Saúde e direitos: tensões de um SUS em disputa, molecularidades

According to the point of view that "every life is worth it", this text, based on a conference made by the author at the XII Congress of Public Health of São Paulo, discusses certain areas of tension that are operative in the field of health regarding the relationship between health and rights. In spite of recognizing the molar constitutive elements of this field, it defends the idea that the vital fights inside the current model, in which there are lives that are more worth it than others, must happen inside the molecularity of the work in health, inside the management and inside the care. It has to put the locus of practice as a key to the effective production of new modes of producing lives, where the differences are wealth and the vicinity between distinct forms of knowledge is nuclear to the making of bets. In these bets the richness of existential connections is the best way of betting that life production expresses the most fundamental aspect when building the field of health. Taking support from authors that discuss micro politics and schizoanalysis, the author tries and conducts a reflection about the implications of this "constructive regard".Sob o perspectivismo de que "qualquer vida vale a pena", o texto produzido a partir de uma conferência explora certos campos de tensões que operam no campo da saúde sob o olhar da relação saúde e direito. Apesar de reconhecer os elementos constitutivos molares desse campo, advoga a noção de que os enfrentamentos vitais do modelo atual, no qual há vidas que valem mais a pena que outras, deve se dar ali na molecularidade do agir em saúde, na gestão e no cuidado, trazendo o lugar da prática como chave para a produção efetiva de novos modos de se produzir as vidas, nos quais as diferenças são riquezas, e a vizinhança entre os distintos saberes é nuclear para a construção de apostas. Nestas, a riqueza de conexões existenciais é o melhor modo de se apostar que a produção de vida expressa o mais fundamental da construção do campo da saúde. Lançando mão de autores da micropolítica e da esquizoanálise, procura conduzir uma reflexão sobre as implicações desse "olhar construtivo

Saúde e direitos: tensões de um SUS em disputa, molecularidades

According to the point of view that "every life is worth it", this text, based on a conference made by the author at the XII Congress of Public Health of São Paulo, discusses certain areas of tension that are operative in the field of health regarding the relationship between health and rights. In spite of recognizing the molar constitutive elements of this field, it defends the idea that the vital fights inside the current model, in which there are lives that are more worth it than others, must happen inside the molecularity of the work in health, inside the management and inside the care. It has to put the locus of practice as a key to the effective production of new modes of producing lives, where the differences are wealth and the vicinity between distinct forms of knowledge is nuclear to the making of bets. In these bets the richness of existential connections is the best way of betting that life production expresses the most fundamental aspect when building the field of health. Taking support from authors that discuss micro politics and schizoanalysis, the author tries and conducts a reflection about the implications of this "constructive regard".Sob o perspectivismo de que "qualquer vida vale a pena", o texto produzido a partir de uma conferência explora certos campos de tensões que operam no campo da saúde sob o olhar da relação saúde e direito. Apesar de reconhecer os elementos constitutivos molares desse campo, advoga a noção de que os enfrentamentos vitais do modelo atual, no qual há vidas que valem mais a pena que outras, deve se dar ali na molecularidade do agir em saúde, na gestão e no cuidado, trazendo o lugar da prática como chave para a produção efetiva de novos modos de se produzir as vidas, nos quais as diferenças são riquezas, e a vizinhança entre os distintos saberes é nuclear para a construção de apostas. Nestas, a riqueza de conexões existenciais é o melhor modo de se apostar que a produção de vida expressa o mais fundamental da construção do campo da saúde. Lançando mão de autores da micropolítica e da esquizoanálise, procura conduzir uma reflexão sobre as implicações desse "olhar construtivo

Becoming cartographer

La producción subjetiva del cuidado constituye un elemento esencial de los procesos de trabajo en salud y un territorio común para todas las personas implicadas. A lo largo del proceso de embarazo, parto y posparto, el cuidado es producido en el cotidiano de forma singular dando lugar a la creación de territorios de prácticas. Se presentan las reflexiones y discusiones producidas a lo largo de la investigación de tipo cartográfico llevada a cabo en un Servicio de Obstetricia y Ginecología de un hospital comarcal. Se exploran de forma situada diferentes dimensiones de una investigación cartográfica: la entrada en el contexto, la construcción del rol, las normas del contexto y sus límites, la construcción de procesos intercesores y los tránsitos entre la mirada retina y vibrátil. La producción de cuidado como un terreno dónde la mirada micropolítica busca revelar e incidir en los procesos de singularización para generar aperturas al sistema de subjetividad dominante.The subjective production of care constitutes an essential element of any health work process and it emerges as a common territory for everyone involved. During pregnancy, birth and in the postnatal period, care is produced daily by health professionals according to their singularity, and it enables them to open up territories of health practices. The article focuses on the reflections and discussions that emerge during a cartographic research, which took place in an Obstetric and Gynecologic Service of a regional hospital. We present a situated discussion of different dimensions of this cartographic research: entering into the context, the construction of the role of researcher, context rules and limits, the construction of intersectional spaces and the articulation between “vibrant eye” and “retina eye”. The production of care is seen as a territory of health practices in which micropolitical field seeks to reveal and create singularities to open fissures in the dominant subjectivity

