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The Multiple Borders in the Health Care Provided to Foreigners in Corumbá

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The Multiple Borders in the Health Care Provided to Foreigners in Corumbá The multiple borders in the health care provided to foreigners in Corumbá, Brazil As múltiplas fronteiras presentes no atendimento à saúde do estrangeiro em Corumbá, Brasil Clarisse Mendes Pinto Gomes Ferreira Abstract Universidade Federal de Mato Grosso do Sul. Campus do Pantanal. Masters in borderland studies Corumbá, MS, Brazil. Corumbá is the largest Brazilian city to border with E-mail: [email protected] Bolivia and has a better health infrastructure than Milton Augusto Pasquotto Mariani its neighbor country and, associated with the fact Universidade Federal de Mato Grosso do Sul. Campus do Pantanal. that Bolivia does not provide free services to all Masters in borderland studies Corumbá, MS, Brazil. its residents, the city of Corumbá has attracted a E-mail: [email protected] significant flow of borderland population who seek Sergio Iván Braticevic local free health services, making it a scenario of Universidade de Buenos Aires. Instituto de Ciências Antropológicas. coexistent behaviors and identities, mostly contro- Buenos Aires, Argentina. versial ones. This article presents some reflections E-mail: [email protected] on empirical data from interviews with health professionals in Corumbá and aims to analyze the multiple borders recognized from these speeches. For that purpose, theoretic contributions are used, with geographical and anthropological supple- mentation, to understand the different border ap- proaches extracted from the perspective of health professionals about the population that lives at the border and also about Integrated Border Health System—SIS-Fronteiras, a project created by the Brazilian Ministry of Health, in 2005. The informa- tion obtained from qualitative field research shows that the high level of permeability with the political border between Brazil and Bolivia has favored the construction of ethnic and cultural boundaries, in which the foreigner, especially the Bolivian, is the “other” in a social interaction among health profes- sionals and users inside health units. And yet they reveal many challenges in implementing the SIS- Fronteiras project in the border region, above all, Correspondence health professional’s lack of knowledge about the Milton Augusto Pasquotto Mariani project and its objectives. Cidade Universitária s/n. Campo Grande, MS, Brazil. CEP 79070-900. Keywords: Borders; Identities; Public Health Care. DOI 10.1590/S0104-12902015137475 Saúde Soc. São Paulo, v.24, n.4, p.1137-1150, 2015 1137 Resumo Introduction Corumbá é o maior município brasileiro limítrofe At the borders, there are multiple dimensions, and com a Bolívia e está dotado de melhor infraestru- each one allows a particular process of identity tura de saúde que seu país vizinho e, aliado ao fato creation. Far beyond representing a limit separating deste não dispor de serviços gratuitos a todos os two or more nation-states, borders also represent seus habitantes, tem atraído um fluxo significati- the convergence of different relationships where vo de fronteiriços para atendimento ao serviço de there is a social, cultural and political exchange that saúde público, tornando-se palco de coexistência provides a process of ambivalence between the “self” de comportamentos e identidades, muitas vezes and the “other”, contributing to the construction and controversos. Este trabalho apresenta algumas reconstruction of identity. reflexões sobre os dados empíricos oriundos das Situated on the international border between entrevistas realizadas junto a profissionais de saúde Brazil and Bolivia, the city of Corumbá has about 107 atuantes em Corumbá e tem como objetivo analisar thousand inhabitants1 and, despite the scarce settle- as múltiplas fronteiras reconhecidas a partir dos ment, it has a striking connection with the Bolivian discursos proferidos por eles. Para tanto, faz-se uso cities of Puerto Suarez and Puerto Quijarro, which de contribuições teóricas, com aportes geográficos together add up to 37 thousand inhabitants, and with e antropológicos, para compreender as diferentes the Brazilian city of Ladário, of only 20 thousand abordagens de fronteira extraídas a partir da pers- inhabitants. With better health infrastructure than pectiva dos agentes de saúde sobre o atendimento its neighbor country and considering the fact that aos fronteiriços e também sobre o Sistema Integrado this country does not offer free services for all its de Saúde das Fronteiras – SIS-Fronteiras, projeto inhabitants, Corumbá has attracted a significant criado pelo Ministério da Saúde do Brasil, em 2005. flow of heterogeneous population to serve with the As informações obtidas a partir da pesquisa de local public, free and