Quando os profissionais de saúde vão além da doença: diálogos e traduções entre o “local” e o “global” para novas formas de promoção da saúde

Abstract

Dos estudos sociais sobre a saúde e a medicina e da antropologia médica chegam-nos debates emergentes sobre a produção de evidências, a ética e a intervenção na saúde global. Esta investigação doutoral propõe uma contribuição reflexiva e multidisciplinar centrada na urgência de outra saúde global, capaz de reconhecer a diversidade de contextos em que os seus problemas se manifestam, assim como os processos biológicos, sociais, políticos, culturais e ecológicos que complexificam e marcam a necessidade de melhores intervenções neste campo. Experiências prévias neste campo definem o caráter heurístico de uma abordagem metodológica que, por um lado, invoca a importância do trabalho de antecipação no processo de indagação moldado pela problemática da investigação e, por outro lado, recorre a metodologias colaborativas que não separam as práticas de conhecimento da produção de intervenções que respondem a necessidades de formas diversas de cuidado. A Plataforma de Saberes (Laboratório de Pesquisa em Epidemiologia e Determinação Social da Saúde, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil) é um espaço de envolvimento de pesquisadores e profissionais de saúde, pacientes e grupos comunitários na produção colaborativa de conhecimento e de criação de práticas de promoção da saúde em contexto de pesquisa clínica, epidemiológica e social para o controlo de doenças infeciosas e doenças crónico-degenerativas. A sua trajetória visibiliza experiências invisíveis ou negligenciadas que não integram as narrativas dominantes da ciência, mas que são parte da ontologia de mundos compostos de enredamentos complexos entre saúde, doenças infeciosas, vulnerabilidade estrutural e sofrimento, mas também de outras possibilidades de futuro. A relevância desta investigação social, das suas práticas e dos seus modos de produção de conhecimento articula-se, na Plataforma de Saberes, com uma atenção renovada sobre a complexidade das situações e dos problemas que nos chegam de diversos lugares do mundo, bem como sobre os encontros divergentes entre o conhecimento biomédico e epidemiológico e os conhecimentos nascidos da experiência. Esta relevância inspira o modo de investigar e de intervir no campo da saúde global, assim como lições futuras para a construção de uma ciência mais ecológica, mais crítica e mais democrática. O contributo aplicado desta tese – o desenho e a implementação da Consulta de Promoção da Saúde – materializa uma ética de pesquisa e intervenção atenta aos espaços de encontro, onde factos e situações problemáticas se transformam em “questões de cuidado” a partir das histórias que nos são trazidas por quem é afetado por elas e desenvolve o cuidado dos outros. Cuidar do conhecimento surge, neste trabalho, como a base da sobrevivência, do florescimento e do reconhecimento da interdependência como condição de uma vida digna.

From the field of social studies on health and medicine and medical anthropology, new debates are emerging on ethics, the production of evidence and interventions in global health.This doctoral research is a reflective and multidisciplinary contribution to another global health, capable of recognizing the diversity of contexts in which its problems manifest themselves and the biological, social, political, cultural and ecological processes that complexify and create the need for improved interventions.This study focuses on Plataforma de Saberes (Epidemiology and Social Determinants of Health Research Laboratory, Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brasil) which promotes a sustained engagement between researchers, health professionals in collaborative production of knowledge on health with patients and community groups, and the creation of innovative health promotion practices in the context of clinical, epidemiological and social research for the control of infectious and chronic-degenerative diseases.My previous experiences in this field define the heuristic character of a methodological approach that invokes the importance of anticipation work throughout the research process,and the use of collaborative methodologies that don’t part knowledge practices from the production of interventions that respond to diverse care needs.This tracking work in Plataforma de Saberes aims to make visible the neglected experiences that are not part of the dominant science narratives, but constitute the ontology of complex and entangled worlds composed by health, infection, structural vulnerability and suffering but also of other possibilities of future.The relevance of this social research, its practices and modes of knowledge production is articulated with a renewed attention to the complexity of situations and problems in different parts of the world, as well as to the divergent encounters between biomedical and epidemiological knowledge and knowledges that arise from experience. Relevance inspires thisresearch and intervention in the field of global health, and future lessons for a more critical, ecological and democratic construction of epidemiology and global health. xiiThe applied contribution of this thesis –the design and implementation of the Health Promotion Consultation –reveal the importance of looking at the spaces for encountering problems, in which facts and problematic situations become matters of care based on the stories brought to us by those who are related to,and affected by,them and develop the care for others. In this work, caring for knowledge is the basis for survivingand flourishing, and the recognition of interdependence as a condition of a dignified life.

From the field of social studies on health and medicine and medical anthropology, new debates are emerging on ethics, the production of evidence and interventions in global health. This doctoral research is a reflective and multidisciplinary contribution to another global health, capable of recognizing the diversity of contexts in which its problems manifest themselves and the biological, social, political, cultural and ecological processes that complexify and create the need for improved interventions. This study focuses on Plataforma de Saberes (Epidemiology and Social Determinants of Health Research Laboratory, Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brasil) which promotes a sustained engagement between researchers, health professionals in collaborative production of knowledge on health with patients and community groups, and the creation of innovative health promotion practices in the context of clinical, epidemiological and social research for the control of infectious and chronic-degenerative diseases. My previous experiences in this field define the heuristic character of a methodological approach that invokes the importance of anticipation work throughout the research process, and the use of collaborative methodologies that don’t part knowledge practices from the production of interventions that respond to diverse care needs. This tracking work in Plataforma de Saberes aims to make visible the neglected experiences that are not part of the dominant science narratives, but constitute the ontology of complex and entangled worlds composed by health, infection, structural vulnerability and suffering but also of other possibilities of future. The relevance of this social research, its practices and modes of knowledge production is articulated with a renewed attention to the complexity of situations and problems in different parts of the world, as well as to the divergent encounters between biomedical and epidemiological knowledge and knowledges that arise from experience. Relevance inspires this research and intervention in the field of global health, and future lessons for a more critical, ecological and democratic construction of epidemiology and global health. The applied contribution of this thesis – the design and implementation of the Health Promotion Consultation – reveal the importance of looking at the spaces for encountering problems, in which facts and problematic situations become matters of care based on the stories brought to us by those who are related to, and affected by, them and develop the care for others. In this work, caring for knowledge is the basis for surviving and flourishing, and the recognition of interdependence as a condition of a dignified life.