COLETIVO DE AUTORES PDF
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La Habana: Coletivo de Autores, , – The Independent politicas_sociais/IgualdadeRacialpdf [accessed 14 January ]. Isin, E. a. micos, assim como de outros autores que consideravam relevantes para os pelos trabalhadores nos contratos coletivos de trabalho, porém, como será visto . stressed the critical–liberating methodology, created by the Coletivo. de Autores ( ), with an obvious influence from the thoughts of.
Disalienating the role of each one in care production, making between-disciplinary therapeutic projects emerge, circulating looks and desires, is a way of making our work become a daily creative work. In this integration movement, which also integrates users, we are getting close to the space where collective welcoming takes place. Collective welcoming The drawing of Figure 2 is a graphical representation that displays the paths to the production of caregiving therapeutic projects using collective welcoming.
This would be the moment of the encounter, a creative space. Users arrive at the Healthcare Unit. Even though the team explains everyday that it is not necessary to arrive right after the opening of the Unit, at seven o'clock in the morning, some of them find it difficult to disregard the history of access to the services in order of arrival.
We sit in a circle in the unit's meeting room, all the team workers doctor, nurse, nursing assistant and community health agents and users.
Eyes and expectations intersect. There is no agenda. We discuss a range of subjects, from the increase in violence in the neighborhood to hypertension control, from diabetes to the problem of open pits that cause so much trouble to some inhabitants. The word is given to anybody who wants to use it. We try, in every possible way, to transform tensions into understanding. In this intercessional space, there is the need to integrate the other, the team and the professionals.
In this communication web, the communicative acts take place, moving needs that had not been seen before to the category of health needs, which allow seeing beyond the demand that is brought.
After a debate that lasts between thirty and forty-five minutes, depending on the number and participation of users, the approach becomes individual, right there at that room.
Each professional welcomes one person at a time. The entire team handles these cases and learn with them everyday, because with the open conversations, one professional solves doubts and proposes answers to another person professional or user. Different problems are discussed, different interventions and articulations of the work of each professional are proposed. Many times, the answer or the proposed path for the user to conduct his life in not contained in protocols.
We find there an instituting challenge, seeing and acting beyond the norms, instituting new ways of providing care. Serious cases receive immediate attention in the unit's observation room sometimes, even before the dialogue starts , where there are resources for emergency assistance. Instructions are given to varied doubts and can represent a calm rest of the day or an immediate intervention.
Services on Demand
Space is guaranteed for those who want to talk outside the meeting room, in one of the unit's rooms. The team's agendas, with their structured offers, can be freely accessed by any of its professionals. Each user has the beginning of his singular therapeutic project in the welcoming, and he can be included in any of the offers: consultations with higher education professionals, home visits, programmatic actions.
During approximately one hour, with all the professionals involved in welcoming, the users' projects have already begun or are under way.
Then, the doctor and the nurse start to assist acute cases and, after them, the scheduled cases. Doctor, nurse and assistant, together with another healthcare team that shares the same unit, ensure the provision of individual welcoming during the whole day. However, it is known that, culturally, the majority of the population of the catchment area seeks for assistance in the early hours of the morning.
There is an articulation of the professionals' agenda with the aim of guaranteeing, after the end of collective welcoming: the programmed consultations, actions relating to each nucleus, team meetings, home visits, and health education, distributed throughout the teams' working week.
There is also some flexibility in this configuration to ensure joint actions among the professional nuclei.
In one level of welcoming the patient's demand, today the professionals have already mastered what welcoming means.
But another level would be embracing this family to do this welcoming. I consider individual welcoming more efficient in the sense of welcoming the patient's demand.
I see this in a good way, it's efficient, because collective welcoming eliminates what is unnecessary in welcoming, it is more efficient in providing solutions. Let necessity define the configuration of offers, and not the contrary. Let responsibility towards the user guide the working process, and not other interests, like the corporative ones. Guaranteeing individual welcoming during and after the performance of collective welcoming complies with this precept, as not all problems should be shared, independently of the reasons.
Besides this role, individual welcoming within the team's working process has the perspective of creating a bond with the users that arrive at the unit at other times, even though the unit is open only during business hours, even though this hinders the access of the working class.
With the difficulty in access caused by the limitation of file cards, the users, attempting to guarantee assistance, had to arrive at the line very early in the morning, running the risk of not receiving assistance.
