The relationship between doctors and their patients is part of everyday life for thousands of professionals. In order to avoid an idealistic or merely emotional approach to this question, it is necessary to investigate how it is related to medical science and to the overall relationship between medicine and society. Indeed, far from being aleatory, the doctor-patient relationship as it has been practiced can be understood as a tool for maintaining the power of both the medical establishment and the state over society. To change this practice, the author proposes two different approaches to specific fields of medical practice: the hospital and non-hospital fields. In the field outside hospitals, the humanization of medical practice depends basically on broadened training for professionals in order to prepare them to deal with this work's inherent demands, where a physiopathological approach is often insufficient. Inside hospitals, a more humanistic relationship depends more directly on the action of a multiprofessional health team.
Reflecting on the current reorganization of the relationship between the state and civil society, the health care field is involved in an intense debate over the organization and use of government and private health services. The authors propose an alternative, consisting of the implementation of primary health care clinics, managed by local institutions and funded by the Unified Health System. To support this proposition, they report on the current experience at the Rocinha slum in Rio de Janeiro, where a community health center was built by the neighborhood association 12 years ago and has been managed by the community since then. The hospital referral rate at the clinic, requests for laboratory tests, and use of precriptions have been considerably limited, although these services are available. These low rates are attributed to the possibility of closer social control by the community, as well as to the geographical features of the center, favoring a broader perception of both health problems and treatment. In order to provide more substantial support to the proposed centers, some suggestions are presented, like the implementation of direct agreements between the government and neighborhood associations (not allowed under current legislation) and expanding potential sources of funding for the health centers, currently restricted to government programs.
INTRODUÇÃOA utilização de agentes comunitários na atenção primária à saúde é uma experiência defendida pela maior parte das instituições ligadas a esta área e tem sido largamente incentivada pela Organização Mundial da Saúde. Não obstante o resultado positivo obtido em diversos projetos, a discussão sobre o perfil de atuação destes agentes esta presente na maioria dos debates de saúde comunitária, e uma definição clara e universal deste parece estar longe de ser alcançada. Isto decorre, possivelmente, da necessidade de adaptação deste modelo às realidades regionais onde são implantados, o que consideramos indispensável, particularmente no que se refere ao aspecto rural/urbano.Harpham (1986), ao rever as concepções de atenção primária mais utilizadas atualmente, afirma que, tanto do ponto de vista operacional quanto conceituai, há o predomínio de uma abordagem rural, baseada em uma epidemiologia rural. De fato, a atuação de moradores treinados para realizar diagnósticos e terapêuti-cas simplificadas tem sido tradicionalmente ligada a estas populações, para as quais o acesso a informações e aos serviços de saúde comuns apresenta obstáculos quase intransponí-veis. Nestas regiões, os indicadores de saúde apontam para altas taxas de morbi-mortalidade, particularmente infantil, provocadas principalmente por doenças infecciosas facilmente preveníveis ou curáveis mediante a execução de procedimentos relativamente simples. Para responder a este desafio de forma efetiva e eficiente, foram desenvolvidos, então, diversos programas, geralmente baseados na utilização de agentes comunitários, cujo objetivo é a melhoria destes indicadores. Trata-se, portanto, de uma abordagem eminentemente epidemioló-gica que tem obtido alguns resultados significativos, como, por exemplo, a redução do número de óbitos por diarréia nos lugares onde foram instituídos programas de TRO, aumento da cobertura vacinal, etc. Em função destes resultados, rapidamente este modelo passou a ser considerado como a grande alternativa para a melhoria das condições de saúde das populações dos países pobres e uma ferramenta indispensável para atingir o objetivo, defendido em Alma-Ata, de promover saúde para todos até o ano 2000 (OMS/UNICEF, 1978).
The importance and complexity of educational work related to HIV prevention demand a continuing discussion of its contents. Regarding the ideologic features, it must be assumed that, with the AIDS epidemic, medical science reaches a dimension of the life relatively preserved from its previous hegemonic position: sexual behavior. In this field, a coercive attitude on the part of health professionals may lead to negative reactions. To avoid this, individual and community participation and self-responsibility are central tools for the improvement of the efficacy of education practices. The author proposes three components that educational planners should consider: information and its effects on knowledge, attitudes, and perception related to HIV infection; response facilitation; and support for individual and collective reflection.
The study aims to evaluate the present stage of knowledge, attitudes, and behavior related to HIV/AIDS in the population of Rio de Janeiro's Rocinha slum, the target of a control program over the last 6 years. We interviewed two hundred and ten people of both sexes, ranging from 13 to 49 years of age, and the results were compared with those of a study conducted in 1990 with the same methodology and sample size. The analysis showed an association between single males and more preventive behavior. Misconceptions about the role of mosquito bites and blood donation in the transmission of HIV persist, almost in the same proportion. Comparing the two samples, there was a significant increase in the role of HIV/AIDS education provided by schools, and the study also identified an increase in the rates and regularity of condom use. More efforts should be made to reduce misconceptions about HIV transmission and the vulnerability of couples. The study also highlights the need for more consistent policies related to condom distribution to the general population.
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