Processo de trabalho do agente indígena de saúde: interrelação étnica e cultural na atenção básica de saúde no contexto

Abstract

Aiming to analyze the working process of the Indigenous Health Agents in Primary Care within the Indian Health Multidisciplinary Team (EMSI), discuss knowledge and health practices from the interrelationship ethnic / cultural development of AIS with others EMSI members and users to identify the facilities, difficulties, conflicts, contradictions and expectations in the development of the labor process in the AIS EMSI, ie between health workers and non-indigenous natives in their work processes and users. This is a qualitative study with an approaching social research whose field of research was the municipality of Banzaê - BA, where Indians reside Kiriri. The subjects of this study consisted of three social sectors, classified into group I: the AIS working in the Family Health Unit Indigenous (USFI) and / or Basic Health Units (BHU) and other members of EMSI, group II, the key informants - healers, shamans, teachers and others, and group III, users of Unity Family Health Indigenous. The techniques used for data collection was participant observation followed by field diary and illustrated photographic record and semistructured interviews. The analysis method used was content analysis. From the data, two analytical categories emerged, with Category 1 - The work process in the context of AIS Kiriri: fragmented, ad hoc, contradictory and conflicting and Category 2 - The health work across cultural boundaries: inter-ethnic and cultural diversity in health Kiriri context. Results presented in the AIS include the community as its object of study in a collective perspective, but there are concepts which are based on a single object (the Indian), and to the professional as the object of his attention; For the purposes of the work process , there is a convergence of the respondents on individual needs and not work toward the collective, prevention and health promotion were identified as constituent elements of the work process of the AIS, although during the observations it was noted that such subjects have away from this reference, including the educational practices in a group are not part of their practice, restricting the actions the individual guidelines in households; major activities that relate AIS perform are home visits and individual guidance, contrary to our observation showed the activities of agents restricted the passage of errands team to the community and the request via car phone for emergencies. The study also revealed the 'excess' of collections that are subjected AIS for not knowing your 'paper', due to lack of professional qualification, causing them to fail to perform the basic tasks of a local agent health and start to perform actions that are beyond the professional duties of the AIS, descaracterizando your work process. Highlighted the difficulties that still face the AIS for the development of their activities: lack of materials and resources, community charges, blaming of AIS for such problems, lack of professional recognition and labor rights, which specifically reveals that overlooks the prerogatives the National Health Policy and the Indigenous laws that address the guarantees reserved for indigenous groups. Instruments of work mentioned by respondents refer to practices based on solid procedures in a mechanistic logic, although some testimonials give emphasis to light technologies in the work process of these agents. As for the design of health there was a variety of concepts that depart from conception hygienist, the absence of disease to the expanded concept of health. The second category revealed the existence of cultural conflicts in the relations of EMSI. The dichotomy between the issue of universalism as a constitutional right guaranteed to all and Cultural relativism as a prerogative to look at indigenous issues. The lack of training was identified as an amplifier of such conflicts to the extent that the AIS can not understand the need for articulation of popular knowledge and clinical; pointed out some testimonials of AIS shares fully focused on their culture, other respondents demonstrated the overvaluation of biomedical knowledge, and articulation of clinical and traditional know was also referenced in some subjects. Yet it was evident the difficulty of access to municipal health services by Indians, strengthened by historical conflicts and the misconception about "special attention" to relieve the municipality of responsibility for the health of indigenous contradicting the overriding principle of the Health System - the universality .