A invisibilidade da leptospirose urbana no cotidiano de uma unidade de APS: a trama da produção de negligência.

Abstract

Communities distanced from health care, education, culture and leisure services are more vulnerable to the occurrence of socio-environmental problems, with damage to the environment and these population groups. Human leptospirosis is a potentially lethal disease whose social and economic impact on the Brazilian population is underestimated. A health problem neglected by the processes that produce programmatic invisibilities of this disease. Given this reality, this study has the general objective of analyzing the process of producing negligence in relation to urban leptospirosis, considering the perceptions and performance of primary health care professionals in a popular neighborhood of Salvador/BA. This is a qualitative study, with semi-structured interviews with health professionals, of different categories, a focus group with community health agents and participant observation in the daily work of health, with records in the field diary. Data analysis, guided by interpretive anthropology, sought to identify the structures of meanings inscribed in the social discourse expressed in the narratives produced by health professionals and / or in their concrete practices in relation to the issues of urban leptospirosis and the territory in question. The results point to leptospirosis as a disease of poverty, marked by invisibility in multiple aspects: the problem itself, its social determinants and its effects on affected communities and people. Such invisibility contributes to the inaction of the health professionals who work there, which is a result of gaps in the training processes (past and continuous in the professional field) about the disease in its broad socio-environmental context. The absence of intersectoral actions coupled with clinical underdiagnosis, underreporting and neglect with the affected population, is the basis for segregation, marginalization and disparagement. Finally, we highlight that the neglect process causes urban leptospirosis to persist in territories and among marginalized social groups, reflecting the systematic absence of public housing, environmental, health and education policies for the most vulnerable classes in the country's history, being one of the expressions of socio-spatial inequalities in our society. Broader approaches for detecting early diagnosis are also considered necessary and urgent, and should be part of PHC, so that actions can be taken to promote the early detection of the disease and reduce the lethality observed in the country.