Formação de agentes comunitários de saúde para o desenvolvimento de práticas de atenção básica relativas ao consumo prejudicial de drogas

Abstract

This investigation takes as its object the development of theoretical and practical resources for health workers in primary health care (PHC), particularly community health workers (CHW), to address drug consumption problems of residents of the catchment areas of Family Health Units (FHU). The health care team is concerned with PHC practices addressing drug consumption. CHW are particularly affected as they are close to daily problematic situations for which they feel unprepared, leading to frustration and debility. Considering the harm reduction paradigm and the emancipatory education prerogatives, this investigation aims to build a theoreticalmethodological and operational framework to conduct education on drugs for PHC workers. This is an emancipatory action research, which included 18 CHW from four FHU of Sapopemba, a district of São Paulo. Nine workshops were conducted regarding drug subjects followed by six others, to elaborate a guide for CHW. Data were analyzed through two analytical categories 1) object-subject unity, as taken by PHC practices related to harmful drug consumption and 2) work process, in PHC in which CHW take part. The results were organized in two themes which express the evaluation of the educational process conducted: transformations in the conceptions of drug and drug users; transformations of working practices of CHW involving problematic drug consumption. It can be stated from the results that participants changed their conceptions about drug and drug users by aggregating social elements into the chain of determination of harmful consumption of drugs. They also relieved the responsibility for drug misuse from users and their families. Ideological mechanisms such as those that underlie the process of social construction of 'scapegoats' to address the problem of drug use were unveiled. Coherently, the proposed practices to be adopted in PHC were transformed as well, to adding elements of social dynamics of the territories where CHW operate. At the same time, they review their frustration considering the practices adopted before the educational process. Perceived contradiction in everyday living and working were discussed in its essence as well. At the end of the process CHW showed that their practices are political, therefore they must stimulate social and political engagement, social movement and reflection on the social determinants of the harmful drug consumption. Health needs of different social groups should be claimed as a result of this political process. To enclose the action research process, we collectively elaborated a CHW working guide, with the contribution of all participants involved. It is considered that the methodological procedures adopted were essential in transforming conceptions about drugs and drug users, as well as the practices involving harmful drug consumption. They composed the foundation for the critical practices propositions in PHC. Thus, we can affirm that this is an essential education for PHC workers.

Practices in primary health care oriented toward the harmful consumption of drugs

“…These conditions have been reported in other work spaces (19,25) . This is due to distortions caused by the war against drugs, which disseminates a set of reactionary and counterproductive concepts regarding drugs and users.…”

Pesquisa-ação na área da saúde: uma proposta marxista a partir de revisão de escopo

“…PAs realizadas recentemente (Cordeiro, 2013;Cordeiro, Soares, Campos, 2013;Forlin, 2014;Oliveira, Soares, Souza, 2015;Oliveira, Soares, Silva, 2016) utilizaram oficinas emancipatórias para realização dos processos educativos, uma vez que essas são um "instrumento que proporciona um espaço de reflexão sobre a práxis, em que os sujeitos -agentes e coprodutores do processo educativoparticipam com a finalidade de transformar a práxis reiterativa em práxis criativa" (Soares et al, 2009, p.192). Nas oficinas lança-se mão de diversas estratégias que facilitem a apreensão da realidade e o processo de reflexão.…”

“…A PAE citada acima (Cordeiro, 2013;Cordeiro, Soares, Campos, 2013) utilizou, dentre outros métodos, de discussão guiada por roteiro previamente elaborado acerca de um documentário. A intenção era contextualizar fatos trazidos pelos ACS e discutir as razões para os fenômenos relacionados ao consumo de drogas que acontecemno bairro em que vivem e atuam, partindo de elementos da estrutura e dinâmica social.…”

Elaboração de material educativo para ações de educação em saúde para portadores de HAS em UBS: uma proposta emancipatória

“…São pautados no modelo biomédico, sem prever a participação e a interação de quem as recebe, nem propõe espaço para reflexão (Cardoso et al;2013 …”