Infant death and interpretive violence in Northeast Brazil: taking bereaved Cearense mothers' narratives to heart Mortes infantis e violência interpretativa no Nordeste brasileiro: levando em conta as narrativas de mães cearenses enlutadas

This study investigates bereaved mothers' ethnoetiologies of avoidable infant deaths in Northeast Brazil. It critically examines the anthropological debate concerning "selective maternal negligence" as a relevant explanation for high infant mortality, based on an analysis of preexisting data. From 2003 to 2006, 316 ethnographic interviews collected by the author from 1979 to 1989 in six communities in Ceará State were retrieved. Forty-five narratives of fatal illness and death of 56 children Investiga a etnoetiologia de óbitos infantis evitáveis na óptica da mãe em luto no Nordeste brasileiro. Refina o debate antropológico sobre a "negligência materna seletiva" como relevante explicação de alta mortalidade infantil. Trata-se de uma análise crítica de dados preexistentes. Entre 2003-2006, foram resgatadas 316 entrevistas etnográficas coletadas pela autora durante 1979-1989, em seis comunidades no Ceará, Brasil. Identificaram-se 45 narrativas de mães sobre a doença fatal e morte de 56 filhos < 5 anos para aprofundamento. Apesar da baixa renda e escolaridade, as mães construíram explicações próprias para a morte precoce. Causas maiores são doenças infecto-contagiosas (37,9%) e cuidados desumanizados do profissional de saúde (24,1%). Nenhuma mãe acusa o descuido, desapego ou negligência materna. Nesse contexto de pobreza, argumenta-se que se existe "desprezo" é do sistema econômico-político e social injusto e da prática da saúde pública desumana que violentam os direitos da mulher-cidadã. Caracterizar essa mãe em luto como "negligente", ou, pior, cúmplice na morte do filho, é uma violência interpretativa que injustamente culpabiliza e desmoraliza a mãe-cuidadosa nordestina

Mystification of a simple solution: Oral rehydration therapy in Northeast Brazil

Problems in the control of access to and administration of oral rehydration therapy (ORT) in Northeast Brazil are described and discussed. Administration of ORT is controlled by the medical establishment, which is in general opposed to the use of home made and home administered ORT. Reasons for this resistance are discussed in terms of anthropological theories on ritual, mystification, and the social constraction of reality; the medical establishment is described as using ORT as a symbol and guarantor of social status and power. Finally, an innovative program to circumvent the medical establishment by teaching ORT to traditional healers is described; the healers' integration of ORT into religious healing ceremonies is analyzed.diarrheal diseases oral rehydration therapy ritual traditional medicine Brazil

Cuidado, "cavalo batizado" e crítica da conduta profissional pelo paciente-cidadão hospitalizado no Nordeste brasileiro

Trata-se de pesquisa antropológica com o objetivo de revelar a apreciação do paciente-cidadão sobre a conduta profissional num hospital geral público, em Fortaleza, Ceará, Brasil. De janeiro a julho de 2005, foi acompanhado o percurso de 13 informantes-chaves durante a hospitalização, e sua narrativa da experiência, analisada. Constata-se que o paciente avalia os gestos e expressões dos cuidadores durante todo o percurso. Valoriza mais, no profissional, a competência humana de ser afetivo, de conversar e incluí-lo em decisões clínicas, do que sua habilidade técnica. Critica a atitude distante, fria e bruta, metaforicamente comparada a um cavalo batizado. Sugere uma ação profissional afetiva, empática e ética e uma comunicação clínica respaldada na fala, na conversa e no costume da vida cotidiana nordestina. Argumenta-se que essa voz legítima e crítica do paciente-cidadão oferece valiosas pistas para transformar a conduta profissional, remoralizar o paciente e construir o hospital humano no contexto de desigualdades sociais

"I'm not dog, no!": Cries of resistance against cholera control campaigns

Popular reactions toward government efforts to control the recent cholera epidemic in Northeast Brazil are evaluated. Intensive ethnographic interviews and participant-observation in two urban slums (favelas), reveal a high level of resistance on the part of impoverished residents towards official cholera control interventions and mass media campaigns. "Non-compliance" with recommended regimens is described more as a revolt against accusatory attitudes and actions of the elite than as an outright rejection of care by the poor. "Hidden transcripts" about "The Dog's Disease," as cholera is popularly called, voices a history of social and economic inequity and domination in Northeast Brazil. Here, cholera is encumbered by the trappings of metaphor. Two lurid cultural stereotypes, pessoa imunda (filthy, dirty person) and vira lata (stray mutt dog) are used, it is believed, to equate the poor with cholera. The morally disgracing and disempowering imagery of cholera is used to blame and punish the poor and to collectively taint and separate their communities from wealthy neighborhoods. The authors argue that metaphoric trappings have tragic consequences: they deform the experience of having cholera and inhibit the sick and dying from seeking treatment early enough. Controlling cholera requires eliminating "blaming the victim" rhetoric while attacking the social roots of cholera: poverty, low earning power, female illiteracy, sexism, lack of basic sanitation and clean water supplies, medical hegemony, etc. For health interventions to be effective, it is necessary to take into account people's "hidden transcripts" when designing action programs.cholera health education messages non-compliance stigma Brazil

"Tooth worms", poverty tattoos and dental care conflicts in Northeast Brazil

While medical anthropologists have studied doctor-patient clinical conflicts during the last 25-30 years, dentist-patient communication clashes have received scant attention to date. Besides structural barriers and power inequities, such conceptual differences further dehumanize dental care and lower service quality. Potential for dentist-patient discordance is greater in developing regions--such as Northeast Brazil--where there exists a wider socio-economic gap between professionals and laypersons. A critical anthropological evaluation of oral health services quality is undertaken in two rural communities in Ceará, Brazil where the PAHO-inspired Local Oral Health Inversion of Attention Program was implemented in 1994. This 6-month qualitative field study utilized ethnographic interviews with key informants, participant-observation and projective techniques to probe professionals' and patients' explanatory models (EMs) of oral health. Despite the recent expansion of services into rural regions, the authors conclude that the quality of dental care remains problematic. Patients' culturally constructed EMs of teeth rotted (estraga) by "tooth worms" (lagartas) differ substantively from dentists' model of dental decay by Streptococcus mutans. "Exploding chins" (queixo estourado), "spoiled, rotting teeth" (dente pôdi) and "false plates" or teeth (chapas) tattoo and stigmatize the poor, reinforcing gross class inequities. Dentists' dominant discourse largely ignores lay logic, ridicules popular practices and de-legitimates, even castigates, popular healers despite their pivotal role in primary oral health care. Poor parents are not only barred from clinics but are blamed for children's rotten teeth. In sum, universal access to dental care is more a myth (even nightmare) than a reality. Dentists all too often "avert"--not "invert"--attention from poor Brazilian patients. In order to improve oral health in this setting, both "societal decay" and bacteria-laden plaque deposits must be removed.Social dentistry Dentist-patient relationship Quality of care Northeast Brazil