Therapeutic itineraries and explanations for tuberculosis: an indigenous perspective

Abstract

OBJECTIVE To analyze explanations for tuberculosis and therapeutic itineraries of Brazilian indigenous people.METHODS Case study with a qualitative-descriptive approach. We conducted semi-structured interviews with 11 Munduruku indigenous, including direct observation of treatment for tuberculosis in the municipality of Jacareacanga, south-western region of the state of Para, Brazil. To identify explanations for tuberculosis and therapeutic itineraries, we performed thematic content analysis.RESULTS Traditional medicine was the first therapeutic option chosen by the indigenous. However, biomedicine was also employed, which indicates a circulation between different therapeutic contexts and health concepts among the Munduruku. The explanations provided ranged from recognition of the signs and symptoms specific to tuberculosis to the attribution of the disease to a spirit that leaves the body and wanders in the woods, returning ill into the body. Unlike the biomedical model, which links tuberculosis transmission strictly to interpersonal contact, in closed spaces without natural lighting and ventilation (preferably domestic environments), the Munduruku associate the disease to an indirect contact between people socially distant (enemies or adversaries) in public and open places.CONCLUSIONS The explanations made by the indigenous are unique and deserve the attention of those who are responsible for developing health public policies, as well as of the teams who work on the villages. To guarantee an efficient control of tuberculosis in these regions, it is necessary that the developed actions integrate biomedicine knowledge and the traditional medicine of the indigenous people, in addition to respecting and welcoming local culture manifestations.

Acesso aos serviços de saúde para o diagnóstico e tratamento da tuberculose entre povos indígenas do estado de Rondônia, Amazônia Brasileira, entre 2009 e 2011: um estudo transversal*

“…The therapeutic options used for TB treatment appeared to be interconnected without clearly defined limits. Similar findings have been reported among indigenous people in the Alto Rio Negro region, 6,28 and in the Munduruku 23 and Xavante ethnic groups.…”

“…As reported in relation to the Munduruku people in the state of Pará, 23 approximately half the indigenous people went to the Casais on their own initiative, suggesting that Primary Care has been inefficient in detecting symptomatic respiratory cases in indigenous villages.…”

Spatial distribution of tuberculosis in indigenous and non-indigenous populations in the state of Pará, Brazil, 2005-2013

“…1 According to the Programa Nacional de Controle da Tuberculose (PNCT -Brazilian Program on Tuberculosis Control), this group is considered to be vulnerable to such disease. 2 Scientific evidence [3][4][5] indicates that the incidence of TB is high in these populations, reaching rates [3][4][5][6]7 that are ten times higher than those found in the general Brazilian population.…”

Tendência da tuberculose em indígenas no Brasil no período de 2011-2017

“…However, this percentage is almost double that of the general population and is an essential operational indicator to evaluate the treatment of TB in the indigenous people 21 . However, the study by Nogueira et al 22 identified essential gaps in the therapeutic itinerary of an indigenous group in Pará concerning the active search for respiratory symptoms, monitoring of cases treated for TB, and control of contacts. The study also highlights the failure to perform DOT in villages, with patients with suspected TB promptly referred to the Indigenous Health Support Houses, where they are confined until the end of treatment.…”

“…Greater incorporation of biomedical practices in the context of TB treatment in indigenous communities is observed despite traditional indigenous medicine's predominance. However, such health systems have not acted exclusively but complementarily in solving health problems 22 . In some indigenous communities, the decision on the type of treatment (whether based on beliefs or biomedical) is dependent on the "origin of the disease", which in the indigenous viewpoint may be spiritual or due to contact with non-indigenous people 23 .…”