Being able to be heard more quickly, due to the fact that the entire team welcomes, and not needing to arrive at the unit at dawn, are extremely valued: "We used to go there, filled in the card and stayed there many hours.
Sometimes, we had to arrive there at 5 in the morning. About three months ago, this stuff of being welcomed at the room [collective welcoming] started. I have nothing against it, we arrive there, you ask what the matter is, due to the problem the person receives assistance right away, doesn't wait until 12 o'clock [noon]". User "I think that it increases the [user's] self-esteem.
This increases the self-esteem, gives more quality of life and there's still time to cook lunch! As everybody will be heard according to their needs, the flow of users improves. The overload of the entrance door early in the morning, which used to be the responsibility of the nurse alone, now is shared with the other team members: "Another factor in this kind of welcoming is that we're also sharing some of this load.
It's not just the nurse who's assisting alone a line of forty people. When welcoming is performed individually, when the twentieth person comes, of course the nurse is saturated and does not assist the 21st in the way she assisted the first one. When we see many people in the welcoming room, we [healthcare team] look at each other and we know we're going to share that". Nurse "You arrive at the welcoming line and there's a nurse who's going to assist you.
That nurse is the one who will decide if you'll go to what you want to consume. What does this population want to consume? Culturally, the medical consultation, because our model has always been centered on the doctor. In that space we have the opportunity to say: now the welcoming is of the team. This takes it away from the doctor.
I [the user] seek for welcoming. I see teamwork, it gets away from that stuff of being assisted only by the nurse. Because what can also happen is the nurse being seen as the wicked one in the story, I didn't go to the doctor because the nurse didn't refer me to the doctor". Doctor The collective welcoming's attempt to transform the model, remove the centrality from medical consultations and amplify the potentialities of the professionals who form the team is well explored by Merhy et al.
The Welcoming Team becomes the center of the activities in user assistance and "the professionals who are not doctors start to use their entire technological arsenal, the knowledge for assistance, in hearing and solving the health problems that are brought by the population that uses the Unit's health services" Merhy et al.
The doctor's social construction as the holder of the knowledge that will be transmitted for the user's cure is one of the barriers to be overcome in order to replace the consumption of consultations by between-disciplinary caregiving therapeutic projects.
The social and economic status and the biologicism of health education make the dialog become unequal and do not favor it.
The view of health as a commodity, and not as a right, ideologically strengthens the valuation of specialization in health more expensive product and of the performance of tests which, many times, are unnecessary more expensive procedures , not to mention medicalization. The dialog is not considered therapeutic and is viewed as not being efficient in problem-solving. This permeates the entire health education, and is very strong in doctor's education: "If consultations could be scheduled to everybody, collective welcoming would not be necessary".
If all patients are referred to consultations, there will be no time". Medicine student "I don't like Dr.
Silvia because I asked for some tests and she asked me if I thought they were really necessary. Well, my son only likes breasts [maternal milk]. He doesn't even like danone [yogurt]. The child doesn't eat anything. She requested the tests reluctantly. What if he had some serious disease? Listening to a patient, informing him about self-limited diseases, and scheduling his return to see their resolution may have a therapeutic and bonding character that is greater than our current means of investigation are able to capture.
The inclusion of the other, his voice, the sensation of involvement in the process, the deterritorialization of the health professionals to the circle, circulates, besides knowledge, power, with reflexes on autonomy construction.
Collective welcoming becomes an escape from the ideologically constructed image of the health professional, mainly those with a university degree, as the holder of the knowledge to be transmitted instead of shared: "Before, the doctors were seen only at the moment of the consultation. He was a pop star [laughs]. He entered through the unit's back door, he went out through the back door, he was seen only in the moment of the consultation.
Just this [being present in the welcoming circle] already is a great difference for the population". Nursing assistant "[The healthcare workers] treat us well, ask what we're feeling, talk to us politely, if we are in pain we are assisted before long, it's much better.
User The space of the dialog, its comprehension as a place of exchanges and understandings, sometimes is not perceived as such.
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The scarcity of public spaces of negotiation, the distance between technical knowledge and popular knowledge, the class differences, the valuation of one culture to the detriment of others, social exclusion, are aspects that, sometimes, are not overcome and jeopardize dialog.
