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Gynaecological Consultations in a Brazilian Context: Technological Toolboxes and the Challenge of
Integrality
Prof. Dora Lucia de Oliveira, Ph.DSchool of Nursing
Federal University of Rio Grande do SulBrazil
Research Funded by the Brazilian Ministry of Health
Analyse, on a national scale and focusing on the Brazilian primary health care network, gynecological consultation scenarios and the capability of this device to produce integral healthcare for women, considering :
the organization of health assistance,the organization of work,the technical quality, the predominant orientation in terms of the
technological nature of these actions,
Analyse, on a national scale and focusing on the Brazilian primary health care network, gynecological consultation scenarios and the capability of this device to produce integral healthcare for women, considering :
the organization of health assistance,the organization of work,the technical quality, the predominant orientation in terms of the
technological nature of these actions,
THE BRAZILIAN CONTEXTFifth largest country in the world; A population of approximately 190 million people; Increasing economic development in the last
decades;Regional diversities and social inequalities; Changes in the demographic profile with an age
range weighted more towards adults and elderly rather than children;
Economic growth accompanied by a reduction in the rates of infectious diseases and a need to prioritize the care for non-communicable diseases in an ageing population;
THE BRAZILIAN CONTEXT
Changes in the social determinants of health;
Ascribed to improvements in the health status of the Brazilian population;
Radical institutional change in the Brazilian health system;
Offering of universal and free access to health care services – creation of the Unified Health System in 1989
THE UNIFIED HEALTH SYSTEM
Funded by taxes and social contributions;
Guarantee equal and free access to health care at primary, secondary and tertiary levels;
Doctrinal Principles: universality, integrality, equity and social control;
Works though decentralization and regionalization processes, with priority given to prevention.
WOMEN’S HEALTHCARE in BRAZIL
The Unified Health System defined new goals to women’s healthcare;
Broadening perspective of women’s health with the intent of overcoming the traditional focus on reproduction;
New Policies - National Program of Comprehensive Care to Women's Health ;
The definition of women as reproductive beings remains significantly influential ;
Policies and Programs - Gynaecological and Maternal Health
WOMEN’S HEALTHCARE in BRAZIL
Care offers usually associated with the competence of women’s bodies to produce and maintain healthy babies;
Pre-natal and post-natal care, breastfeeding check-outs and education;
Neglecting of other issues: menopause (post reproductive years); conditions commonly experienced post menopausally like urinary incontinence, high blood pressure and cardiovascular diseases.
GYNAECOLOGICAL CARE – PRIMARY CARE SERVICES
Cervical and Breast Cancer- prevention and diagnose;*
Sexually Transmitted Diseases;
Genital-Urinary Infections;
Family Planning - contraception
THE FOCUS ON CANCER-EPIDEMIOLOGICAL REASONS
In 2012 cervical cancer was the third highest cause of death from cancer among Brazilian women;
Cervical cancer rates are highest in the poorest Brazilian regions;
Breast cancer is the most common type of cancer among women in most regions of the country.
THE ARGUMENT
While currently gynaecological consultations in Brazil are restricted to programmatic targets, complaints and symptoms associated with sexual and reproductive functions; they still have potential to respond comprehensively to women’s needs, depending on the combination of health technologies being employed.
Such potential could be achieved through implementation of care services that truly follow the principle of ‘integrality’, one of the doctrinal principles of the Brazilian health system.
THE ARGUMENT
In order to reduce women`s suffering from gynaecological cancers, it is not sufficient to guarantee the technical capacity of gynaecological consultations;
Promoting women’s health via gynaecological
care cannot be successfully achieved by using biomedical technological tools only.
OUR PROPOSAL
Gynaecological consultation shall not be restricted to a pathological focus and related issues, such as clinical diagnose and treatment;
This understanding is anchored in an amplified notion of health (taking into account social, religious, economic, racial and gender issues, etc.), in line with the assumptions of health promotion and the meanings of integral health;
Gynaecological consultation is
an interactive encounter between at least one
health professional and one woman, which is
carried out with the aim of understanding and
meeting this woman’s health care needs. Such
needs are to be assessed not only considering
the demands posed by health policies and
programs but also by valuing more personal
demands that can possibly be hidden behind
usual programmatic priorities.
SMEAR TEST AND BREAST EXAMINATION
Opportunities for establishing dialogue,
connection and affirmation of women’s sexual
and reproductive rights;
Opportunities for valuing women’s decisions
regarding sexual and reproductive health;
Opportunities for optimising the health
promotion potential of the health acts.
THEORETICAL CONSTRUCTS
INTEGRALITY
embodies the idea of health as a right and
health needs as marked by a high level of
subjectivity, unpredictability and complexity.
THEORETICAL CONSTRUCTS
INTEGRALITY
*implies a healthcare that not only includes actions
to reduce the burden of diseases in terms of
suffering, risk of death or possible complications;
*demands the enlargement of the assistance
response by providing a broad range of support
for the people so that, despite the disease, they
can have the best life possible;
THEORETICAL CONSTRUCTS
INTEGRALITY AS APPLIED TO
GYNAECOLOGICAL CONSULTATIONS
women should not be treated as a group but as
individuals, a position that may have the
potential to reconfigure their relation (as users)
with the system, in the sense of defining the
healthcare trajectory in particular terms.
THEORETICAL CONSTRUCTS
Health Technologies
Tools that are combined in the work process that
results in health acts (equipments, instruments,
professional experience, technological
knowledge…) .
Based on Marx’s notion of “living and dead labor”.
THEORETICAL CONSTRUCTS
Marx Theory
Labor is configured not only in terms of its operative
dimension (as an activity), but as a praxis, which in
its turn gives meaning to the work.
Dead Labor- all products used in the production
process, which are results of a previous human work.
Living Labor -is a process that makes use of the
products of dead labor in a creative work, which ends
up in the manufacture of a new product.
THE TOOLBOXES OF HEALTH TECHNOLOGIES -
The first toolbox is constituted by “hard technologies”, which allow the health professional to make use of machines or equipments (dead labor) to carry out physical, laboratorial and imaging examination (speculum, microscope…)
THE TOOLBOXES OF HEALTH TECHNOLOGIES -
The second toolbox is constituted by “soft-hard technologies”. Combines ‘hard’ (epidemiological and professional knowledge..) with more reflexive tools in a process through which the professional reasoning is developed. Uncertainty of what to do demands reasoning .
THE TOOLBOXES OF HEALTH TECHNOLOGIES -
The third toolbox is constituted by “soft technologies,” which allow the professional to get a more accurate perception of the particular situation of the user (interactive tools: listening, developing a bond, …).
Meeting the Challenge of Women’s Health Integrality in Gynaecological Consultationsto re-arrange the logic of the care that has been
provided;to stimulate health professionals to revise their
ways of approaching women’s health in gynaecological consultations;
to open the encounter professional-user to the guidance of “soft technologies”;
to give more value to the dialogic potential of the consultation and invest into a more horizontal relation professional-user.
To repeat this process of invention in each encounter in order to make possible the dialogue with the woman’s singularities.