Adolescence is a time of great changes, a time where experimentation and exploration is expected and when the values of authority figures are examined and challenged. Adolescents will experiment and push the boundaries of all aspects of their life in order to find their own place and identity in a world that has changed its expectations of them. Use of drugs is one of the ways that they do this. Australian adolescents grow up in a society where alcohol and tobacco is an acceptable part of daily life. Their use of drugs is at least on par with and in some cases exceeds that of the general population. The overall goals of this research were to gain more information on drug use of Australian adolescents, using existing data sets. This research examined, using a number of different age groups, the differences in adolescent drug use between urban and rural Australia for lifetime use, use in the last year and use in the last month using the 2002 edition of the Australian School Student Alcohol and Drug (ASSAD) survey series in conjunction with the 2001 National Drug Strategy Household Survey (NDSHS). It also used these data sets to investigate differences between indigenous adolescents and non-Indigenous adolescents and whether there were any differences in adolescent drug use across socio-economic status groups. Four hypotheses were developed. The first was that rural adolescents are more likely than urban adolescents to use licit drugs and the second was that urban adolescents are more likely than rural adolescents to use illicit drugs. Thirdly, that Indigenous adolescents are more likely than non-Indigenous adolescents to use both licit and illicit drugs and the fourth was that adolescents from low socio-economic status (SES) groups are more likely than adolescents from high SES groups to use licit and illicit substances. The data offered little support for any of the hypotheses. The hypothesis on rural adolescents being more likely to use licit drugs was supported by the ASSAD surveydata but not the NDSHS. All other hypotheses were not supported by either of the data sets. While there are aspects of the information from the two data sets that are contradictory making it difficult to prove or disprove the hypotheses formulated for this research, they highlighted a number of aspects of adolescent drug use. The first of these is that this research supports the premise that rural adolescent drug use rates are converging with urban drug use rates for younger adolescents. It also highlighted that there are a large number of rural school students who are using alcohol and cannabis. The ASSAD data also confirmed other Australian research showing that Indigenous adolescents are less likely than their non-Indigenous counterparts to use alcohol. Both data sets confirmed previous research by indicating that adolescents from the high SES groups are more likely than their counterparts in the lower SES groups to consume alcohol. Further investigation is needed to find out why the data sets did not substantiate each other and to gain further insight into the consumption of alcohol by Indigenous adolescents and adolescents from the higher socio-economic status groups. Increasing the samples of Indigenous people in both of the data sets and lobbying the Australian Bureau of Statistics to increase their sample for the Indigenous Social Survey to include 12-14 year olds should give more information on Indigenous adolescents that could be used in research and prevention activities.

The global phenomenon of population ageing has major ramifications for societies and governments around the world. In New Zealand, efforts to address the impacts of population ageing have centred on the Government’s Positive Ageing Strategy. This is a thesis about positive ageing as viewed through Maori eyes. It has been informed by the memories and aspirations of older Maori who have lived through challenging times but have emerged with qualities that enable them to enjoy older age and to contribute to their own whanau, Te Ao Maori (the Maori world) and Te Ao Whanui (wider society). The thesis is philosophically located at the interface between Western science and matauranga Maori, an Indigenous inquiry paradigm. It is argued that Western science and matauranga Maori are relevant to research in the contemporary context, and reflect the realities of older Maori who live in both Te Ao Maori and Te Ao Whanui. The study used research techniques that draw on Western science (literature review), matauranga Maori (review of 42 Maori proverbs) and both inquiry paradigms simultaneously (qualitative study with 20 older Maori people). The research found that Maori positive ageing can be characterised by a two dimensional concept that incorporates a process dimension and an outcome dimension. The process dimension is consistent with a lifecourse perspective and therefore recognises that ageing is a life-long process where circumstances encountered during life may impact cumulatively and manifest in old age. The outcome dimension can be described in terms of complementary ‘universal’ and Maori specific outcome domains. The universal outcome domains are encapsulated in the New Zealand Positive Ageing Strategy and more recently are expressed in the Positive Ageing Indicators 2007 Report. The Maori-specific outcome domains identified in this Study are: kaitiakitanga – stewardship; whanaungatanga – connectedness; taketuku – transmission; takoha – contribution; takatu – adaptability; and, tino rangatiratanga – selfdetermination. The overarching outcome domain is taupaenui – realised potential.

