Psicodinâmica do trabalho dos Agentes Comunitário de Saúde no período da pandemia da covid-19

Abstract

Community Health Workers (CHWs) have been going through an arduous path in search of recognition and strengthening of their professional identity and their attributions, intensified specifically during the covid-19 pandemic. During the pandemic, CHWs were recruited to perform routine activities already recommended in territorial health care, with some adaptations, as well as having to accumulate other responsibilities related to the control of the pandemic in the territory. This study aims to analyze the psychodynamics of CHWs' work in the context of the covid-19 pandemic. To do so, the theoretical framework of the psychodynamics of work in health was used. For the psychodynamics of work, work is a constitutive factor of a person's psychic formation, and it can cause suffering or pleasure. This is a qualitative study developed in the city of Vitória da Conquista, Bahia. The research subjects were eighteen CHWs who worked in family health units in rural areas. Data were produced through semi-structured interviews. Data interpretation was anchored in thematic content analysis and was organized into six thematic categories: a) Meanings of being a CHW; b) Working in the pandemic: suffering and pleasure; c) Creation process: the prescribed and the real; d) Meeting the reality of the pandemic: fear; e) Defense strategies: experiencing the work in the pandemic; and f) Recognition: a meaning to continue working in the pandemic. The main results indicate that: 1) being a CHW, was not a desired profession and the motivator was to achieve financial stability, especially for not having other employment opportunities. Thus, the adaptation, the learning, and the professional identity occurred in the process of daily work in the community; 2) "Not positive" feelings were externalized, such as, for example, the psychological suffering caused by the practice, the powerlessness in the face of adversity, the permanence in the job for lack of option to have another professional occupation, the interference in their family nucleus, for not having a limit "respected" by the community between working time and rest time; 3) Working as CHWs was a challenging activity, particularly during the pandemic period. In some situations, the CHW has to be a "psychologist" to be able to receive the demands of the community. Such need required a cognitive effort and a permanent search to maintain a balance in relations with the population and, often, attempts to put themselves in the other's shoes to understand the complexity of the health-disease-care process. In addition, they emphasized that they were sometimes blamed from all sides by the community and the service for not being able to meet the various demands of the users. Finally, the CHWs recognized the relevance of their work for the success of the actions developed by the APS team, with special emphasis on rural areas. Not coincidentally, they highlighted the importance of the link they develop between technical-scientific knowledge and popular knowledge, the link of trust and information between the service and the population, and perceive themselves as fundamental to the SUS (National Health System), even in the context of the pandemic.