Zika, protagonismo feminino e cuidado: ensaiando zonas de contato

[Primary care in the context of the Zika epidemic and congenital Zika syndrome in the state of Pernambuco, Brazil: context, bond and care]

The Zika epidemic brought to the fore the birth of children with unknown and unexpected needs that demand longitudinal follow-up, strengthening the bond, comprehensiveness and coordination of care in health, which are essential attributes of primary health care (PHC). This article aims to evaluate the orientation of PHC care, using the PCATool-Brasil. The data were collected between 2016 and 2019, by means of interviews with parents of children who were born in a public maternity hospital in Recife (state of Pernambuco) between October 2015 and February 2016, a critical period of the microcephaly outbreak, especially in the Northeast of Brazil. The parents of 109 children participated in the survey, 15.6% of which had a confirmed microcephaly diagnosis. The degree of affiliation and access was sufficient, but the aspects of coordination of care, longitudinality, comprehensiveness, family and community orientation were insufficient. In the context of congenital Zika syndrome, these attributes are essential for the care of children and families. The fostering of health from these domains depends on the orientation of the models of care and their management with state and federal investments. The defense of life depends on the ability to place life above all other rationalities.

Stigmas of congenital Zika syndrome: family perspectives

This article uses a socio-anthropological framework to explore the stigmas around interactions with children born with congenital Zika syndrome caused by the Zika virus epidemic in two Brazilian municipalities. Semi-structured interviews were conducted with parents and other relatives. We reflected on the search for meaning when having a baby with unexpected body marks, the moral suffering, the societal ableism, the burden of care, and the need for support networks. We concluded that public policies, especially social policies (health, education, and social assistance), are essential for compensatory mechanisms, recognition, and social inclusion of these children and their families.

Abortion in the times of Zika: the perspective of women in two Brazilian municipalities

In Brazil, abortion is considered a crime under the Criminal Code since 1940. After the Zika virus epidemic (2015-2017) and the consequent appearance of microcephaly in newborns struck South America, the debate on the decriminalization of abortion in the Brazilian society was reignited. Using data obtained from focus groups comprising women of reproductive age across different socioeconomic strata and two Brazilian cities, we investigated the perceptions of the participants on abortion, especially its use during the Zika epidemic. Although legally criminalized, abortion is prevalent among women, as a way to fulfill their reproductive desire. Criminalization puts the health and lives of women at risk, particularly those with less economic and cultural capital. We also discover the role of friends in women's decision to utilize the procedure. The strong asymmetry of power between men and women contributes to the greater vulnerability of women. The results suggest an urgent need to review the legislation on abortion concerning its criminalization and the option of safer abortion within the scope of the public health service.

["That was where the story started...": psychosocial frailty in the Zika virus epidemic]

The article focuses on the experience of family and social frailty of children with congenital Zika virus syndrome (CZVS) and discusses the changes in support networks, in the sense of both their capacities and shortcomings. This qualitative study adopted a clinical-psychosociological approach. The study analyzed family narratives in 32 group meetings conducted in an outpatient setting in a referral research institute for CZVS care in the State of Rio de Janeiro, Brazil. The article presents part of the results from a larger study focused on understanding the psychosocial effects of illness and its impact on parenting and care of children with CZVS. The article concludes by discussing how parents' experience expresses complex processes that reveal family and social movements of support and recognition, but also, in the opposite sense, the lack of backup for mothers and fathers who struggle for recognition, social inclusion, and their children´s right to health and education.

"Life Is Taking Me Where I Need to Go": Biographical Disruption and New Arrangements in the Lives of Female Family Carers of Children with Congenital Zika Syndrome in Pernambuco, Brazil

The congenital Zika syndrome (CZS) epidemic in Brazil turned the spotlight on many other factors beyond illness, such as poverty, gender, and inequalities in health care. Women were the emblematic subjects in this study, not only because Zika virus is a vertical transmission disease, but also because women—in Brazil and elsewhere—typically represent the primary carers of children. This is a qualitative analytic study using semi-structured interviews with 23 female family carers of children with CZS in Brazil. Through the concept of biographical disruption, we analysed some of the social impacts experienced by women involved in caring for affected children. We identified that the arrival of a child with disabilities resulted in biographical disruption similar to that experienced by people with chronic illnesses. Social support networks were configured through an alliance between women from different generations, revealing solidarity networks, but also highlighting the absence of the state in tackling these social vulnerabilities. Tracing the pathways of these biographical narratives enables us to understand how women have acted to defend the value of their disabled children in a society structured on the model of body normativity and inequality. These results may provide clues to a more inclusive society, which confronts systems of gender oppression and the sexual division of labour focused on women.

Facing a new reality from the Zika Virus Congenital Syndrome: the families' perspective

This paper presents the partial results of the research on the social implications of addressing the Zika Virus Congenital Syndrome (ZVCS). This study aimed to analyze the repercussions of the diagnosis on the life of the families attended at an Institute of reference in Rio de Janeiro, based on a qualitative study built on the thematic analysis of the data collected through semi-structured interviews with 15 mothers from October 2017 to June 2018. The results revealed the helplessness of families and health professionals faced with the revelation of an unprecedented and challenging diagnosis, the lack of a structured referral and counter-referral network in the care of children when newly diagnosed, the imposition of an exhaustive care routine, generating social isolation, exhaustion and overload of these women, and the difficult access to public policies. Among the primary resources to cope with these adversities were the religiosity and articulation with other women who experienced the same situation.

Adaptive problems arising out of the progenitor's abandonment after Zika Congenital Syndrome

OBJECTIVE

to reveal the adaptive problems of the woman abandoned by the child's parent after Congenital Zika Syndrome, in the light of Roy's Adaptation Model.

