds in all."
Because it was a private group, it didn't need to be governed by public tenders, making the exact choices and justifying purchasing decisions like a manager that drives a business that exists to make profit. The profile of manager, which characterises her so well, was inherited from her time at the Maternity, where she decided to do a course backed by the European Union, "to be a manager is a mix of Psychology and Mathematics."
At her new hospital, she conducted an exhaustive analysis on the pathologies of the paediatric population of that area and evaluated the need for an adequate response. "You cannot imagine how the absence of bureaucracy avoids waste."
She stayed for 11 years with the Mello Group, which she summarised as an "extraordinary time, and one of great learning." The optimisation of human resources and techniques provided Maria do Céu Machado with macro vision that helped to strengthen Medicine. She served as Clinical Director between 2015 and 2016, always with Amadora-Sintra with private management, but the first turbulence began to appear, with winds of change sweeping through the Hospital. It was then that she received the invite from then-Minister of Health, Luís Filipe Pereira, to be Chairwoman of the National Child and Teenage Health Commission. She accepted and developed various initiatives in conjunction with the Ministry's institutions. Already with the successor in the Health Ministry, Minister António Correia de Campos, she was invited to serve as High Commissioner of Health, a post she first held in November 2006, thus accepting another challenge. "I asked the Minister what this position entailed, and he responded that it was a kind of Big Brother for Health, because it was necessary to coordinate the National Health Plan and the various entities involved."
She was responsible for planning strategies, covering very different areas, such as mental illnesses, AIDS, cancers and heart diseases, as well as international areas: European Union, World Health Organisation and Cooperation and Development. From the microenvironment of the hospital, she crossed over to the global scale. "It was a brutal change that I wasn't used to. I had a tough time with it, but from the Public Health standpoint, it was as if I were doing a new speciality.
She received a new invitation from Adalberto Campos Fernandes (then-Chairman of CHLN's Board of Directors), and then after four and a half years as High Commissioner, she returned to Santa Maria, where she says, "she had come full circle after such a long time."
The return to Santa Maria and to Paediatrics, however, was not easy. Thirty-eight years later, she was aware of the closed and conservative environment and of the difference between the worlds she had travelled through. "The Department at Santa Maria is great and the people are very special and competent, but they were used to a Director that was chosen internally and someone from outside was hard to for them accept."
Too entrepreneurial to not create change wherever she goes, she managed to have refurbishing work done in Paediatrics and to improve some units, with other done at various Services, giving them greater responsibility. For all this, she drew up a three-year plan. Once again, it involved all the people under her management. While being demanding, she still enjoys seeing her teams feel satisfied and useful but expects the same commitment from them. From the balance between the private experience and then the public one, she says that the major challenge was that "in the public sector, everyone tries not to comply, even if they agree with the policies undertaken, but it's a way of being that has been internalised."
She has gone through all levels of teaching, saying that she loves the role of Teacher because she needs to get to know the younger people, "because of the drive and because they are increasingly demanding and eager for knowledge." She ended up reaching the top with the aggregation tests, becoming Full Invited Professor at the Faculty. At that point, she was already Clinical Director of Santa Maria, between February 2013 and September 2014.
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What were these two years as Clinical Director like?
Maria do Céu: It was very difficult because Santa Maria is a large university hospital that is complicated to manage. I often heard this: "it's been like this for thirty years, why change it now?" It seems that some customs have become habits. An example of this includes stretchers in the internment corridors! I had very good assistants, established the regular Clinical Board with all services the directors and in which I made them aware of the strategic evolution that was required of us, to control the Hospital's debt. I listened to the complaints and problems. I'm going to tell you a secret (she laughs). João (Lobo Antunes) was very nervous in the first meetings at my Clinical Directorate. He said, "you're going to be there in front of forty directors, they're going to kill you and I'm going to have to stand up for you." And I laughed and guaranteed that I had the experience to run the more complicated meetings. I served at the Portuguese Medical Association and I ran for Chairwoman but, luckily (!) I lost. But the Clinical Board went well because we only wanted to uphold the good name of the hospital and the Faculty and it was useful, for whoever directed the services, to know what was happening and to be able to speak about their problems which were often transversal to everyone.
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Do you make enemies when implementing such changes?
Maria do Ceú: Of course, but not many, only some. Power is said to be isolating. Those with power and wanting to change something can't give in to pressures and that's not easy.
