Building an explanatory model for snakebite envenoming care in the Brazilian Amazon from the indigenous caregivers’ perspective

Abstract

Background In the Brazilian Amazon, snakebite envenomings (SBE) disproportionately affect indigenous peoples. Communication between indigenous and biomedical health sectors in regards to SBEs has never been explored in this region. This study aims to build an explanatory model (EM) of the indigenous healthcare domain for SBE patients from the perspective of the indigenous caregivers. Methodology/Principal findings This is a qualitative study involving in-depth interviews of eight indigenous caregivers who are representatives of the Tikuna, Kokama and Kambeba ethnic groups, in the Alto Solimões River, western Brazilian Amazon. Data analysis was carried out via deductive thematic analysis. A framework was built containing the explanations based on three explanatory model (EM) components: etiology, course of sickness, and treatment. To indigenous caregivers, snakes are enemies and present conscience and intention. Snakebites have a natural or a supernatural cause, the last being more difficult to prevent and treat. Use of ayahuasca tea is a strategy used by some caregivers to identify the underlying cause of the SBE. Severe or lethal SBEs are understood as having been triggered by sorcery. Treatment is characterized by four components: i) immediate self-care; ii) first care in the village, mostly including tobacco smoking, chants and prayers, combined with the intake of animal bile and emetic plants; iii) a stay in a hospital, to receive antivenom and other treatments; iv) care in the village after hospital discharge, which is a phase of re-establishment of well-being and reintroduction into social life, using tobacco smoking, massages and compresses to the affected limb, and teas of bitter plants. Dietary taboos and behavioral interdictions (avoiding contact with menstruating and pregnant women) prevent complications, relapses, and death, and must be performed up to three months after the snakebite. Caregivers are in favor of antivenom treatment in indigenous areas. Conclusions/Significance There is a potential for articulation between different healthcare sectors to improve the management of SBEs in the Amazon region, and the aim is to decentralize antivenom treatment so that it occurs in indigenous health centers with the active participation of the indigenous caregivers.

Snakebite envenomations and access to treatment in communities of two indigenous areas of the Western Brazilian Amazon: A cross-sectional study

“…Treatment of SBEs in indigenous villages is characterized by the use of tobacco smoking, chants and prayers, combined with animal tissues and bitter plants [ 25 ]. In this study, a considerable variety of medicines, with a predominance of medicines derived from plants and animals, alone or in combination with chants and prayers, was used.…”

“…Indeed, there is a persistent role of indigenous healers in Amazonian societies after the introduction of western medicine and advanced stage of medical pluralism in villages that are located closer to urban areas [ 26 ]. In the case of SBEs, this persistence may be associated with the thought that this health problem can only be treated by indigenous therapy due to an underlying extraphysical cause; for instance, if it is possible to incorporate characteristics of the perpetrating snake by using parts of this animal as medicine, as commonly seen in this study, this will benefit the patient regarding SBE complications [ 25 ]. Moreover, there is a tension among different categories of healers and resistance to being treated by a biomedical health system that is not tailored to indigenous needs [ 25 , 27 ].…”

“…Treatment of SBEs in indigenous villages is characterized by the use of tobacco smoking, chants and prayers, combined with animal tissues and bitter plants [25]. In this study, a The Chi-square test demonstrated a significantly higher frequency of access to hospital for participants living in the area of the Upper Rio Solimões SIHD compared to those of the Upper Rio Negro SIHD (p<0.0001), and the frequency of participants that had access to hospital with more than 24 hours after bite was significantly higher for those living in the Upper Rio Negro SIHD (p = 0.001).…”

Children Growing Up with Severe Disabilities as a Result of Snakebite Envenomations in Indigenous Villages of the Brazilian Amazon: Three Cases and Narratives

“…Snakebite incidence is five-fold higher in the Brazilian Amazon compared to the rest of the country [11]. Furthermore, in the Amazon region of Brazil, children are proportionally more affected than in the other regions of the country [13]. In Brazil, living in rural areas and time to care of >3 h are risk factors for severity following snakebites in children [14].…”

“…In general, previous studies carried out in the Amazon on disabilities caused by snakebites have described only the clinical aspects of the problem [19,[25][26][27], without stressing the repercussions of the problem on the social life of patients. In this study, which seeks to address this problem, we report the clinical characteristics and narratives obtained from interviews with the parents and with three children presenting severe physical disabilities from snakebite envenomations in indigenous villages of the Brazilian Amazon, which were identified in previous surveys carried out in these areas [13].…”