Settler colonialism has detrimental effects on the health and wellbeing of Indigenous peoples, as seen, for example, in the disproportionately high rates of chronic diseases experienced among Indigenous peoples. Indigenous peoples in Canada experience higher levels of ill health related to obesity, diabetes, and other chronic conditions than non-Indigenous people. Indigenous women experience greater incidents of chronic disease than men and are thus particularly vulnerable to ill health. Current research has focussed on documenting the health disparities between Indigenous and non-Indigenous peoples. While insightful, health disparity research reproduces settler colonial discourses of erasure and provides no meaningful or lasting solutions for addressing these disparities, thus demonstrating the need for Indigenous-led thinking regarding potential solutions. Therefore, the guiding research question for my dissertation was, “Can physical activity that encompasses a decolonization approach be a catalyst for regenerative wellbeing for Anishinaabeg women?” Using Indigenous feminist theory that is informed by Anishinaabeg gikendaasowin, I looked to the dibaajimowinan of Anishinaabeg women, Elders, and urban Indigenous women, which occurred in three stages of research and culminated in five publishable papers. In the first stage of research, I interviewed seven Anishinaabekweg who are exemplars of decolonized physical activity. In the second stage of research, I held a sharing circle with eight Elders from Naicatchewenin in Treaty #3 territory. In the last stage of research, I implemented Wiisokotaatiwin with 12 urban Indigenous women with the Odawa Native Friendship Centre, my community partner. The results of my research revealed that wellbeing for Indigenous women can be improved through decolonized physical activity, remembering Anishinaabeg stories, and building community in urban spaces. More specifically, these activities are important resistance tools that can lead to meaningful ways of addressing embodied settler colonialism and can also make strong contributions to Indigenous health research. Overall, my research showcased how Anishinaabeg gikendaasowin can be used as a foundation to improve Indigenous women’s health and wellbeing.

Introdução: A pesquisa analisa em uma perspectiva etnográfica o cotidiano de cuidado de enfermeiras à população indígena Mura do município de Autazes-Amazonas. Objetivo: Analisar a perspectiva das enfermeiras sobre o cuidado à saúde da população indígena Mura do município de Autazes-Amazonas. Metodologia: Trata-se de um estudo etnográfico, realizado com dez enfermeiras que atuavam no cuidado à população indígena Mura no Município de Autazes, nos cenários do Hospital de Autazes e dos Polos- Base das aldeias de Pantaleão e Murutinga. O trabalho de campo foi realizado no período de agosto de 2015 a janeiro de 2016, sendo coletados os dados por meio da observação participante, com anotação sistemática em diário de campo, e de entrevistas semi- estruturadas, seguindo um roteiro com aspectos relacionados ao perfil das participantes e perguntas voltadas ao conhecimento sobre saúde indígena, experiência do cuidar do indígena e formação do enfermeiro para atuação em contexto indígena. A coleta e a análise de dados foram realizadas concomitantemente durante toda a realização do trabalho de campo, que foram agregados em temas, elaborados com base nas observações de campo e nos dados das entrevistas, sendo discutidos segundo o referencial da antropologia da saúde, das Políticas de Saúde Indígena, dos conceitos de cuidar/cuidado em um sentido mais amplo no campo da Enfermagem e, em particular, na perspectiva do cuidado transcultural. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa da Escola de Enfermagem de São Paulo. Resultados: Foram elencados seis temas que discorrem sobre os cuidados de enfermagem à saúde indígena, envolvendo os desafios e as dificuldades vivenciadas pelas participantes do estudo. Os temas que emergiram foram: Práticas de cuidado de enfermeiras à população indígena Mura de Autazes; O contexto hospitalar e o cuidar do indígena Mura; Cuidados diferenciados e atenção diferenciada: entre modos de olhar e de cuidar da população indígena Mura; Aspectos culturais que envolvem o cuidado ao indígena Mura: dificuldades e desafios para enfermeiras; Fragilidades estruturais dos serviços: dificuldades e desafios para as ações de saúde junto à população indígena e Fragilidades na formação do enfermeiro para atuação em contexto intercultural. Conclusão: Os resultados revelam a necessidade premente de mudanças estruturais no processo de trabalho e melhores condições para realização das ações de cuidados da enfermeira à população indígena; de formação continuada que contemple as especificidades culturais da população indígena; de ação interdisciplinar que promova o diálogo entre saúde, antropologia e cuidado transcultural para minimizar atitudes etnocêntricas dos profissionais de saúde à população assistida no contexto investigado. Recomenda-se fortemente que as Instituições de Ensino Superior em regiões geográficas com população indígena reorientem seus currículos para a formação do enfermeiro para atuar em contexto intercultural e com competências para prestar atenção diferenciada à população indígena. Novas pesquisas precisam ser desenvolvidas para preencher lacunas nessa área de conhecimento. / Introduction: The research analyzes, from an ethnographic perspective, the daily care of nurses to the indigenous Mura population of the municipality of Autazes-Amazonas. Objective: