Abstract

Quilombola communities have felt the effects of racism deepened by COVID-19, whose repercussions are amplified in contexts of racial inequalities, characterizing it as a syndemic. The term refers to the synergy of biological, economic, environmental, political, and social elements that enhance coexisting conditions and states, impacting life and affecting health. Thus, our study seeks to analyze the repercussions of the COVID-19 syndemic based on the perceptions of quilombola community leaders in Mato Grosso, Brazil. In a qualitative study, three leaders were interviewed in May 2022, using a semi-structured script and treating the data through thematic analysis. The COVID-19 syndemic highlighted the structural precariousness of transport, roads, sanitation, and access to water, food, and health services. Isolation, deaths, and fears had psychosocial repercussions, but little attention was paid to mental health. Anti-racist proposals call for: repairing precariousness by recognizing the State’s debt to the black population; valuing experiences, way of life, cosmovision, and Afro-centered ancestral civilizational values. Finally, the aim is to strengthen, reaffirm, and implement anti-racist actions, such as the Statute of Racial Equality and the PNSIPN, in all possible spaces, policies, and institutions.

Key words:
Quilombolas; COVID-19; Syndemic; Iniquities; Racism

Introduction

The present article aimed to analyze the repercussions of COVID-19 from the perspective of the syndemic, based on the perceptions of quilombolas in a community in Mato Grosso, Brazil. To achieve this, we provide a panoramic view of racism and ethnic-race relations through the mobilization of three quilombola voices, a body-place that, through the experiences of the COVID-19 syndemic, places us in their lives and, respectively, in the struggles for the right to exist/resist and the (re)knowledge of their rights.

Perceptions arise from the relationship with the world, mediated by corporeality and apprehended by the senses, that is, a body open to places, in tune with the things, events, and people that constantly request it in the continuous flow of Being-world¹1 Barsaglini R. Experiência: fundamentos conceituais e a abordagem socioantropológica em saúde e cronicidade. In: Barsaglini R, Portugal S, Melo L, organizadores. Experiência, Saúde, Cronicidade: um olhar socioantropológico. Rio de Janeiro: Editora Fiocruz, Imprensa da Universidade de Coimbra; 2021. p. 39-62.. Talking about perception is considering the legitimacy of looking from the inside, of someone who tells us something with the authority of someone who was there, present, that is, experienced and tells us what is capable of being retained by memory and (always) situated sensitivities¹1 Barsaglini R. Experiência: fundamentos conceituais e a abordagem socioantropológica em saúde e cronicidade. In: Barsaglini R, Portugal S, Melo L, organizadores. Experiência, Saúde, Cronicidade: um olhar socioantropológico. Rio de Janeiro: Editora Fiocruz, Imprensa da Universidade de Coimbra; 2021. p. 39-62.. The interlocutors inhabit, live the place, constitute a link between the community and public authorities, and collectively felt the repercussions of the syndemic, hence the relevance of their speech in approaching perceptions that are not limited to the individual.

Quilombola communities constitute ethnic-racial groups with their own trajectories, united in a unique temporality (past, present, future), endowed with specific territorial relationships, a feeling of people, of black ancestry, and carry a history of resistance, struggles, and actions against the persistent oppression suffered to achieve the guarantee of and access to rights²2 Christovão SRT. Impactos da covid-19 nas comunidades quilombolas do Estado de Santa Catarina: enfoque para Comunidade Quilombola São Roque/SC/RS. In: V COPENE SUL; 2021 out 26-28.. As Abdias do Nascimento claimed, “the quilombo does not mean an escaped slave. Quilombo means fraternal and free gathering, solidarity, coexistence, existential communion”³3 Nascimento A. O Quilombismo. São Paulo, Rio de Janeiro: Editora Perspectiva, IPEAFRO; 2019., so that, in addition to responding to the slavery system, the quilombo is also the right to exist in all its plenitude²2 Christovão SRT. Impactos da covid-19 nas comunidades quilombolas do Estado de Santa Catarina: enfoque para Comunidade Quilombola São Roque/SC/RS. In: V COPENE SUL; 2021 out 26-28..

According to IBGE data from 2019, in Brazil, there were 1,674 municipalities with quilombola locations, 90 of which were in the Midwest region and 17 in the state of Mato Grosso⁴4 Arruti JM, Cruz, C, Pereira A, Sartori J, Sousa CJ, Gusmão HNB, Bertolozzi TB. O impacto da covid-19 sobre as comunidades quilombolas. Informativo Desigualdades Raciais COVID-19 AFRO-CEBRAP 2021; 6:1-58., where, in one of them, the research that led to this article⁵5 Madureira KG. A sindemia da covid-19 em uma comunidade quilombola de Mato Grosso: repercussões e iniquidades em saúde [dissertação]. Cuiabá: Programa de Pós-Graduação em Saúde Coletiva/Universidade Federal de Mato Grosso; 2023. was carried out. Quilombola communities have experienced the effects of structural racism⁶6 Almeida SL. O que é racismo estrutural. Belo Horizonte: Letramento; 2018. materialized by barriers in access to fundamental public policies (health, education, transport, sanitation, territorial regularization), which have been reproduced for generations⁷7 Silva GM, Souza BO. Quilombos e a luta contra o racismo no contexto da pandemia. Bol Análise Político Institucional 2021; 26:85-91.. In this context, vulnerability in quilombos deepens during serious crises, such as the COVID-19 pandemic⁷7 Silva GM, Souza BO. Quilombos e a luta contra o racismo no contexto da pandemia. Bol Análise Político Institucional 2021; 26:85-91., whose repercussions do not operate alone in contexts of inequalities, mainly racial, leading one to understand this process as a syndemic, as claimed by Richard Horton⁸8 Horton R. Offline: COVID-19 is not a pandemic. Lancet 2020; 396(10255):874..

