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. 2023 Mar 3;15(3):194.
doi: 10.3390/toxins15030194.

"Two Cultures in Favor of a Dying Patient": Experiences of Health Care Professionals Providing Snakebite Care to Indigenous Peoples in the Brazilian Amazon

Felipe Murta  1   2   3 , Eleanor Strand  4 , Altair Seabra de Farias  1   2 , Felipe Rocha  1   2 , Alícia Cacau Santos  1   2 , Evellyn Antonieta Tomé Rondon  1   2 , Ana Paula Silva de Oliveira  2 , Hiran Satiro Souza da Gama  1   2 , Yasmim Vieira Rocha  1   2 , Gisele Dos Santos Rocha  1   2 , Mena Ferreira  1   2 , Vinícius Azevedo Machado  1   2 , Marcus Lacerda  1   2   3 , Manuela Pucca  5 , Felipe Cerni  5 , João Ricardo Nickenig Vissoci  4 , Anna Tupetz  4 , Charles J Gerardo  4 , Ana Maria Moura-da-Silva  6 , Fan Hui Wen  6 , Jacqueline Sachett  1   2   7 , Wuelton Monteiro  1   2
Affiliations

"Two Cultures in Favor of a Dying Patient": Experiences of Health Care Professionals Providing Snakebite Care to Indigenous Peoples in the Brazilian Amazon

Felipe Murta et al. Toxins (Basel). .

Abstract

In the Brazilian Amazon, deaths and disabilities from snakebite envenomations (SBEs) are a major and neglected problem for the indigenous population. However, minimal research has been conducted on how indigenous peoples access and utilize the health system for snakebite treatment. A qualitative study was conducted to understand the experiences of health care professionals (HCPs) who provide biomedical care to indigenous peoples with SBEs in the Brazilian Amazon. Focus group discussions (FGDs) were carried out in the context of a three-day training session for HCPs who work for the Indigenous Health Care Subsystem. A total of 56 HCPs participated, 27 in Boa Vista and 29 in Manaus. Thematic analysis resulted in three key findings: Indigenous peoples are amenable to receiving antivenom but not to leaving their villages for hospitals; HCPs require antivenom and additional resources to improve patient care; and HCPs strongly recommend a joint, bicultural approach to SBE treatment. Decentralizing antivenom to local health units addresses the central barriers identified in this study (e.g., resistance to hospitals, transportation). The vast diversity of ethnicities in the Brazilian Amazon will be a challenge, and additional studies should be conducted regarding preparing HCPs to work in intercultural contexts.

Keywords: Brazilian Amazon; access to health care; antivenom; indigenous peoples; intercultural health care; snakebite envenomations.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Main snakebite care pathways described by HCPs. An indigenous village calls the nearby UBSI team for help immediately after the SBE. The team and patient’s family carry the patient to the base hub, where they remain for three days with their family. An indigenous villager seeks care from the shaman after a snakebite. When the patient does not improve, the village calls the base hub. The base hub’s team takes a speedboat and then hikes through the forest to reach the village and stays there for two days to provide care alongside the shaman. The base hub’s team is called to an indigenous village four days after a snakebite. Traditional medicine and home remedies did not improve the patient’s condition. The patient has a severe case, and the team, patient, and patient’s family travel by speedboat to a hospital. An indigenous village calls the UBSI team immediately to help a pediatric snakebite patient. The team travels by speedboat to the village and provides basic care. After two days, the patient is not improving, and the family accepts transport. The village is remote, and it takes an additional day to organize aerial transport to the hospital.
Figure 2
Figure 2
A case example of a care pathway for an indigenous snakebite patient. (A) A typical indigenous structure for patient accommodation duri›ng disease treatment and recovery in the forest. (B) Male SBE patient resting in the structure and undergoing traditional treatment. (C) Ulcer from snakebite observed in the left foot of the same patient, 12 days post-bite. (D) HCPs transporting the patient using a hammock to the base hub and then to the hospital to receive treatment.
Figure 3
Figure 3
Study setting. (A) Brazilian territory; (B) Nine special indigenous health districts (DSEIs), two in Roraima and seven in Amazonas, where participants were recruited.
See this image and copyright information in PMC

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