To analyze the nurses\' perspective on the health care of the indigenous Mura population of the municipality of Autazes-Amazonas. Method: This is an ethnographic study carried out with ten nurses who worked in the care of the indigenous Mura population in the municipality of Autazes, in the settings of the Hospital of Autazes and the Base Poles of the villages of Pantaleão and Murutinga. Field work was carried out from August 2015 to January 2016, and data were collected through participant observation, with systematic annotation in field diaries, and semi-structured interviews, following a script with aspects related to the profile of the participants and questions related to knowledge about indigenous health, indigenous care experience, and nurse training to work in an indigenous context. Data collection and analysis were performed concomitantly throughout the field work. Data were aggregated into themes, elaborated based on field observations and interview data, discussed according to the anthropology of health, the Indigenous Health Policies, the concepts of care/caring in a broader sense in the field of Nursing and, in particular, from the perspective of cross-cultural care. The research was approved by the Research Ethics Committee of the School of Nursing of São Paulo. Results: Six themes were named that discuss nursing care for indigenous health, involving the challenges and difficulties experienced by the study participants. Themes that emerged were: Practices of care of nurses to the indigenous population Mura de Autazes; The hospital context and the care of the indigenous Mura; Differentiated care and differentiated attention: between ways of looking and caring for the indigenous Mura population; Cultural aspects that involve care for the indigenous Mura: difficulties and challenges for nurses; Structural weaknesses of services: difficulties and challenges for health actions with the indigenous population and Fragilities in the training of nurses to work in an intercultural context. Conclusion: The results reveal the urgent need for structural changes in the work process and better conditions for carrying out nursing care actions to the indigenous population; Continuing education that contemplates the cultural specificities of the indigenous population; Interdisciplinary action that promotes the dialogue between health, anthropology and transcultural care to minimize ethnocentric attitudes of health professionals to the population assisted in the investigated context. It is strongly recommended that Higher Education Institutions in geographic regions with indigenous populations reorient their curricula to the training of nurses to act in an intercultural context and with competencies to give differentiated attention to the indigenous population. New researches need to be developed to fill gaps in this area of knowledge.

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No. of bitstreams: 1 Dissertacao - Bahiyyeh Ahmadpour Futado.pdf: 6136354 bytes, checksum: 0360c59eb530a20c26a82ea357932a3f (MD5) Previous issue date: 2015-12-09 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Introduction: The National Policy for Health Care of Indigenous Peoples, as part of the Brazilian National Health, provides a differentiated service by the Brazilian Unified Health System to indigenous peoples, to guarantee respect for the cultural specificities of each indigenous group. The Subsystem of Attention the Indigenous Health is organized into 34 Special Districts Indigenous Health, which are configured as a dynamic ethno-cultural space, geographic, population and administrative framework for the scope of the resolution of the health needs and problems of indigenous peoples. Objective: To analyze the solving of health services in Kwata indigenous community, through the perspective of health professionals and Munduruku Indians. Methodology: This is a qualitative and descriptive study, based on ethnographic assumptions. Data collection was carried out in June and September 2015, totaling twenty days of stay in the village. The techniques for data collection were semi-structured interviews and participant observation with notes in a field diary. Participated in this research: Fifteen health professionals and five users of the polo-base Kwata. The data were organized and processed through content analysis. Results: The study revealed that the pursuit of solving the health problems of the Munduruku Indians is related to continuing education for Indigenous Health Agents, safety in inland waterway transport of patients, investment in physical and human resources, nursing-Indian dialogue on the health process -doença-care. The study showed that there are work processes that are facilitators and resolving capacity in indigenous health, such as nursing actions polo-base Kwata and processes and situations that weaken the practice of solving the problems, such as distance from the village location to House of Support for Indigenous Health and the hospital in the nearest county seat, given the need for referencing the patient for care and treatment in healthcare levels of more complex health. Conclusions: From the point of view of indigenous and health team, prevailed some categories associated with solving health problems, but in practice, some aspects were not found. One of these important aspects treated factors that go beyond the health team actions, as challenges in the use of river transport, lack of material and human resources and barriers in the therapeutic itinerary. On the other hand, there