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Gynaecological Consultations in a Brazilian Context: Technological Toolboxes and the Challenge of Integrality Prof. Dora Lucia de Oliveira, Ph.D School of Nursing Federal University of Rio Grande do Sul Brazil [email protected]
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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

[email protected]

INTRODUCTION

WHO?

WHERE?

WHY?

WHO?

WHERE?

WHY?

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.


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