Itinerários terapêuticos no cuidado em Saúde em comunidades quilombolas

Abstract

The remnants of the quilombo communities are "ethnic-racial groups, according to criteria of self assessment, with black ancestry and own historical trajectory, endowed with specific territorial relations". These black rural communities have their ways of life, production andsocial reproduction related predominantly to the land and have been fighting permanently for the conquest of constitutional rights. Some quilombos do not have access to collective services, such as schools, roads, water supply systems and health care, strengthening living conditions with a very low quality index and human development. The health system in Brazil has been trying to organize itself, through the implementation of several public health policies that privilege some population groups considered more vulnerable. However, the predetermined flows in health care or the aspiration of health service managers and workers do not necessarily coincide with the paths taken by individuals seeking therapeutic care. Their choices express individual and collective subjective constructions about experiences of illness and how to treat, built under the influences of various personal, cultural and socio-environmental factors. It is these characteristics that define the therapeutic itinerary of the quilombola population. This study aimed to map the therapeutic itineraries in health care in rural quilombola communities in northern Minas Gerais, Brazil. This is a cut of a qualitative research conducted in six communities visited. The data were produced through 18 narrative interviews and analyzed through the theoretical-methodological framework of the Therapeutic Itineraries based on the model of Health Care System proposed by Arthur Kleimann. The narratives allowed the understanding of the paths taken in health care by the quilombola population, the identificationof the components of the popular subsystem (natural resources, the use of teas and homeremedies), the family subsystem (transmission of knowledge and cultural heritage of care) and the professional subsystem (hospital level, medical care, primary and specialized care). The difficulties of access are not only due to geographical distances, but involve broader aspects of social determination, such as institutional racism, low supply of services, need for payment for travel and medical procedures. In this sense, it is necessary an approach and interventions of public policies in the face of ethnic-racial inequalities, economic and access to health care services in these territories.