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Monteiro WM, de Farias AS, Val F, Neto AVS, Sachett A, Lacerda M, Sampaio V, Cardoso D, Garnelo L, Vissoci JRN, Sachett J, Wen FH. Providing Antivenom Treatment Access to All Brazilian Amazon Indigenous Areas: 'Every Life Has Equal Value'. Toxins (Basel) 2020; 12:toxins12120772. [PMID: 33291444 PMCID: PMC7762137 DOI: 10.3390/toxins12120772] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/28/2020] [Accepted: 11/29/2020] [Indexed: 02/04/2023] Open
Abstract
Snakebites are more frequent in the Brazilian Amazon than in other parts of Brazil, representing a high cost for the health system since antivenoms are only available through medical prescription from central municipal hospitals in most cases. The need for a cold chain and physicians usually restricts access to the only effective treatment of a snakebite, the antivenom. The complex topography of the rivers contributes to delays in treatment, and consequently increases the risk of severe complications, chronic sequelae and death. Thus, decentralization of antivenom treatment to primary healthcare facilities in the interior would increase access by indigenous population groups to proper healthcare. To standardize and evaluate the decentralization to low complexity indigenous healthcare units, we suggest the (i) development and validation of standardized operational procedures, (ii) training of professionals in the validated protocol in a referral health unit, (iii) implementation of the protocol in an indigenous healthcare unit, (iv) assessment of perceptions towards and acceptability of the protocol, and (v) estimation of the impact of the protocol's implementation. We expect that antivenom decentralization would shorten the time between diagnosis and treatment and, as such, improve the prognosis of snakebites. As health cosmology among indigenous populations has an important role in maintaining their way of life, the introduction of a new therapeutic strategy to their customs must take into account the beliefs of these peoples. Thus, antivenom administration would be inserted as a crucial therapeutic tool in a world of diverse social, natural and supernatural representations. The information presented here also serves as a basis to advocate for support and promotion of health policy initiatives focused on evidence-based care in snakebite management.
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Affiliation(s)
- Wuelton Marcelo Monteiro
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus 69065-001, Amazonas, Brazil; (W.M.M.); (A.S.d.F.); (F.V.); (J.S.)
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040-000, Amazonas, Brazil; (A.V.S.N.); (A.S.); (M.L.); (V.S.)
| | - Altair Seabra de Farias
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus 69065-001, Amazonas, Brazil; (W.M.M.); (A.S.d.F.); (F.V.); (J.S.)
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040-000, Amazonas, Brazil; (A.V.S.N.); (A.S.); (M.L.); (V.S.)
| | - Fernando Val
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus 69065-001, Amazonas, Brazil; (W.M.M.); (A.S.d.F.); (F.V.); (J.S.)
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040-000, Amazonas, Brazil; (A.V.S.N.); (A.S.); (M.L.); (V.S.)
| | - Alexandre Vilhena Silva Neto
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040-000, Amazonas, Brazil; (A.V.S.N.); (A.S.); (M.L.); (V.S.)
| | - André Sachett
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040-000, Amazonas, Brazil; (A.V.S.N.); (A.S.); (M.L.); (V.S.)
| | - Marcus Lacerda
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040-000, Amazonas, Brazil; (A.V.S.N.); (A.S.); (M.L.); (V.S.)
- Instituto Leônidas & Maria Deane, Fiocruz, Manaus 69057-070, Amazonas, Brazil;
| | - Vanderson Sampaio
- Department of Teaching and Research, Dr. Heitor Vieira Dourado Tropical Medicine Foundation, Manaus 69040-000, Amazonas, Brazil; (A.V.S.N.); (A.S.); (M.L.); (V.S.)
- Technical Department, Amazonas Health Surveillance Foundation, Manaus 69093-018, Amazonas, Brazil;
| | - Deugles Cardoso
- Technical Department, Amazonas Health Surveillance Foundation, Manaus 69093-018, Amazonas, Brazil;
| | - Luiza Garnelo
- Instituto Leônidas & Maria Deane, Fiocruz, Manaus 69057-070, Amazonas, Brazil;
| | - João Ricardo Nickenig Vissoci
- Division of Emergency Medicine, Department of Surgery and Duke Global Health Institute, Duke University, Durham, NC 27710, USA;
| | - Jacqueline Sachett
- Department of Medicine and Nursing, School of Health Sciences, Amazonas State University, Manaus 69065-001, Amazonas, Brazil; (W.M.M.); (A.S.d.F.); (F.V.); (J.S.)
- Department of Teaching and Research, Alfredo da Matta Foundation, Manaus 69065-130, Amazonas, Brazil
| | - Fan Hui Wen
- Bioindustrial Centre, Butantan Institute, Butantã 05503-900, São Paulo, Brazil
- Correspondence:
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Ribeiro AERA, Beretta RCDS, Mestriner Junior W. Promoção da saúde e efetivação da Reforma Sanitária no contexto dos povos originários. SAÚDE EM DEBATE 2019. [DOI: 10.1590/0103-11042019s821] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO O Brasil teve atos e políticas excludentes que levaram à quase dizimação dos variados povos indígenas. Buscando voz e inclusão, o movimento dos povos originários contou com a presença de representantes das próprias comunidades para a consolidação da Reforma Sanitária nesse contexto. Conselheiros indígenas de saúde e agentes indígenas de saúde fomentam a resiliência para reivindicar, proteger e curar relações, lidando com a perspectiva biomédica, e atuação de profissionais não indígenas. Este trabalho objetiva evidenciar as aprendizagens colaborativas e práticas interdisciplinares no atual sistema de saúde brasileiro, para a promoção da saúde dos povos originários. Em uma revisão integrativa, propôs-se discorrer sobre o impacto da formação profissional com ênfase na questão étnica, possibilidades de atuação não colonizadora e inclusiva, e a contribuição dos diversos atores, indígenas ou não, que possibilitam a consolidação desse subsistema de atenção, considerando suas especificidades e sua maneira própria do fazer da saúde. A autonomia, com foco no empoderamento, fortalecida por meio do reconhecimento do papel fundamental dos próprios indígenas e de pessoas ligadas à causa indigenista que se estabeleceram para tal assistência, consolidaram a Reforma Sanitária também nesses territórios, na tentativa de universalidade no acesso, integralidade da atenção, promoção da equidade e redução de iniquidades.
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