Sítios simbólicos de pertencimento e prevenção e controle da tuberculose: percepções e práticas dos Agentes Comunitários de Saúde no Brasil e na Etiópia / Symbolic sites of belonging and prevention and control of tuberculosis: perceptions and practices of community health workers in Brazil and Ethiopia

Resumo O objetivo do artigo é avaliar a contribuição do DOTS comunitário, do inglês "Directly Observed Treatment Short-Course", nas ações de prevenção e controle da tuberculose na atenção primária no Brasil e na Etiópia, a partir das percepções e práticas dos agentes comunitários de saúde (ACS). Utilizou-se o referencial conceitual e metodológico dos sítios simbólicos de pertencimento, com suas três tipologias: caixas preta, conceitual e operacional. Empregou-se o estudo de dois casos contrastantes, triangulando e complementando informações advindas de entrevistas semiestruturadas com ACS e profissionais de saúde e também observação participante. Os achados destacam o sentido de comprometimento dos ACS como um valor importante nas ações desenvolvidas em ambos contextos. Os principais desafios são a insuficiência de capacitação e supervisão das ações realizadas (caixa conceitual), assim como as dificuldades de acesso (caixa de ferramentas), expressas em distâncias geográficas no caso etíope e em barreiras relacionadas à violência no território, não explicitadas, no contexto brasileiro. Isto implica em um esforço contínuo dos ACS para adaptar suas práticas, respeitando os valores culturais (caixa preta) que dão sentido e direção às suas ações na superação dos desafios.

Abstract This article aims to evaluate the contribution of Community DOTS, Directly Observed Treatment Short-Course, for the prevention and control of Tuberculosis actions in primary care in Brazil and Ethiopia, based on the perceptions and practice of the community health care workers. We employed the Symbolic Sites conceptual-methodological framework, accounting for its three types: Black box, Conceptual box, and Toolbox. The contrasting case study involved triangulating and complementing data collection and analysis from semi-structured interviews with community health workers and health professionals, site observation, and document analysis. The results highlight a sense of commitment as an essential value regarding the activities developed by community health workers in both contexts. The main challenges are the insufficient capacity building and supervision (Conceptual box), and the difficulties related to access (Toolbox), expressed in long geographic distances in the Ethiopian case and barriers related to territory violence, mostly drug trafficking, although not explicit, in the Brazilian context. This implies in a continuous effort for the community health workers to adapt their practices, respecting the cultural values (Black box), in order to direct their actions to overcome these challenges.

Programa de cooperación quirúrgica en un hospital rural de Etiopía. ¿Podemos ofrecer cirugía de calidad? / Surgical Cooperation Program in a Rural Hospital of Ethiopia. Can we Offer Quality Surgeries?

RESUMEN Introducción: En Etiopía la asistencia quirúrgica en el medio rural es deficitaria por la falta de cirujanos y por los limitados recursos sanitarios, y este escenario subóptimo puede provocar un incremento de morbilidad y mortalidad operatoria. Objetivos: Describir las intervenciones quirúrgicas realizadas durante ocho años de cooperación en el Hospital Rural de Gambo y analizar la morbilidad y mortalidad posoperatoria. Método: Se realizó un estudio descriptivo, retrospectivo, de las intervenciones quirúrgicas practicadas en el Hospital Rural de Gambo, por un grupo de cooperación quirúrgica entre 2007-2017 en ocho campañas quirúrgicas. Se recogieron en una base de datos el sexo, edad, diagnóstico, tipo de cirugía (urgente o programada), operaciones realizadas, complicaciones posoperatorias, infecciones del sitio quirúrgico, morbilidades, reintervenciones, transfusiones de sangre y mortalidad posoperatoria. Resultados: Se operaron 587 pacientes, 389 de cirugía general, 78 de obstetricia-ginecología, 77 lesiones urológicas y 38 pacientes de traumatología. El 13 por ciento (89) pacientes fueron operados de urgencia. Se aplicó anestesia general con intubación traqueal a 143 pacientes, anestesia raquídea en 167 casos y anestesia local en 277. En cirugía mayor (310 pacientes), la mortalidad fue 2 por ciento, con 5,3 por ciento de infección del sitio quirúrgico, 3 reintervenciones (1 por ciento) y 9 (3 por ciento) transfusiones sanguíneas perioperatorias. Conclusiones: Para la cooperación quirúrgica en el entorno rural de Etiopía es necesaria una formación adicional en cirugía obstétrica-ginecológica, urología y traumatología. A pesar de los escasos medios tecnológicos del Hospital Rural de Gambo es posible realizar una cirugía mayor con seguridad, con un bajo índice de infecciones de herida, de necesidades transfusionales, reoperaciones y mortalidad(AU)

