Da participação ao controle social: reflexões a partir das conferências de saúde indígena

Abstract

Resumo Embora a Constituição Federal de 1988 assegure aos povos indígenas o direito às políticas sociais, a saúde permanece um campo de tensão no trato desses povos com o Estado. Muito se tem defendido a necessidade de garantir a diretriz de participação no Sistema Único de Saúde e a inserção dos indígenas nos mecanismos de controle social. Dessa forma, este trabalho busca contribuir com o debate sobre os sentidos da participação e refletir sobre os desafios da sua configuração como controle social no âmbito da saúde indígena. A análise foi feita com base nos relatórios das conferências de saúde, na bibliografia afeita ao tema e em entrevistas realizadas com atores-chave. A pesquisa buscou lançar luz sobre a diversidade dos contextos, dos atores e das pautas das cinco conferências de saúde indígena realizadas. Concluímos que houve um deslocamento na participação nas conferências para uma atuação mais burocrática dentro dos estritos limites estabelecidos pela gestão. Ainda assim, é fundamental valorizarmos a potência contida nos mecanismos do controle social, que não à toa são objetos de combate dos grupos mais conservadores da sociedade. Neste sentido, há que se valorizar tais espaços, ocupá-los e transformá-los.

Health and Mining Practices in Indigenous Territories

“…In the lungs, symptoms such as shortness of breath, fever, fatigue, and chest pain have been reported. A metallic taste in the mouth and gingivitis have also been observed 5,6 .…”

“…In this context, the convergence of healthcare, psychological, and legal fields becomes essential for interdisciplinary efforts, given the limitations of Primary Health Care (PHC) actions within the villages. Referring cases of violence to medium and high complexity levels of the Brazilian Unified Health System (SUS), located in urban areas, brings about situations involving organizational and cultural differences that pose additional challenges for indigenous users 6,10 .…”

“…Professionals working in the Special Indigenous Health Districts (DSEI), in these cases, in addition to their technical skills, would consider the cultural and historical nuances of the peoples they serve 1 . This allows them to identify, address, and properly refer cases of physical violence 27,28 through the National Foundation of Indigenous Peoples (FUNAI), the Center for Reference and Social Assistance (CRAS), the Center for Specialized Reference in Social Assistance (CREAS), mobilizing preventive approaches and support to strengthen a protection network 6,27,28 .…”

“…Fish easily absorb Hg and accumulate it in their tissues as methylmercury (MeHg), but they exhibit gradual elimination. Therefore, the higher the trophic level, the higher the concentrations of this metal, causing harmful effects on human health since fish constitute the primary protein source for indigenous peoples [5][6][7] The situation is exacerbated by the vulnerability of indigenous peoples to the impacts of the dominant economic model 1,9,10 and by health crises that demand urgent control of health risks, such as the COVID-19 pandemic, which amplified the vulnerabilities of indigenous peoples. Invasions by illegal loggers, land grabbers, missionaries, and miners acted as "vectors" for the spread of the virus 11 , and with the weaknesses in public policies, environmental surveillance, and health issues were exacerbated during this pandemic period due to social isolation and the implementation of sanitary barriers in villages, further magnifying the vulnerabilities of indigenous peoples 7 . In this scenario, the ongoing presence and flexibility of mining and prospecting activities alarmingly threaten the livelihoods and health of indigenous peoples [2][3][4] .…”

Reflexões sobre a participação popular e social na Saúde indígena

“…A inserção indígena nos espaços de Participação Social ocorreu pós CF-88, e no campo da saúde com as Leis Orgânicas 8.080/1990 e 8.142/1990 e demarcado com a Lei Arouca 9.836 de 1999, como espaços de controle social no Subsistema (Abrunhosa et al, 2020).…”