are factors that have proven to be possible to achieve the solving through health team actions, such as the appreciation of indigenous traditional knowledge in the planning of health actions. The establishment of cultural competence, proposed by the anthropology and that inspired the Transcultural Nursing, it is a consistent way to the scope of problem solving in a different context, as is the indigenous health. The link between the Special Indigenous Sanitary District of Manaus, the professionals of the House of Support for Indigenous Health, professional health health polo-base and Munduruku Indians, it is essential to the search for solutions to the problems related to health, and these can be shared and learned with a view to building a dialogue between these stakeholders, with a view to ensuring the resolution of health problems for individuals and the community / Introdução: A Política Nacional de Atenção à Saúde dos Povos Indígenas, como parte integrante da Política Nacional de Saúde, prevê um atendimento diferenciado pelo Sistema Único de Saúde aos povos indígenas, com garantia do respeito às especificidades culturais de cada etnia indígena. O Subsistema de Atenção à Saúde Indígena está organizado em 34 Distritos Sanitários Especiais Indígenas, que se configuram como um espaço étnico-cultural dinâmico, geográfico, populacional e administrativo para o alcance da resolução das necessidades e problemas de saúde das populações indígenas. Objetivo: Analisar a resolutividade dos serviços de saúde na aldeia indígena Kwatá, por meio do ponto de vista dos profissionais de saúde e dos indígenas Munduruku. Metodologia: Trata-se de um estudo qualitativo e descritivo, embasado nos pressupostos etnográficos. A coleta de dados foi realizada nos meses de junho e setembro de 2015, totalizando vinte dias de permanência na aldeia. As técnicas para coleta de dados foram entrevista semiestruturada e observação participante com anotações em diário de campo. Participaram desta pesquisa: quinze profissionais da saúde e cinco usuários do polo-base de Kwatá. Os dados foram organizados e tratados por meio da análise de conteúdo. Resultados: O estudo revelou que a busca da resolutividade dos problemas de saúde dos índios Munduruku está relacionada a educação permanente dos Agentes Indígenas de Saúde, segurança no transporte fluvial dos pacientes, investimentos em recursos materiais e humanos, diálogo enfermagem-indígenas sobre o processo saúde-doença-cuidar. O estudo mostrou que há processos de trabalho que são facilitadores e resolutivos na saúde indígena, como as ações de enfermagem no polo-base de Kwatá e processos e situações que fragilizam a prática de resolução dos problemas, como a distância da localidade da aldeia até a Casa de Apoio a Saúde do Índio e ao hospital situado na sede do município mais próximo, tendo em vista a necessidade de referenciamento do paciente para atendimento e tratamento em níveis assistenciais de saúde mais complexos. Conclusões: Sob o ponto de vista dos indígenas e da equipe de saúde, prevaleceram algumas categorias associados à resolutividade dos problemas de saúde, porém na prática, alguns aspectos não foram encontrados. Um destes aspectos relevantes tratou-se de fatores que vão para além das ações da equipe de saúde, como desafios no uso do transporte fluvial, a falta de recursos materiais e humanos e os entraves no itinerário terapêutico. Por outro lado, há fatores que demonstraram ser possíveis para o alcance da resolutividade através de ações da equipe de saúde, como a valorização dos saberes tradicionais indígenas no planejamento das ações de saúde. O estabelecimento da competência cultural, proposta pela antropologia e que inspirou a Enfermagem Transcultural, é um caminho coerente para o alcance da resolutividade num contexto diferenciado, como é a saúde indígena. O elo entre o Distrito Sanitário Especial Indígena de Manaus, os profissionais da Casa de Apoio à Saúde do Índio, os profissionais de saúde do polo-base de saúde e os indígenas Munduruku, torna-se essencial para a busca de soluções dos problemas relacionados à saúde, e estes podem ser compartilhados e aprendidos com vistas a construção de um diálogo entre estes atores sociais, tendo a finalidade de garantir a resolução de problemas de saúde para os indivíduos e a aldeia

Introduction: Around 80% of the population in sub-Saharan Africa use indigenous medicine when ill, before consulting biomedical health practitioners, and many only consult doctors when their disease is at an advanced stage or the indigenous medicine has failed. The rise in TB infection has led the South African government to consider collaboration between African indigenous health and biomedical health practitioners in order to counter a pandemic among communities. The World Health Organisation (WHO) advocates incorporating African indigenous health and biomedical health practitioners to promote quality service delivery among the communities. Support for cooperation between these health practitioners was promoted in South Africa with the passing of the Traditional Health Practitioners Act of 2007 (Act. 22 of 2007) to promote collaboration. The government introduced programmes and models of health promotion related to TB management but they focussed on the prevention of the disease, promotion of health, and programmes about HIV/AIDS rather than on how a model of convergence and engagement between the African indigenous health and biomedical health practitioners regarding treatment of TB should be created. Research design and methods: A