à custa da primeira consulta pré-natal

05:36 May 22, 2009 

"at least for the first prenatal consultation" - There may have been a mistake in the original text.

00:06 May 21, 2009 

‘à custa’ according to Houaiss:

A.1 à(s) custa(s) de

1. às expensas de
Ex.: desempregado, vivia à c. do pai
2 . com sacrifício de
Ex.: deu um fim àquela situação, porém à c. de sua tranqüilidade

A.2. à custa de
m.q. por conta de

B. por conta de
1. em nome de; para deduzir de
Ex.: dê-me dois mil por c. do meu pagamento
2. por incumbência ou sob a responsabilidade de
Ex.: despediu-os por c. do diretor
3. mantido, financiado, sustentado por
Ex.: vive por c. do marido
4. a pretexto de
Ex.: por c. de sua doença não vai às reuniões de condomínio
5. por causa de
Ex.: p. conta da nova lei, os impostos serão aumentados

10:49 May 20, 2009 

I understand what you mean [if they don't go to the next consults, at least in the first they will have the high PNC coverage]. In my opinion, that way the sentence doesn't show them that they MUST go to the first consult. If for them it is complicated to go to this type of appointments, then it does make sense the "à custa de". It means that they have to go to the first consult to have that "high PNC coverage". I guess if you say "at least", you are settling to something that is below expectations. Sorry, this is only my opinion and what I understand of the sentence. I am sure you have another, "righter" perspective!! Have a nice day :)

07:43 May 20, 2009 

Thanks for all your suggestions. Having your advice is comforting. What would you think of:
"High PNC coverage **at least for** the first consultation"?

07:19 May 20, 2009 

I suggested something... I saw the sentence as a condition: they will have that coverage IF / as long as they attend that first consult.
In this way, it is a strength: they will have that full coverage as long as they just do this small thing that is coming for the first consult. Hope the suggestion and the discussion helps!

00:59 May 20, 2009 

I have had a few ‘experiences’ with the public healthcare system in Brazil, which seems to be the topic of your text. I worked in Marabá, PA (Projeto Rondon, last century) and currently, I live in the rural area in the hinterland of the state São Paulo where my neighbors, most of them ex-rural workers, are attended by the municipal healthcare system. What I’ve noticed is that medical care could be of higher standard, if professionals were better trained… And this is what I believe ‘à custa’ means in the text context, especially in the areas where malaria is endemic. CPN might attain high coverage only if the first prenatal visit is good enough to convince women to face tough trips to the healthcare center. That is, the first visit to the center is the key to have patients return to a second consultation.

20:47 May 19, 2009 

SWOT consists of 4 lists: strengths, weaknesses, opportunities, and threats. The items are supposed to be expressed in these terms.

20:43 May 19, 2009 

Later on the text cites the following WEAKNESS:
"Fraca mobilização da mulher grávida para pelo menos duas CPN". In other words, the do come for one visit (but not the second). How can that be stated as a STRENGTH?