ABSTRACT Introduction: In Ethiopia, surgical assistance in rural areas is deficient due to the lack of surgeons and limited health resources. This suboptimal setting can cause an increase in morbidity and surgical mortality. Objectives: To describe the surgical interventions carried out during eight years of cooperation in Gambo Rural Hospital and analyze the postoperative morbidity and mortality. Method: A retrospective and descriptive study of the surgical interventions performed at Gambo Rural Hospital was carried out by a surgical cooperation group between 2007-2017 in eight surgical campaigns. Sex, age, diagnosis, type of surgery (urgent or scheduled), carried out operations, postoperative complications, surgical site infections, morbidities, reoperations, blood transfusions and postoperative mortality were collected in a database. Results: 587 patients were operated on: 389 for general surgery, 78 for obstetrics-gynecology, 77 urological lesions, and 38 for traumatology. 13 percent (89) patients were operated urgently. General anesthesia with tracheal intubation was applied to 143 patients, spinal anesthesia was used in 167 cases and local anesthesia was used in 277 cases. In major surgery (310 patients), mortality was 2 percent, with 5.3 percent of surgical site infection, 3 reinterventions (1 percent) and 9 (3 percent) perioperative blood transfusions. Conclusions: Additional training in obstetric-gynecological surgery, urology and traumatology is necessary for surgical cooperation in the rural setting of Ethiopia. Despite the scarce technological means of Gambo Rural Hospital, it is possible to perform major surgery safely, with a low rate of wound infections, transfusion needs, reoperations and mortality(AU)

Estudios de susceptibilidad de cepas de Leishmania aethiopica frente a alcaloides de Galipea longiflora (Evanta) / Susceptibility studies on Leishmania aethiopica strains against total alkaloids from Galipea longiflora (Evanta)

El Instituto de Investigaciones Fármaco Bioquímicas (IIFB), de la Facultad de Ciencias Farmacéuticas y Bioquímicas, de la UMSA, desarrolla trabajos sobre la actividad leishmanicida, de los alcaloides totales (CAT) obtenidos de la corteza de la especie medicinal amazónica conocida como Evanta (Galipea longiflora) por los Pueblos Tacana, Tsimane y Mosetene. Como parte de las actividades del Proyecto UMSA-ASDI Biomoleculas de interés medicinal e industrial (antiparasitarios) hemos podido contar con la estadía, en el IIFB, de un investigador del Armauer Hansen Research Institute (AHRI) de Etiopia, lo que nos ha permitido desarrollar evaluaciones de CAT, Miltefocine y Amfotericina B, frente a cepas de Leishmania aethiopica, agente causante de las diversa formas de Leishmaniais cutánea en Etiopía. Un total de seis cepas, de L. aethiopica, fueron adaptadas a condiciones in vitro y mostraron un comportamiento homogéneo frente a CAT, cinco de estas cepas mostraron un valor promedio de IC50 = 8,68 ±1,56 mg/mL, valor algo inferior a los calculados para nuestras cepas de referencia, L. amazonensis y L. braziliensis con IC50 = 11,73 ± 4,32 mg/mL y IC50 = 12,28 ±- 2,95 mg/mL, respectivamente. Excepto por una cepa de L. aethiopica que mostro valores consistentemente más elevados que el resto con IC50= 14,37 ± 3,58 mg/mL. Como consecuencia de esta interacción científica, la Universidad Mayor de San Andrés (UMSA) ha firmado un Memorandum de Entendimiento para el desarrollo de investigaciones conjuntas, con el Armauer Hansen Research Institute (AHRI), dependiente del Ministerio de Salud de Etiopia y explorar la posibilidad de que nuestra experiencia de validación clínica con Evanta en el tratamiento de leishmaiasis cutánea, en Bolivia, podría ser replicada en Etiopía, donde se reportan entre 20,000 a 30,000 nuevos casos de Leismaniasis por año.

