General Articles
36Turra LF, A Ramos, D Pires, F Rocha, G Rego, P Collety, R Luiz, S
Cos\a. \99'2 Vivendi e aprettdatdo: Pleveltgao da AIDS etll
esco/ares do .A4z//zfczbfo de .d/zg/a dos .leis. NQcleo de Estudos :de
SaQde Coletiva, Centro de Saide Coletiva da UFRJ e SecretAria
Estadual de Saide, Rio de Janeiro, Report, Conv6nio PMAR/UFRJb Rio de Janeiro
Monteiro S, AC Almeida, V Schall, AB Rodrigues, A Silva 1993
Investigating knowledge and attitudes of elementary students. .d/z- ola!s IXth intenlatiolla} Collference on AIDS, Bet\\n
Standard, Ogilvy, Mater 1993 Uma convocagao social: a guerra contra a AIDS. f/s/e/zilng Pos/ 67: Fevereiro
At the end of the project period the Department of Education of Belo Horizonte solved their difficulties and asked ABBA for assis- tance. ABIA then made some recommendations and suggested that they make contact with Ttabira, as one of the proposals of the project was to share the project experience with other cities
In May 1995, Palmas organized a Seminar about AIDS Preven-
tion and invited ABIA, the other municipalities and the Save the
Children representative to go. Only Florian6polos could not at-
tend the invitation
41
42 43 44 45
IBGE (Instituto Brasileiro de Geografia e Estatistica) 1989
Cr/a/?(as e ado/ence/z/es: inez'cczdo/e.9 socfafs, Vole 3 e 4, Rio de
Janeiro
Jornal do Brasil 1995 .A/EC a/zt//?c/a repo/u(27o /zo e/7sino de /'
groh, January
Jornal do Brasil 1 995 it4EC/ard /es/es pczra riva/far e/zsfno bdsfco, January
This evaluation has already begun. Jornal do Brasil 1996 7WEC
cone/zzz ' ql/e 2' gut/ & ''//"dgico ''. November, 26
,4ck/zow/edge/}7e/7/s: I wish to thank the Save the Children Fund,
especially Euclisia (lsa) Ferreira, the Welfare Foundation, Cristina C Branco, Elizabeth M dos Santos, ABIA staff and the educators
from the municipalities for their support and encouragement. I
would also like to thank Prof Lois Monteiro, Prof Lucile Newman, Rachel Christina, lsabela F de Sousa and the anonymous reviewer for their comments
37
38 39
40
Received 1 0 March 1997 Accepted 31 March 1998
A missing agenda in Brazilian schools:
The debate on popular health practices
ISAnKLA C '. F. DE SOUSAi , BRANI RozEMBERC 1 , EvELV BoRucnoviTcn2, VIRGINIA SCnALLt
Laborclt6rio de EdttcctQao Ambiei tat e dc{ Snide (LEAS), Departalneilto de Biotogia, Fulldagao
Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, RJ 2}04S-900 attd
Depcirtamento de Psicologia Educucional. FacuLdade de EducaQiio, Universidade Estadual de CalnpLnas UNICAMP, Cainpincts, SP }3083-97Q, Brasil
Popular health practices are an expression of the Brazilian popular culture but the debate about them has not been present in our schools. Such debate should be initiated in they may so that schools play a role in promoting all types of knowledge on health and become places where a more realistic and multifaceted view of our culture is portrayed. In this research, questions were asked to teachers and students in order to assess the frequency of references to the use of popular health practices as well as to compare these references based on: The
nature of these practices; students' ages and grades; the type of school; and teachers' level of proficiency in health. The results evinced that: 79 These practices are learned informally; 2y homemade medicine is more referred to than folk healers and prayers; S9 as students progress in grades they become less likely to believe in and exemplify these practices and V9 teachers, specially science and health teachers, tend to believe less in and provide less information on these practices than students. The authors stress the value of popular health practices and describe the findings in the light of some research and pedagogical recommendations.
