Made available in DSpace on 2016-04-26T14:52:57Z (GMT). No. of bitstreams: 1 Eduardo Carrara.pdf: 20763634 bytes, checksum: 3defc4e3e68427008077bebb40f2a7f3 (MD5) Previous issue date: 2010-12-02 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / This Ph.D dissertation based on ethnographical research performed in Pimentel Barbosa and Etenhiritipá indigenous villages in state of Mato Grosso, city of Canarana, investigates a specific process of alcoolization. This ultimate process can not be classified as constructive drinking. The Dependence Alcohol Syndrome (DAS) directly means chronical disease named alcoholism, but this concept is inadequate to a preview diagnosis of individuals or to understand an entire collectivity of Xavante people relation to a industrial alcoholic beverages. This research is not an epidemiological study with statistical quantity, frequency and other factors utilized to measure health indigenous diseases. This qualitative anthropological research has turned into an interdisciplinary study, then scientifical developments about alcohol use in Heath Sciences and in Social Sciences too have been interconnected here. Despite, there is a new neuroscience perspective to which body, brain and mind are inseparable. This postulate makes no division between reason and emotion. Cells and symbols are profoundly interrelated, when Xavante individuals take decisions based on the complexity of their emotions and sentiments actuated by person during body and mental experience. Alcohol ingestion influences the biochemistry of the human body, although this influence is not decisive to a social action of the subject. Memory was constructed inside culture and Xavante ethos by autonomy of individual s self decision and relationships between old/ new generations. Based on dynamics of emotional individuals balance in relation to indigenous villages and urban spaces are the construction of new memories. But Xavante individuals can change their perception with alcohol usage and feel quite different from when they haven t taken alcoholic beverages. Then, the essence of community, the corporal and substance of the collective physical-mental feeling begin to disappear from individuals memory with alcohol deregulated ingestion. In result, Xavante people s sentiment demonstrates a kind of metamorphosis / A tese procura demonstrar, por meio de pesquisas etnográficas realizadas nas aldeias Pimentel Barbosa e Etenhiritipá (Canarana-MT), que o específico processo de alcoolização em curso na sociedade Xavante não está ligado a um beber estruturado ou ritualizado. A síndrome de dependência do álcool (SDA) que melhor caracteriza a doença crônica chamada alcoolismo não é aqui utilizada para pré-diagnosticar as relações dos indivíduos e da coletividade com as bebidas industrializadas. Mesmo porque não se trata de uma pesquisa epidemiológica com objetivos de quantificar o uso, a quantidade, a frequência, entre outros fatores para se ter o perfil de saúde indígena em relação a um problema específico. Este trabalho antropológico qualitativo se pretende interdisciplinar, pois existem avanços científicos tanto do âmbito das ciências da saúde quanto do lado das ciências sociais que lidam com esse fenômeno. Além da nova perspectiva gerada pela neurociência, para a qual é impossível separar o corpo do cérebro e os dois da própria mente, como também a razão da emoção. Células e símbolos estão profundamente entrelaçados na base das tomadas de decisão, nos comportamentos apoiados em uma complexidade de emoções e sentimentos dos indivíduos Xavante frente às bebidas ou qualquer outro evento que se coloque como desafio à experiência corporal e mental da pessoa. O álcool interfere na bioquímica corporal, mas não determina a ação social do próprio sujeito. A memória impregnada de cultura, o ethos A uwe e o livre arbítrio, além das relações entre velhas e novas gerações juntamente com o ambiente da aldeia e o mundo urbano, entre outras vivências históricas e biográficas vão interferir no equilíbrio emocional do ser e na forma e conteúdo dos seus sentimentos. Ao embriagar-se o sujeito se desprende momentaneamente do seu corpo, altera sua percepção, seu quadro emocional e a formação de novas memórias, deixa de sentir como antes sentia sem o uso do álcool. Dilui-se no indivíduo a essência de sua formação corpóreo-mental coletiva, a comunidade de substância fica mais distante, mais que isso metamorfoseia-se o sentimento coletivo A uwe

