Implicações e desafios da saúde indígena na atenção especializada: perspectiva dos profissionais de saúde e residentes em um hospital de referência no Mato Grosso do Sul, Brasil

Abstract

This is a cross sectional study, with a qualitative and quantitative approach, which aims to identify the perspective of health professionals and residents about the challenges faced in the care of indigenous users in a reference hospital in Mato Grosso do Sul, a state that includes the second largest indigenous population in the country. In addition, the study aims to describe some initiatives in welcoming and humanizing care for these peoples, highlighting the creation of an Indigenous Health Center (NSI), developed with the aim of articulating and enabling strategies aim ed at the demands of indigenous users, with the aim of implementing the financial resources provided by the IAE PI Ordinance, which is committed to improving care for indigenous people who access specialized care services. Thus, the research discusses how differentiated care is incorporated (or not) within the University Hospital of the Federal University of Grande Dourados (HU UFGD) through the workers' eyes. For this purpose, an online semi structured questionnaire sent was by email to health professional s and residents working in the maternal infant axis of the HU UFGD, from June to August 2020. The data analyzed were in the Software STATA® Version 13.1, and discrete variables synthesized were as mean and standard deviation, and median and interquartile r ange (5% significance level). A total of 230 health professionals and 29 residents collaborated with the study, most of whom reported having trouble at some level in caring for the indigenous population. Among the findings, there was low knowledge (14.7%) about the ethnicities attended at the hospital and that most participants (60.2%) had never witnessed any indigenous practice, indicating low articulation between the care systems. Differences observed were also between residents and effective professional s, where residents have a more positive view of approaching the indigenous reality. In the comparison between professional categories, the divergence of opinions of the medical category stands out. Regarding the application and implementation of the object ives of the IAE PI Ordinance, through the NSI, it observed is that hospital management does not prioritize the demands of indigenous users. Thus, it becomes important to reorganize and restructure this nucleus, with a view to finding ways to improve it. Th e results show the centrality of the biomedical model, the lack of knowledge on the part of professionals about the reality of the community served and its sociocultural context, in addition to the devaluation of indigenous knowledge and practices, which e nds up hindering the guidelines regarding indigenous medicines. There are several implications and challenges of differentiated care in the context of specialized care; thus, it becomes relevant to understand this perspective and approach reality in the ho spital context in order to promote debates about health policies with the purpose of qualifying care offered to indigenous people during their hospital stay. In addition, it recommended is to carry out a broad dialogue with the indigenous community with a view to evaluating and making a decision on the way forward.