The global phenomenon of population ageing has major ramifications for societies and governments around the world. In New Zealand, efforts to address the impacts of population ageing have centred on the Government’s Positive Ageing Strategy. This is a thesis about positive ageing as viewed through Maori eyes. It has been informed by the memories and aspirations of older Maori who have lived through challenging times but have emerged with qualities that enable them to enjoy older age and to contribute to their own whanau, Te Ao Maori (the Maori world) and Te Ao Whanui (wider society). The thesis is philosophically located at the interface between Western science and matauranga Maori, an Indigenous inquiry paradigm. It is argued that Western science and matauranga Maori are relevant to research in the contemporary context, and reflect the realities of older Maori who live in both Te Ao Maori and Te Ao Whanui. The study used research techniques that draw on Western science (literature review), matauranga Maori (review of 42 Maori proverbs) and both inquiry paradigms simultaneously (qualitative study with 20 older Maori people). The research found that Maori positive ageing can be characterised by a two dimensional concept that incorporates a process dimension and an outcome dimension. The process dimension is consistent with a lifecourse perspective and therefore recognises that ageing is a life-long process where circumstances encountered during life may impact cumulatively and manifest in old age. The outcome dimension can be described in terms of complementary ‘universal’ and Maori specific outcome domains. The universal outcome domains are encapsulated in the New Zealand Positive Ageing Strategy and more recently are expressed in the Positive Ageing Indicators 2007 Report. The Maori-specific outcome domains identified in this Study are: kaitiakitanga – stewardship; whanaungatanga – connectedness; taketuku – transmission; takoha – contribution; takatu – adaptability; and, tino rangatiratanga – selfdetermination. The overarching outcome domain is taupaenui – realised potential.

The global phenomenon of population ageing has major ramifications for societies and governments around the world. In New Zealand, efforts to address the impacts of population ageing have centred on the Government’s Positive Ageing Strategy. This is a thesis about positive ageing as viewed through Maori eyes. It has been informed by the memories and aspirations of older Maori who have lived through challenging times but have emerged with qualities that enable them to enjoy older age and to contribute to their own whanau, Te Ao Maori (the Maori world) and Te Ao Whanui (wider society). The thesis is philosophically located at the interface between Western science and matauranga Maori, an Indigenous inquiry paradigm. It is argued that Western science and matauranga Maori are relevant to research in the contemporary context, and reflect the realities of older Maori who live in both Te Ao Maori and Te Ao Whanui. The study used research techniques that draw on Western science (literature review), matauranga Maori (review of 42 Maori proverbs) and both inquiry paradigms simultaneously (qualitative study with 20 older Maori people). The research found that Maori positive ageing can be characterised by a two dimensional concept that incorporates a process dimension and an outcome dimension. The process dimension is consistent with a lifecourse perspective and therefore recognises that ageing is a life-long process where circumstances encountered during life may impact cumulatively and manifest in old age. The outcome dimension can be described in terms of complementary ‘universal’ and Maori specific outcome domains. The universal outcome domains are encapsulated in the New Zealand Positive Ageing Strategy and more recently are expressed in the Positive Ageing Indicators 2007 Report. The Maori-specific outcome domains identified in this Study are: kaitiakitanga – stewardship; whanaungatanga – connectedness; taketuku – transmission; takoha – contribution; takatu – adaptability; and, tino rangatiratanga – selfdetermination. The overarching outcome domain is taupaenui – realised potential.

A whanau is a social construct of Maori society in Aotearoa/New Zealand that is likened to an extended family. This thesis describes principles and practice that whanau utilise in decision processes from the findings of a retrospective qualitative case study of three whanau, who decided to participate in genetic research into a medical condition affecting their health. Four elements of whanau decision processes emerged from the data. Hui, rangatiratanga, manaakitanga and kotahitanga are Maori constructs that emphasise the collective nature of whanau decision making, and substantiate philosophical, theoretical and anecdotal evidence that Maori have distinctive ways of reaching decisions, underpinned by unique philosophical conventions. The results of this research place greater significance on the process of decision making than actual decisions, an incidental finding that has not been articulated by previous studies of Maori health and whanau. Contrary to western theoretical knowledge of decision making, whanau decision processes are collective activities. Individual decision making is closely linked to and depends on the collective, because individual identity manifests from the collective, and individual wellbeing is closely linked to that of the collective. When decision processes are familiar to members of a whanau, they are more likely to engage in decision making because they have a greater sense of knowledge and thus control of the processes, and they feel more able to contribute meaningfully to achieving aspirations for their own health. This thesis provides evidence that the New Zealand health sector, health legislation and policies are largely unfavourable for guaranteeing whanau engagement in decision processes. Yet, whanau decision making is an overall objective of the Government’s Maori Health Strategy: He Korowai Oranga, to address inequalities in health between Maori and other New Zealanders that have unacceptably become the norm.