The Instituto de Investigaciones Fármaco Bioquímicas (IIFB), at the Faculty of Pharmaceutical and Biochemical Sciences, from UMSA, carry out work related to the leishmanicidal activity of the total alkaloids (CAT) obtained from the bark of the Amazonian medicinal species known as Evanta (Galipea longiflora) by the Tacana, Tsimane y Mosetene people. As part of the activities develop by the UMSA-ASDI Project Biomolecules of medicinal and industrial Interest (antiparasitic) we had a visit, in our laboratories at IIFB, of a researcher from The Armauer Hansen Research Institute (AHRI) from Ethiopia, during his stay we were able to carry out evaluations of CAT, Miltefocine and Anphotericin B, against strains of L. aethiopica, causative agent of the different manifestations of cutaneous leishmaniasis in Ethiopia. A total of six strains of L. aethiopica, were adapted to in vitro a conditions, at IIFB; and did show homogenous behavior against CAT. Five of the strains, showed an average calculated value for IC50 = 8.68 ±1.56 mg/mL, a value somewhat lower to the calculated for the reference strains L. amazonensis and L. braziliensis with IC50 = 11.73 ± 4.32 mg/mL and IC50 = 12.28 +/- 2.95 mg/mL, respectively. Except for one strain that showed values somewhat higher, to the other strains, consistently through our studies, with IC50 = 14.37 ± 3.58 mg/mL. As a consequence of our scientific interaction, the Universidad Mayor de San Andrés (UMSA) has signed a Memorandum of Understanding for the development of joint research with the Armauer Hansen Research Institute (AHRI) that belongs to the Ministry of Health in Ethiopia, and explore the possibilities to replicate the Bolivian clinical validation experience of Evanta in the treatment of cutaneous leishmaniasis, in Ethiopia where the annual incidence is estimated to be between 20, 000 to 30, 0000.

Ethnobotany of medicinal plants of northern Ethiopia / Etnobotánica de plantas medicinales del norte de Etiopía

An ethnobotanical survey based on semistructured questionnaires among 35 farmers was carried out in two regions in Tigray, northern Ethiopia. Ethiopia is one of the poorest countries in the world with low level of medical care; therefore indigenous knowledge of medicinal plants is highly priced information and can be a good source of income to family or community. In total, 58 plant species were detected, while 48 plants, and 44 genera, belonging to 27 families have been identified as medicinal. Vernacular, as well as scientific names, plant part used, way of use and modes of preparation and application are included. Majority of plants were used for various gastrointestinal disorders, sprains treatment or to heal bronchitis, however, interesting aspects are the uses of plants to cure bilirubinemia, prostate disorders, syphylis and milk ingest disorders.

En dos regiones del Tigray (Tigré), en el norte de Etiopía se realizó un estudio etnobotánico, basado en un cuestionario semiestructurado, entre 35 agricultores. Etiopía es uno de los países más pobres del mundo con un bajo nivel de atención médica, por lo tanto, el conocimiento autóctono de las plantas medicinales es una información muy valiosa y puede ser una buena fuente de ingresos para la familia o comunidad. En total, se detectaron 85 especies de plantas, de las cuales fueron identificadas como plantas medicinales 48 especies y 44 géneros pertenecientes a 27 familias botánicas. En el estudio están incluídos los nombres vernaculares y científicos, como también parte de la planta utilizada y su forma de uso, modos de preparación y aplicación. La mayoría de las plantas se usan para el tratamiento de diversos trastornos gastrointestinales y esguinces o para curar la bronquitis; sin embargo, son interesantes los usos reportados para tratar la bilirrubinemia, dolencias de la próstata, sífilis y la intolerancia a la lactosa.