Esta dissertação de mestrado problematiza a relação das mulheres mbyá-guarani com as práticas e políticas de saúde diferenciada, especialmente aquelas que dizem respeito ao processo de gestação, parto e puerpério. Primeiramente, trazendo recortes históricos e legislativos, faço uma discussão a respeito da emergência da “população indígena” como uma “população governável” em que a questão “étnica” aparece de maneira relevante nas práticas de governo, implicando em novos dispositivos de controle e formas de subjetivação a partir da “diferença cultural”. As políticas de saúde diferenciada são analisadas nesse contexto, tratando de traçar um solo sob o qual se sustenta o Posto de Saúde situado na Tekoá Koenju (aldeia mbyá-guarani localizada no município de São Miguel das Missões/RS), onde realizei parte de meu trabalho de campo. Um segundo momento deste trabalho dedica-se às práticas cotidianas de produção do que seria a “cidadania indígena” em um contexto de etnogovernamentalidade, salientando as formas pelas quais os profissionais de saúde atuam tanto baseados em valores morais e concepções próprias, quanto na racionalidade técnica (biomédica e biopolítica). A motivação humanitária (da política e da atuação dos profissionais) muitas vezes acaba por produzir uma população mbyá vulnerável, precária, a qual se justifica a intervenção. A partir da história contada por um karaí opygua suspendem-se certas regras desse jogo (político-conceitual) e adentra-se em outras possibilidades imaginativas mais atentas ao que os Mbyá vêm dizendo. Nessa direção, o terceiro momento atenta-se ao modo mbyá de fazer mundos, levando a política para o nível ontológico, e produzindo deslocamentos nos conceitos biomédicos. Seguindo histórias emblemáticas de partos (narradas e vivenciadas em diferentes espaços e momentos de minha trajetória etnográfica), busco trazer as formas mbyá de produção de corpos e pessoas, nas quais as práticas dos profissionais de saúde e o ambiente hospitalar também ganham um lugar específico. Os partos são, nesse sentido, como uma porta de entrada para pensar a cosmopolítica implicada no processo de produção da pessoa mbyá, situada também nas relações cotidianas com as políticas e práticas de saúde biomédica. / The purpose of this study is to reflect upon the relationship of Mbyá-Guarani women with specialized health policies and practices, especially those concerning pregnancy, birth and postpartum processes. First, bringing historical and legislative elements, I engage in a discussion about the emergence of the "indigenous population" as a "governable population" where "ethnicity" takes a significant role in governance practices resulting, therefore, in new control devices and forms of subjectivity that are built on "cultural difference". Indigenous health policies are analyzed in this context as to outline a ground upon which rests Tekoá Koenju’s (a Mbya-Guarani community, situated in São Miguel das Missões/RS) Health Center, where part of my fieldwork was conducted. A second stage of this work is dedicated to the daily production practices of what would be the "indigenous citizenship" in a context of “ ethnogovernmentality”, highlighting the ways in which health professionals work based both on moral values and personal views, and on technical (biomedical and biopolitical) rationality. The humanitarian reason (present in the policies and in specialists’ work) can often produce a vulnerable, precarious mbyá population that justifies an intervention. From a story told by a karai opyguá (mbyá shaman), certain rules of this political and conceptual game are suspended and other imaginative possibilities are able to emerge. In this direction, the third part of this study pays special attention to the mbyá way of “worlding”, taking politics to the ontological level and producing changes in biomedical concepts. Following emblematic stories of births (narrated and experienced in different moments of my ethnographic trajectory), I seek to convey the mbyá modes of producing bodies and persons in which health professionals’ practices and the hospital environment also have a specific place. Childbirth is, in this sense, a way to think about the cosmopolitics involved in the production process of the mbyá person, also situated in daily relationships with the biomedical health’s policies and practices.

