Migração boliviana e doença de Chagas: limites na atuação do Sistema Único de Saúde brasileiro (SUS)

Abstract

Migration provoke changes in epidemiological profiles impinging on the health care systems of reception countries. Immigrants come to Brazil from neighbor countries usually having precarious insertion in metropolitan areas. Chagas disease is endemic in Bolivia, something that has to be taken into account by the SUS. This paper analyzes both action and limits regarding health professionals who provide services to Bolivians in SUS with a focus on Chagas disease.Interviews were applied to primary, secondary and tertiary health services in the central region of São Paulo, the main destination of Bolivian immigrants. The precarious living conditions of Bolivians are the cause of health inequities. Language and culture also hamper their understanding about care. There is a lack of knowledge about clinic and epidemiology aspects of Chagas disease among the professionals who attend these immigrants. It is necessary to rethink strategies of health care and control of Chagas disease.

Conocimientos, actitudes y prácticas sobre la enfermedad de Chagas en Aguazul Casanare

“…La enfermedad de Chagas solía ser endémica desde el norte de México hasta Argentina (14,15) , pero su presencia se ha incrementado gracias al resultado de la migración rural-urbana existiendo casos en países no endémicos (16) , además de la presencia de triatomíneos silvestres y de mamíferos que se han adaptado a condiciones ambientales potenciando la trasmisión del parásito (17) ; situación que afecta a innumerables personas en condición vulnerabilidad (18,19) . Por esto, la población está expuesta a entrar en contacto con posibles factores que deben ser evaluados y establecer su línea de base de conocimiento.…”

Experiences of Providers and Immigrants/Refugees with Health Care: A Meta-Synthesis of the Latin American Context

“…The primary findings show that health systems in Latin American countries and professional activities with immigrants/refugees are determined by the hegemonic, curative and disease-centered biomedical model (Aizenberg et al, 2015). In addition, there is lack of formal health policies aimed at caring for immigrants/refugees (Aizenberg et al, 2015), adequate infrastructure, inputs, and human resources for care (Barbosa et al, 2020;Duden & Martins-Borges, 2021), and health services that are more articulated and less bureaucratic (Carneiro-Junior et al, 2018;Carneiro-Junior et al, 2022;Motizuki et al, 2019;Ojeda et al, 2020). As a consequence, immigrants/ refugees face difficulties accessing health services (Aizenberg et al, 2015;Arcos et al, 2018;Calderón et al, 2020;Giraldo et al, 2021;Ramírez-Santana et al, 2019), especially primary care services (Pedrozo et al, 2021;Pinto et al, 2019), compelling them, especially undocumented ones, to extensivily use emergency units as a gateway (Agudelo-Suárez et al, 2022;Barreto et al, 2019;Giraldo et al, 2021;Pedrozo et al, 2021).…”

“…Current and Past Vulnerabilities of Immigrants/Refugees. Several studies indicate that immigrants/refugees experience intense and diverse situations of vulnerability that interfere in their relationship with providers (Agudelo-Suárez et al, 2022;Aizenberg et al, 2015;Arcos et al, 2018;Barbosa et al, 2020;Barreto et al, 2019;Bernales et al, 2017;Carneiro-Junior et al, 2018;Shedlin et al, 2014;Souza et al, 2021). These vulnerabilities are related to the migration/refugee process and are maintained in the host country.…”

“…[…] They [Bolivian women] are very quiet. I think the interaction does not end up being of quality (interviewee 15 -health professional) (Carneiro-Junior et al, 2018). They start prenatal care late, they never arrive before 14 weeks.…”

Vivências E Estágios Na Realidade Do Sistema Único De Saúde: Contribuições Na Formação Profissional

“…Still, the unfamiliarity of knowledge about the treatment protocol of Chagas disease is visualized, that is, secondary health care in that country also seems to fail (CARNEIRO JUNIOR et al, 2018). In this sense, it is analyzed that the lack of initial care aggravated the situation of patients, denoting the importance of primary care in public health.…”