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She was letting out some of the details of her personal life. She told me that she had a very conservative family. Was it difficult to go through a divorce?
Maria do Céu: It was difficult. When you have children, it is always much more difficult, but we went through the empty nest syndrome. I would always tell my daughters that the bed, table and clean laundry were only up to age 25, and , it's funny, because they both got married at 25. Then I was a grandmother from 2000 onwards. Now I do some lovely theatre with my 7 grandchildren (she showed me a Christmas video with all the grandchildren, where they recreated the birth of Jesus) and I took my oldest grandchildren to London to take an English course, we went to a pub and everything. But looking back, I got married very young (which I don't regret) and after 28 years of marriage, and with the kids away, I found it difficult to continue. Afterwards, I was re-married fifteen years to a very interesting person, but with a special temper. And they were fantastic years of companionship... We travelled a lot, toured a lot.
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Some time ago I read an interview with one of Professor Lobo Antunes' daughters and she said that everyone asks her to speak about her father, but that recalling him causes in her a sense of longing and is an invasion of her feelings. Do I have the right to ask you to recall it and tell me about it?
Maria do Céu: (It's the first time she closes her expression) There were some months where it was very difficult to talk about it. The image that I had was the final image, sick and I was also unable to listen to music. Now I listen to music and have fond memories. He was very precise, with a fabulous memory. He read really quickly and quoted, knowing which book and the exact page. He was incredibly knowledgeable.
We worked a lot, but always had our formal dinner at home. We spent hours talking about everything, I remember and miss it a lot. We laughed a lot, he had a great sense of humour. We travelled a lot, we toured the world. I forced him to ride a bicycle in Vietnam, through the rice paddy fields. I told him that only then would we get to know their culture and we were invited to enter some houses, as they are such a sweet people. We also went to the Quirimbas Islands, in Mozambique, the best beach in the world; we went to Brazil on numerous occasions and rode horses. We went on several safaris, in South Africa and Tanzania. Those who got to know him couldn't imagine everything that we did, but I have photographs to prove it! (She laughs)
Long before he got ill, he told me: "we have to make the most of it, since we don't have a lot of time. Incredible, isn't it? And we had time for family, his four kids and my two and then we got grandchildren competing with each other, but he beat me because he had nine grandchildren and I had seven. (She laughs)
And you have some daughters with a strong personality, because one of them said to you, on a day when everything seemed to be going wrong, that if you didn't feel sorry for yourself you would be able to solve all the problems.
Maria do Céu: It's true. My eldest daughter was eighteen and we decided to give her a dog. The maid, when she saw the dog (who had diarrhoea), quit. That day there was dinner for the whole family and I had work to submit the next day, with handwritten notes (different times). When the youngest (16) arrived, I was drenched in tears, because everything was going wrong and she told me "if you didn't feel sorry for yourself, you'd be organising yourself and getting everything done." And I've never ever forgotten that. I remember the advice and organise myself. That day, there was dinner, I finished work and the dog stayed there.
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Perhaps alone in the professional role that she occupies, she knows that she has to decide for herself, whether or not she makes friends. She has two Epagnaul Bretons that she walks at the end of the day. Sometimes, she gets her grandchildren together, writes a script and makes films. Accompanied by memories, she draws on them through the music of Bach, one of her husband's favourite composers, and through photographs. These are all the ways that continue to keep her company when she "needs" her husband João.
On the meeting table in her Infarmed office, I noticed the book, Cronicas de Vida y de Muerte Memorias de Un Neurocirujano , by João Lobo Antunes. The book is the compilation of his best essays on ways to confront death. Maybe because it was intrusive, maybe because I hadn't read it, I didn't open the book.
Despite not being on top of that table, I know that the last book by João Lobo Antunes, Ouvir com Outros Olhos, has a message of gratitude that repays company and love which don't die: "to Maria do Céu, who made me better, when I thought that I was a finished work."
Maria do Céu Machado is an unforgettable woman that you don't want to stop listening to, like a symphony played live, only once.
In October 2019 she will turn 70. She hopes to say goodbye to the role of Full Professor and give her last class at the Faculty of Medicine. It will be difficult to stop there because the energy that moves her has not yet run out of plans.
The daughter was right: with little self-pity, Maria do Céu Machado doesn't have time to waste on regrets. There is still something to do.
So be it.
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Joana Sousa
Editorial Team
