Hitupmã'ax: educação intercultural e atendimento diferenciado à saúde do povo maxakali / Hitupmã'ax: intercultural education and specific health care for the Maxakali people

Resumo Este trabalho analisou um artefato (um livro de saúde) concebido pelo povo maxakali, denominado Hitupmã'ax: curar (2008). Tangenciado o projeto de produção do livro, o objetivo foi entender o processo de negociação da saúde pública no Brasil, dentro de uma perspectiva histórica e intercultural das epistemologias não ocidentais. Constatamos que a construção da obra maxakali representa um esforço para diminuir a distância da percepção e dos cuidados de saúde entre indígenas e não indígenas, e por essa via demonstramos a importância desse projeto intercultural para a efetivação de políticas públicas voltadas para o público indígena em geral e, especificamenete, para a promoção da história, dos saberes e da cultura maxakali.

Abstract This study analyzed an artifact (a book on health) conceived by the Maxakali people, called Hitupmã'ax: curar (2008). Parallel to the project for the production of this book, the aim was to understand the negotiation of public health in Brazil from a historical and intercultural perspective of non-Western epistemologies. It was found that the construction of the Maxakali work represented an effort to bridge the gap in the perception of health and health care between indigenous and non-indigenous people. This was then used to demonstrate the importance of this intercultural project for the shaping of public policies for indigenous people in general and particularly for the promotion of the history, knowledge, and culture of the Maxakali people.

La atención a la salud en Mesoamérica antes y después de 1519 / Health care in Mesoamerica before and after 1519

Resumen En este ensayo se discute la situación de la atención a la salud en Mesoamérica antes e inmediatamente después de 1519. En los primeros 50 años después de la Conquista, los españoles hicieron un uso muy extensivo de la medicina náhuatl. Sin embargo, con el tiempo, el ámbito de influencia de esta tradición se vio limitado debido a la rápida imposición de un sistema de atención muy diferente que poco aprovechó, entre otras cosas, la riqueza terapéutica de la medicina prehispánica.

Abstract This paper discusses the situation of healthcare in Mesoamerica before and immediately after 1519. In the first 50 years after the Conquest, the Spaniards made extensive use of Nahuatl medicine. However, the influence of this medical tradition was limited due to the rapid imposition of a very different medical system which took little advantage of, among other things, the therapeutic wealth of pre-Hispanic healing traditions.

Migração boliviana e doença de Chagas: limites na atuação do Sistema Único de Saúde brasileiro (SUS) / La migración boliviana y la enfermedad de Chagas: límites en la actuación del Sistema de Salud Brasileño (SUS) / Bolivian migration and Chagas disease: boundaries for the action of the Brazilian National Health System (SUS)

Migrações acarretam mudanças nos perfis epidemiológicos, impactando sistemas de saúde dos países receptores. O Brasil atrai imigrantes que se inserem precariamente nas metrópoles. Na Bolívia, a doença de Chagas é endêmica, fato relevante para o SUS brasileiro.O texto analisa a atuação e os limites dos profissionais de saúde no atendimento aos bolivianos no SUS, enfocando a doença de Chagas, por meio de entrevistas aplicadas nos serviços primário, secundário e terciário na região central da cidade de São Paulo, principal destino dos imigrantes bolivianos. As precárias condições de vida dos bolivianos caracterizam iniquidades em saúde. Idioma e cultura limitam a compreensão sobre o cuidado. Constata-se desconhecimento da clínica e epidemiologia da doença de Chagas entre os profissionais que atendem esses imigrantes. Faz-se necessária a revisão de estratégias assistenciais e de controle da doença de Chagas.(AU)

Las migraciones traen consigo cambios en los perfiles epidemiológicos, impactando los sistemas de salud de los países receptores. Brasil atrae a inmigrantes que se insieren de forma precaria en las metrópolis. En Bolivia, la enfermedad de Chagas es endémica, hecho relevante para el SUS. El texto analiza la actuación y los límites de los profesionales de salud en la atención a los bolivianos en el SUS, enfocando la enfermedad de Chagas, por medio de entrevistas realizadas en los servicios primario, secundario y terciario en la región central de la ciudad de São Paulo, principal destino de los inmigrantes bolivianos. Las precarias condiciones de vida de los bolivianos caracterizan iniquidades en salud. El idioma y la cultura limitan la comprensión sobre el cuidado. Se constata el desconocimiento de la clínica y de la epidemiología de la enfermedad de Chagas entre los profesionales que atienden a esos inmigrantes. Es necesaria la revisión de estrategias asistenciales y de control de la enfermedad de Chagas.(AU)

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.(AU)

Educación médica para la inclusión intercultural desde un estudio de caso entre los Mbyá-guaraní / Medical education for intercultural inclusion based on a case study of a Mbya-guarani child