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.

Submitted by Mario Mesquita (mbarroso@fiocruz.br) on 2014-11-12T18:03:58Z No. of bitstreams: 1 Nubia_Horiba_EPSJV_Mestrado_2012.pdf: 879313 bytes, checksum: e01f512161002bf195c164487941bc24 (MD5) / Approved for entry into archive by Mario Mesquita (mbarroso@fiocruz.br) on 2014-11-12T18:47:01Z (GMT) No. of bitstreams: 1 Nubia_Horiba_EPSJV_Mestrado_2012.pdf: 879313 bytes, checksum: e01f512161002bf195c164487941bc24 (MD5) / Made available in DSpace on 2014-11-12T18:47:01Z (GMT). No. of bitstreams: 1 Nubia_Horiba_EPSJV_Mestrado_2012.pdf: 879313 bytes, checksum: e01f512161002bf195c164487941bc24 (MD5) Previous issue date: 2012 / Fundação Oswaldo Cruz. Escola Politécnica de Saúde Joaquim Venâncio. Programa de Pós-Graduação em Educação Profissional em Saúde. / Este estudo discute o modelo de atenção à saúde da população indígena vigente no Brasil na perspectiva do trabalho de enfermagem nas equipes de saúde indígena do Distrito Especial de Saúde Indígena do Alto Rio Negro - AM. Trata-se de uma pesquisa exploratória realizada com intuito de tornar explícito o problema do processo de trabalho da enfermagem nas equipes de saúde indígena do Distrito Sanitário Especial Indígena (DSEI) inseridas no modelo de atenção a saúde indígena brasileiro implantado no final da década de 1990. Portanto, este trabalho pretende rever e discutir a prática do cuidado em saúde indígena à luz do arcabouço teórico empregado para fornecer subsídios para o aperfeiçoamento do modelo de atenção à saúde indígena no Brasil em particular no que se refere às práticas e ações de saúde realizadas com essas populações específicas. Essa dissertação apontou alguns nós críticos do modelo de saúde indígena praticado no Brasil, que apesar dos avanços em termos de concepção, e de organização em forma de Distritos Especiais Indígenas, ainda há muito que fazer em termos de organização do processo de trabalho, composição das equipes, formação e capacitação de profissionais, permanência e envolvimento desses nos DSEIs, e gestão. Uma das chaves para a solução desses problemas poderia ser a territorialização da atenção, com a confecção de um planejamento local de saúde com a participação das comunidades, de modo a direcionar as intervenções de acordo com a situação de saúde cada comunidade, seus problemas e necessidades de saúde, mas também suas potencialidades e respostas sociais. / This study discusses the model of health care for indigenous people in Brazil from the perspective of the nursing work in health teams Special Indigenous Health District of the Upper Rio Negro - AM. This is an exploratory research with the aim of making explicit the problem of the process of nursing in health teams of the Special Indigenous Health District of the Upper Rio Negro - AM. (DSEI) included in the model of the Brazilian indigenous health care implemented at the end of the 1990s. Therefore this paper intends to review and discuss the practice of indigenous health care in the light of the theoretical framework of indigenous public health and the social sciences with the framework of cathegories like health labour and intersubjectivity that can provide subsidies for the improvement of the model of attention to indigenous health in Brazil with particular regards to health practices and actions taken with such specific populations. This study pointed out some critical nodes of the model of indigenous health practiced in Brazil, despite the advances in design, and organization in the form of Indigenous Health Districts, there is still much to do in terms of organization of the work process, composition teams, professional training, retention and involvement of the staff in these DSEIs and management. One of the keys to solving these problems could be the territorialization of attention, with the construction of a local health planning with the participation of communities, in order to guide interventions according to each community health status, problems and needs but also their potential and social responses

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.

