O modelo de atenção diferenciada nos Distritos Sanitários Especiais Indígenas: reflexões a partir do Alto Rio Negro/AM, Brasil

Abstract

ResumoAnalisou-se a implementação do modelo de atenção da Política Nacional de Saúde Indígena (Pnaspi) no Distrito Sanitário Especial Indígena do Alto Rio Negro, à luz da diretriz da atenção diferenciada. A temática foi investigada sob três perspectivas: formulação da diretriz; itinerários terapêuticos em aldeias indígenas; atuação dos Agentes Indígenas de Saúde (AIS). Pesquisa qualitativa, apoiada na perspectiva antropológica de Menéndez sobre modelos de atenção. A coleta de dados compreendeu observação participante, entrevistas e análise documental. A formulação da diretriz da atenção diferenciada enfatiza a adequação de tecnologias e profissionais, minimizando a dimensão da coexistência e disputas entre formas de atenção. A perspectiva de análise dos modelos de atenção desde os sujeitos, proposta por Menéndez, mostrou-se fundamental para demonstrar que a partir dos itinerários terapêuticos é possível verificar a coexistência e a articulação de diversas formas de atenção. A começar da análise das rotinas dos AIS não foi possível encontrar a inclusão ou o reconhecimento das representações e práticas indígenas de saúde. Destaca-se a autoatenção, protagonizada por sujeitos e famílias.

The work process and care production in a Brazilian indigenous health service

“…[5][6][7][8]21 This issue was not a high priority in the teaching and learning processes of the study participants.…”

“…In other words, the provision of care should focus on indigenous needs and integrate traditional native medicines. 8 Some investigations have, however, pointed out that the indigenous healthcare knowledge and their traditional healing practices are not included in the professional care provided in the villages. 4,5,8 Since the inception of the National Indigenous Healthcare Policy, the various forms of indigenous care in Brazil have not been evaluated by governmental agencies.…”

“…8 Some investigations have, however, pointed out that the indigenous healthcare knowledge and their traditional healing practices are not included in the professional care provided in the villages. 4,5,8 Since the inception of the National Indigenous Healthcare Policy, the various forms of indigenous care in Brazil have not been evaluated by governmental agencies. 11,12 The National Indigenous Healthcare Policy established 34 Special Indigenous Health Districts covering all Brazilian indigenous territory.…”

“…9,10,13 The forces intrinsic to the work process include: social inequalities, conditions of work, and insecurity and health in the job, as well as the different concepts of the health-illness-care process shared by healthcare providers and indigenous people. 4,8,9,13 Indigenous healthcare encompasses different types of knowledge from Public Health and other areas of expertise, such as Clinic, Epidemiology, Management and Social Sciences, of the public health field. Among other fields of knowledge, Anthropology and Psychology should be mentioned.…”

“…Health workers involved in indigenous healthcare constantly face perspectives that differ from the classic biomedical model prevalent in Western societies. [5][6][7][8] Additionally, at healthcare centers, the quality of the provision of care is affected by the organization of the work process, such as the technological material and non-material instruments, the type of work contract, the professional training, the flexibility of work rights, and the technical division of the labor. 9,10 Since aspects of the work organization greatly influence care production, 9,10 we asked how the aspects of work organization influence the provision of nursing care in an indigenous health center, which is also shaped by cultural, social, and historical factors?…”