Students' perception of health on Quilombola Rural Communities in the North of Minas Gerais, Brazil

Abstracts

OBJETIVO: verificar a percepção de estudantes da área da saúde sobre as condições de vida e saúde de Comunidades Quilombolas. MÉTODO: trata-se de uma pesquisa qualitativa realizada com estudantes da área de saúde que participaram de uma atividade de pesquisa e extensão em Comunidades Rurais Quilombolas do norte de Minas Gerais. Foram usados dados de Diário de Campo de Pesquisa, entrevista feita em grupo focal, e os resultados estudados sob o prisma da Análise de Conteúdo. RESULTADOS: as percepções dos estudantes foram categorizadas em três dimensões: reconhecimento das diferenças culturais, perplexidade com as condições precárias de vida e crescimento pessoal com a experiência. A análise de conteúdo mostrou a importância deste tipo de atividade para estudantes da saúde. CONCLUSÃO: o estudo demonstrou a perplexidade dos estudantes quanto aos aspectos de desigualdade que vive as populações quilombolas do norte de Minas Gerais.

Vulnerabilidade em Saúde; Saúde Pública; Etnia e Saúde; Brasil

ORIGINAL ARTICLES

Students' perception of health on Quilombola Rural Communities in the North of Minas Gerais, Brazil

Daniel Antunes Freitas^I; Géssica Lafetá Rabelo^II; Jéssica Camila Santos Silveira^III; Lucas Ramos Souza^IV; Mateus Costa Lima^V; Mayane Moura Pereira^VI; Paulo Henrique Tolentino Moura^VII; Stéphany Ketllin Mendes Oliveira^VIII; Walter dos Reis Siqueira Junior^IX; Amaro Sérgio Marques^X; Cláudia Danyella Alves Leão^XI; Clayton Paraíso Macedo ^XII; Antônio Prates Caldeira^XIII

^IProfessor of Dentistry (SOEBRÁS/FUNORTE); Advisor of the Research Group for the Study of Health in Quilombola Populations of Northern Minas Gerais, The State University of Montes Claros (UNIMONTES), MS in Dentistry, Ph.D. Candidate in Health Sciences (UNIMONTES)

^IIMedical Student (UNIMONTES); Student Researcher of the Research Group for the Study of Health in Quilombola Populations of Northern Minas Gerais, The State University of Montes Claros (UNIMONTES)

^IIIDentistry Student (SOEBRÁS/FUNORTE); Acadêmica do Curso de Odontologia da SOEBRÁS/FUNORTE; Student Researcher of the Research Group for the Study of Health in Quilombola Populations of Northern Minas Gerais, The State University of Montes Claros (UNIMONTES)

^IVMedical Student (UNIMONTES); Student Researcher of the Research Group for the Study of Health in Quilombola Populations of Northern Minas Gerais, The State University of Montes Claros (UNIMONTES)

^VMedical Student (UNIMONTES); Student Researcher of the Research Group for the Study of Health in Quilombola Populations of Northern Minas Gerais, The State University of Montes Claros (UNIMONTES)

^VIDentist; Researcher of the Research Group for the Study of Health in Quilombola Populations of Northern Minas Gerais, The State University of Montes Claros (UNIMONTES); MS Candidate in Health Sciences (UNIMONTES)

^VIIMedical Student (UNIMONTES); Student Researcher of the Research Group for the Study of Health in Quilombola Populations of Northern Minas Gerais, The State University of Montes Claros (UNIMONTES)

^VIIIDentist; Researcher of the Research Group for the Study of Health in Quilombola Populations of Northern Minas Gerais, The State University of Montes Claros (UNIMONTES); MS Candidate in Health Sciences (UNIMONTES)

^IXMedical Student (UNIMONTES); Student Researcher of the Research Group for the Study of Health in Quilombola Populations of Northern Minas Gerais, The State University of Montes Claros (UNIMONTES)

^XProfessor of Medical Anthropology; Advisor of the Research Group for the Study of Health in Quilombola Populations of Northern Minas Gerais, The State University of Montes Claros (UNIMONTES); MS in Social Development (UNIMONTES)

^XIProfessor of Nursing; Advisor of the Research Group for the Study of Health in Quilombola Populations of Northern Minas Gerais, The State University of Montes Claros (UNIMONTES); MS in Health Sciences (UNIMONTES)

^XIIMedical Student (UNIMONTES); Student Researcher of the Research Group for the Study of Health in Quilombola Populations of Northern Minas Gerais, The State University of Montes Claros (UNIMONTES)

^XIIIProfessor of Medicine; Advisor of the Research Group for the Study of Health in Quilombola Populations of Northern Minas Gerais, The State University of Montes Claros (UNIMONTES); Ph.D. in Health Sciences (UFMG)

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ABSTRACT

PURPOSE: to verify the perception of students about the conditions of life and health of Quilombo Communities.