qualitative, exploratory, descriptive and contextual research design was used. The study conducted within the biomedical health and African indigenous health practitioner's context and was conducted in three phases. Non-probability, purposive sampling was used to choose a population that comprised three groups of participants, namely, biomedical health practitioners, African indigenous health practitioners and supporters of direct observed treatment (DOT).The sample size was large enough to determine differences between groups. The researcher conducted in-depth individual interviews and focus group to explore and describe their views regarding convergence and engagement about the treatment of TB. Questions were asked following the interview guide until data saturation occur. Data analysis was conducted following Tesch method. Findings: The study found they perceived the treatment of TB differently, largely because of cultural diversity, for instance, differing beliefs and worldviews that had an impact on understanding the meaning of concepts such as disease, illness and wellness. Some believed that it was caused by witchcraft, others the result of cleansing rituals not having been carried out. It was also believed that Isidliso entered the victim while sleeping, in the form of food. Thus, the development of the model of convergence and engagement between the biomedical health and African indigenous health practitioners will sort out the myths that is in the mind of the people regarding the cause of TB. Conclusion: The model of convergence and engagement between the biomedical health and African indigenous health practitioners regarding the tuberculosis (TB) treatment was developed following the steps proposed by Dickoff, James and Wiedenbach and Walker and Avant. / Thesis (PhD)--University of Pretoria, 2016. / Nursing Science / PhD / Unrestricted

Submitted in partial completion for the degree of PHD in Community Psychology in the University of Zululand, 2006. / HIV/AIDS is the current century's challenge that stares humanity in the eye. The socio-political, economic, spiritual and philosophical dimensions of our society have to face up to this challenge. This brings one to the conclusion that HIV/AIDS is a national disaster and should be dealt with as such. In other words, interventions geared towards combating this epidemic should address all the spheres mentioned above. The main purpose of this study then was to investigate the role of indigenous healers in combating HIV and AIDS. The rationale for looking at the role of indigenous healers was to ensure that their role is highlighted for a joint effort that is necessary for the advocacy, awareness, education, care and medical intervention which is necessary to combat the HIV/AIDS crisis. This challenge goes as far as involving non-medical professionals and stakeholders in the fight against HIV/AIDS. Focus group interviews and individual interviews were conducted with indigenous healers in the Gauteng and North West provinces. The results were analysed thematically. The results are presented in relation to the questions which were posed. The results reflected that traditional healers have demonstrated that they can make a very important contribution to the treatment of HIV/AIDS. However, they feel that they are not receiving a fair opportunity to demonstrate their knowledge and expertise in treating HIV and AIDS. They also lack support from the public, from government policy, and from the modem medical fraternity. There have been efforts by the Minister of Health to incorporate traditional healing and traditional medicine as part of a holistic approach to the treatment and containment of HIV. This strengthens holistic health care ensuring the advocacy, awareness, education, care and medical intervention which is necessary to combat the HIV/AIDS crisis. Traditional healers need support and recognition from the public, the government and the modem medical fraternity. It was also evident from the results that the indigenous healers were very willing to co-operate with biomedical practitioners as shown in the statement below. Traditional healers reported that they did not routinely test their patients for HIV as they had no means of doing that. They were legally required to send their patients for testing through modem medical procedures. Most healers also said that they preferred their patients to be checked using modem medicine, and thereafter they would treat them accordingly. This is because they currently relied only on their ancestors to show them when the patient was positive. What is important to note is that these healers said that the disease was not presented to their bones as HIV/AIDS, but that they were only shown the known symptoms of HIV and then were able to deduce that the person was HIV positive.