Introducción: es un error ver la enfermedad solo como algo somático, debe ser vista en el contexto macro-cultural que el experto en medicina debe conocer e interpretar. Comprender esta relación es crucial para la formación de profesionales de la salud. Se hace necesaria una comprensión transcultural de la salud, tanto para gestionar políticas públicas como para avanzar hacia una comprensión holística. Objetivo: poner en evidencia esta necesidad mediante un ilustrativo estudio de caso. Métodos: mediante procedimientos cualitativos de estudio de caso se abordó el estudio del caso Julián, un niño de una comunidad Mbyá­guaraní afectado de una cardiopatía congénita. Las fuentes de información utilizadas fueron entrevistas no estructuradas, una filmación documental e informaciones de los medios de comunicación masiva. Resultados: se pusieron en evidencia las serias implicaciones y trastornos acaecidos en la atención de la salud del caso estudiado y de las relaciones con su comunidad. Se analiza el caso desde un enfoque antropológico que destaca la importancia del dominio de la interculturalidad por parte del personal de salud y la importancia de que este tipo de conocimiento se incluya en los planes de formación de estos profesionales. Conclusiones: la desatención del debido respeto y comprensión hacia las diferencias culturales puede ocasionar serias dificultades en la atención de salud de comunidades y minorías. Una formación que enfatice la necesidad de profundizar en el relativismo metodológico y en la interpretación de las diferencias culturales en torno a la salud es de imperiosa necesidad(AU)

Introduction: It's a mistake to see the disease as something only somatic, it must be seen in the macro-cultural context that the medical expert must understand and interpret. Understanding this relationship is crucial for the formation of health professionals. Cross-cultural understanding of health, both to manage public policies to move towards a holistic understanding is necessary. The aim of this study was to highlight this need through an illustrative case study. Methods: Congenital heart disease affected Guarani - using qualitative case study methods case study Julian, a child from a community Mbya addressed. The information sources used were unstructured interviews, documentary footage and information from the mass media. Results: The serious implications and disorders occurring in health care case study and community relations was highlighted. The case is analyzed from an anthropological approach that emphasizes the importance of intercultural domain by health personnel and the importance of this kind of knowledge is included in the training plans of these professionals. Conclusions: The neglect of due respect and understanding cultural differences can cause serious difficulties in the health care community and minorities. Training that emphasizes the need to deepen the methodological relativism and the interpretation of cultural differences on health is imperative(AU)

Na simplicidade a complexidade de um cuidar: a atuação da benzedeira na atenção à saúde da criança / The complexity inside the simplicity of the care: the role of a healer in child healthcare

Falar em cultura e saúde é adentrar questões como religião e espiritualidade, terapias não oficializadas que perpassam o misticismo dessas questões, e que, apesar de não possuírem a comprovação técnico-científica exigida pelo atual modelo em saúde hegemônico, são um saber que se mantém vivo durante toda a história da humanidade e que se perpetua até os dias de hoje. O trabalho objetivou analisar a percepção das benzedeiras sobre o cuidado à saúde da criança, enfocando a prática da benzeção no município de Caraúbas. Trata-se de estudo qualitativo de caráter exploratório, realizado por meio de entrevista semiestruturada, com amostra composta por 16 benzedeiras residentes no setor urbano do município de Caraúbas-RN. Evidencia-se um cuidado baseado em aspectos que envolvem a afetividade, observando-se que as benzedeiras seguem um perfil muito semelhante no tocante às crenças e na utilização do ritual de cura. As benzedeiras apresentam disposição em articular arte e ciência, visualizado pelo encaminhamento e reconhecimento da importância do sistema oficial em saúde. Configura-se um espaço para a Estratégia Saúde da Família realizar parcerias que incentivem o uso concomitante entre essa modalidade terapêutica e o sistema oficial, contribuindo assim para melhoria da assistência.

Speaking about culture and health issues is also speaking of matters of religion and spirituality, therapies that were not yet made official and cross the mysticism of these issues. Moreover, despite lacking the technical-scientific proof demanded by the current hegemonic model in healthcare, they are knowledge kept alive throughout the history of mankind and perpetuate until the present day. The study aimed to analyze the perceptions of traditional healers about the child healthcare in the city of Caraúbas-RN, Brazil, focusing on the practice of blessing. It was a qualitative and exploratory study, conducted through semi-structured interviews and with a sample of 16 traditional healers who live in the urban area of the city. It was clear that the care delivered is based on aspects that involve affection, and it was noticeable that the healers are very similar among themselves when regard their rituals. The healers show that they are willing to put together art and science, since their acceptance of the importance of the official healthcare system. This set up a place for the Family Health Strategy to create partnerships that promote the concomitant use of this therapeutic modality and the official system, thereby contributing to the improvement of the care itself.

Pattern of diseases among visitors to Mina health centers during the Hajj season, 1429 H [2008 G]

While performing the Hajj, hajjis face different risks related to the environment, their behaviors and their health conditions that can result in a variety of diseases. The objective of this study was to determine the pattern of diseases among pilgrims seeking medical services in Mina primary health care centers [PHCCs] during the Hajj season in 1429 [2008]. This is a descriptive study based on the medical records of a random sample of 4136 patients who attended 13 randomly selected Mina PHCCs from 8 to 12 Dhu-Alhijja, 1429 H [6-10 December 2008]. The majority of the patients were men [70.7%], and most of the patients were between 45 and 64 years of age [42.8%]. One-fifth [20.2%] of the patients suffered from multiple diseases. Respiratory diseases were the most common [60.8%], followed by musculoskeletal [17.6%], skin [15.0%] and gastrointestinal [13.1%] diseases. Diabetes, asthma and hypertension each constituted less than 3% of the total diseases. Respiratory diseases were the most common independent of nationality or the day of visit, while the frequency of the other diseases varied according to nationality and the day of visit. The most frequently prescribed drugs were analgesics, antipyretics, antibiotics and cough syrups. This study describes the pattern of diseases among pilgrims attending Mina PHCCs, which may aid in providing the best possible health care services to pilgrims. 2011 King Saud Bin Abdulaziz University for Health Sciences. Published by Elsevier Ltd. All rights reserved