METHOD: it is a qualitative research with students of health field who participated in an activity of research and extension in Rural Communities Quilombola in northern Minas Gerais. We used data from Field Journal for Research, focus group interview, and the results analyzed through the prism of Content Analysis.

RESULTS: the perceptions of students were categorized into three dimensions: recognition of cultural differences, perplexity with the poor living conditions and personal growth through experience. The content analysis showed the importance of this activity for students of health.

CONCLUSIONS: the study showed the amazement of the students on the aspects of inequality that people living north of the Maroons of Minas Gerais.

Keywords: Health Vulnerability; Public Health; Ethnicity and Health; Brazil

INTRODUCTION

The Black communities formed by descendants of runaway slaves known as Quilombola populations may be great vestiges of institutionalized racism in Brazil. For many years these populations were invisible to governmental officials and they didn't receive any type of socio-economic incentives. In other words, for these communities, slavery of another inhumane and unacceptable form continued.

The Quilombola communities were officially recognized by the Brazilian government in 1988 and only became eligible for social assistance programs beginning in 2003/2004^1,2, when ethnic and racial discrimination were first considered to be part of Basic Social Protection³. Health policies also arrived late for this population. In the analysis of Volochko e Batista, this aspect cannot be unconsidered as the authors comment that data regarding skin color in relation to mortality rates only became compulsory in 1996 and in relation to morbidity only at the end of 2007⁴.

The recognition of institutional racism and the historic lack of data regarding health inequalities between Whites and non-Whites has not yet changed the behavior and attitudes in academic arenas. For some authors there remains a subtle and insidious prejudice that perpetuates the invisibility of Black and Quilombola communities by some institutions of higher learning⁵.

This invisibility of Quilombola communities that is perpetuated in academic environments, at least in the area of health studies, is shown by the lack of publications regarding these groups. Authors agree that,although there has been some progress in studies that focus on the relationship between race/ skin color, and health, there are not sufficient academic works addressing these themes⁶.

Therefore, this national context calls for the insertion of students in the health-related fields into research studies that address questions of ethnic and racial inequalities. Such projects can help bring to light aspects of institutional racism and help promote debates regarding this theme in academic contexts. The present study is part of a research and service-learning project developed in Northern Minas Gerais with rural Quilombola communities. 40% of the Quilombola communities in the state of Minas Gerais live in this region, almost always in rural areas that are difficult to access. The objective of this study was to investigate the perception of students in health-related fields regarding the living and health conditions in Quilombola communities.

METHOD

This study was approved by the Institutional Review Board of UNIMONTES (Protocol number 076/2010).

This is a qualitative study conducted with students in health-related fields that participated in research and service-learning activities in two rural Quilombola communities in Northern Minas Gerais. Before the beginning these activities, the students were asked to complete a field diary relating to their activities during their stay in the communities and to use this to keep track of their perceptions regarding their contact with the local population. After carrying out their activities, the students also participated in a focus group where they were invited to discuss their perceptions of the communities that were visited. The focus group interview was recorded and later transcribed.

The interpretation of the field diaries and the transcription of the focus group interview was conducted by means of content analysis⁶.

The field diaries and video recordings from the field registered in a complementary form the perceptions of the students by incorporating informal quotes, pauses, facial expressions, and body language⁷.

RESULTS

During the process of analyzing the data, the perceptions of students were grouped into three categories: recognizing cultural differences, perplexity with the precarious living conditions, and personal growth through experience. In the following section, these categories will be presented and discussed considering the conducted analysis.

Recognizing Cultural Differences

Students clearly highlight in their diaries being surprised in a positive way in relation to the local culture. They point out the hospitality and warm embrace of the communities as something unexpected. Likewise, they note that there is a habitual joy for living in the visited communities.

