Guinjoan, G. Quesada, S. Silvestre, A. Chouder, E. Winter, D. Micha, N. Klein, M. Pires, P. Okada, Y. Shoji, C. Hung, D. Farrell, T. Ji, D. Jung, C. Won, B. Lee, J. L earn more about our Partner Support program here. We recognise your right to privacy.
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All articles. Partnership with the Synergos Institute. What comes next. About global Partner Support at Luminate. The names are fictitious. The investigation was approved by the National Research Ethics Committee under no. They are presented in this section intertwined with the discussion. Sueli is a year-old woman who begins her journey across different points of the health network in , referred or by herself, with recurrent complaints of headache, dizziness and blurry vision.
After many fruitless passages in the network, she is diagnosed as having a benign frontal lobe brain tumor with a diameter of approximately seven centimeters. She undergoes a surgery to remove it, not without difficulties to obtain such intervention, even after the diagnosis had been made. In one of our visits to the Primary Care Unit of Sueli's catchment area, the team responsible for her care invites us to visit her.
When we arrive at her home, an unexpected scene takes place: the team workers are prevented from going in. Sueli kindly states that the problem has already been solved and she does not need the unit anymore. She reveals that she intends to acquire a private healthcare insurance, as she no longer wants to depend on the public system - she had an experience that she considers bad.
At this moment, we reach the climax of the scene when we watch, astonished and helpless, the whole team - physician, nurse, nurse technician and community health agent - remain there, in front of the gate of Sueli's house, claiming their right to enter and discussing, in loud voices, that this refusal derives from an alleged mental confusion and cognitive difficulties caused by the tumor.
Finally, we go away. The team members were visibly revolted by what had happened and someone suggests she should be interdicted.
Fragment from the field diary. If we take the concept of bond expressed in the policies, we can think that, if a bond had been established at some moment of the relationship between Sueli and that team, it did not exist in the witnessed scene.
In this scene, similarly to what happens with so many Suelis we assist on a daily basis, the door was closed and the bond was not produced.
But what led her to give up the possibility of establishing a bond with the team? It seems that this is a key point to reflect on the events of Sueli's trajectory. When she fails to receive the care she needed, she no longer sees the team as a reference. Thus, when the team argues that Sueli allegedly has an incapacitating condition, they question her autonomy.
However, Sueli upsets them precisely because she refuses to adhere to a project outlined without her participation and does not accept to lose control over her body and life as a condition to the establishment of the bond. A mismatch is established and the only alternative that remains to the team is an immediate and radical interventionism on the health problems 26 But is it possible to construct bonds unilaterally, exercising control over the other's life?
However, lamb people do not exist. Some lamb people brace themselves and take the wool off in the light of day, lock the master outside and do whatever they want. And when they cease being a lamb, they really annoy teams that do not have opportunities to reflect on their practice and assume the responsibility for prescribing how the other should lead his life.
The findings of this study suggest that the bond is something that can be constructed, but it can also be deconstructed or never be achieved. Therefore, it must be cultivated. Based on this acknowledgement, it becomes possible to share therapeutic projects in the space between the desires of users and workers 29 It is clear that operating this concept in the complexity of the daily routine of the health work is neither simple nor natural.
Furthermore, when we present this scene, we do not intend to disqualify these workers nor stigmatize their practice in a Manichean way. In fact, we witnessed that they assumed responsibility for Sueli and for many other users of that service in countless situations.
In November , the researchers contacted the workers of an Emergency Unit and asked them to make a narrative about a user that had affected them in some way - due to success, to some difficulty or to failure.
Ricardo, the chosen user, was a year-old man diagnosed as having alcoholic neuropathy. Ricardo lived with his family - five brothers and sisters, three nephews and the father - of Paraguayan and Indian origin. There were many bottles of spirits in the house, a strong smell of marijuana and inhalant drugs, and several signs of violence were invariably perceived by the team. No one takes care of me here, only Ana, when she can. However, it is not possible to schedule the sessions due to hindrances in the services: there is no place, the patient does not have the adequate profile, there is no transportation, there is no patient sitter.
The team feels their hands are tied and define Ricardo as a problem, a complex case. In the first encounters, it was visible that there were many barriers to his treatment. In Ricardo's story, as well as in Sueli's, the construction of relationships between interlocutors who consider themselves as mutually valid also emerges as a necessary condition to the construction of the bond. Ricardo and his family, in turn, feeling acknowledged in their difference - even though, at that moment, their demand was not met -, also perceive the interlocution with Lia as valid, which allows them to establish a relationship based on mutual acknowledgement.
Thus, the differences between the subjects involved did not constitute an asymmetry between them and did not produce, neither in the worker nor in the user, a feeling of repulsion against each other; rather, it produced a feeling of symmetry.
Sztutman R. Encontros: Eduardo Viveiros de Castro. Rio de Janeiro: Azougue Editorial; There is not a denial of singularities and no one overlooks the fact that there are differences. This requires actions in relationships of symmetry, of equivalents - symmetry between the self and the other as an ethical and political bet on a certain mode of relationship 31 Divulg Saude Debate. Our first encounter with Rosa occurs when we listen to the narrative constructed by the FHT. They present her as a case that they considered difficult but succeeded in terms of articulating the various health services involved.
Rosa was introduced to us as a child who suffered abuses in her childhood. After this, she was expelled from home and was included in the child and adolescent protection network. However, as she does not see the care provided in the network as something meaningful to her, she runs away from the shelters. On the streets, she builds her life in the midst of prostitution and drug use.
Subsequently, her mother dies of AIDS. She acknowledges the healthcare unit as a place where she obtains support for hygiene actions and, sometimes, food.
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