Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Nesta dissertação são analisadas, a partir de uma situação social específica, as articulações entre práticas de cura e relações de gênero entre grupos Maxakali população indígena que reside no Vale do Mucuri, Minas Gerais, Brasil. Trata-se de uma abordagem antropológica sobre uma situação social na qual grupos Maxakali e a equipe de atendimento sanitário da Fundação Nacional de Saúde (FUNASA) enfrentaram uma epidemia de diarréia infantil. O estudo etnográfico aborda a maneira como os diferentes sujeitos em interação lidaram com a perturbação buscando o restabelecimento da condição de saúde, a partir de dois referenciais de conhecimento: a concepção Maxakali e a medicina ocidental. De acordo com a perspectiva de entendimento sobre a perturbação, distintos recursos de cura foram utilizados, demonstrando a interdependência entre os sujeitos e percepções nesta situação social específica. / This thesis analyzes, from a specific social situation, the articulation between the healing practices and the relations of gender in Maxakali groups indigenous people from the Valley do Mucuri, Minas Gerais, Brazil. It is an anthropological take on a social situation where Maxakali groups and the team of sanitary service of the National Heath Foundation (FUNASA) faced an epidemic childrens diarrhea. From the knowledge frameworks of both the Maxakali conceptions and those of Western medicine, the ethnographic study shows how the different subjects have dealt with the problem trying to achieve the improvement of the health condition of the population. Depending on the perspective assumed to understand the disturbances, it was observed that different resources for healing were used, showing the reciprocal dependence among the subjects and perceptions involved in this specific social situation.

Na última década ocorreram transformações positivas na saúde indígena brasileira. A saúde bucal é um dos temas relevantes da saúde indígena e carece de informações na literatura. O objetivo deste trabalho foi descrever o perfil de saúde bucal e sociodemográfico da população indígena Guarani do Rio Grande do Sul. Este é um estudo de prevalência com levantamento epidemiológico de saúde bucal e variáveis demográficas. Um total de 203 sujeitos em diferentes idades e faixas etárias e em 19 aldeias foram examinados. As crianças Guarani de cinco anos de idade apresentaram um índice de cárie (ceo-d) 2,8 com 37,7% destas crianças livres de cárie. Os adolescentes de 12 anos e de 15 a 19 apresentaram um CPO-D, respectivamente, de 1,31 e 3,39, sendo o maior percentual do índice aos 12 anos o componente cariado (C) com 54,3%; entre adolescentes de 15 a 19 anos é o obturado (O) com 49,4%. Entre os adultos na faixa etária de 35 a 44 anos o CPO-D médio foi de 11,55, sendo que o componente perdido (P) foi responsável por 69,3% do índice. Entre os idosos, faixa etária de 65 a 74 anos, o CPO-D médio foi de 18,58. Os dados desta investigação demonstram que a média do CPO-D nas diferentes idades e faixas etárias é mais baixa na população indígena Guarani indicando uma menor experiência de cárie dental do que a população em geral. Acesso ao creme dental fluoretado e uma política de saúde indígena diferenciada podem estar relacionados com estes resultados. No entanto é necessário mais pesquisa acercada influência de hábitos culturais sobre o processo saúde doença bucal destas populações. / Over the past decade, positive changes have occurred to Brazilian indigenous health. Oral health is one of the relevant issues of indigenous health, but there is a lack of information about it in literature. The aim of this paper is to describe the oral health and sociodemographic profile of the Guarani indigenous population in Rio Grande do Sul. This is a prevalence study using an epidemiological survey on oral health and demographic variables. A total of 203 subjects in 19 villages at different ages and in different age groups were examined. Five-year-old Guarani children showed a dental caries index (DEF) of 2.8, with 37.7% of these children being free of caries. Teenagers aged 12 and from 15 to 19 years showed a DMF index of 1.31 and 3.39, respectively, the highest rate at age 12 was for the decayed component (D), 54.3%; and among teenagers from 15 to 19 years, the filled component (F) had the highest rate, 49.4%. Among adults in the age group of 35 to 44 years, the mean DMF index was 11.55, and the missing component (M) accounted for 69.3%. Among the elderly, in the age group of 65 to 74 years, the mean DMF index was 18.58. The data from this investigation demonstrated that the mean DMF index at different ages and in different age groups was lower in the Guarani indigenous population, indicating a lower presence of dental caries than in the general population. Access to fluoridated dental cream and a specific indigenous health policy may be associated with these results. However, further studies on the influence of cultural habits on the process of oral health and disease among these populations are necessary.