The objectives of this research were to (a) explore nursing educators' experiences of integrating cultural safety in nursing education, (b) describe the strategies that nurse educators use, and (c) identify the barriers and possible solutions to facilitate the integration of cultural safety into nursing education. Indigenous Research Methodology was used to gain insight into nurse educators' experiences of integrating cultural safety in nursing education. Conducted in Ontario with 15 participants from 11 of the 14 accredited SON across Ontario. Conversing and listening to personal stories was the primary knowledge-seeking method. A harmonized narrative and thematic approach were used to analyze the conversations and stories from nurse educators. The results demonstrated the current colonial structure of nursing education is incompatible with and a barrier to the integration of cultural safety. As a consequence, this study reveals more barriers than strategies for integration, which demonstrates the substantial need for leadership, resources, and institutional support to integrate cultural safety. Current approaches have amplified forms of structural violence experienced by Indigenous nurse educators. This form of violence has been labeled a sophisticated type of racism that manifests in ways such as tokenism and othering of Indigenous nurse educators. Information about barriers, challenges and successes experienced by study participants supports recommendations for the dismantling of colonial discourses that are pervasive in nursing education and a barrier to integration of cultural safety. This study of integrating cultural safety supported the problematic nature of decolonization and Indigenization approaches as solutions to ensure cultural safety. Micro-reconciliation was identified as a possible solution to promote successful integration of cultural safety in nursing education. / Thesis / Master of Science in Nursing (MSN)

The Canadian medical education system is to increase curricula on Indigenous health as outlined in the Truth and Reconciliation Commission’s (TRC) Call to Action #24; medical schools need instructors with cultural competency. As most instructors are non-Indigenous Medical Educators (NIMEs), medical educators urgently need to understand what it means to be culturally competent within Indigenous health and engage with the TRC Calls to Action #24, which states: “We call upon medical and nursing schools in Canada to require all students to take a course dealing with Aboriginal health issues... This will require skills-based training in intercultural competency, conflict resolution, human rights, and anti-racism (TRC, 2015, 3).” This research examines what constitutes competency in teaching Indigenous health curricula in medical education. Using critical race theory for analysis, three areas are explored: 1. understanding competency; 2. the role of Indigenous health in medicine; and 3. educator and learner perspectives. One-to-one interviews were conducted with Indigenous learners and medical educators, frontline non-Indigenous medical educators and senior leadership from across Canada’s medical schools. The data allowed for a robust understanding of what competency to teach Indigenous health means when the participants in systems of Indigenous health curricula share their views on NIMEs and account for how Indigenous and Western knowledge often difer in conceptualization and expression. The analysis provided recommendations for NIME training and a snapshot of NIME professional competencies from their perspectives and those of people receiving their teaching. From this research, an initial framework of ethical standards for the teaching of Indigenous health was developed. This framework can be instrumental in developing territorial-based standards between medical schools and local Indigenous communities in which medical schools are situated. It can also support medicine’s regulatory, policy, and academic bodies of medicine in addressing the TRC Call to Action #24. / Dissertation / Doctor of Philosophy (PhD) / The Canadian medical education system is to increase curricula on Indigenous health as outlined in the Truth and Reconciliation Commission’s (TRC) Calls to Action; medical schools need instructors with cultural competency. Non-Indigenous medical educators (NIMEs) urgently need to understand what it means to be culturally competent in Indigenous health. This research examined what constitutes competency in teaching Indigenous health curricula in medical education.

Introdução - Desde a criação do Sistema Único de Saúde (SUS), muitas mudanças ocorreram nas políticas públicas voltadas aos povos indígenas. A intensa luta dos movimentos indígenas subsidiou a proposta da criação e organização do Subsistema de Atenção à Saúde Indígena em 1999, sendo a Fundação Nacional de Saúde (FUNASA) designada como gestora e executora das ações de saúde indígena no país, no período de 1999 a 2010. Após 2010, a responsabilidade pela saúde indígena foi atribuída a Secretaria Especial de Saúde Indígena (SESAI). Em 2011, a Política Nacional de Saúde Bucal definiu a reorganização do modelo de atenção em saúde bucal para os povos indígenas, propondo-se que seja planejada a partir de um diagnóstico das condições de saúde-doença e subsidiada pela epidemiologia e informações sobre o território indígena, além de acompanhar o impacto das ações por meio de indicadores adequados. Objetivo - Analisar componentes de saúde bucal da Política Nacional de Saúde Indígena com foco na atenção à saúde bucal das comunidades do Xingu, considerando as tendências da cárie dentária entre crianças e jovens e as ações implementadas no período de 2004 a 2013. Método - Pesquisa com abordagem qualiquantitativa, do tipo estudo de caso, com o uso de dados secundários do Distrito Sanitário Especial Indígena Xingu e do Projeto Xingu, da Universidade Federal de São Paulo, a partir dos quais foram gerados indicadores de avaliação. Foi analisada a evolução, nesse período, dos indicadores de cobertura de primeira consulta odontológica programática, tratamento odontológico básico concluído, proporção de exodontia em relação aos procedimentos, média da ação coletiva de escovação dental supervisionada do Baixo, Médio e Leste Xingu. Foram utilizados os índices de experiência de cárie