03297nas a2200313   4500000000100000008004100001260003700042653002400079653005700103100001700160700002100177700001900198700001300217700002400230700001600254700001100270700001900281700001200300700001500312700001400327700001600341700001300357245013400370856009900504300000900603490000700612520235000619022001402969       2023                            d  bPublic Library of Science (PLoS)10aInfectious Diseases10aPublic Health, Environmental and Occupational Health1 ade Farias AS1 ado Nascimento EF1 aGomes Filho MR1 aFelix AC1 ada Costa Arévalo M1 aAdrião AAX1 aWen FH1 ade Carvalho FG1 aMurta F1 aMachado VA1 aSachett J1 aMonteiro WM1 aHabib AG00aBuilding an explanatory model for snakebite envenoming care in the Brazilian Amazon from the indigenous caregivers’ perspective  uhttps://journals.plos.org/plosntds/article/file?id=10.1371/journal.pntd.0011172&type=printable  a1-270 v173 a<p>Background: 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.</p>

<p>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.</p>

<p>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.</p>
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