Discursos de usuários do SUS sobre a integralidade do cuidado em rede num hospital público em Belém - Pará

Abstract

In this study were analyzed users speeches in the Unified Health System (SUS) attended in a public hospital in Belém-Pará, focusing on the meaning attributed by them to the comprehensive care network. The hospital was the place of reference for this study, but the approach also included the discursive practices of users about experiences and pathways within the health network, whereas several other local or accessed health services before and after its passage by unit hospital. The methodological approach used was the social constructionism, in which are sought directions from the discourses of users within a dialogic relation and shared, with placements of both the user-participant and the researcher, resulting in an interaction in the production of discursive meanings. Already theoretical conception of health practices was based on the intersection between social psychology and collective health, from the adoption of such notions as discursive practices and care integral in network. The research was conducted in a public hospital where the researcher works as a psychologist and was attended by five users who were in some time treated in this hospital, but had also accessed other services of the health network. Data collection was through semistructured interviews taped, transcribed and analyzed with reference to three categories identified in the discursive production of subjects. 1) Suffering and crisis of user. 2) Access and trajectory in the health network. 3) Positionings about integral care practices. The directions given by the participants to integrality care obtained in the health system signaled facilitating and hindering aspects living side by side in health practices. It was observed on the one hand users linked to SUS services, extolling the teams and health professionals by whom were assisted, with feelings of gratitude, recognition, affection, friendship and solidarity. On the other hand, several reports of failures of the health system emerged in the embracement, in the bond, in referencing to other units, in the difficult access, discontinuity of treatment, delay in examinations and consultations, in the absence of the diagnosis of diseases causing low solving in assistance, in the not meeting to demands of users increasing pain, suffering, fear, anger, indignation and exclusion. By analyzing the diversity of meanings and relations that emerged from the perspective of users, it was arrived necessarily to reflection as regards the institutional, political and governmental issues involved behind the working procedures and practices in health, scoring here one political place, social, historical and epistemic of critical reflection and theoretical contribution to the change of the existing models in public health and in the SUS. So, it was concluded that the issues of health and illness follow permeating life through the field of health, producing subjects and subjectivities still guided on the biomedical paradigm, where often the subject of rights can not have recognized their problems and their options to exercise your right to choose.