dentária (CPO-D e ceo-d) para as idades de 5 e 12 anos e no grupo etário de 15 a 19 anos, a partir de inquéritos epidemiológicos, realizados em 2007 e 2013, utilizando a padronização preconizada pela Organização Mundial da Saúde (OMS). Para contextualizar os indicadores, foi realizada uma revisão da produção científica sobre saúde bucal dos povos indígenas no Brasil no período de 1999 a 2014, bem como a análise de propostas relacionadas à saúde bucal dos povos indígenas nas cinco Conferências Nacionais de Saúde Indígena (1986 a 2013), na 3ª Conferência Nacional de Saúde Bucal (2004) e nas 13ª e 14ª Conferências Nacionais de Saúde (2007 e 2011). Resultados - Observou-se uma cobertura de primeira consulta odontológica programática maior que 60 por cento em todos os anos analisados, exceto nos anos de 2009 e 2010 com uma cobertura de 44,68 por cento e 53,41 por cento , respectivamente. O indicador de tratamento odontológico básico concluído apresentou um aumento significativo entre os anos 2006 e 2008, de 44,89 para 79,93. A proporção de exodontia em relação aos procedimentos apontou queda de 24,26 em 2004 para 3,84 em 2011. A média da ação coletiva de escovação dental supervisionada foi o indicador com maior variabilidade (de 1,25 a 23,27) entre os anos. Os valores de ceo-d e CPO-D indicaram padrões diferentes de cárie dentária entre os grupos. Foram examinados 368 pacientes em 2007 e 423 em 2013. Aos 5 anos, apresentou-se uma média de ceo-d de 6,43 em 2007 e 5,85 em 2013. Aos 12 anos de idade, média de CPO-D de 2,54 em 2007 e 2,78 em 2013. No grupo etário de 15 a 19 anos, verificou-se uma média de 6,89 em 2007 e 4,65 em 2013, sendo o único grupo com diferença estatisticamente significante (p<0,05). O Índice de Cuidados Odontológicos diminui em todos os grupos entre 2007 e 2013, sendo que aos 5 anos houve uma diminuição de 21,74 por cento para 7,14 por cento , aos 12 anos de 44,09 por cento para 16,35 por cento e de 63,14 por cento para 41,14 por cento no grupo etário de 15 a 19 anos. Conclusão - Este estudo descreve avanços e dificuldades na implementação do programa de saúde bucal no Baixo, Médio e Leste Xingu, com implicações importantes para programas de saúde bucal em áreas indígenas e para a produção de indicadores válidos nos serviços de atenção à saúde indígena. As estratégias de intervenções e parcerias com instituições privadas e públicas identificadas para melhorar a organização dos serviços, a equidade e o acesso da população indígena à saúde bucal, buscaram diminuir os entraves burocráticos e as iniquidades de saúde. A busca da integralidade da atenção através de parcerias com a própria comunidade e com outros setores foi realizada através de estratégias sensíveis às especificidades locais. Os resultados refletem uma tendência de diminuição da cárie nos dentes permanentes, apresentando um declínio da média de CPO-D no grupo etário de 15 a 19 anos e de avanços do programa. A efetiva diferenciação proposta nas conferências nacionais e nas políticas direcionadas aos povos indígenas, não tem se concretizado integralmente. O direito e o acesso à saúde para os povos indígenas são grandes desafios, sendo ainda tratados de forma homogênea e não diferenciada. Sugere-se a incorporação efetiva da realização de levantamentos epidemiológicos de saúde bucal que sejam específicos para cada realidade e que os programas busquem tecnologias, determinantes e especificidades no cotidiano do trabalho, para buscar minimizar os impactos que a sociedade nacional envolvente vem produzindo na saúde indígena. / Introduction - Since the creation of the Unified Health System (SUS), many changes have taken place in public policies related to indigenous population in Brazil. The intense struggle of the indigenous movements supported the proposal of the creation and organization of the Subsystem of the Indigenous Healthcare in 1999. The National Health Foundation (FUNASA) has been designated as manager and executor of actions indigenous health in the country, from 1999 to 2010. After 2010, responsibility for indigenous health was awarded the Indigenous Health Special Secretariat (SESAI). In 2011, the National Oral Health Policy defined the reorganization of the oral health care model for indigenous population, proposing that it be planned from a diagnosis of the health-disease conditions and subsidized by the epidemiology and information on the indigenous territory, monitor the impact of actions through appropriate indicators. Objective Analyze oral health component of the National Indigenous Health Policy focused on attention of oral health of the Xingu Indigenous Park, considering the trends of tooth decay among children and youth and the actions from 2004 to 2013. Method - research with quali-quantitative approach, the case study type, using secondary data from the Xingu Indigenous Special Sanitary District and the Xingu Project at the Federal University of São Paulo, from which evaluation indicators were generated. It was analyzed the evolution of the first programmatic dental consultation coverage indicators, basic dental treatment finished, extraction of proportion in relation to the procedures, average collective action of supervised toothbrushing the Lower, Middle and East Xingu. The indices of dental caries experience (DMFT and dmft) were used for ages 5 and 12 years and those aged 15-19 years from epidemiological surveys conducted in 2007 and 2013, using the standardization recommended by the World Health Organization (WHO). To contextualize the indicators, a review of scientific literature on oral health of