This dissertation compares and connects the parallel histories of two indigenous community-controlled health services, the Seattle Indian Health Board (SIHB) and The Aboriginal Medical Service (AMS) of Sydney. These were among the first clinics of their kind to be established and run by and for urban indigenous communities in the U.S. and Australia. Formed in the 1970s within months of each other, I bring their seemingly disconnected histories together to illuminate a larger transnational history about the political ramifications of twentieth-century postwar urbanization (and the associated growth of an indigenous diaspora) on native people’s concepts and practices of political sovereignty. By considering how these clinics provided a key forum for new urban pan-indigenous forms of political and cultural identity—and claims to indigenous rights—to be expressed and recognized, my work makes two significant contributions. First, it reveals the importance of health as an arena of indigenous political action in the twentieth century. Second, it underscores that indigenous sovereignty, as a political project, must be understood as both adaptive and responsive to change. Drawing on archival research and oral histories conducted over two years across Australia and the United States—including interviews with activists and health workers who were on the front lines of indigenous politics in the 1950s-1970s—I explain why in their pursuit of self-determination, urban pan-indigenous communities steadily turned away from a purely western conception of sovereignty as jurisdiction over land. The health struggles of urban indigenous peoples since the Second World War are a pointed demonstration of how the loss of even limited territorial sovereignty (that is, relocation from reserves and reservations) led to damaging structural invisibility, discrimination, and neglect within the social welfare system. Thus, this dissertation shows how and why the communities in Seattle and Sydney were driven to pursue other forms of practiced, or what I call “deterritorialized”, sovereignty centering on their rights to self-governance through the creation and transformation of various social organizations (in this case health clinics) in line with distinctive cultural perspectives. This is the first book-length study to take healthcare reform seriously as an arena in which indigenous political actors worked to redefine the reach and the meaning of indigenous sovereignty for communities without recourse to land or nationhood in the assertion of their sovereign rights. Moreover, by bringing a comparative view to this historical inquiry, my work reminds us that trans-Pacific networks of ideas and people formed a shared context for these peoples and histories. I argue that indigenous health activists in the U.S. and Australia became active at precisely the same moment, because each saw their struggle for recognition and self-determination as part of a global challenge to racism during the Civil Rights era. Moreover, these indigenous community-controlled clinics should be recognized as part of broader changes taking place in grassroots health advocacy at the time, as reflected in the contemporaneous community and women’s health movements, and the movement to form People’s Free Clinics by the Black Panthers. In its consideration of the unique problems of recognition faced by urban pan-indigenous communities, “Sovereign Bodies” also contributes towards an understanding of processes of ‘place-making’ in a period of great mobility following the Second World War. This dissertation argues that the indigenous urban health clinics very quickly came to represent the social production of a new kind of political space: not a tribal homeland or even a mosaic of different homelands, but a generic native space in the city that gave physical form to new ideas of a non-territorial, or ‘deterritorialized’ sovereignty. Moreover, it shows that at work in the efforts of Seattle and Sydney’s urban indigenous health activists, was the idea of a ‘portable’ or ‘mobile’ indigenous status. This was intended, among other things, to allow indigenous people to live in cities—or wherever they choose for that matter—without having to give up their identity, cultural practices, or their legal status as indigenous people and ensuing ability to make special claims on the government. At stake in their health activism, this dissertation argues, was a form of place-making that aimed to make indigenous people at home everywhere within the national spaces of the U.S. and Australia.

The present day world has been experiencing rapid technological advancement on the one hand and increasing number of diseases afflicting the human beings on the other. To deal with the later, medical devices are innovated and introduced in to the market (making use of the technological advancements), on a continuous basis across the world. However, taking an innovated medical device to the market poses innumerable challenges and therefore, these have to be clinically trialled before its launch to ensure safety and efficacy. Of late, India has emerged as one of the preferred destinations to carry out clinical studies due to numerous advantages, primarily its diverse human gene pool and cost-competitiveness. However, there is very little understanding on the landscape of medical devices clinically trialled in India. It is to throw light on this critical issue with respect to the selection of participants in the clinical trial process, selection of locations and determination of trial duration that the present study has been carried out. In addition, the role of patents associated with the introduction of new medical devices in relation to the key challenges is examined. Furthermore, we studied the characteristics of clinical trials by industry and non-industry sponsors and between cardiovascular and other disease related trials. The present study has been carried out based on secondary data covering 108 medical device clinical trial registrations accessed from Clinical Trial Registry of India (CTRI) database pertaining to the period 2008-2014. At the outset, the pattern of trials related to the most prominent diseases such as cardiology and cardiovascular diseases and those which are invasive and non-invasive are examined. Our findings indicate that almost 50% of the trials are related to diseases of cardiology, cardiovascular diseases and those which are invasive in nature. For studying the patenting aspect, we proposed a conceptual grouping of sponsors as Incumbent, Potential Entrant and Supporter, based on their patent holdings in the domestic market and in PCT (Patent Cooperation Treaty) filings. Patents owned by Primary Sponsor (PS) showed significant variations in their clinical trial characteristics particularly the invasiveness of device, disease type, locations and participants. Three quantitative models are developed to identify the factors that influence the selection of number of participants, locations and time taken to execute medical device clinical trials using multivariate statistical techniques. The results of the three conceptual models on number of participants, locations and trial duration showed invasiveness of device and disease type playing significant roles in all the three models. The number of PCTs owned by PS was found to be influential in selecting the number of locations and participants but not the patents owned in IPO (Indian Patent Office). We also observed significant differences between industry and non-industry sponsors in terms of their clinical trial characteristics. The findings of the study formed the basis to understand the medical device clinical trial landscape and other pertinent issues in the Indian context, which enabled us to derive appropriate inferences and policy implications.

