Organizações indígenas e distritalização sanitária: os riscos de "fazer ver" e "fazer crer" nas políticas de saúde

Snakebites from the standpoint of an indigenous anthropologist from the Brazilian Amazon

Conflicting attempts between indigenous caregivers trying to exercise their healing practices in hospitals have been recorded in the Brazilian Amazon. In this work, we present an interview with the Baniwa indigenous anthropologist Francy Baniwa. In an external and colonial interpretation, it was previously stated that indigenous people attribute the origin of snakebites as supernatural and that indigenous medicine, when it saves a patient from complications and death, has symbolic efficacy. In this interview, we observed that this form of interpretation is asymmetric because, for indigenous people, their understanding of nature is broader than ours, with more possibilities of ways of existence, including non-human entities as well or ill-intentioned as humans. The interaction of humans with these identities produces a form of existence with its own clinical reality, which is full of symbolism. Effective communication between health agents and indigenous patients and caregivers must undergo this exercise of otherness and interculturality.

Indigenous health in Brazil: Reflections on forms of violence

Abstract This article concerns public health policies for the Indigenous peoples of Brazil, focusing on relations of violence observed by the authors during their research. We draw attention to different types of violence through an analysis that articulates fieldwork on primary health care in Indigenous Areas with observations of political negotiations concerning health issues involving Indigenous leaders and government workers. There is, on the one hand, the habitual symbolic violence that can be observed in daily interactions between health workers and Indigenous patients, and, on the other, the contradictions of an official political rhetoric that assents to Indigenous authority and then systematically dismisses it when decisions that involve public health are put into practice. The research combines different methodological strategies (intensive fieldwork, research on public policy documents, participant observation of political meetings, interview with indigenes and managers, etc.) to establish correlations between interpersonal violence and structural violence along democratic processes of public policies building in Indigenous health. From this perspective, the paper addresses the violence in health sector beyond the individuals and their intentions; it proposes that violence in health must be interpreted against the backdrop of a broader discussion on the construction of Indigenous citizenship that articulates tutelage and political participation in the politics of health practices in Brazil.

Articulation between health services and “indigenous medicine”: Anthropological reflections on policies and reality in Brazil

Este artículo contribuye al diálogo entre las ciencias sociales y la medicina social en América Latina a través de la exploración del pluralismo terapéutico en las políticas y servicios de salud indígena en Brasil. Revisa las investigaciones recientes en antropología, así como los conceptos y debates actuales, para examinar críticamente las políticas de salud indígena en Brasil y su concepto de “atención diferenciada”, que propone la articulación entre las prácticas oficiales de salud y las terapias indígenas. Varias contradicciones y tensiones están presentes entre la organización estructural del subsistema de salud indígena en el nivel nacional y las prácticas cotidianas de los equipos de salud en el nivel local. Guiados por la ideología hegemónica de la biomedicina, los profesionales de salud no reconocen las dinámicas y la agencia expresada en las practicas indígenas de salud.

[Health and gender relations: a reflection on the challenges for the implementation of public policies for health care for indigenous women]

This article presents some contrasts that exist between the discourses of public policies concerning women's health care, especially with respect to indigenous women, and the ethnological discourse which emphasizes the specificity of gender relations within indigenous societies. We worked on the assumption that the development of these public policies as well as the organization of health care services offered, which in fact are necessary, have a transforming effect on prevailing gender relations within Amerindian Societies. On the one hand, gender relations between indigenous people are associated with the domains of kinship and corporeality. On the other hand, the process of creating public policies, by means of biomedical intervention and the medicalization of the female body, constitutes a powerful tool for body modeling and the construction of subjectivities contributing to making women worthy of citizenship. The female gender is under discussion and its content is being negotiated.

[The emergence of traditional indigenous medicine in the public policy field]

The article explores the emergence of traditional indigenous medicine as an object of discourse within the field of public policy and indigenous health. There are a gamut of meanings that inform the notion of traditional indigenous medicine in this field and they are steadily being revised and/or created in concrete dialogical situations, which endows them with an emergent nature. If official discourses use the power of naming to conceptualize traditional medicine, indigenous discourse designates knowledge and practices of self-attention rooted in specific local contexts. Public policy is appropriated and indigenized by indigenous peoples, gaining new meanings and influencing the sociocultural re-organization of health care.

[Politics and inter-medicality in the Upper Xingu: from model to practice in indigenous health care]

The indigenous healthcare model in Brazil is premised on comprehensive care combined with the notion of differentiated care and provides for respect for cultural diversity, seeking to incorporate traditional therapeutic practices into the health services that serve indigenous peoples. This study aimed to determine how to reconcile universal access to health goods and services with a model of care that guarantees differentiation, without interfering in the quality of services. It is also necessary to define which parameters should be used for evaluating the quality and efficacy of such services in an intercultural context. Based on a case study - the implementation of health services in the Upper Xingu - the author addresses some issues related to the political uses and "dangers" associated with "health spaces" and the distinct concepts (indigenous and non-indigenous) of what constitutes health and quality of health services. These issues affect not only health services but also the local political situation.

