Se você está aqui, é porque eu existo: percepções múltiplas e deslocamentos do Sistema Único de Saúde no encontro com refugiados.

Abstract

This thesis aims to explore the perception of diverse subjects about the access to health among persons on refugee situation on a primary health care center at the north side of Rio de Janeiro city. This area of the city concentrates a great number of refugees, from Congolese and Angolan origins. The perceptions of public managers, workers, community leaders and refugees-users were investigated. The methodological approach chosen was the ethnographic. During seven months, domiciliary visits, working groups and other events were followed, using participatory observation methods, as well as semi-structured interviews were conducted by the researcher. The perception of these multiple voices were identified and compared, generating a rich and complex study of the theme, with special remarks for the community leaders participation, uncommon on similar researches. The results indicate that the waiting time for treatment is the main access barrier referred by the users, as the access to exams and specialized appointments, while the access to medications is widely defined as positive. It is important to highlight that the refugees relate their hardships on the access with the discrimination linked to being foreigners and black, factors that also permeate all aspects of their adaptation process on Brazil. The presence of the refugees emphasizes the difficulties and questions about the health services operation, even as the conflicts caused for different expectations about the treatment and the understanding about the right to health. Important strategies were created by workers and the primary health service manager to better receive this population, like a different access flux, that uses a broad conception of territory and health. Finally, its necessary to focus on the impact of the myriad of violences lived by the refugees on their health, being them caused by discriminatory situations, negligence by the refuge institutions or related to the neighborhoods they live, echoing violences experienced before, on the migratory process.