indigenous population in Brazil from 1999 to 2014 was carried out and an analysis of proposals related to the oral health of indigenous population in five National Conference of Indigenous Health (1986 to 2013), the 3rd National Conference on Oral Health (2004) and the 13th and 14th National Health Conferences (2007 and 2011). Results - It was observed a cover of first programmatic dental consultation greater than 60 per cent in all years studied, except in 2009 and 2010 with a cover of 44.68 per cent and 53.41 per cent , respectively. The basic dental treatment finished indicator showed a significant increase between 2006 and 2008, from 44.89 to 79.93. The proportion of extraction for procedures faced decrease of 24.26 in 2004 to 3.84 in 2011. The average of collective action of supervised toothbrushing was the indicator with the highest variability (1.25 to 23.27) among years. The values of dmft and DMFT showed different patterns of dental caries between groups. 368 patients were examined in 2007 and 423 in 2013. At 5 years old, performed an average of dmft of 6.43 in 2007 and 5.85 in 2013. At 12 years old, a DMFT average of 2.54 in 2007 and 2.78 in 2013. In the age group 15-19 years of 6.89 in 2007 and 4.65 in 2013, the only group with a statistically significant difference (p < 0.05). The Dental Care index decreased in all groups between 2007 and 2013, and to 5 years old there was a decrease of 21.74 per cent to 7.14 per cent , to 12 years old 44.09 per cent to 16.35 per cent and 63 14 per cent to 41.14 per cent in the age group 15-19 years. Conclusion - This study shows progress and difficulties in the implementation of oral health program in the Lower, Middle and East Xingu, with important implications for oral health programs in indigenous territories and to produce valid indicators in care services for indigenous health. The strategies of interventions and partnerships with private and public institutions identified to improve the organization of services, equity and access of the indigenous population to oral health, sought to reduce the bureaucratic barriers and health inequities. The pursuit of integrality care through partnerships with the community and other sectors was conducted through sensitive strategies to local conditions. The results reflect a trend of reduction in decay in permanent teeth, showing a decline in DMFT average in the age group 15-19 years and the progress of the program. The effective differentiation proposed in national conferences and targeted policies on indigenous population, has not fully realized. The right and access to health care for indigenous population are major challenges still being treated evenly and undifferentiated. It is suggested the effective incorporation to carry out epidemiological surveys of oral health that are specific to each reality and that programs seek technologies, and specific determinants in daily work, to seek to minimize the impacts that nacional society surrounding has produced in indigenous health.

Este trabalho pretende compreender como se dá o Processo de Nascimento entre a população indígena Pankararu de Pernambuco, tratando principalmente dos cuidados e itinerários a ele associados, a partir da experiência de algumas mulheres indígenas. Para isso, será feito o exercício de olhar primeiramente o contexto e cultura indígena locais, considerando suas relações com os encantados e a sociedade envolvente, principalmente com os sistemas oficiais de saúde disponibilizados pelo Estado. No contexto Pankararu, o nascimento envolve tanto os conhecimentos e práticas biomédicas e indígenas, como a utilização de remédios do mato, passar pelo atendimento pré-natal, a realização do parto domiciliar ou hospitalar, além do batizado em casa. Para esta pesquisa foi utilizado o método etnográfico por meio da observação participante e de entrevistas semiestruturadas que viabilizaram apreender alguns dos saberes locais dessa população, relacionados ao parto e nascimento. O principal resultado desta investigação foi a revelação de como tem sido a assistência e experiência dessas mulheres com relação à sua saúde reprodutiva, considerando a demanda de contracepção, a ocorrência de partos em casa e nos hospitais, o trabalho das parteiras indígenas e o resguardo para controle da dona-do-corpo. / This work tries to understand the Process of Birth in the Pankararu indigenous population, in Pernambuco, focussing primarily on its associated cares and itineraries, based on the experience of some indigenous woman. To achieve this, an exercise of looking at the local indigenous context and culture will be conducted, considering the relations with the encantados and the absorbing society, mainly with the official health systems made available by the State. In the Pankararu context, birth involves both biomedical and indigenous knowledges and practices, the use of remédios do mato (medicinal herbs), frequenting prenatal care, giving birth at the hospital or at home and a home baptism. For this research, the ethnographic method was used, through participant observation and semi structured interviews that made it feasible to grasp some of the local knowledge of this population about labour and birth. The primary result of this investigation was the revelation of how the assistance has been received by these women and their experience regarding their reproductive health, taking into account the demand for contraception, the occurrence of home and hospital deliveries, indigenous midwives and the resguardo (postpartum restrictions period) for dona-do-corpos control.

