Condicionantes do diagnóstico tardio do câncer cervical na ótica das mulheres atendidas no Inca / Conditioning factors in the late diagnosis of cervical cancer from the perspective of women treated at Inca

Neste estudo, identifica-se a contribuição de fatores para o diagnóstico tardio do câncer de colo uterino entre mulheres atendidas no Instituto Nacional do Câncer no Rio de Janeiro. Considerou-se as categorias 'acessibilidade' e 'vínculo' na análise das informações, tendo como pressuposto a importância da integralidade como eixo norteador das práticas em saúde. Apoiado na abordagem qualitativa, as estratégias metodológicas incluem a observação direta e entrevistas semiestruturadas. Os resultados sugerem que as concepções e percepções das mulheres em relação à doença e à atenção à saúde e o vínculo destas com os profissionais atuam de modo inter-relacionado, condicionando o acesso aos serviços.

This study identifies the contribution of some factors for the late diagnosis of cervical cancer among women treated at the National Cancer Institute in Rio de Janeiro. The categories considered in analyzing the information were 'accessibility' and patient-doctor 'relationship', based on the premise of the importance of comprehensiveness as a guiding principle in health care. A qualitative approach was adopted involving the methods of direct observation and semi-structured interviews. The results suggest that the women's ideas and views regarding the disease and the health care, and their bond with the health care professionals are interrelated and condition access to the services.

Reacciones a la violencia institucional: estrategias de los pacientes frente al contraderecho a la salud en Brasil / Reactions to institutional violence: patient strategies for facing infringements of the right to health in Brazil

Este artículo se propone identificar evidencias de desigualdades, preconceptos y discriminación en el acceso y utilización de los servicios públicos del Sistema Único de Salud de Brasil, consideradas como violencia institucional y denegación de los derechos, con el fin de abordar las reacciones de los sujetos perjudicados en este proceso. La metodología utilizada articuló observación participante y entrevistas semiestructuradas a las técnicas de grupo focal y talleres de dramatización. Los resultados señalan la peregrinación como la mayor expresión de las desigualdades, acentuada por factores estructurales como la precarización de los servicios, que potencian las asimetrías de poder, y la discriminación derivada de estigmas y preconceptos. La mayoría de las reacciones de los pacientes a la situación de violencia institucional busca una solución individual que, en muchos casos, refuerza las condiciones que generan el contraderecho. Pocas reacciones cuestionan las condiciones sistémicas que determinan la persistencia de la discriminación.

In this article we identify evidences of inequalities, prejudices and discrimination in the access and utilization of public health services belonging to the Brazilian Unified Health Care System, considering them to be institutional violence and a negation of rights, in order to look at the reactions of the subjects victimized by this process. This research study utilized different methodologies, articulating participant observation, semi-structured interviews, focus groups and dramatization. The results highlight the trajectory in seeking health care as the main expression of inequalities, strengthened by structural factors such as the precarious condition of health care services, which potentiate power asymmetries, and the presence of discrimination derived from stigmas and prejudices. Most patients' reactions to the situation of institutional violence seek an individual solution to the problem, often reaffirming the conditions that generate rights violations. Few patients' reactions question the systemic conditions that determine the continued discrimination.