Malaria control in an Amazon municipality

This study aimed to evaluate the organization of malaria control actions in the Indigenous population of the municipality of São Gabriel da Cachoeira, Amazonas, AM, Brazil, from 2003 to 2007. This is an ecological study to evaluate the impact of control measures. Statistical analysis of the indicators revealed that the number of cases showed an increasing trend, with the highest numbers occurring in the rural areas. The same trend was observed for the Annual Parasite Index (API), however the highest APIs were found in the urban areas. The proportion of cases caused by Plasmodium falciparum showed a reduction. Hospitalization and mortality rates presented fluctuations and the fatality rate decreased. The findings indicate that control actions have proved partially effective and that they have provided a broader capacity to detect cases and to provide immediate treatment. Although the municipality still presents a high risk for transmission, the Pluriannual Plan in progress seems to have a good prognosis for the control of the disease, if maintained in a sustainable and permanent way.

The active search for respiratory symptomatics for the control of tuberculosis in the Potiguara Indigenous Scenario, Paraiba, Brazil

This study sought to analyze the actions of an active search for respiratory symptomatics (RSs) in the control of tuberculosis (TB) in the Potiguara Special Indigenous Sanitary District, Paraiba, Brazil, between May and June 2007. After approval by the Research Ethics Committee, 23 professionals were grouped, including physicians, nurses, nurse technicians and indigenous health agents. The focus group technique was used as an instrument for data collection, based on the discourse analysis technique. Weaknesses of an operational nature that became apparent, related to the organization of local health service for the implementation of routines for diagnosing TB: absence of a systematic routine for searching for RSs, difficulties in organizing the material for bacteriological examination, inadequate approach to patient during sputum collection and inadequate professional training. It is deemed necessary to improve the organization of services for early detection of TB cases in the local indigenous scenario.

Temas e abordagens das ciências sociais e humanas em saúde na produção acadêmica de 1997 a 2007

Analisa-se a produção intelectual das ciências sociais e humanas em Saúde a partir de 498 artigos e resenhas de livros selecionados em oito periódicos de Saúde Pública/Saúde Coletiva, registrados na base eletrônica de dados SciELO no período 1997 a 2007, através de palavras-chave. Os textos foram selecionados através de critérios de uma listagem de 1.926 artigos identificados. Os temas pesquisados e suas proporções no conjunto da literatura foram: política e instituições de saúde, 32,5%; saúde e doença, 18,5%; gênero e saúde, 16,5%; violência e saúde, 9%; velhice e envelhecimento, 4,0%%; recursos humanos, profissões e formação, 7,5%; produção social das ciências e das técnicas, 7,0% e educação e comunicação em saúde, 4,0%. Os resultados apontam a expansão da produção acadêmica; concentração de 50% dos textos nos dois primeiros assuntos; uso de teorias de médio alcance; das mediações e de teorias e metodologias combinadas; incipiente interdisciplinaridade entre ciências sociais e ciências da vida; abordagens disciplinares. Recomenda-se a discussão de uma agenda de investigação multicêntrica, capaz de diversificar e aprofundar temas sobre condições de saúde e mudanças sociais; a política e serviços de saúde; a formação profissional e conhecimento e tecnologias.

Morbidade hospitalar de indígenas Xavante, Mato Grosso, Brasil (2000-2002)

OBJETIVO: Analisar as causas de hospitalização de indígenas Xavante, Estado de Mato Grosso, Brasil, no período 2000-2002. MÉTODOS: As causas de hospitalização foram pesquisadas nos prontuários de oito hospitais que atendem aos Xavante das reservas Areões, Pimentel Barbosa, Sangradouro e São Marcos. Os dados coletados incluíram: nome, idade, sexo, terra indígena, data de admissão, data de alta, diagnóstico no momento da internação. Os diagnósticos foram classificados segundo a CID-10. RESULTADOS: Foram analisados 1.698 prontuários. As idades variaram entre 0-93 anos. Mais da metade dos pacientes eram crianças < 5 anos (65,8%). As cinco principais causas de hospitalização foram: doenças do aparelho respiratório (41,5%); doenças infecciosas e parasitárias (17,4%); gravidez, parto e puerpério (12,7%); doenças endócrinas, nutricionais e metabólicas (9,7%); e lesões, envenenamentos e conseqüências de causas externas (3,7%). Se excluídas as causas relacionadas à gravidez, parto e puerpério, a distribuição passa a ser a seguinte: doenças do aparelho respiratório (47,7%); doenças infecciosas e parasitárias (19,9%); doenças endócrinas, nutricionais e metabólicas (11,2%); e lesões, envenenamentos e conseqüências de causas externas (4,3%). As crianças Xavante foram proporcionalmente mais hospitalizadas por doenças infecciosas e parasitárias, respiratórias e desnutrição que as não-indígenas de Mato Grosso. CONCLUSÕES: O perfil de morbidade hospitalar Xavante é coerente com a reconhecida precariedade do perfil sanitário e nutricional predominante nas aldeias. Destacam-se as seguintes conclusões: crianças < 5 anos constituem mais de 50% das hospitalizações; as principais causas de internação na população são devido a doenças respiratórias, nutricionais e infecciosas e parasitárias. Frisa-se a relevância dos achados para a discussão do modelo de assistência à saúde indígena no Brasil.

[Globalization and environmentalism: polyphonic ethnicities in the Amazon]

The article examines the issue of globalization, along with its contradictions and the ways in which it guides and shapes specific situations within the Amazon's present-day reality, while simultaneously engendering the uniformization of economic production and the valorization of cultural differences. The discussion explores the nuances of implementing a massified, standardized productive base that paradoxically fosters the valorization of cultural differences and favors alliances between, on the one hand, ethno-political leaders from indigenous Amazon groups and, on the other, environmentalists and other transworld actors who wield strong decision-making power. The article analyzes the indigenous movement's network of alliances and highlights the polyphony of the different political agents that come to clash with each other within this post-modern geopolitical setting.