Perception of the Women of the Mandacaru Settlement about Health Care

Introduction

In the context of rural agrarian reform settlements, which consist of sets of agricultural units installed by the National Institute of Colonization and Agrarian Reform (INCRA) in a rural property [1], landless rural women farmers find diverse and beneficial spaces that go beyond land ownership. They offer a wide range of products, strengthen family farming, agroecology and are considered reference spaces in social participation and health care practices [1].

They are structures where there is the possibility of adding values, building a consolidated identity and encompassing their ways of life. In addition, settled women have a very strong representation in the preservation of skills needed in different productions, which can range from basic food crops to the raising of animal species [2].

Women who live in rural settlements can be important references in their communities due to their important representativeness in family farming, in the process of agroecological transition, for seeking their own livelihood, but also for building their identities as settled women in the search for autonomy and rights and it is within the context in which they live that they develop their health care practices based on their knowledge and experiences full of meaning.

When it comes to care, it is discussed that it involves an attitude about one’s own life, a way of looking at or establishing relationships with the world, and the construction of a set of practices that would serve as support for the elaboration and modification of one’s knowledge of oneself and of the other [3]. In other words, care is born from a relationship between oneself and with the other, based on a construction of care practices and, for the author, caring for the other consists of also taking care of oneself.

In the common sense, care can be attributed to a meaning of “a set of procedures technically oriented to the success of a certain treatment” Ayres JRCM [4], but health care practices are produced from several aspects that involve experiences and actions, going beyond sets and technical knowledge.

Therefore, the main objective of this research was to understand the perception of health care of women living in the Mandacaru Settlement, seeking to understand its codes and meanings in the sociocultural context in which they are inserted.

Discussion

Health care involves a complex network of interactions that “encompasses different forms of knowledge, values, beliefs and meanings that shape health practices within a sociocultural context. Reflecting on the relationship between health care and the women of the Mandacaru Settlement, it is understood that health results from care practices that are cultivated from their experiences and relationships with the community and the health system.

For the women of the Mandacaru Settlement, these experiences and relationships also involve the process of illness, which can guide the way they experience their care practices. The representation of diseases, popular beliefs, cognitive models, culturally constituted realities can be considered the main paradigms related to the health-disease process that guide various health care practices.

“Be careful with that so you don’t let the disease arrive. It is for one to be on the safe side” (Jericho, 45). Jericho brings a perception in her narrative to express that, for her, health care has to do with prevention, but it is a relationship that goes beyond that. For the women of the Mandacaru Settlement, it is also a relationship with work.

“I think it has everything to do with the work, because our work is very heavy. For those who have back problems, a certain time will come... Just like a doctor once said to me, he said I wouldn’t be able to pick up the weight of a needle. And that the time would come when I would be in a wheelchair, if I didn’t take care of myself. Then I said, ‘Mercy!’ But even so, I didn’t go into his conversation and I keep working. But now, I’m feeling (pain) more constant, right? I took injections, I spent more than six ‘months’... Six ‘months’ like this, just shaking, not feeling much. But now, unfortunately, it’s more frequent (the pain).” (COACH, 50) For the community, the risk at work is imminent and daily. These risks can directly affect your health, but on closer reflection, there is a cultural logic permeated in this life trajectory. Everyone deals with daily risk in a natural way, as it is part of their routines.

Such risks are part of the deep-rooted culture that in the hinterland it is normal, it is common to face high temperatures, the possibility of encountering a venomous animal and this coexistence can lead to a fragility in health care practices in terms of prevention, protection, but for the community it is something natural. It is something that can be seen as vulnerability from the point of view of health professionals, but it is a situation that they demonstrate mastery and knowledge of the main problems faced are caused by excessive sun exposure among this class, according to several studies, and may include the appearance of melasmas and skin cancer. Thus, it is argued that many farmers in the semi-arid region of the Northeast avoid the use of Individual Protective Equipment (PPE), under various allegations such as the high cost of materials and the discomfort at work due to the weather.