Correspondence to: lsabela Cabral F61ix de Sousa, Laborat6rio de Educagao Ambiental e da Sa$de (LEAS), Departamento de Biologia, Fundagao Oswaldo Cruz, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, RJ 21045-900, Brasil
328 . Ci6ncia e Cultura Journal of the Brazilian Association for the Advancement of Science Volume 50(5) ' September/October 1 998
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Gene-raf Articles
tific medicine is undergoing a crisis regarding its dominant paradigm. Queiroz (5), among others, asserts that this crisis relates to its failure in recognizing social, cultural and histori- cal roles in the determination of diseases and their treatment.
Inequality of production, distribution and consumption of medical care, iatrogenic diseases, viral and bacterial resis tance, dependence generated by drugs, and the growing medical specialization that diverts attention from the totality of the human being, are some of the "symptoms' . of medicine's paradigm crisis. In addition, another noticeable sign of this crisis is the middle and upper classes' growing interest m alternative health practices and religious systems of cure, reflected in a recent intemational campaign launched by WHO and UNESCO valuing these practices(6).
The study on popular health practices is part of a larger research project investigating health issues among teachers and lst to 8th grade students from several regions of Rio de Janeiro(12,13). The results analyzed in this paper refer to the
northern part of Rio de Janeiro municipality. In this region,
ten schools were selected, five of them public and five pri- vate. While the selection of public schools attempted to ac- count for the various social strata of the region, the selected private schools were geographically close in order to provide populations as similar as possible to the public schools. This was done because private schools, by their very nature, tend to have more afHuent populations.The sample of teachers selected encompassed those who taught health issues (elementary teachers and onlyjunior-high teachers who taught issues related to health and/or science) The original open-ended questions related to popular health practices are listed in the Appendix. There were no closed finn questions addressing popular health practice issues.
Three types of questionnaires were designed: For teach ers, for students from 3rd to 8th grades and for students from I st to 2nd grades (13). These questionnaires were pretested and included the following topics: Socioeconomic and edu- cational background; concepts of health and illness; nutri- tion and health patterns; Hlrst aid knowledge; personal hy- giene habits; knowledge about Brazilian tropical diseases;
consumption of drugs, alcohol and cigarettes; pollution and conservation of the environment; mental health; homemade medicine, folk healers and prayers; attitudes and opinions. In this paper we are only analyzing the topics related to home- made medicine, folk healers and prayers
While teachers and students from 3rd to 8th grades were given written questionnaires, students from lst and 2nd
grades were interviewed orally due to their lack of writing
ability. The procedure to interview young children about ideas and behaviors related to health has been reported, among others, by Gochman and Saucier (14) and Lau and Klepper (1 5). Theoretically, this research is based on Vygotsky's so-cial constructivism which takes into account the social and
cultural context in building knowledge of concepts in general and scientific concepts at school (1 6,1 7). Vygotsky's theoryis a framework of reference for those working with young children since he considers that the leaming process does
not necessarily correspond to children's development be- cause the former does not need to coincide with the latter but can precede it. vygotsky even stressed that educational int-ervention could be ahead of the next phase of children's
development(18), and suggested the existence of a "proximalThe hegemony of science in Brazil
In the Brazilian society, health practices defined as scientific have usually been legitimated. Costa(7) provides a historical
analysis of the support received by the scientific medical
model in Brazil through a hygienic pedagogy, which pemle-ates everyone's lives and uses the family as a controlling
institution. However, the hegemony of scientific knowledge has not been translated into scientific medical treatments ac cessible to all. The poor population in Brazil is the most likely to be excluded from scientific medicine, and popular health practices have been in many cases the only alternative tohealth care as Scheper-Hughes' (8) study showed in
Pemalnbuco. Brazil.
In other- areas, the poor population is being exposed to indiscriminate pharmaceutical prescriptions, and has strongly internalized western medical practices and discourse as the
only trustworthy health alternative. Data on psychotropic
drug use among rural workers in Espirito Santo, Brazil sug-gested devaluation of previous commonly used natural teas as medication against stress (9). This author discusses the overwhelming influence of medical consultations on the popu-
lation health view, and the pervasiveness of multinational
pharmaceutical interests in health choices. Cordeiro (lO) and Th6baud and Len( 11), among others, explain the pressure of these interests resulting from the capitalization of medicine.
