A produção do cuidado alimentar e nutricional às pessoas indígenas com condições crônicas não transmissíveis na Atenção Primária

Abstract

Indigenous populations are native peoples made up of distinct groups and cultures that identify with each other and have their own organization. The health of indigenous populations is guaranteed by the 1988 Brazilian Federal Constitution, and in 1999, it became a responsibility of the Unified Health System, with the Arouca Law (nº 9.836), establishing the Indigenous Health Care Subsystem of the Unified Health System and the creation of Indigenous Health Districts. Primary Health Care is the gateway to the Unified Health System, which aims to ensure comprehensive care. In indigenous areas, PHC actions and services must be based on a collaborative perspective that involves recognizing and valuing the cultural diversity of the peoples, especially regarding interculturality and traditional care practices. The objective of this study is to understand how health care and nutritional care are provided to indigenous people with chronic non-communicable conditions from the perspective of primary care health professionals at the Paulo Afonso Base Center of the Bahia Indigenous Health District. This is a qualitative exploratory study, whose data were produced from semi-structured interviews with nine indigenous health professionals, between 2022 and 2023.The interviews were analyzed through exploratory content analysis, from which nine subcategories emerged, distributed in three categories: indigenous health care/production of care, interculturality, and challenges for the production of care. The interviewees reported that indigenous health care is carried out in an interdisciplinary manner, including educational actions and respect for traditional practices. The narratives mention the increase in chronic non-communicable conditions in the population served, associated with changes in lifestyles and eating habits. Regarding interculturality, the professionals' understanding is to respect the culture, have a differentiated perspective, and also that traditional medicine and the biomedical model must go hand in hand, so that they aggregate each other. The challenges for the production of care include conflicts over territories, lack of basic infrastructure, work overload, excessive use of allopathic medicines, access to quality food, replacement of traditional foods with ultra-processed foods, and difficulty in adherence to treatment by the indigenous people assisted. The importance of the territory for promoting food and nutritional security is highlighted. In addition to strategies that reconcile traditional practices and the biomedical model, to promote integrated care, the results contribute to broadening the discussion on the topic, which is still little discussed, especially in the Northeast region.