universal health service, char- campo, dotada de caráter qualitativo, evidenciam acteristic of the Brazilian National Health System que o elevado grau de permeabilidade com a fron- [Sistema Único de Saúde] - SUS, making it a setting teira política entre Brasil-Bolívia tem favorecido for coexisting behaviors and identities often contro- a construção de fronteiras étnicas e culturais, em versial among those involved. que o estrangeiro, especialmente o boliviano, é o “outro” na interação social entre profissional de Worried about better understanding the needs saúde e usuário dentro das unidades de saúde. E and health problems in border areas, the Brazilian ainda revelam inúmeros desafios na concretização government created the Integrated Border Health do projeto SIS-Fronteiras nessa região fronteiriça, System - SIS-Fronteiras, on July 6, 2005, with the sobretudo o desconhecimento dos profissionais de goal of increasing the operational capacity through saúde quanto ao projeto e seus objetivos. a financial compensation system, 121 border cities Palavras-chave: Fronteiras; Identidades; Atendi- located up to 10 km from the border and that attract mento à Saúde. regular visits of patients from the neighbor country. Corumbá joined the SIS-Fronteiras officially on December 29, 2005, and since then no study has been done on the understanding and perception of the project among health professionals working in the city. With this in mind, the objective of this study is to analyze the multiple recognized borders from the discourse of these health professionals, when asked about access and demands by foreigners and 1 Data obtained from IBGE. Departamento de Atenção Básica (DAB)/Ministry of Health, 2013. 1138 Saúde Soc. São Paulo, v.24, n.4, p.1137-1150, 2015 Brazilians that do not reside in the country for local which in the process of consolidation during the service and about the SIS-Fronteiras program. This eighteenth and nineteenth centuries had, and still study did not include interviews with users of the have, to clearly demarcate their borders to enforce service, despite their importance, because it is a par- the limit of order, standard and of the established tial result of an ongoing investigation, that is part power. The border is thus understood as a territorial of the Master’s project entitled “O SIS-Fronteiras na limit between Nation States, as sovereignties divider fronteira Brasil-Bolívia: o caso de Corumbá.”2 (Nogueira, 2007). The article is structured in two parts. In the first In the same nineteenth century, another ex- part we use theoretical contributions, essentially ponent stands out in the analysis of border, the bibliographic ones, with preferential geographical historian Frederick Jackson Turner, whose studies and anthropological augmentation, to understand developed on the American expansionist move- the different approaches that focus on the term bor- ment to the west allowed the establishment of an der. Then, aiming to present how these approaches economic conception of the border, in which it’s relate at the moment of service to the border popula- presented as fluid, mobile, in constant progress and tion, we will present the results and reflections of the setback. In Brazil, this concept was assimilated dur- field research, in which we interviewed—through ing the Vargas government in the 1930s, associated a semi-structured script that guaranteed a enrich- with the internal territorial expansion process and ing freedom and spontaneity—10 Brazilian health the incorporation of areas to productive activity professionals from different specialties (physicians, (Nogueira, 2007). nurses, social workers and psychologists) working In Latin America as a whole, the Turner model in the City Emergency Unit, Santa Casa de Miseri- of border based on the process of advancement in- cordia, Health Centers and Basic Health Units, all fluenced countless historical, social and structural situated in the city of Corumbá. conflicts, such as the expulsion of the natives in the case of the Mapuche people in Patagonia and of the The types of borders in the view of “march to the West” replicated in Brazil, reinforcing the myth of free and unexplored lands. This takes social studies us back to an approach of border as a pioneer front, There are several approaches to the analysis of bor- a ‘limit’ area, marginal, representative of unstruc- ders, stimulated by multiple approaches to their de- tured spaces, bringing out the distinction between signs and the myriad of interpretations in the social the terms border and frontier: sciences (geography, history, sociology, economics La primera refleja el límite territorial entre la and anthropology, among others). jurisdicción de distintos Estados-Nación. Por su In classical geopolitics, Friedrich Ratzel,3 in his parte, el segundo remite a la articulación entre book Politische
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