When asked about the lack of use of PPE, she said that they are used to it, that clothing is already a form of protection, but recognizes that they should protect themselves better. Few have access to sunscreen and Faveleira said he does not use it due to a strong allergy to the product. Crown-of-friar, Mandacaru and Bromeliad claimed to use it constantly, but it has not been a practice for all.

In addition to the relevant relationship with work, the concern with access to health units permeates the health care of these women. The Mandacaru Settlement depends on the health units located in the urban area, but most often uses the Basic Health Unit (UBS) that is located in the rural village at a distance of about seven kilometers from the community. To get to the city, it can take an average of forty minutes. To go to any of the services, it is necessary to use transportation, whether collective or private, which becomes a barrier, as many do not have the financial conditions to pay for transportation.

The nearby UBS is composed of CHA, nurse, physician, nursing technicians, receptionists, offices, vaccination room and blood collection. In the city, the most accessed places are the Emergency Care Unit (UPAE), the University Hospital and the Polyclinic, in addition to the Dom Malan Hospital for obstetric urgencies and emergencies. These services are used in cases of greater urgency and for services of greater complexity. At the UBS they manage to solve most of the problems, but they complain that the number of tickets that are distributed daily for medical appointments is insufficient.

One of the main complaints of these women is the delay in consultations, the difficulty in accessing vaccination and referral for exams or surgeries. According to Coroa-de-frade, vaccination at the UBS which, because there is no refrigerator, there is no vaccine on a daily basis. Many mothers take their children to the city or even get appointments in the urban area due to the long wait and, in order to get these services, they use strategies such as third-party addresses in order to register in these central units.

Studies show that most health services are located in urban areas of municipalities and do not cover settlement areas. To meet these needs, the women of the settlements use strategies similar to the women of the Mandacaru Settlement, when using other addresses, considering the economic and geographical difficulties to access services.

The services most sought by women in the professional health system are usually related to reproductive health, such as the use of contraceptives, prenatal care, pediatric consultations, vaccination, as well as preventive cytopathological and breast exams. They still seek to perform laboratory tests to monitor chronic diseases such as hypertension and diabetes mellitus. The ACS always assists with guidance, with information about the days of appointments and vaccinations, informs about the scheduling of exams and tries to help in some more specific and more time-consuming exams.

Studies show that there is an important difference between the care offered to women in urban and rural areas, especially with regard to obstetrics and gynecology, that is, women of reproductive age [13]. Among the women of the Mandacaru Settlement, it is common for them to seek care in the city, even though it is more distant, while they are of reproductive age. However, the nearest UBS provides prenatal care, cytopathological and laboratory tests and other needs through the Family Health Strategy (FHS) program in Primary Health Care. This program offers a follow-up structure for the mother-baby binomial from the diagnosis of pregnancy to the birth and growth of the child through childcare consultations with medical professionals and nurses.

For the climacteric and menopause periods, the UBS also offers follow-up services through the FHS, but these women very often resort to popular knowledge through the use of herbs and medicinal plants that they learned from their ancestors. Younger women prefer to use industrialized medicines and rarely, if ever, resort to natural products for their health care.

In the field of Public Health, the scientific and popular knowledge produced by consumers, health workers and the general population is considered for the organization of the care strategies and practices of the public health system. Thus, the care practices of the women of the Mandacaru Settlement follow a logic that organizes, guides and leads to the development of their own practices, many of which are passed down from generation to generation.

The sociocultural context in which a group is inserted shapes the therapeutic itineraries experienced by individuals. These experiences guide health practices, reflecting the patterns of certain social groups, such as settled women.

These experiences have a depth and complexity that is particular to the settled women, and this complexity establishes the meanings that construct this health care. Groups like this can offer their members many benefits, such as sharing lifestyle advice or coping strategies, or acting as a refuge for isolated individuals.