"I observed that they were very hospitable, they always gave us a warm welcome… They offered us the best of what they had in their houses". (S8)

"They made us feel welcome. On the day of a wedding we were like… like guests of honor". (S5)

"It seems like a cultural trait this warm welcome they gave us and the communal way of life that they have there". (S1)

Some students expressed their surprise at their own prejudices that were probably passed to them by family and friends:

"At the beginning I was afraid, I went there afraid because I heard they were dangerous, that they had big knives..." (S6)

The real meaning of "community" as perceived by Quilombola people was also noted by the students:

"They organize themselves in a society that seeks out the best for all…They all known each other and this helps them work together..." (S3)

"They are united in defense of their culture..." (S7)

"They have a social organization that is helping improve things for them. This contributes to the betterment of their quality of life. They fight for this." (S2)

Other student entries denounce conflicts present in the communities that are possibly the result of invasions of other cultures.

"They defend their culture, but city life enters the community and some of them have televisions..." (S1)

"A little while ago they didn't have problems like alcoholism or drug abuse, but these things have arrived..." (S8)

"There seems to be disputes between the Catholic and Protestant churches within the communities… This is taken on by the people… It isn't always apparent, but it is very strong." (S4)

Perplexity with the Precarious Living Conditions

They students registered very clearly their surprise with the observed reality.

"I was shocked by some of the things I saw… To know that in the 21^st Century that there are people that live so close to civilization in such precarious conditions… it was a rude awakening." (S5)

"I noticed the juxtaposition of a region very poor and yet very close to the city. It is really close to where we live too… I never imagined that I would encounter a situation like that so close to home..." (S4)

"In one house there were nine people living off of a government assistance program for families… There was a lot of poverty, houses falling down around them..." (S1)

It is important to note that the surprise of students was especially directed as the health conditions of the population in question:

"Health conditions are really bad, many children have diarrhea and young mothers that married young and whose children are not cared for… dirty… hanging out with animals… one mother did not know who was the father (of her child)… is it possible that these mothers know how to care for their children?" (S2)

Personal Growth through Experiential Learning

Unanimously, the students referred to their time spent in the Quilombola communities as an important learning experience for both their personal and professional lives.

"Personally I learned how to deal with differences. I perceived that at the beginning there was a distance between us and the participants, but this distance was caused by us. As soon as we got closer to them and had closer interaction, the differences disappeared." (S3)

"We had a lot of personal growth… Only if a person was really cold could they not feel touched, sensitized. For us health students, it was the only opportunity we've had [to cultivate] a desire to want to help the next person… to really want to help." (S7)

"It taught me to value small things more, to value what you have..." (S2)

"It was important to perceive and prove the importance of basic health care. Professionally, I realized that medications are not enough. In college, there is a lot of emphasis on different diseases, but the people there are suffering from basic diarrhea. That shows you something about a lot of people in this country..." (S1)

DISCUSSION

The rural Quilombola communities represent population centers that were organized over many years in rural areas. This fact may justify, partially, the lack of interaction between these groups and academic centers. The literature demonstrates that the interaction between Quilombola groups and academics almost always happens through service-learning or research activities. It was in this context that the State University of Montes Claros provided opportunities for some students to have contact with two rural Quilombola communities, certified by the Palmares Foundation, in districts of the municipality San Francisco in Northern Minas Gerais.

Recognizing Cultural Differences

The identity of Quilombola is based on self-recognition. It is also important to note the importance of historical trajectories and territorial definitions in addition to African and slave ancestries^5,8. There doesn't exist a singular reference to cultural issues in the process of recognizing Quilombola communities and, in some ways, this fact is a result of the impact of chronic oppression of their culture.

Certainly the Quilombola communities have not maintained statistics as part of their traditions and cultural ways. However, since these communities have contact with others, they have established interethnic and intercultural exchanges⁹.

The students' notes did not point out tribal or primitive behaviors, but observed the positive aspects of a harmonious, peaceful, and hospitable coexistence among people that interact positively with outsiders. It is possible to assume that the students were prepared to encounter people who, in spite of their difficulties and limitations, were more resistant and adverse to contact with other communities. However, Quilombolas face the struggle of ensuring their everyday survival (and that of their families) and strengthening the community in the fight against prejudice and discrimination^5,10. These difficulties do not translate into hostility or rejection as documented comparatively by the students in relation to the "White" individualism of city life.