In countries like Brazil, submitted to a late and accelerated industrialization, medical practices unfortunately tend to ap-
pear not only as a result of social needs, but also due to
market strategies.Research context of this study
This study began within the Fundagao Oswaldo Cruz, in the Department of Biology, specifically the Laboratory of Envi- ronmentaland Health Education, which has investigated sev- eral issues of health knowledge among the population with the aim to improve its health status. Some of the results of research carried out in this laboratory have been transformed into the development of educational materials for health pre vention.
Table 1 - Age distribution of students interviewed according to type of school
PUS = Public schools; PRS = Private schools.
Mean(X) - 11.69; Median(Md) -.11.5; Mode(Mo) 12
330 e Ci6ncia e Cultura Journal of the Brazilian Association for the Advancement of Science Volume 50(5) ' September/October 1 998
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General Articles
As for the student progress in school, he/
she becomes less likely to assert a positive answer to the use of homemade medicine.
Such results might be related, to some ex- tent, to the usc of oral interviews with only
I st and 2nd grades (Table 2).
In any case, it is quite interesting to note that students from lst and 2nd grades ac-
count for the majority of positive answers
regarding homemade medicine practice (85. 14% of all students' answers) while they are only 25.6% of the student population.The reported examples of homemade medicine practices (Tables 3 and 4) reveal a rich variety ofreasons for their use as wel I as elements employed in their preparation. Ex amining the categories of answers on Table
3, it is revealing that the population placed
emphasis on physical dimensions ofdisease.Although it is not clear ifinterviewees were less infonned or even embarrassed to dis- cuss other dimensions, it can bc argued that this focus, to some degree, supports the sci- entific medical model which clearly favors
the physical aspects of health and illness
rather than psychological ones.Analyzing Table 4 we see that the rich
diversity of elements used concentrates on plants. The students' knowledge of so many plants is amazing considering that they arc urban children. It is possible to infer that their parents and/or grandparents have rural back- grounds due to the recent urbanization ofBrazil. Thus, more qualitative research is
needed to explain why and how students lean informally so much about plants andhomemade medicine.
Among the elementary school teachers, 4 1 .2% believed in the use ofhomcmade medi- cine, 34% did not and the remaining 24.7%
were uncertain. The majority of those who believed (3 1 .9%) provided examples ofele ments used in homemade medicine.
Of the junior-high school teachers, 40%
believed in homemade medicine, 50% did not and 10% were uncertain. Contrary to the ex- pectation that junior-high school teachers involved in health and science subjects - if they believed in these practices would be more prone than elementary school teachers to supply examples, it did not happen. Only 20%, half of the believers, provided examples, so few in number that they were not included in Table 3. This might suggest that elemen tary school teachers are more familiar with and/or less prejudiced against homemade medicine.
Another interesting comparison relates
Table 4 - Students' answers regarding homemade medicine elements.
