Ethics of care and construction of rights: psychosocial care in family health practices in social exclusion situations

Abstract

The implementation of the Family Health Strategy (FHS),has, for more than twenty years, faced many difficulties of consolidation, such as organizing the health system actions. The social determinant of health has been a major obstacle to the effectiveness of its actions, demonstrating the consequences of social inequality. We therefore considered it was necessary to look at structural issues in our society, which faces a neoliberal capitalist logic that is exclusive and perverse, and minimizes the responsibilities of the state for providing basic rights to citizens, thereby putting at risk the achievements of the Unified Health System. As a result, we see a greater gap between the FHS and the real needs of people and communities; it is intensified in contexts marked by social exclusion. In this sense, we considered the idea that intersubjectivity may be a methodological strategy for understanding the way of life and specific needs of people and communities. From the perspective of historical social psychology, affectivity is an analytical category of subjectivity production, understood through the interaction between the particular experience of the subject and the social-historical and cultural context. We believe that intersubjectivity may be a strategy for understanding the relationship between the ethics of care and human and social rights in health practices, because we consider that in this way, the politicization of care, and consequently, coping with social injustice, is possible. The ethics of care, as discussed by feminists, can contribute to a broader argument about the ethics of liberation, as proposed by Dussel, and so we sought to investigate other points of view that humanize individuals and respect them as citizens. Since 2009, we have developed activities of teaching, extension and research at UNIFESP. These kinds of activities have become easier with intense routine integration into family health units in the area of the Baixada Santista municipalities. This approach began through extension activities geared to the Community Health Agents (CHAs) in order to give psychosocial support because of the suffering that resulted from the work routine. This situation is made more difficult because the CHA occupies the place of mediation between the health service and the community. We noticed that the main strength of CHAs is to develop an affective bond, built from the home visits, which is achieved by developing a warm relationship and through sensitive listening. However, we note that very little of the bond built with the health service user is reversed in a deeper understanding of the process of health-disease and care of people. Therefore, we theorize the general hypothesis that there is a split between care, in the dimension of an emotional and social bond, based on the reception and sensitive listening, and the construction of health practices as a civil right. This results in a disqualification of the main prerogative of the FHS, which aims to provide comprehensive care to the individual and the community. Furthermore, we reiterated the split between technical practices (health practices based on a biomedical view) and policies (weak politicization of health actions as a basic right of citizens). Therefore, this study has the general objective of analyzing and discussing the care practices in the light of the strengthening of basic rights or ethical principles, from FHS actions in vulnerable territories. Specifically, we aim to understand the meanings attributed to the care of oneself and others, and the actions of the FHS in these territories. This qualitative research intends to contribute to the raising of awareness processes and psychosocial intervention. As a result, this research will bring contributions to the strengthening of public policies of primary health care. (AU)