Método: Trata-se de uma pesquisa qualitativa de cunho documental utilizando o audiovisual como lócus de instalação de depoimentos de lideranças indígenas do Estado do Acre, Brasil. O objetivo é analisar registros de vivências de lideranças indígenas sobre suas condições de vida, como contribuição às políticas públicas do SUS. E apresentar uma proposta interventiva a partir das potencialidades do vídeo documentário. Resultados: A população indígena, por uma série de motivos, certamente é a parcela da população brasileira sobre a qual menos existem dados específicos que permitam o estabelecimento de políticas de saúde pública eficazes. Embora tenham ocorrido avanços significativos no conhecimento das questões indígenas e um crescente empoderamento das lideranças indígenas na luta por seus direitos básicos de cidadania, a situação ainda está aquém do esperado. Temas relevantes abordados: 1. Participação nas instâncias do poder público/ direitos indígenas. 2. Medicina tradicional exterioridade da doença. 3. Dificuldades com o SUS. 4. Cuidados de saúde nas aldeias. 5. Segurança Alimentar e desnutrição. 6. Qualidade da água e saneamento básico. 7. Logística. 8. Cobertura vacinal. 9. Saúde das mulheres indígenas. 10. Ecologia e biodiversidade. 11. Morte de crianças indígenas. Conclusões: 1. A omissão sistemática dos governos em qualificar agentes de saúde indígenas no tocante às intervenções em saúde individual e coletiva e no exercício dos direitos sociais. 2. Falta de empenho do SUS em contratar profissionais com formação especializada para compor as equipes e direções do Sistema de Saúde que atuam nas aldeias e nos postos avançados de saúde no interior do território. 3. Dificuldades de comunicação entre as equipes do SUS e os povos indígenas. Há barreiras de idioma, de cultura e de percepção do processo saúde-doença / Method: This is a qualitative research that uses the documentary audio-visual like a place of installation register statements of native indigenous leaders of Acre, Brazil. The objective is to analyze records of indigenous leaders from experiences about their living conditions as a contribution to public SUS policies. And present an interventional proposal from the documentary video potentiality. Results: The indigenous population, for a number of reasons, it is certainly the Brazilian population, on which there is less specific data that allow the establishment of effective public health policies. Although there have been significant advances in knowledge of indigenous issues and a growing empowerment of indigenous leaders in the struggle for their basic rights of citizenship, the situation is still below expectations. Relevant topics approached:1. Participation in public authoritys instances / indigenous rights. 2. Traditional medicine - externality of the disease. 3. Difficulties with SUS. 4. Health care in villages. 5. Food security and malnutrition. 6. Water quality and basic sanitation. 7. Logistics. 8. Vaccination coverage. 9. Indigenous women\'s health. 10. Ecology and biodiversity. 11. Death of indigenous children. Conclusions: 1. the systematic omission of governments in qualify indigenous health workers with regard to the individual and collective health interventions and the exercise of social rights. 2. Lack of commitment of the SUS in hiring professionals with specialized training to compose the teams and directions of the Health System that work in the villages and in the outposts of health in the territory. 3. Difficulties in communication between SUS teams and indigenous peoples. There are barriers to language, culture and perception of the health-disease process

Esta pesquisa investiga a multiplicação dos diagnósticos de doenças mentais junto aos Wajãpi do Amapari e, concomitantemente, o aumento gradativo e discreto de prescrições de medicamentos psicotrópicos. A fim de compreender este fenômeno, são analisadas as explicações fornecidas pelas famílias acerca dos estados alterados de seus parentes, bem como os vários caminhos trilhados na tentativa de reversão dos mesmos. Nestes, as famílias estabelecem relações com os mais diversos agentes: pajés, médicos, psicólogos, missionários, pastores e curandeiros. Todas as relações abordadas nesse trabalho reforçam que, para os Wajãpi, só é possível viver realizando composições. / This research investigates the multiplication of mental illness diagnosis among the Wajãpi of Amapari and in parallel the gradual and discrete rise in prescriptions of psychotropical medications. In order to understand this phenomenon, the study analyzes both the family explanations about the altered states of their relatives and also the different paths taken to try to reverse such states. In doing so, these families establish relations with very different agents, such as: shamans, doctors, psychologists, missionaries, pastors and healers. All the relations described in this study reinforce the idea that, to Wajãpi, it is only possible to live realizing different compositions.