The entries are in agreement with the discussion of a gradual loss of Quilombola identity. Some social scientists argue that "ethnic identities are not composed of essential elements"⁹. However, on the other hand, if it is not possible to establish cultural and ethnic norms based on a supposed Black ancestry, it is also not possible to fail to recognize that such communities are modified by territorial invasions that are not limited to geographic issues because they also include the spread of television, access to drugs and the debates of world religions.

Perplexity with the Precarious Living Conditions

The entries point out that the observed precarious living conditions were worse than expected by the students and they emphasized their lack of knowledge regarding the living conditions of Quilombola communities in Northern Minas Gerais. Students in health-related fields normally develop service-learning projects in peri-urban communities, allowing them to better understand the living conditions of patients who use city resources. However, this contact does not reflect the degree of vulnerability that exists in the visited rural Quilombola communities.

In some ways, the students perceptions support the concept of institutional racism, discrimination, and/or a perception of stratification based on skin color^11,12. On the other hand, the documented perplexity confirms the invisibility of the living conditions of many Black and traditional communities in Brazil⁵. The student observations also reveal aspects of the relationship between ethnic identity and power and may stimulate the development of better understandings in university centers of these new conceptual constructions that facilitate the promotion of appropriate public policies¹³.

As a rule, the placement of Quilombola communities in rural areas reinforces the geographic isolation of these groups. The social inequalities and health disparities in which we live are the result of historical processes of submission to a dominant ideology, with differential restrictions and access to goods and services that cause insufficiencies for some groups of people such as lack of food security¹⁴. A large part of the living conditions in Quilombola communities are a result of subsistence agriculture, centered on natural resources, in the limited number of members if each community, in the isolation of these communities, and in underdevelopment or a lack of access to technological goods⁹.

The legal recognition of Quilombola communities was officially established in the New Brazilian Constitution of 1988 and since then the registering of such communities has been under the jurisdiction of the Palmares Cultural Foundation⁸. Once a community has been officially recognized, anti-discrimination policies in the areas of social and public health rights are implemented.

If the conceptual gaze of students can embrace an understanding of health as a social product that is not based solely on biological limits, we may also be able to assist these same students to expand their growing understanding as future health professions to the recognition of how historical processes such as oppression and invisibility function as mechanisms of disease.

Personal Growth through the Learning Experience

The students' observations relate to their experiences of research and service-learning that included immersion in communal spaces. The activity was carried out in order to positively impact students by increasing their understanding of the restricted conditions of survival faced by others and to provoke students into critically analyzing biomedical paradigms presented in traditional university programs geared at future health professionals.

Not a single student referred to the ethnic or racial issues when describing their personal perceptions of their experience in the communities. It is not possible to guess why students did not consider ethnicity, race, or skin color in their analysis of the restricted living and health conditions of the community. In the health field, national studies normally do not refer to ethnic and racial issues as determinants of health or disease. Philosophical traditions regarding the history of racial intermarriage and the myth of racial democracy have repressed discussions regarding health disparities in Brazil. It is only in the past few years that public health studies have taken on the issue of race/ skin color as a variable which impacts on social well-being and vulnerability to disease¹⁰. Still, the lack of standardization of the definition of this variable and its measurement compromise the development of usable evidence for the health policy and planning⁹. The invisibility (in the view of students) of blackness in the studied Quilombola population (whether in total blackness or in the form of mixed race) is something that should be further considered in future studies. The importance of ethnic and racial cultural constructions based on skin color deserves more attention in university studies, particularly in health-related studies. The interaction between the living conditions of Black populations and susceptibility to health risks deserves special mention because of both the social and biological determinants of disease. These facts are not something new to scientific studies of health as bibliographic studies have already pointed out the importance of new knowledge about Quilombola populations¹⁵.

CONCLUSION

Student quotes demonstrate that the students have a great deal of understanding of social factors related to disease and illness; however, they also demonstrate that there is a high level of misunderstanding regarding the particularities of health in Quilombola populations. This study reaffirms the urgent need for future health professionals to always be confronted with diverse realities, social inequalities, and related health disparities that remain in Brazil.

REFERENCES

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Publication Dates

• Publication in this collection
  18 Sept 2013
• Date of issue
  Aug 2013

History

• Received
  01 May 2012
• Accepted
  26 Mar 2013