Interpretações locais sobre a malária e o discurso sobre os provedores tradicionais de cuidados de saúde no sul de Moçambique

Abstract

The narratives on the diagnosis and causes of malaria are diverse and apparently ambiguous, being based beyond the body, on the social relations among peers, their ancestors, and nature. Based on a qualitative study and a four-year stay in Mozambique, this article analyzes the discourses of patients and biomedical practitioners on traditional health care providers, i.e., tinyanga and zion pastors, linking them to local terminology of malaria, in a rural district in southern Mozambique. In the current context of therapeutic pluralism and high mobility, the lack of solidarity and compassion attributed to tinyanga is supported by the monetization and commodification of their medicinal rituals and knowledge, as well as by competition with other providers in attracting patients. The implementation of zion churches, of Christian nature and performing therapeutic practices similar to tinyanga, is presented as a local advantageous solution due to the strong community connection, the comfort and reciprocity among the members, and the therapeutic results at low cost. In terms of health care policies and clinical practice, the invisibility of zion pastors and the subordinate role of healers is managed according to interests, based on vague ideas and prejudices from biomedical providers. The implementation of health policies that address the local diversity, the existing power relations and medical knowledge and practices can strengthen the biomedical care services and harmonize relations between the providers and the population. Keywords: Malaria; Mozambique; Traditional Healers/ Tinyanga; Zion Pastors; Local Illness Interpretation.

“Xilala is only treated with a good hand”: a study on the treatment of malnutrition in Mozambique

“…A fundamental aspect to be considered regarding the set of social representations on malnutrition and its treatment refers to the diversity of ethnomedical systems in Mozambique 8 . It is noted here that, unlike malaria, whose studies in Africa report that the patient's relatives do follow the treatment "trusting and recognizing in biomedicine the means and knowledge necessary to ensure their cure" 8 (p. 397), the symptoms that comprise malnutrition are not configured for the local population as a "hospital disease", but as a "traditional disease".…”

“…If you really want to know about my feelings, I think this baby food that is given to children in the hospital is more to help with food, to make them want to eat" (Traditional medicine informants). The definitions of disease that guide healing practices obey their own coherence 16 and are based not only on manifested dysfunctions in the biological body, but also include sets of social relations between persons, ancestral spirits and nature 8 .…”

“…The different ends of the use of the supplement translate differences between cosmologies. Xilala refers to other languages of suffering that trigger particular care ecologies, and it seems that these lifemanagement modes operate within a specific cultural logic based on the relational and daily experience between the living and the dead, which restructures personal and body agentially 8,29 .…”

Perspectivas e dilemas da enfermagem na p�s-modernidade: dialogando com Zygmunt Bauman

“…Dão-se frequentemente por intermédio do choque com o saber dos provedores de cuidados, que exercem competências "médicas" e terapêuticas, depreendendo cuidados em saúde assentados na subjetividade, socialização e experienciação da tradição. Tais sistemas etnomédicos foram identificados em Moçambique, relativos às cosmovisões, diferentes nomenclaturas da doença e grupos de provedores de cuidado aos quais os adoecidos pela malária recorriam em primeira instância, todo o processo de padecimento é entrecortado por narrativas em que a gama de aspectos socioeconômicos e ambientais é privilegiada (22) . É interessante notar em casos como do distrito de Chókwè em Moçambique que o saber instituído pelo modelo biomédico penetra o léxico e os diagnósticos locais, não obstante, reconfigura a rede de cuidados e sobrepõem-se aos provedores tradicionais nas políticas de saúde.…”

“…É interessante notar em casos como do distrito de Chókwè em Moçambique que o saber instituído pelo modelo biomédico penetra o léxico e os diagnósticos locais, não obstante, reconfigura a rede de cuidados e sobrepõem-se aos provedores tradicionais nas políticas de saúde. O reconhecimento da malária realizado pelos saberes e terapias locais vai ajustando-se às novas terminologias introduzidas e torna-se intricado devido aos sintomas de outras etnodoenças também enfrentadas (22) . Na conjuntura brasileira, a Saúde Coletiva tornou-se o preâmbulo do encontro das ciências humanas e sociais com as da saúde, exercendo a respeitável atribuição de produzir conhecimento e pôr em prática políticas públicas.…”