The fieldwork for this study was conducted in the West Kimberley region of Western Australia between 1997 and 1999. Qualitative and quantitative information provided by 170 Aboriginal participants enabled an exploration of the context and patterns of Aboriginal alcohol use; Aboriginal perceptions of the alcohol issue, existing interventions, research findings, 'culture' and its role in prevention and intervention; and participants' incorporation of these perceptions into an Aboriginal model for alcohol misuse prevention, intervention and evaluation. Findings were based on the results of individual and focus group interviews, serial model-planning focus groups, documentary data and observation.Study findings generally suggest that in addition to self-determination and support components, 'cultural context' retains an important role for many remote area Aboriginal people. The findings from a small sub-sample tentatively suggest that 'cultural' disruption, in addition to the socio-economic consequences of colonisation and dispossession, may play an important role in alcohol misuse. Consequently, it appears that in combination with self-determination and support components, the strengthening of a locally-defined 'cultural' context may have an important role in alcohol misuse prevention and intervention - an approach frequently unrepresented in existing symptom-focused models and one inviting further investigation. The model developed by study participants expands significantly on existing symptom-focused approaches through a comprehensive life-enhancement focus on aspects of identity, opportunity and hope. This approach adds depth and meaning to understandings of cultural appropriateness and of culturally relevant models for substance misuse prevention and intervention.

Recent Māori, sexual, and primary health developments have been influenced by the principle of participation. For example, the use of a whānau-centred approach, of community development, and of Primary Health Organisations allows participation in decision-making. However, none of the abovenamed strategies adequately explain how young Māori women can participate in decision-making in one common area: Māori, sexual, primary health policy. This thesis explores how Primary Health Organisations can work with young Māori women to promote sexual health to whānau by focusing on policymaking processes and effective participation mechanisms. Māori health development from colonial Contact to 2005 is reviewed before the broad health framework (the New Zealand Health Strategy and the New Zealand Public Health and Disability Act 2000) is defined. A critique of relevant policy, in particular He Korowai Oranga (2002), the Sexual and Reproductive Health Strategy (2001), and The Primary Health Care Strategy (2001), reveals scope for participation and whānau-centredness. Primary Health Organisations pose challenges to whānau sexual health promotion. However, with public participation from young Māori women, like the thesis participants, new opportunities can be realised. The research was conducted in accordance with a Mana Wāhine-based methodology called Tāniko The four parts (Mana Wāhine, Te Ao Tawhito, Te Ao Hou, and Te Ao Mārama) defined the research aim and objectives. A qualitative strategy employing semi-structured interviews with three young Māori women was followed by a confirmatory stage of content analysis utilising a deductive public participation evaluation tool: the Tāniko instrument. The instrument analysed four policymaking decisions and two mechanisms: organised peer groups and the wāhine-centred approach. The research concluded that when defining how, by whom, and to whom information is presented, organised peer groups can be utilised at the coordination and evaluation policymaking stages. The wāhine-centred approach can share or manage participation through problem definition, consultation, decision, and implementation.