Submitted by Igor Matos (igoryure.rm@gmail.com) on 2017-02-02T15:07:52Z No. of bitstreams: 1 DISS_2015_Viviane Francischini Fagundes.pdf: 2504190 bytes, checksum: b0b434170521a8b4c4bbfa5e42ac2117 (MD5) / Approved for entry into archive by Jordan (jordanbiblio@gmail.com) on 2017-02-03T11:51:56Z (GMT) No. of bitstreams: 1 DISS_2015_Viviane Francischini Fagundes.pdf: 2504190 bytes, checksum: b0b434170521a8b4c4bbfa5e42ac2117 (MD5) / Made available in DSpace on 2017-02-03T11:51:56Z (GMT). No. of bitstreams: 1 DISS_2015_Viviane Francischini Fagundes.pdf: 2504190 bytes, checksum: b0b434170521a8b4c4bbfa5e42ac2117 (MD5) Previous issue date: 2015-07-31 / Introdução – O conceito de vulnerabilidade possibilita a superação das dificuldades e dos problemas encontrados no âmbito do processo saúde-doença, facilitando a compreensão da vida e de seus determinantes. A dimensão programática da vulnerabilidade pressupõe a existência de elementos chave para a análise de como se dá o compromisso político governamental frente às necessidades de saúde da população, à definição de políticas específicas e as condições de sua governabilidade e do controle social. Objetivo - Analisar a vulnerabilidade da atenção à saúde da criança Xavante menor de cinco anos, no polo base Marãiwatsédé. Métodos - Estudo de caso com coleta de dados em pesquisa documental (leis, portarias, livros de anotações); entrevistas semiestruturadas, com lideranças indígenas, conselheiros locais de saúde, professores, profissionais de saúde, moradores da aldeia Marãiwatsédé e trabalhadores não governamentais. As informações e observações foram registradas no diário de campo. Resultados e Análises: A análise da vulnerabilidade programática da atenção à saúde da criança no polo base Marãiwatsédé destacou-se com a institucionalidade da atenção à saúde dos povos indígenas respaldada pelo Subsistema de Saúde Indígena, pela Política Nacional de Atenção à Saúde dos Povos Indígenas e pela Secretaria Especial de Saúde Indígena. A organização da atenção no polo base evidenciou problemas como demora no agendamento e atendimento da média complexidade, baixa resolutividade nos serviços ofertados e discriminação étnica por parte das referências municipais, grave realidade vivida pelos indígenas e pelos profissionais de saúde. O planejamento distrital seguiu normas estabelecidas pelo Ministério da Saúde e sua construção de maneira ascendente, contou com a participação de representantes das comunidades. Na gestão do trabalho os problemas estão voltados para vínculo empregatício terceirizado, número e categoria profissional aquém das reais necessidades e o não cumprimento da carga horária contratual, pelo profissional médico. A baixa carga horária do médico e a necessidade da enfermeira se ausentar para resolver questões relacionadas às referências municipais comprometem a resolutividade da atenção à saúde, reforçando a vulnerabilidade institucional do polo base. A qualificação profissional tem priorizado a saúde da criança, mas não tem sido trabalhada com as dimensões culturais do Povo Xavante. A atenção à saúde do recém-nascido acompanha os protocolos do Ministério da Saúde e apresenta aspectos positivos como 90,9% dos partos são naturais; 70,0% ocorreram na aldeia; 93,2% dos nascidos vivos apresentaram peso adequado para a idade. A cobertura do acompanhamento do peso das crianças < de 5 anos, em 2013 foi maior que em 2012. Do total de crianças, 79,5% apresentou peso adequado para a idade e 21,1% das crianças na faixa etária de 0 < 6 meses apresentaram muito baixo peso para a idade em 2012 e 2013, 90,0% apresentou peso adequado para a idade. Baixas coberturas vacinais em relação aos parâmetros estabelecidos pelo Ministério da Saúde. Vulnerabilidade individual marcada pelas altas Taxas de Mortalidade Infantil, Perinatal e em crianças de 1 a 5 anos. Vulnerabilidade social baseada no conflito territorial e na degradação ambiental comprometendo aspectos fundamentais para a manutenção da vida / Introduction - The concept of vulnerability makes it possible to overcome the difficulties and problems encountered in the health-disease process, facilitating the understanding of life and its determinants. The programmatic dimension of vulnerability presupposes the existence of key elements to analyze how is the government's political commitment across the health needs of the population, the definition of specific policies and the conditions of their governance and social control. Objective - To assess the vulnerability of the health care of Xavante children under five years old, in the Marãiwatsédé base pole.. Methods - Case study with data collection in documentary research (laws, ordinances, notebooks); semi-structured interviews with indigenous leaders, local health counselors, teachers, health professionals, residents of the village Marãiwatsédé and non-governmental workers. The information and observations were recorded in the field diary. Results and analysis: The organization of health care at the pole base Marãiwatsédé presented low resolution and ethnic discrimination in medium complexity services by municipal references in the region; District Plan for Xavante Indigenous Health 2012-2015 followed the upward logic in its preparation; Actions to increase the value of culture and traditional healing practices not included in plan. Work management with outsourced employment and professional category number and fallen short; the medical professional performance in precarious base polo and not contractual compliance; the need of nurses to leave to meet the needs of patients in referral centers, committed to solving the health care and reinforces the institutional vulnerability of the pole base. Professional qualification gives priority attention to children's health; cultural approach and traditional healing practices not inserted in the skills; relationship of commitment observed in the base pole health professionals, who work in an atmosphere of mutual collaboration. Low resolution rates of the base pole provide the leadership with misinterpretation of the situation, transferring the cause of problems to the base pole in the village. Proper attention to newborn as provided in the district plan: 90.9% natural deliveries; 70.0% in the village; 93.2% of live births with adequate weight for age, no weight lower than expected. Newborn screening held in the village. Coverage monitoring the weight of children < 5 years, in 2013 more than in 2012. Of the children, 79.5 % had adequate weight for age and 21.1 % of children aged 0 <6 months had very low weight for age in 2012 and in 2013, 90.0 % had adequate weight for age. Low vaccination coverage regarding the parameters established by the Ministry of Health. Individual vulnerability marked by high rates of infant mortality, Perinatal and children 1-5 years. Social vulnerability based on the territorial conflict and environmental degradation compromising fundamental aspects for the maintenance of life

