School of Health Sciences, Universidade do Estado do Amazonas, Manaus, Brazil.
Distrito Sanitário Especial Indígena Alto Rio Solimões, Secretaria Especial de Saúde Indígena, Tabatinga, Brazil.
PLoS Negl Trop Dis. 2023 Mar 10;17(3):e0011172. doi: 10.1371/journal.pntd.0011172. eCollection 2023 Mar.
In the Brazilian Amazon, snakebite envenomings (SBE) disproportionately affect indigenous peoples. Communication between indigenous and biomedical health sectors in regards to SBEs has never been explored in this region. This study aims to build an explanatory model (EM) of the indigenous healthcare domain for SBE patients from the perspective of the indigenous caregivers.
METHODOLOGY/PRINCIPAL FINDINGS: This is a qualitative study involving in-depth interviews of eight indigenous caregivers who are representatives of the Tikuna, Kokama and Kambeba ethnic groups, in the Alto Solimões River, western Brazilian Amazon. Data analysis was carried out via deductive thematic analysis. A framework was built containing the explanations based on three explanatory model (EM) components: etiology, course of sickness, and treatment. To indigenous caregivers, snakes are enemies and present conscience and intention. Snakebites have a natural or a supernatural cause, the last being more difficult to prevent and treat. Use of ayahuasca tea is a strategy used by some caregivers to identify the underlying cause of the SBE. Severe or lethal SBEs are understood as having been triggered by sorcery. Treatment is characterized by four components: i) immediate self-care; ii) first care in the village, mostly including tobacco smoking, chants and prayers, combined with the intake of animal bile and emetic plants; iii) a stay in a hospital, to receive antivenom and other treatments; iv) care in the village after hospital discharge, which is a phase of re-establishment of well-being and reintroduction into social life, using tobacco smoking, massages and compresses to the affected limb, and teas of bitter plants. Dietary taboos and behavioral interdictions (avoiding contact with menstruating and pregnant women) prevent complications, relapses, and death, and must be performed up to three months after the snakebite. Caregivers are in favor of antivenom treatment in indigenous areas.
CONCLUSIONS/SIGNIFICANCE: There is a potential for articulation between different healthcare sectors to improve the management of SBEs in the Amazon region, and the aim is to decentralize antivenom treatment so that it occurs in indigenous health centers with the active participation of the indigenous caregivers.
在巴西亚马孙地区，蛇伤（SBE）对原住民的影响不成比例。在该地区，原住民与生物医学卫生部门之间从未就 SBE 进行过沟通。本研究旨在从原住民照顾者的角度，为 SBE 患者构建一个关于原住民医疗保健领域的解释模型（EM）。
方法/主要发现：这是一项定性研究，涉及来自 Alto Solimões 河，巴西亚马孙西部的提库纳，科卡马和坎贝巴族的 8 名原住民照顾者的深入访谈。数据分析通过演绎主题分析进行。构建了一个框架，其中包含基于三个解释模型（EM）组件的解释：病因，疾病过程和治疗。对原住民照顾者而言，蛇是敌人，具有意识和意图。蛇咬伤有自然或超自然的原因，后者更难预防和治疗。一些照顾者使用雅鲁安神茶来确定 SBE 的根本原因。严重或致命的 SBE 被认为是由巫术引起的。治疗有四个组成部分：i）立即自我护理；ii）在村里进行初步护理，主要包括吸烟，吟唱和祈祷，并结合摄入动物胆汁和催吐植物；iii）住院接受抗蛇毒血清和其他治疗；iv）出院后在村里进行护理，这是重新建立幸福感和重新融入社会生活的阶段，使用吸烟，按摩和对受影响的肢体施加压缩，并饮用苦味植物茶。饮食禁忌和行为禁令（避免与经期和孕妇接触）可预防并发症，复发和死亡，必须在蛇咬伤后三个月内执行。照顾者赞成在原住民地区进行抗蛇毒血清治疗。
结论/意义：在亚马孙地区，不同医疗保健部门之间存在协同作用的潜力，可以改善 SBE 的管理，目标是将抗蛇毒血清治疗去中心化，以便在原住民卫生中心进行，同时让原住民照顾者积极参与。