Doctor of Philosophy / This thesis analyses the concept of indigenous peoples’ right to self–determination within the international human rights system and explores viable avenues for the fulfilment of indigenous claims to self–determination through the design, implementation and evaluation of development policies. The thesis argues that development policy plays a crucial role in determining the level of enjoyment of self–determination for indigenous peoples. Development policy can offer an avenue to bypass nation states’ political unwillingness to recognize and promote indigenous peoples’ right to self–determination, when adequate principles and criteria are embedded in the whole policy process. The theoretical foundations of the thesis are drawn from two different areas of scholarship: indigenous human rights discourse and development economics. The indigenous human rights discourse provides the articulation of the debate concerning the concept of indigenous self–determination, whereas development economics is the field within which Amartya Sen’s capability approach is adopted as a theoretical framework of thought to explore the interface between indigenous rights and development policy. Foundational concepts of the capability approach will be adopted to construct a normative system and a practical methodological approach to interpret and implement indigenous peoples’ right to self–determination. In brief, the thesis brings together two bodies of knowledge and amalgamates foundational theoretical underpinnings of both to construct a normative and practical framework. At the normative level, the thesis offers a conceptual apparatus that allows us to identify an indigenous capability rights–based normative framework that encapsulates the essence of the principle of indigenous self–determination. At the practical level, the normative framework enables a methodological approach to indigenous development policies that serves as a vehicle for the fulfilment of indigenous aspirations for self–determination. This thesis analyses Australia’s health policy for Aboriginal and Torres Strait Islander peoples as an example to explore the application of the proposed normative and practical framework. The assessment of Australia’s health policy for Indigenous Australians against the proposed normative framework and methodological approach to development policy, allows us to identify a significant vacuum: the omission of Aboriginal traditional medicine in national health policy frameworks and, as a result, the devaluing and relative demise of Aboriginal traditional healing practices and traditional healers.

Globally, the prevalence of Type 2 diabetes is rising. The most affected populations are those that have undergone recent and rapid transition towards a Western lifestyle, characterised by energy-dense diets and physical inactivity.¶ Two major hypotheses have attempted to explain the variation in diabetes prevalence, both between and within populations, beyond the contributions made by adult lifestyle. The thrifty genotype hypothesis proposes that some populations are genetically well adapted to surviving in a subsistence environment, and are predisposed to develop diabetes when the dietary environment changes to one that is fat and carbohydrate rich. The programming hypothesis focuses on the developmental environment, particularly on prenatal and early postnatal conditions: nutritional deprivation in utero and early postnatal life, measured by low birthweight and disrupted child growth, is proposed to alter metabolism permanently so that risk of diabetes is increased with subsequent exposure to an energy-dense diet. Both hypotheses emphasise discord between adaptation (genetic or developmental) and current environment, and both now put forward insulin resistance as a likely mechanism for predisposition.¶ Diabetes contributes significantly to morbidity and mortality among Australia’s Indigenous population. Indigenous babies are more likely to be low birthweight, and typical patterns of child growth include periods of faltering and rapid catch-up. Although there have been numerous studies in other populations, the programming hypothesis has not previously been tested in an Australian Indigenous community. The framework of the programming hypothesis is thus expanded to consider exposure of whole populations to adverse prenatal and postnatal environments, and the influence this may have on diabetes prevalence.¶ The present study took place in Cherbourg, a large Aboriginal community in southeast Queensland with a high prevalence of diabetes. Study participants were adults with diagnosed diabetes and a random sample of adults who had never been diagnosed with diabetes. Data were collected on five current risk factors for diabetes (general and central obesity, blood pressure, age and family history), in addition to fasting blood glucose levels. A lifestyle survey was also conducted. Participants’ medical records detailing weight growth from birth to five years were analysed with regard to adult diabetes risk to determine whether childhood weight and rate of weight gain were associated with subsequent diabetes. Adult lifestyle factors were xiialso explored to determine whether variation in nutrition and physical activity was related to level of diabetes risk.¶ Approximately 20% of adults in Cherbourg have diagnosed diabetes. Prevalence may be as high as 38.5% in females and 42% in males if those who are high-risk (abnormal fasting glucose and three additional factors) are included. Among those over 40 years, total prevalence is estimated to be 51% for females and 59% for males.