Made available in DSpace on 2016-06-02T19:00:20Z (GMT). No. of bitstreams: 1 2073.pdf: 2769076 bytes, checksum: dd547572945b861ea730dcc29b9f1525 (MD5) Previous issue date: 2008-08-12 / Universidade Federal de Minas Gerais / In the context of restructuring the indigenous health policies over the last 20 years in Brazil, and the consequent creation of the Special Sanitary Indigenous Districts since 1999, the Indigenous Health Agents appear as central elements of this new model for indigenous health attention, since they are understood as possible links or translators between the traditional systems and the official biomedicine. Considering this context, my intention was, through the presentation of ethnographic data about the formation process and the performance of the Indigenous Health Agents at the Upper Xingu, to question the role attributed to them, as well as the model of differentiated attention where this role was proposed. Exactly because they occupy a border position between different medicaltherapeutic systems, the agents performances are involved in several ambiguities and conflicts, which result from the imprecise definition of their functions, as well as from the effective existing conditions for their acting in the spaces attributed to them. I intend to show that the Indigenous Health Agents have their role redefined twice: by the non-indigenous professionals who think of them as transmitters of the biomedical knowledge to the attended populations as well as by the indigenous themselves, who see them as sources of goods and services from national society, in the general context of the political appropriation of this role and its acting spaces by the upper-xinguanos and local leaders themselves. / Dentro do contexto da reestruturação das políticas de saúde indígena ao longo dos últimos 20 anos no Brasil, e a conseqüente criação dos Distritos Sanitários Especiais Indígenas/DSEIs a partir de 1999, os Agentes Indígenas de Saúde/AISs aparecem como elementos centrais desse novo modelo de atenção à saúde indígena, na medida em que são entendidos como possíveis elos de ligação ou tradutores entre os sistemas tradicionais e a biomedicina. Tendo em vista este contexto, o objetivo desta dissertação foi, por meio da apresentação de dados etnográficos relativos à formação e à atuação dos AISs no Alto Xingu, problematizar o papel que lhes foi atribuído, bem como o modelo de atenção diferenciada no qual este papel foi proposto. Observa-se que, exatamente pelo fato de ocuparem uma posição de fronteira entre distintos sistemas médico-terapêuticos, a atuação dos AISs está envolta em ambigüidades e conflitos de diversas naturezas, decorrentes quer de certa imprecisão na formulação do seu papel, quer das condições efetivas das suas atuações nos espaços que lhes foram atribuídos. Procura-se mostrar que os Agentes Indígenas de Saúde têm sua atuação duplamente redefinida: tanto pelos profissionais não-indígenas que os pensam como transmissores dos conhecimentos biomédicos às populações atendidas quanto pelos próprios indígenas, que os vêem como fontes de acesso a bens e serviços provenientes da sociedade nacional, no contexto mais geral da apropriação política deste papel e dos seus espaços de atuação pelos próprios alto-xinguanos e lideranças locais.