Perspectivas Atuais Do Sus E O Agir Tecnológico Do Trabalhador Como Um Ato ético-político

Palestra proferida no Auditório da Faculdade de Ciências Médicas em 13/11/2003 em comemoração ao XX Ciclo de Debates do Serviço Social do Hospital das Clínicas da UNICAMP.331-12Serviço Socia

Governing tensions in the health action as a permanent challenge of some managerial strategies

In the current essay, the author tries to synthesize what has livened him up lately in relation to his thinkings over the act of governing health organizations having several articles and books as a starting point, taking as a challenge the attempt of imprinting changes in the everyday life of the making of health attention models, in the core of the workers practices, even when a great concentration of power is not noticed as for transformation feasibility. Therefore there is a search to understand how and where power may be produced. How to explore terrains of potencies within the health field which are present in the tensional conformation of its action territory, using the managerial tools which are available in the area of science and government techniques - in health. Use managed care to developed analysis.O autor procura sintetizar, neste ensaio, o que tem animado, recentemente, suas reflexões sobre o ato de governar estabelecimentos de saúde, em vários artigos e livros, tomando como desafio a tentativa de imprimir mudanças no dia-a-dia do fabricar os modelos de atenção à saúde, no interior das práticas dos trabalhadores, mesmo não tendo grande concentração de poder para a transformação, procurando então compreender como e por onde produzir poderes. Como explorar terrenos de potências no campo da saúde que estão presentes na conformação tensional de seu território de ação, fazendo-se uso das distintas ferramentas gerenciais disponíveis no campo das ciências e técnicas de governo, na saúde. Utiliza a atenção gerenciada para desenvolver certas análises.30531

Mapas analíticos: una mirada sobre la organización y sus procesos de trabajo

The center of the discussion that this paper tries to face is the challenge of a method. An analytical look is searched for about the health organizations that have a mode of production depending on the "alive work in action", which in its own, provides a high complexity to the scene, since this alive work, while being operated in action in the work processes, contains a great power to form networks with a high capacity of subjectivity. We suggest the unions of workers build the cartography: a) the "maps of conflicts", b) the "maps of unusual acts", c) the "maps of useless acts", and from these maps, we may proceed with the discussion, analysis and self-analysis of the processes lived in the work situation. Through this experience, it was proved the efficiency of the "analytical maps" as cartographic tools. Applied to the work processes, we captured the continuous and non-continuous movements of the alive work in its dynamics, also revealing the affection and manifestations of desire in the production of the reality. These maps had the function of the "lens" of the cartographer to visualize the work process and the production of reality in its micropolicy.El centro de la discusión que este texto intenta enfrentar es el desafío de un método. Se busca una mirada analítica sobre las organizaciones de salud, que tienen un modo de producción dependiente del "trabajo vivo en acto"; lo que por sí solo aporta una alta complejidad a la escena, pues este trabajo vivo, al ser operado en acto en los procesos de trabajo, contiene una gran potencia instituyente para formar redes, con alta capacidad de subjetivación. Les proponemos a los colectivos de trabajadores la siguiente construcción cartográfica: a) los "mapas de conflictos", b) los "mapas de actos inusitados", c) los "mapas de actos inútiles"; y a partir de estos mapas se procede a la discusión, análisis y autoanálisis de los procesos vividos en situación de trabajo. A través de esta experiencia se comprobó la eficacia de los "mapas analíticos" como herramientas cartográficas. Aplicadas sobre los procesos de trabajo, captaron los movimientos continuos y discontinuos del trabajo vivo en su dinámica, revelando además los afectos y las manifestaciones deseantes en la producción de la realidad. Estos mapas cumplieron la función de las "lentes" del cartógrafo para visualizar el proceso de trabajo y la producción de la realidad en su micropolítica