The answer given by the team is to guarantee the space of reterritorialization - the professional, the user, the room - verbally, in the collective welcoming. Besides the fact that the team maintains collective welcoming open during the unit's working hours. Sometimes, they want this differential assistance [individual assistance, in the room] and don't express it in the circle".
Medicine student "Many people feel at ease, but many people feel cornered, scared of making mistakes while talking. But we have to say how we feel". User "If it's necessary, he [the user] shouts, he speaks. Only a minority keeps silent. If he's not enjoying it, he opens his mouth and says so.
Here, people have freedom to say what they think, many times, even if it hurts someone else". Community Health Agent "But when we say that anyone who wants to speak in private just has to say so, this is also intimidating. People may think I have some serious stuff [serious disease]. He prefers to schedule a consultation and wait". Nursing assistant The population gathered can express needs of the collectivity, and new voices are integrated into care production.
The new therapeutic projects make us learn with the new practices of facing challenges. In addition to more needs, views, prejudices and conceptions come to light.
If the person wants to talk to the doctor, we say: wait just a little. Even he has something that involves more secrecy, he doesn't tell and he tells it individually and he'll be assisted according to his needs. As soon as possible. My area [catchment area] has approved it and I hope it doesn't change in the near future".
Community Health Agent "And we learn with each other. Sometimes, a patient has a problem that he doesn't want to tell us and we say: say more or less how it is, wait a minute that I'll talk to the doctor". Community Health Agent "He's already acting like a doctor [laughs]" Community Health Agent, after the speech above We already know more or less which case the doctor assists, which case the nurse assists.
When they come to me I already pass them to him. We develop ourselves a lot".
Community Health Agent "They [the users] give their opinion about what is happening, if it's good or bad to them in relation to the unit and the community. There they have a greater opportunity, even those who are ashamed of talking". Medicine student "In collective welcoming, a problem of the population becomes more visible. If you see many pregnant adolescents in the collective welcoming, you are going to approach sexual education.
So, this welcoming is not the responsibility only of the health agent, it goes to the whole team. Movement and life to be defended in the construction of caregiving, integrative therapeutic projects, building autonomy. The search for an inclusive Health System and for a working process that brings also the professional fulfillment of the members of the healthcare team.
Provisional synthesis Collective welcoming as a proposal for the organization of the healthcare team's working process is innovative because it is a space for the integration of the other, users and workers, and also of knowledge. The horizontal dialog with users and the relevance given to their opinions and desires provide the unit with a profile of therapeutic space and integral healthcare, enabling, also, that the professional gets in close contact with the way of living and feeling the needs that are brought to the space by the population.
The greatest challenge of placing oneself in a public space of negotiation is the sensation of lost security that occurs in the search for metastable balance. The search for this balance, this instituting challenge, brings with it new forms of producing and being happy at work. It is also defined as the "plane of immanence" Deleuze, Parnet, , the instituting plan Lourau, , or the plan of relations Veyne, Simondon , calls this instituting plan of power "transindividual plan" and states that it is related to the collective level, understood as a space-time relation between the individual and the social levels, the space of intrinsic elements.
This is the plan of creation or co-engendering of individual and social forms, the origin of all changes, the plan of movement. And that is what makes psycho or social living beings always incomplete and in a permanent process of individuation. The transindividual collective is, therefore, the instituting and molecular plan of the collective. Consequently, some questions arise: have all and every "so called" collective practices in Public Health had the power to mobilize this pre-individual and molecular plan of the collective, allowing the movement of creation and transformation of forms?
Or have specific practices blocked access to this plan of creation, working for the permanence and crystallization of certain institutionalized forms? Take an institutional device that is often experienced in Public Health as an example: the management collegiate. As the name says, its objective is to implement processes of shared management through the participation of subjects and groups in the institutional processes of formulation, decision, planning, implementation and evaluation.
However, in daily practices, we can frequently see the bureaucratization of those spaces, which are reduced to formally instituted representations. As representatives or spokesmen, their members operate a strange protagonist role, in which they do not allow to be affected by the other or by what emerges as different, and become impermeable to changes.
They do not access the relational plan, once neither do they interact with the others in their differences nor they get involved in the movement that goes on in these spaces.