Made available in DSpace on 2015-04-11T13:40:56Z (GMT). No. of bitstreams: 1 Esron Soares Carvalho Rocha.pdf: 1656624 bytes, checksum: 9da4d4e6670ca378c18430e36df82a61 (MD5) Previous issue date: 2008-10-02 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This study is characterised as ethnography of the sanitary practices developed at the Rio Negro Indian Sanitary Special District (DSEI), highlighting the work organization of nursing professionals, such as, nurses, nursing technicians and the Indian health-care agent. Its aims comprise the sanitary practices employed by the Indian Health-Care Multidisciplinary Team (EMSI) nursing corps regarding the provision of differentiated attention to health-care as it interacts with the Baniwa Indian health-care agent (AIS), his forming process and sociodemographic profile; social representations and sanitary practices, seeking to grasp his compatibility and/or incompatibility with the policy of differentiated attention to the Indian health-care subsystem. The present research entails a prospective, descriptive, qualitative type study, directed by the interpretative model of the social representation theory and health evaluative survey. The findings here obtained show that the Baniwa AIS, faces problems regarding his low schooling, along with the fact that his professional forming process has advanced very little since the DSEI was implemented six years ago. The EMSI acting profile is marked by the care treatment model to the spontaneous demand, even though the professionals provide care for diseases of the infectious, chronic-degenerative type to specific population groups (mother-child group), with detriment to health surveillance components presupposed on the design of the National health programs. Among the set of essential activities developed in the DSEI, the travelling logistics consumes a large part of the EMSI time and energy, with negative implications on the health-care agent overseeing and followup as well as on the implementation of the differentiated attention principle presupposed by the National Indian Health-Care Policy. The areas are still greatly patched and the differentiated attention gets mixed up with the extension of the coverage provided by the DSEI Implantation. / O estudo se caracteriza como uma etnografia das práticas sanitárias desenvolvidas no DSEI Rio Negro, com ênfase na organização do trabalho dos profissionais de enfermagem, aí compreendidos o enfermeiro, o técnico de enfermagem e o agente indígena de saúde. Os objetivos compreendem a análise das práticas sanitárias do corpo de enfermagem da Equipe Multidisciplinar de Saúde na oferta de atenção diferenciada à saúde e em interação com o agente indígena de saúde; do perfil-sócio-demográfico e o processo de formação dos Agentes Indígenas de Saúde (AIS) Baniwa; das representações sociais e práticas sanitárias dos AIS, buscando apreender sua compatibilidade e/ou incompatibilidade com a política de atenção diferenciada do subsistema de saúde indígena. A pesquisa é um estudo exploratório, descritivo, do tipo qualitativo, orientado pelo modelo interpretativo da teoria das representações sociais e da pesquisa avaliativa em saúde. Os resultados obtidos mostram que os AIS Baniwa enfrentam problemas ligados à baixa escolaridade, e que seu processo de formação profissional pouco avançou após 6 anos de implantação do DSEI. O perfil de atuação da EMSI é marcado pelo modelo assistencial curativo à demanda espontânea, ainda que os profissionais efetuem assistência a agravos de tipo infeccioso, crônico-degenerativo e de grupos populacionais específicos (grupo materno-infantil), com prejuízo dos componentes de vigilância a saúde previstos na organização dos programas nacionais de saúde. Dentre o conjunto de atividades essenciais desenvolvidas no DSEI, a logística de deslocamento consome grande parte do tempo e energia da EMSI, com implicações negativas na supervisão e acompanhamento dos agentes de saúde e na implementação do princípio da atenção diferenciada previsto na Política Nacional de Saúde Indígena. As áreas são ainda bastante fragmentadas e a atenção diferenciada se confunde com a extensão de cobertura provida pela implantação do DSEI.

In this Master’s thesis, I attempt to illuminate the historical relationship between Classical Indian medical practice and Buddhist monastic law codes, vinaya, in India around the turn of the Common Era. Popular scholarly conceptions of this relationship contend that the adoption of the Indian medical tradition into the Buddhist monastic institution is directly traceable to the Pāli canon. The Mūlasarvastivāda-vinaya (MSV) does not appear to take issue with physicians or medical knowledge, yet the condemnation of physicians in ancient Indian literature strongly suggests that the relationship between monks and medicine is more complex than the Pāli canon illustrates. Similar to other vinaya traditions, the MSV includes detailed information about permitted medicaments, as well as allowances for monastics to provide medical care to other monastics and even, in particular cases, the laity. I argue that the incentives for monastics to maintain a positive relationship with the medical world were driven by the economic benefits of monastic medical knowledge, as well as associations with wealthy physicians. Using a variety of extant Sanskrit materials, as well as epigraphic evidence, I aim to present a nuanced picture of the history of the relationship between Indian Buddhist monasticism and medicine around the turn of the Common Era. / Thesis / Master of Arts (MA)