Tensões e potências no cuidado a mulheres acometidas por câncer de colo de útero: um estudo etnográfico.

Abstract

This thesis deals with the tensions between various institutional dimensions and possibilities produced in the care of women diagnosed with cervical cancer based on ethnography in a reference institution for the treatment of gynecological cancer. The aim is to analyze how the autonomy ideal in the treatment process of the disease materializes in everyday and particular situations in which decision-making is effectively carried out by professionals and patients. An outline of the disease and the history of explanations and interventions constructed by biomedicine for the treatment was drawn. This analysis showed that not only biomedical technologies and knowledge but also the ways therapies are offered by health policies and services were modeled using the references of the global North. When these standards are exported to places with diverse sociocultural characteristics, they generally ignore the differences in the model of person and the experiences with health, disease and care. The analysis of the practices in the field of research reveals a myriad of tensions and potentialities. The tensions refer to the conflicts between the set of ideas about patient autonomy and the paternalistic model of interaction; to the ways care is offered in the institution; to the difficulties in translating medical information to the patients deprived of educational capital; to reporting difficult cancer news; to the treatment protocols, whose effects remain throughout the patients life, in the material and symbolic senses; to gender issues. Potencies are found in the particular production of care. It is concluded that critical analyzes on health actions should not reaffirm autonomy as a model of individual and self-determined choice, escaping from reflections on the modes of biomedical regulation produced in this field. It is necessary to include the prescriptions, the social actors involved in these productions and to what extent they consider the agency, desires and values of the patients, which in turn are updated and modulated from an inescapably social matrix.