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A space resultant from this way of functioning, despite being called collective, demonstrates to be insufficient to guarantee the access to the plan of construction of subjects and groups. Although this text does not aim at entering the debate of representative democracy and participative democracy, we would like to point out that this seems to be one more effect of the lack of articulation, highlighted by Santos , between these two important dimensions of democratic practices: representation and participation.
We could say that a specific way of operating representativeness excludes the dimension of participation, once it takes place in the relational plan. From the conceptual point of view, there was a need to review the problem of humanization by pushing the boundaries of the concept beyond its established meaning. As stated by the authors, "against an idealization of human being, the challenge is to redefine the concept of humanization based on a 're-enchantment of the concrete' or of the "SUS that works" Benevides, Passos, , p.
We should think of human beings not as having an ideal figure, but taking into account their concrete existences, and considering their normative diversity and changes experienced in collective movements.
From that point on, the NHP has defined its principles, directions, devices and a working method to attend and manage the SUS: the triple inclusion method, which points out the importance of collective spaces in order not to imprison the powers in an instituted health model. This method has been frequently experienced as an institutional support, an activity carried out by consultants and supporters of the NHP in the municipal, state and federal health networks and services, whose objective is to trigger, in an inseparable way, the processes of production of health and subjectivity.
Understanding device as something that makes a method work, we can say that the institutional support is a device that embodies procedures or technologies that make us see and speak Foucault, We will point out, in the following paragraphs, three functions updated in effective practices of institutional support that enable it to be a device capable of accessing the instituting plan of powers or the plan of transindividual collective: the intersection function, the tranversalization function and the transduction function.
The intersection function appears whenever principles, guidelines, devices and subjects operate as references or vectors that trigger the collective action at the same time that other references, knowledge and practices are built within the movement of intervention itself.
More than a starting point, the support works as an intersection of ideas, experiences, expectations and emotions, and creates conditions and possibilities to produce a common plan, a relational plan, a plan that affects the collective. The transversalization function is related to increasing the capacity of communication between subjects and groups Guattari, and of intersection of elements and heterogeneous flows, material and immaterial. It refers to the ethics of connectivity in processes Simondon, that searches to overcome vertical and horizontal communication logics, which are individualizing in themselves.
Deleuze points out the power of those connections when he states that: "the collective problem, then, is to institute, find or recover the maximum of connections. For connections and disjunctions are nothing other than the physics of relations, the cosmos" Deleuze, , p.
As far as the transduction function is concerned, we consider that the ways of including subjects, evaluators and collectives is transductive when it takes place through actions and movements that are gradually transferred from an area to the other in various directions, producing attractions, involvement, meetings and changes.
The emphasis of a transductive action lies in a boundary zone or in the interface between subjects, between networks, between subjects and networks, between subjects and technologies of care or management. They are, in these cases, places- in-between and established temporalities or temporalities in process of being established.
Then, to state that the transindividual collective is a relational plan does not mean to reduce it to formal spaces of meetings, workshops, group or inter-individual dynamics. By analyzing the spaces of management collegiate, we can notice that, depending on the way they are conducted and occupied, those spaces of democratic representation may operate as obstacles to transindividual collective experience.
However, it is also in spaces like these that the overlapping of the plan of forms and the plan of powers may occur, producing this experience. What makes the difference is the way of operating, doing things, which makes use of devices. The challenge is, thus, to stimulate the permanent movement of creation of collective spaces, but, at the same time, to turn them into spaces of intersection and assemblage agencements. To assemble with someone does not mean to replace them, imitate them or identify yourself with them: it is to create something that is neither in you nor in the other, but between the two, in this common, impersonal and sharable space-time that all the collective assemblage reveals.
We need to remember, however, that the potentialities of a transidividual collective brings possibilities, and not guarantees, of its occurrence. We know that the connectionist capitalism and its resultant institutional dynamics may reabsorb the political potential of the collective and the common levels, destroying them and making them work for it. This is always the imminent risk. Therefore, in a policy of Public Health, we shall not reify, naturalize these concepts, but take them as contingent concept-devices which always answers, partially and provisionally, the problems that each time and political circumstance presents.Direitos Difusos e Coletivos.
Pesquisa sobre o corpo: This permanent transformation breaks the logics of closed and programmatic agendas. Higher Education Research and Development ; 26 4 The new therapeutic projects make us learn with the new practices of facing challenges.
We try, in every possible way, to transform tensions into understanding.