A construção das práticas de integralidade no cotidiano de uma equipe de saúde da família

Abstract

This is a qualitative case study, based on the comprehensive sociology of Michel Maffesoli, with the objective of understanding practices of integrality in the daily routine of a Family Health Team from Belo Horizonte, State of Minas Gerais, Brazil, from the point of view of the health workers. Data collection was carried out from March to June 2005, with individual interviews using a semi-structured outline anddirect observation of daily work in the Family Health Team of a Basic Health Unit in the North Sanitary District. Secondary sources were documents from the institution. Nine health workers from the team and four key-informers were interviewed. This included a doctor, a nurse, a nursing auxiliary and the health unit manager. The data was analyzed using the content analysis technique proposed by Bardin (1995) andMinayo (1998). An analysis of the data showed two empirical categories: a history built on daily practice changes experienced; and practices of integrality, as a daily construct, divided into three sub-categories: experienced practices of integrality, difficulties faced and interaction spaces. The analysis, based on comprehensive sociology, made it possible, with a look from the inside, to show how the process ofbuilding the national health system has happened in Belo Horizonte. Theunderstanding of the data showed that in their daily routine, the family health team workers develop practices filled with integrality, even though they do not use this term, because they act according to their own understanding and not according to the formal construct of the organization or the theoretical discourse determined byBH VIDA: SAÚDE INTEGRAL. The work of the family health team has shown a receptive posture, creating a relationship and taking responsibility for patients. They attempt to solve problems at the local level, often with great difficulty, such as: a lack of a system of referral and counter-referral, a lack of materials or premises and a lackof training. Those practices are carried out in collective work which respects differences, because health workers recognize that in alterity, in the difference of the other, both of the team and the patients, it is possible to build a common project, with different gazes, and not a single one. Through the accounts, it became clear that the subjects lived moments of expressing their actions and interactions, revealing a tendency to overcome fragmentation, as when they seek moments to be with otherssharing a common feeling described as sociability. In others, mechanisms of resistance are used to show a will to live, that is, breathers to ventilate their daily practice, avoiding hypoxia of the overload of work and the constant demands to produce results. It is, therefore, the task of management to make relative the rationality of the project with the several nuances full of subjectivity which occur in theday-to-day work of the Family Health Teams, as well as to make availableopportunities for joint reflection with the health workers in order to recognize the discourse of these social actors and their practice, which are so essential to build the integrality of health care and attention.