Exatnptes/ lst and 2nd glades 3rd to 8th grades Total
Ntintberoj
times N (%) N (%} N(%}
Fruits and trees
Pitanga(fz£genia if/z{/Tora) Guava (Psidfzln7 Ezra/avcz) Lemon (Cifl'zzs /Imo/z) Orange(Cffrzfs aHrcz/zffu/n) Others'
Plants
Acre stone crop (Sean/}z acre) Bay leaf
(Oco ea w Nectrartda) Boldu tree (reef/n s ho/airs) Chamomile(.4/7r;ze/7zis spp) Common balm
(Metlisa ogicinalis) Cinnamon
(Ocotea ax Nectra+tda) lwarancusa grass
tCymbopogan jawarattcusa]
Fly-roost leaf flower tPhy!!atlthus nirurb Mate (//ex paragErayensis) Mint (]t/enf#zz peel'ffa) Red-gartered coot
tFu!!ica arn\i!!ata) Anise (Pit?ipinelia anisum)
Watercress (;?or@pa
n f! turtium - cicltlaticutll )
Othersz
Miscelaneous Garlic
(Xlliun? scorodolprasum) Honey
(Melopossa filscipenllis)
Milk
Onion(.4//Ilan/zzsffanfciu/n) Salt
Sugar Others' To ta I
(2.0) (2.0) (5.0) (9.0)
0
5 7
4 (o.o) (0.8) (4.2) (6.0) ( 1.6)
2 3
10 16
(0.8) ( 1 .2) (4. 1 ) (6.6)
1 6 (1 6.0) 24 (20.0) 40 (1 6.5)
I (I.o)
1 7 ( 1 7.0)
2 (2.0)
1 (0.8)
9 ( 1 6.0)
1 (0.8)
2 (0.8)
3 6 (14.8)
3 (1.2)
6 (6.0)
2 (2.0)
2 (2.0)
9
0
0
3 0 5
3 6
8
14
(7.6) 15
2
2
3 3 11
5 14 13
(6.2)
(o.o) (0.8)
(o.o) (0.8)
0 3 6
2 8
5
(o.o) (3.0) (6.0) (2.0) (8.0) (5.0)
(2.5) (o.o) (4.2)
(1.2) (1.2) (4.5) (2.5)
(5.1) (6.8) (5.8)
(2.0) (5.8) (5.3)
l
5 3 2 0 0
99
(I.o)
(5.0) (3.0) (2.0) (o.o) (o.o)
3 (2.5) 4
17 9 3
2
9
243 (1.6) (7.0) (3.7) (] .2) (0.8) (0.8) 12
6
2 9 3 1 18
(l0.2)
(5.1) (0.8) (1.7)
( 1 .7)
(3.3)
Avocado (Persia a/nerica/nl), banana (J/usa pal'adfsfacaJ , passion fruit (PassW07'a) and prune(Pref/?us do/nesrfca)
b "Ararueira" wood (Sc'hilnrs /?70//e), belly sptirge nettle (Jafrop/la gassy piHu/ia), black
tea (T#e/z si/ze/7sfs), cotton (Gossypil/rn har&zz'/e/zse), daisy (C;zrysrz/zr/le/771/fz
crlrolla/,I /it), eucalyptus(Ezlca/zpfus reslllHera), dropseed grass(Sporbo/z{.s' rzxpel'€#o/fzn),
horse mint (J/enf#a /ongfHo/fa), mountain arnica (.4nziaz fnonra/la), littleflower quickweed (Ga/f/zsoga parvd7ora), rosemary (Rosma/ f/firs- qgici/?a/is) and Saint Mary herb, white plant and light green plant.
In the others' category: Beet, codfish, animal (chicken) fat, earth, sheet pea, vin- egar, water and wheat.
Table 5- Students' answers regarding whether there is the practice at home of treating any disease with a religious prayer or folk healer.
Grade
}st 2ttd 3l'd 4th Stat 6th 7tlt 8th
NN NN NN N N
Zo/a/Yes 19 19 14 10 7 10
No 18 17 18 13 29 28
DNK,NA,AW 3 5 10 ll 5 5
Total 40 41 42 34 41 43
4 7 90 (28.6)
30 21 174 (55.2)
5 7 5] (16.2)
39 35 3]5 (100.0)
DKN = Does not know; NA = No answer; AW = Awry.
X2(Y and N) - 25.8; )C: p - 14.1; oc = 0.05; X: p < X:
P ' 0.0005
332 . Ci6ncia e Culture Journal of the Brazilian Association for the Advancement of Science Volume 50(5) ' September/October 1998
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Comparing answers:
More coinciding patterns than dissimilar ones
ence. In short, popular health practices are part of our cul-tural thinking heritage, anchored in systems of thoughts that have permeated human mind. Thus, instead of eliminating or devaluing not scientific health altematives, it will be interest-
ing to develop a historical analysis of human discoveries
given by these different systems. Societies can only profit from the awareness about paths undertaken by men in order to continuously recreate their worldThe second reason why popular health practices should be valued is that they tend to materialize among the poor population. Popular health practitioners often emerge from their same social strata, thus having a common culturalback- ground. Therefore, they may be more capable to help their fellow citizens, developing trust through a more effective com- munication than that provided by their outsider counterparts.