METHOD

a qualitative, descriptive study, based on Roy's Adaptation Model, developed with six women abandoned by their child's parent after Zika Congenital Syndrome diagnosis, through interview and Content Analysis technique.

RESULTS

adaptive problems appeared in nutrition, activity, rest, and protection patterns, due to limitations in self-care; self-concept, related to dissatisfaction with body image and personal being; in the role of transition role, through difficulties in taking over new roles and in interdependence, related to changes in affective needs.

FINAL CONSIDERATIONS

the overload of care for children with Congenital Zika Syndrome, added to the challenges of the abandoned woman by her child's parent, led to adaptive problems, showing their main difficulties of coping.

Zika epidemic and microcephaly in Brazil: Challenges for access to health care and promotion in three epidemic areas

Since 2015 Brazil has experienced the social repercussions of the Zika virus epidemic, thus raising a debate about: difficulties of diagnosis; healthcare access for children with Zika Congenital Syndrome (ZCS); the search for benefits by affected families; social and gender inequalities; and a discussion on reproductive rights, among others. The objective of this article is to analyse access to specialized health services for the care of children born with ZCS in three North-eastern states of Brazil. This is an exploratory cross-sectional study which analyses recorded cases of microcephaly at the municipal level between 2015 and 2017. Most of the cases of ZCS were concentrated on the Northeast coast. Rio Grande do Norte and Paraiba had the highest incidence of microcephaly in the study period. The states of Bahia, Paraiba and Rio Grande do Norte were selected for their high incidence of microcephaly due to the Zika Virus. Socio-territorial vulnerability was stratified using access to microcephaly diagnosis and treatment indicators. The specialized care network was mapped according to State Health Secretaries Protocols. A threshold radius of 100 km was stablished as the maximum distance from municipalities centroids to specialised health care for children with microcephaly. Prenatal coverage was satisfactory in most of the study area, although availability of ultrasound equipment was uneven within states and health regions. Western Bahia had the lowest coverage of ultrasound equipment and lacked health rehabilitation services. ZCS's specialized health services were spread out over large areas, some of which were outside the affected patients' home municipalities, so displacements were expensive and very time consuming, representing an extra burden for the affected families. This study is the first to address accessibility of children with microcephaly to specialised health care services and points to the urgent need to expand coverage of these services in Brazil, especially in the northeastern states, which are most affected by the epidemic.

A rosácea do cuidado às crianças com síndrome congênita por zika: atitudes cuidativas dos familiares

RESUMO Objetivo Compreender a modelagem do cuidado familiar à criança com Síndrome Congênita por Zika a partir das contribuições teóricas da Rosácea do Cuidado na situação crônica. Métodos O estudo foi realizado entre outubro e novembro de 2017 com 11 familiares, explorando entrevistas em profundidade e o desenho estória-tema para a produção de dados. Resultados A Rosácea do Cuidado pode ser disparada a partir do cuidado próprio ou do cuidado familiar, desempenhando atitudes cuidativas construídas por experiências familiares anteriores e interações com o cuidado apreendido nos serviços de saúde. A modelagem do cuidado é sustentada pelo núcleo familiar constituído por mãe, pai e avó, organizando-a em quatro dimensões: Cuidar integralmente, “Tomar conta”, Estimular e, Acessar recursos e serviços. A mãe reconhece as necessidades da criança, julga as habilidades dos familiares e define o responsável pelo cuidado. Conclusão e implicações para a prática A modelagem do cuidado é personalíssimo devido o cenário de epidemia e de pouco conhecimento científico à época, resultando em inovações das atitudes cuidativas. Cabe às(aos) enfermeiras(os) apoiar os familiares para reconhecimento das necessidades de saúde que emergem da criança, bem como potencializar a divisão de tarefas de cuidado, estimulando, principalmente, a adequação da carga horária de trabalho dos pais.

[The need to act together in every way possible: inter-sector action in health and education for children living with the congenital Zika syndrome]

The experience with an intervention program conducted in an educational institution and targeted to families of children with congenital Zika syndrome, which includes multiple disabilities, revealed the challenges and strides with the entry of these families in the school system. This article aimed to explore the findings from a study conducted after the conclusion of an intervention program, using semi-open interviews with professional staff at the institution and the possible contributions towards establishing inter-sector relations aimed at school inclusion of children with disabilities. A change was seen, as a result of the program, in the relationship between the families and the professionals at the educational institution, whereby the families had room to voice their fears and discuss the school's role in the lives of their children with disabilities. The professionals thus came to see the families taking a more active stance. This experience can favor other services and municipalities that seek school inclusion for children and adolescents with disabilities, as well as their social inclusion and that of their families.

The everyday political economy of health: community health workers and the response to the 2015 Zika outbreak in Brazil

How is neoliberalism implicated in concrete health vulnerabilities? How do macro-level political economy, policy and institutions translate into everyday experiences? Drawing on Marxist, feminist and International Political Economy critiques of everyday life, the article advances an everyday political economy of health focused on four key components: power, agency, intersectionality and the mutual implication of the global and the local. These components enable a nuanced investigation of concrete experiences of health and disease, and of the local implementation of health policies in the context of neoliberalism. The framework is applied to the case of the 2015 public health response to Zika in Brazil, and specifically to the role of community health workers, close-to-community healthcare providers tasked with bridging the health system and vulnerable groups. The everyday practice of these workers, and their working conditions overwhelmingly characterized by precarity and low pay, reveal the presence of global neoliberal dynamics pertaining to the reconfiguration of the Brazilian state as healthcare provider in a context of encroaching austerity, privatization and narrowly-defined cost-efficiency. These dynamics impacted detrimentally upon the effectiveness of the Zika response.