These women articulate health care practices that go beyond the public and private spheres, in addition to being shared both with other women and with the health professionals with whom they relate. The production of health involves understanding how health care practices are inserted in an ever-changing scenario. That is, it is not something constant, fixed or inflexible. On the contrary, there are exchanges, lived experiences and socio-cultural relations that permeate such productions.

Health for these women is intrinsically related to rural work and the opportunity to work with agroecology, that is, without the use of pesticides, is something of paramount importance for this population in view of the great damage to health that these harmful chemicals can cause to health, including leading to death. The World Health Organization (WHO) has published several publications discussing the use of pesticides in food and their impact on 300,000 deaths per year [14]. In addition, several other studies discuss the impacts of pesticides on women’s health, from poisoning to infertility [15].

The diversity of these women’s daily practices showed a constant and daily exercise of care in its multiple dimensions. Their health care practices include concern with food, the use of natural products from the region for the production of teas, sitz baths and, among others, with water treatment, with the hygiene of both the body and the environment in which they live. There is also a care that involves spiritual, social and financial life.

In this sense, health care practices can be understood as socially organized responses. They reflect the interactive complex between social groups, institutions, relationship patterns, and a specific body of knowledge. They show the diversity in the forms of care in different groups and can be understood as social conditions for such practices.

The Health Care System is constituted by the interaction of three different sectors: the traditional, the popular and the professional, so that each sector conveys specific beliefs and norms, legitimizing different health care practices. Each sector has its own ways of explaining and treating the lack of health, defining who is the person who heals and who is the patient, and specifying how they should interact during the therapeutic encounter. The traditional sector is the lay, non- professional and non-specialized domain of society, in which the lack of health is first recognized and defined. It is in this sector that primary health care is provided.

The logic that guides this care practice is based on beliefs about the structure of the body, the origin and nature of diseases. In fact, the main sphere of care is the family, so that it is in the family environment that complaints are identified and dealt with. In these groups, women are the main providers of health care, usually mothers and grandmothers, who diagnose most of the diseases and treat them with the available resources.

The folk sector is one in which certain individuals specialize in sacred or secular forms of healing. In other words, they are care practices that do not belong to the official medical system and occupy an intermediate position between the traditional and professional sectors.

In this sector, it operates with a holistic understanding of health and disease, involving all aspects of the patient’s life: relationships with other people, the natural environment or supernatural forces. Thus, the popular sector operates within a relational logic, so that health care involves the entire network of relationships of which the patient is a part.

On the other hand, the professional sector is dominant and hegemonic in our society, in health care it comprises the health treatment professions that are organized and legally sanctioned, as is the case of biomedicine. In this sector, most health professionals orient their health care practices within a logic specific to the biomedical model, based on an anatomical and physiological understanding of the body, health and disease.

Studies argue that half of the world’s population lives in areas considered rural, with only 38% of nurses and less than 25% of doctors working in these areas. This context of health services reveals the lack of quality of care in rural communities. Thus, this settled population needs to resort to a set of practices to take care of their health, including seeking care in the services located in the surroundings.

In the face of the struggle for the health of the settled population and the expansion of health services implemented in settlements or in the surrounding areas, the difficulty of access is still great and the care models often do not take into account their particularities.

Conclusion

During this trajectory, the paths of these women around the health care systems are discussed, but it is evident that the theme does not end here. Quite the opposite. There is much to know and deepen about these women who seek popular, scientific or professional knowledge and reflect this life experience in their daily lives.

In the midst of all this complexity, they develop their health care practices that carry diverse meanings permeated by cultural, social, political and historical contexts. This care involves rites, relationships with nature, social relationships, with work and with themselves. [16, 17, 18].

Therefore, in order to think about the health care of settled women, we must look at the totality of the sociocultural context in which they are inserted, so that I hope that this research will be an incentive for new studies in order to expand the scientific knowledge of these women and their experiences about the body and health.