El reconocimiento de la producción subjetiva del cuidado

This article assumes that there is a subjective production implicit in health care and suggests that qualitative investigation in health should also take into account studies on this dimension of reality. The subjective production of health care manifests itself on three levels: the first, the rizomatic networks which are formed and act in flows of intensities within health services and connect the workers in their working environment through lines of integral care; the second, the desire which is formed in primary, unconscious processes and operates as a productive energy to propel the processes that construct reality; and the third, the "live work in action" which serves as a platform upon which the networks of health care are produced. There is a combined and synergic movement among the three dimensions. This tells us that workers construct their work processes according to a unique way of understanding the world and taking part in it, putting a limit on the normative frameworks that attempt to structure the practice of care into rigid protocols. It is within the work of caring for health that these personal singularities manifest themselves and for this reason is a diverse, varied expression of manifold subjectivities in action.Este artículo parte del supuesto de que hay una producción subjetiva del cuidado en salud por lo cual sugiere que la investigación cualitativa en salud debe contemplar también estudios sobre esta dimensión de la realidad. La producción subjetiva del cuidado en salud se manifiesta en tres planos: el primero, las redes rizomáticas que se forman y actúan en flujos de intensidades al interior de los servicios de salud y conectan a los trabajadores en el ambiente del trabajo a través de líneas de cuidado integral; el segundo, el deseo que se forma en los procesos primarios, inconscientes, y opera como una energía de producción propulsora de los procesos de construcción de la realidad; y tercero, el "trabajo vivo en acto" que actúa como una plataforma sobre la cual se producen las redes del cuidado. Es un movimiento combinado y sinérgico entre las tres dimensiones. Esto nos revela que los trabajadores construyen su proceso de trabajo de acuerdo con un modo singular de significar el mundo e intervenir en él, poniendo un límite a las directrices normativas que intentan encuadrar las prácticas del cuidado en fórmulas rígidamente protocolares. El plano del trabajo y del cuidado en salud es el lugar de manifestación de las singularidades y por ello es diverso, múltiple, como expresión de las subjetividades en acción

Mapas analíticos: una mirada sobre la organización y sus procesos de trabajo

The center of the discussion that this paper tries to face is the challenge of a method. An analytical look is searched for about the health organizations that have a mode of production depending on the "alive work in action", which in its own, provides a high complexity to the scene, since this alive work, while being operated in action in the work processes, contains a great power to form networks with a high capacity of subjectivity. We suggest the unions of workers build the cartography: a) the "maps of conflicts", b) the "maps of unusual acts", c) the "maps of useless acts", and from these maps, we may proceed with the discussion, analysis and self-analysis of the processes lived in the work situation. Through this experience, it was proved the efficiency of the "analytical maps" as cartographic tools. Applied to the work processes, we captured the continuous and non-continuous movements of the alive work in its dynamics, also revealing the affection and manifestations of desire in the production of the reality. These maps had the function of the "lens" of the cartographer to visualize the work process and the production of reality in its micropolicy.El centro de la discusión que este texto intenta enfrentar es el desafío de un método. Se busca una mirada analítica sobre las organizaciones de salud, que tienen un modo de producción dependiente del "trabajo vivo en acto"; lo que por sí solo aporta una alta complejidad a la escena, pues este trabajo vivo, al ser operado en acto en los procesos de trabajo, contiene una gran potencia instituyente para formar redes, con alta capacidad de subjetivación. Les proponemos a los colectivos de trabajadores la siguiente construcción cartográfica: a) los "mapas de conflictos", b) los "mapas de actos inusitados", c) los "mapas de actos inútiles"; y a partir de estos mapas se procede a la discusión, análisis y autoanálisis de los procesos vividos en situación de trabajo. A través de esta experiencia se comprobó la eficacia de los "mapas analíticos" como herramientas cartográficas. Aplicadas sobre los procesos de trabajo, captaron los movimientos continuos y discontinuos del trabajo vivo en su dinámica, revelando además los afectos y las manifestaciones deseantes en la producción de la realidad. Estos mapas cumplieron la función de las "lentes" del cartógrafo para visualizar el proceso de trabajo y la producción de la realidad en su micropolítica

Medicina social latinoamericana: aportes y desafíos

This piece presents and analyzes a number of issues related to social medicine: the context of the emergence of social medicine; the differences between social medicine and public health; the theories, methods, and debates in social medicine; the main subjects or problems considered in social medicine; and the difficulties of disseminating the concepts of social medicine among English-speaking persons and among medical and public health professionals in general. Latin American social medicine has challenged other views by contributing to an understanding of the determinants of the health-disease-health care process and by using theories, methods, and techniques that are little known in the field of public health. Introducing Latin American social medicine, especially among English speakers, will be difficult due to the conceptual complexity of this field for persons who are accustomed to the theoretical framework of public health and medicine and also due to skepticism concerning research coming from the Third World. A multidisciplinary team is facing this challenge through two primary initiatives: 1) the creation of an Internet portal and database where there are structured abstracts in English, Portuguese, and Spanish of books, book chapters, and articles on social medicine and 2) the electronic publication of two journals on Latin American social medicine