Introdução - O estado nutricional tem repercussões importantes durante as mudanças pelas quais passa o corpo da mulher no processo de ser mãe, desde a concepção, gestação, parto e puerpério, continuando após este período. Porém, o estado nutricional da mulher é muito priorizado antes, durante e até um ano após a gestação - mais em função da influência que este pode ter sobre o peso ao nascer e as condições de amamentação da criança, do que pelos benefícios potenciais para a própria mãe. Por isso, há escassez de estudos sobre o estado nutricional de mães fora do período gravídico-puerperal. Objetivo - Descrever e analisar o estado nutricional e o acesso a serviços de saúde materna das mulheres, mães de crianças menores de cinco anos, no município de Jordão, Acre - Brasil no ano de 2005. Método - Trata-se de um estudo transversal de base populacional com 267 mulheres mães de crianças menores de cinco anos participantes da pesquisa Situação Nutricional do Município do Jordão (SINJORDÃO). Foram coletadas informações sobre características demográficas, socioeconômicas, antropométricas, de morbidade e condições de saúde. O estado nutricional foi classificado de acordo com o IMC adotando como ponto de corte os sugeridos pela Organização Mundial de Saúde (1995): Baixo peso (IMC < 18,5); Eutrófico (18,5 IMC < 25); Sobrepeso ( 25 IMC < 30) e Obesidade (IMC 30). A determinação de hemoglobina sangüínea foi feita por punção digital com uso de hemoglobinômetro portátil Hemocue, adotando-se Hb <12,0 g/dL para diagnóstico de anemia. Para análise estatística utilizou-se o teste de quiquadrado, adotando-se p<0,05. Resultados - O percentual de baixo peso foi de 3,4 por cento e não houve diferença estatística para nenhuma das variáveis avaliadas, a de sobrepeso (SP) foi de 27,7 por cento e a de obesidade (OB) foi de 6 por cento. Somando estas duas últimas categorias (SP+OB), o excesso de peso foi maior entre as indígenas (41,4 por cento p = 0,011), quem recebia benefícios sociais (50 por cento p = 0,005), casadas (35,5 por cento p = 0,038), não fumantes (38,3 p = 0,056) e quem pariu acompanhada de profissional de saúde (39 por cento p = 0,05). A anemia foi encontrada em 26,1 por cento das mulheres e foi maior entre as que não fizeram pré-natal (32,9 por cento p = 0,008), tiveram internação após o parto (57,1 por cento p = 0,007) e as que amamentaram exclusivamente menos de trinta dias (29,2 por cento p = 0,038). Apenas 45,5 por cento fez pelo menos uma consulta no pré-natal, e apenas 44,2 por cento tiveram parto em instituições de saúde. Conclusão - Este trabalho mostrou que as mulheres mães de crianças com 5 anos ou menos, o acesso ao serviço de saúde é muito abaixo do esperado para a região Norte. Apesar de viverem em situação sócio-econômica precária, vivenciam a transição nutricional. Foi possível observar que entre as mulheres menores de cinco anos no Jordão, Acre, o baixo peso se apresenta de forma normal, não sinalizando como problema de Saúde Pública, ao contrário do excesso de peso e da anemia, que apesar de ainda não se configurar com a gravidade que se encontra de modo geral no Brasil, apresenta uma tendência a agravar conforme se promovem mudanças na ordem econômica / Introduction - the nutritional state has important repercussions during the changes for which it passes the body of the woman in the process of being mother, since the conception, gestation, childbirth and puerperium, continuing this period after. However, the nutritional state of the women is very prioritized before, during and up to one year after the gestation, more in function of the influence that this can have on the birthweight and the conditions of breast-feeding of the child, more than for the potential benefits for the mother. Therefore, the scarcity of studies on the nutritional state of mothers is of the childbearing year. Objective - To describe and to analyze the nutritional state and the access the health services materna of the women five year mothers of lesser children, in the city of Jordão, Acre - Brazil in the year of 2005. Method - Cross-sectional study with population base of 267 women, mothers of children under five year old, participants of the research Nutritional Situation of the City of Jordão (SINJORDÃO). Information on demographic, socioeconomic, and anthropometrical characteristics have been collected, as well as related morbidity and conditions of health. The nutritional state was classified in accordance with the IMC adopting as cut point the suggested ones for the World-wide Organization of Health (1995): Low weight (IMC < 18,5); normal range (18,5 IMC < 25); Overweight (25 IMC < 30) and Obesity (IMC 30). The determination of hemogloblin was made by digital punch with use of portable hemoglobinometer Hemocue, adopting itself Hb>12,0g/dL. Findings. The prevalence of underweight was 3,4 per cent, with no statistical association with any variables; overweight (OW) was present in 27,7 per cent, and obesity (OB) in 6 per cent. Adding these two last cathegories (OW+OB), weight excess was higher in indigenous (41,4 per cent p = 0,011), those receiving social benefits (50 per cent p = 0,005), married women (35,5 per cent p = 0,038), non-smokers (38,3 p = 0,056), those who delivered with a trained practitioner (39 per cent p = 0,05). The prevalence of anemia was 26,1 per cent, higher in those who had no antenatal care, (32,9 per cent p = 0,008), were re-hospitalized (57,1 per cent p = 0,007) and those who breastfed exclusively for less than 30 days (29,2 per cent p = 0,038). Conclusions: Regardless of their poor economic status, they already live the nutritional transition. Among women with children under 5 years old in Jordão Acre, low birth weight is within the expected rate, not as a public health problem. On the contrary, weight excess and anemia, although not as high as the rest of the country, is already a trend, following the changes in the cash transfer programs, indicating the need for specific programs of nutritional education. This study shows that women with children under 5 years old, have limited access to health services, much below those in the Northern region