¶ Patterns of early childhood growth may contribute to risk of diabetes among adults. In particular, relatively rapid weight growth to five years is associated with both general and central obesity among adult women. This lends some qualified support to the programming hypothesis as catch-up growth has previously been incorporated into the model; however, although the most consistent association was found among those who gained weight more rapidly, it was also found that risk is increased among children who are heavier at any age.¶ No consistent associations were found between intrauterine growth retardation (as determined by lower than median birthweight and higher than median weight growth velocity to one and three months) and diabetes risk among women or men. A larger study sample with greater statistical power may have yielded less ambiguous results.¶ Among adults, levels of physical activity may be more important than nutritional intake in moderating diabetes risk, although features of diet, such as high intake of simple carbohydrates, may contribute to risk in the community overall, especially in the context of physical inactivity. A genetic component is not ruled out. Two additional areas which require further investigation include stress and high rates of infection, both of which are highly relevant to the study community, and may contribute to the insulin resistance syndrome.¶ Some accepted thresholds indicating increased diabetes risk may not be appropriate in this population. Given the relationship between waist circumference and other diabetes risk factors and the propensity for central fat deposition among women even with low body mass index (BMI), it is recommended that the threshold where BMI is considered a risk be lowered by 5kg/m2 for women, while no such recommendation is made for men.¶ There are a number of social barriers to better community health, including attitudes to exercise and obesity, patterns of alcohol and tobacco use and consumption of fresh foods. Some of these barriers are exacerbated by gender roles and expectations.¶

In New Zealand Māori are under-represented in the workforce across multiple sectors. This thesis explores this incongruity with regard to Māori health. A Māori perspective and philosophical foundation formed the basis of the methodological approach, utilising a case study research design to inform the study. This provided the opportunity to explore Māori health workforce development initiatives and their potential to contribute to improvements and gains in Māori health. It was important that this work take into account social and economic factors and their impact on health, as well as the varying political climates of market oriented reform and a fiscal policy focus, because it has not only challenged Māori health development but also provided opportunities for increased Māori involvement and participation in health and New Zealand society. Therefore the thesis, while focused on health takes cognisance of and, coincides with the capacity and capability building efforts that have been a feature of overall Māori development, progress and advancement. In the context of this thesis Māori health workers are seen as leaders within their whānau, hapū, iwi, and Māori communities. Consequently a potential workforce that is strong and powerful can lead to anticipated gains in Māori health alongside other Māori movements for advancement. The potential cannot be under-estimated. This thesis argues that there are critical success factors, specific determinants, influencing Māori health workforce potential, and that these success factors have wider application. Therefore, as this thesis suggests Māori workforce development, especially in relationship to the health workforce, is dependent on effective Māori leadership, the application of Māori values to workplace practices, levels of resourcing that are compatible with training and development, critical mass, and targeted policies and programmes.

This study aimed to understand how Maori women negotiate decisions about alcohol and pregnancy. It was based in the recognition that Maori women?s decisions about drinking alcohol when pregnant are shaped by social and cultural expectations about gender roles, as well as their knowledge about alcohol and pregnancy. Maori attitudes to alcohol have also been influenced by colonisation and Maori responses to it. Alcohol use in pregnancy also exists in the context of potential impacts, including fetal alcohol spectrum disorder. There is little knowledge about how and why women may or may not drink during pregnancy. The research used grounded theory methods. Information was gathered through in-depth interviews with ten Maori women. The information they provided was analysed using constant comparative analysis, and a series of categories was generated. The grounded theory proposes that Maori women manage decisions about drinking alcohol when pregnant using a process of Trading off. Trading off is supported by three key processes: drawing on resources, rationalising, and taking control of the role. Maori women start by learning the rules about alcohol, get messages about alcohol and pregnancy, change their alcohol use while making role transitions, and use alcohol in the processes of fitting in where you are, releasing the pressure, and carrying on as normal. Trading off is an individual process, but exists in a complex social context. The process is fluid, conditional, and continues throughout pregnancy. The theory must be recognised as my interpretation, although I believe it is grounded in the data, accounts for the data, and offers a new, modifiable and potentially useful interpretation. While the body of theory that can be compared to the theory of Trading off is limited, the interpretation is consistent with several models of health behaviour, including Maori health models. This research has implications for future research, and for the development of programmes to support Maori women.