Boulton et al (apud Reference 20) concluded that the resem-
blance between the social background of doctors and pa tients was likely to promote a more productive communica- tion. Likewise, Szasz and Hollander(26) and Loyola(22) ar- gued that patients seek and evaluate doctors not only for their expertise. The type of human relationship that can be developed in a patient/doctor encounter, in which doctors attentively listen to patients, providing explanations on symp- toms, examinations and treatment is also germane.
The third reason why popular health practices should be endorsed is that, contrary to scientific medicine, they tend to share a holistic view ofhealth and disease. In fact, popular health practices have in common the premise that health and disease are based on the relationship the body has with its different parts, and with the social and cultural context (5).
According to this author, western medicine needs to recover this dimension to surpass its paradigm crisis.
Finally, popular health practices should be comtnended because they tend to be less costly than medical practices However, this fact should not legitimate low quality care for the poor (27). Indeed, no population should be restricted to any practice, and access to scientific medicine should not be denied to the poor because of its costs. Furthermore, it is important not to romanticize the economic aspect ofpopular health practices which, according to Loyola(22) are inclined to hide their economic nature using the exchange of favors.
Comparing the three types of answers, we find more parallel
patterns than dissimilar ones. Examining al I responses, the type
of school did not elicit any difference even though students flom public schools tend to be older than their counterparts in private ones. Thus, it seems that, regardless of age, there was homogeneity of the communities' cultures in which the schools were located, since private schools were chosen to attract popu- lations as similar as possible to the public ones. Coleman 's and
Homer 's (2 1 ) study which compared public and private schools
in the United States found differences among high-schools
related to distinct strength of community cultures.The fact that students from the first two grades, rather than from higher grades, provided more examples to allques- tions, corroborates the results ofelementary school teachers providing more examples than junior-high school teachers.
These results support Loyola's (22) conclusions that more schooling was one of the factors, besides urbanization and
youth, that led the population to adopt western scientific
medicine and view popular or traditional medicine as an out- dated practice.Since regarding all responsess as the student progresses
in school, he/she becomes more prone to share the view of modem science, it would seem that the school may be play- ing a role in spreading the hegemonic view of science, and in restraining the students' expression of popular health prac- tice knowledge. This view is similar to that portrayed by Ivan lllich when criticizing the schools' role in promoting a type consciousness which only values the knowledge shown in the school cuiTiculum(23). Despite the fact that health devel- opment and medical anthropology have grown to value local cultures, schools appear to still share the hegemonic view of science giving no attention to other kinds of knowledge. Other authors have argued that schools provide a general percep bon of scientific concepts which changes children's aware- ness of their mental processes(16,17,24).
Finally, another interesting aspect of this study is that
among the answers on popular health practices, the responses related to homemade medicine were the ones that elicited more positive answers and examples both from teachers and students. It seems that the concreteness of homemade meds cine led the population to identify more with them or to feel less embarrassment to discuss them. These practices are deft - nitely more tangible than those that state relationships with religiosity, spirituality, disease and health.
Recommendations for research and pedagogical practices
Vygotsky identified the role of formal education in teaching scientific concepts to children. By observing children in real life situations this author testiHled that children 's initial
spontaneous concepts evolve to scientific ones during for- mal education when children interact with scientiHlc con- cepts. For Vygotsky, this process of concept change pro- vides children with a new perception of themselves and their
own mental processes, through the development of a self-
reflective activity.
Fomlal education is an extra tool to teach the young the culture(values and ideas) of the adult world(28) and cultural experiences influence individual development in such a way
Reasons for valuing popular health practices
Even though scientific medica] services have undoubtfu]
validity in many instances, this is also true for popular health practices. First of all, popular health practices are important
because they carry cultural heritage. For example,
;curanderismo" in Mexico has been defined by Spector(25) as a medical system which encompasses elements of Aztec culture, Spaniard culture, spirituality, homeopathy and sci-
334 Ci6ncia e Cultura Journal of the Brazilian Association for the Advancement of Science Volume 50(5) ' September/October 1998
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