Promoting Health in the Brazilian Amazon: one nation but many cultures

Jair Messias Bolsonaro, the 38th President of Brazil                                                                           (Fabio Rodrigues Pozzebom/Agência Brasil, 2016)

This article was exclusively written for the The European Sting by Ms. Clarissa Garcia Custodio, a 2th year medical student at Pontifical Catholic University of São
Paulo, Brazil. She are affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

The training of the health professional is complemented by it extracurricular experiences that guarantee no proposed experiences in the pedagogical project of the medical course. In January 2018, I spoke about the work of a Community Agent of Indigenous Health in the Seminar on Innovation in Primary Care (SIAP).

By spent hours reflecting on how I could learn about the Ianomami culture in some Internet research and only tried to answer one question, What can a Doctor do in an isolated village without any essential knowledge of that culture and what can a Community Health Agent who works in that region do “beyond” without clinical knowledge?

The subsystem of Attention to Indigenous Health, created in 1999, in Brazil, works according to the principles of the Unified Health System (SUS). It is linked to the Indigenous Health Agent (AIS) which, in addition to the functions of the Community Health Agent (ACS), such as work on disease prevention and health promotion, compose a multiprofessional team, register families residing in its area of ​​coverage, detect health problems, follow treatments and developments, also, is inserted in the village, translates languages ​​and, mainly, is a bridge between their different conceptions of health and world having responsibilities as the only health professional of the place when the rest of the team cannot be around.¹

Imagine a mountainous region, frontier between Brazil and Venezuela, with cultural contrasts within the same ethnic group, different languages ​​and located in the largest tropical forest in the world with the extension of land along a river explored by illegal mining. Think that in this region, in a continuous area of ​​approximately 9 million hectares, lives an indigenous population. Given these geographical and cultural obstacles, it is evident that an anthropological study is needed for both an expeditionary and an Community Health Agent (ACS) that aims to facilitate the relationship between indigenous people such as traditional medicine and AIS is apt to enter into part of local medicine.²

Our health training, which is sometimes strictly technical and biological, tends to limit clinical functions to professionals with higher education. Although we think of the role of the ACS as being strictly bureaucratic, in some cases it is clear that we must see the demand, that is, how to adapt the only health resource in the region to the needs of the community.³                                              

Promoting AIS clinical training does not mean depriving them of their pre-established functions, but prepares them for situations in which it is the determinant of health and disease, because if fear is the screening of unduly diagnosed diseases, perhaps the risk is less than the damage. That is, it is important that this professional know how to determine the boundary between a traditional treatment when identified the basic clinical pathophysiology of a case of disease endemic to that region and the need for a referral or assistance from a multidisciplinary team.

References

1. (ISA) IS. Almanaque Socioambiental Parque Indígena do Xingu : 50 anos. 2011. 22-23 p.
2. Louzada, Jaime; Lopes Neto D. Abordagem crítico-interpretativa das fragilidades e potencialidades do trabalho de enfermagem aos ianomâmis, Amazonas. Enferm em Foco. 2010;1(2):42–5.
3. Garnelo L, Pontes AL. Política de Saúde Indígena no Brasil: notas sobre as tendências atuais do processo de implantação do subsistema de atenção à saúde. Saúde Indígena: Uma Introdução ao Tema. 2012. 18-60 p.

About the author

Clarissa Garcia Custodio is a 2th year medical student at Pontifical Catholic University of São Paulo, Brazil. She is interested in professional photography and horse riding. She loves her life style between taking care of people and animals. Also, she has shown a lot of interest in the activities proposed by the institution she is joining, been it curricular or extracurricular. She worked with International Federation of Medical Students’ Associations of Brazil (IFMSA – Brazil) as a Local President. Her initiatives give the opportunity to show anyone what we are capable to produce in science by raise the name of her Institution without missing any opportunity to show well done work.