The notion of syndemic was conceived by Merrill Singer (American doctor and anthropologist) in the 1990s as an approach revealing biological, social, economic, and environmental interactions (synergism) that negatively affect prognosis, treatment, and health policies⁸8 Horton R. Offline: COVID-19 is not a pandemic. Lancet 2020; 396(10255):874.^,99 Bispo Jr JP, Santos DB. COVID-19 como sindemia: modelo teórico e fundamentos para a abordagem abrangente em saúde. Cad Saude Publica 2021; 37(10):e00119021..

The relevance of considering COVID-19 as a syndemic is due to the blatant denunciation of its social origin and not a purely biological phenomenon, making it possible to understand the combined unfair and unequal repercussions aggravated by the overlapping burden of chronic diseases, racism, poverty, in short, by structural violence⁹9 Bispo Jr JP, Santos DB. COVID-19 como sindemia: modelo teórico e fundamentos para a abordagem abrangente em saúde. Cad Saude Publica 2021; 37(10):e00119021.. According to the syndemic theory, the synergism of biological, environmental, and social interactions between conditions and states feeds back on each other, increasing the susceptibility of a population, with expanded effects harming or worsening their health status⁸8 Horton R. Offline: COVID-19 is not a pandemic. Lancet 2020; 396(10255):874.

9 Bispo Jr JP, Santos DB. COVID-19 como sindemia: modelo teórico e fundamentos para a abordagem abrangente em saúde. Cad Saude Publica 2021; 37(10):e00119021.^-1010 Singer M, Bulled N, Ostrach B, Mendenhall E. Syndemics and the biosocial conception of health. Lancet 2017; 389(10072):941-950..

The repercussions of COVID-19 follow this perspective due to the interaction between diseases and social markers that culminated in greater exposure of the black population to the virus, resulting in a higher mortality rate¹¹11 Baqui P, Bica I, Marra V, Ercole A, van Der Schaar M. Ethnic and regional variations in hospital mortality from COVID-19 in Brazil: a cross-sectional observational study. Lancet 2020; 8(8):e1018-e1026.. This concept is well suited to thinking about the repercussions of COVID-19 in a context of racial inequalities, such as the Brazilian reality and, more specifically, in a quilombola community. It also encourages us to think synergistically about anti-racist confrontations, given that, in the contemporary world, episodes of racism are recurrent, whether in sport, in games (recreational racism), in entertainment (dramaturgy), in politics, or in institutions. Human relations are racialized and based on the difference of races, classes, and power, in which the principle of exclusion is based on racial hierarchization¹⁰10 Singer M, Bulled N, Ostrach B, Mendenhall E. Syndemics and the biosocial conception of health. Lancet 2017; 389(10072):941-950.^,1212 Santos BS. A construção multicultural da igualdade e da diferença. Coimbra: Oficina do CES; 1999., representing a historical process in which a culture, through the discourse of truth, creates the interdict and rejects it.

This is institutional racism¹³13 Werneck J. Racismo institucional e saúde da população negra. Saude Soc 2016; 25:535-549. and necropolitics. The first induces, maintains, and conditions the organization and action of the State, its institutions, and public policies in order to (re)produce the racial hierarchy¹³13 Werneck J. Racismo institucional e saúde da população negra. Saude Soc 2016; 25:535-549. by updating colonial interests. Institutional racism is crystallized in institutions and acts in spite of an agent or individual actions¹⁴14 Mbembe A. Necropolítica. São Paulo: N-1 edições; 2018.. It is discrimination based on race that arises not from someone’s concrete action, but from the way in which institutions are organized, operating under an invisible racial framework that hinders or prevents the access of black people to places of power and social prestige, blocking access to rights and the exercise of citizenship¹²12 Santos BS. A construção multicultural da igualdade e da diferença. Coimbra: Oficina do CES; 1999.

13 Werneck J. Racismo institucional e saúde da população negra. Saude Soc 2016; 25:535-549.^-1414 Mbembe A. Necropolítica. São Paulo: N-1 edições; 2018..

The second, a State policy that points to death, where it is chosen who will live and who can die¹⁴14 Mbembe A. Necropolítica. São Paulo: N-1 edições; 2018.. The necrostate, through necropower, looks at social minorities and, bluntly, at black bodies, as disposable, not endowed with humanity, and creates a stereotype of a backward subject¹⁵15 Schucman LV. Entre o encardido, o branco e o branquíssimo: hierarquia, branquitude e poder na cidade de São Paulo [tese]. São Paulo: Universidade de São Paulo; 2014., archaic, savage, bestialized, weakened, and vulnerable, whose most objective outcome is death. Thus, when humanity is denied, the practice of violence becomes possible and legitimized¹⁴14 Mbembe A. Necropolítica. São Paulo: N-1 edições; 2018.^,1515 Schucman LV. Entre o encardido, o branco e o branquíssimo: hierarquia, branquitude e poder na cidade de São Paulo [tese]. São Paulo: Universidade de São Paulo; 2014.. In the syndemic, the extermination of the black population (Necropolitics!) was accelerated by a (mis)government that used politics to deny science, propagated fake news, implemented ineffective treatment, and delayed social protection and the fight against inequalities, concentrating the monopoly of violence, exclusion, and death upon the black population.

In the COVID-19 syndemic, we saw the State make the black body invisible and be animalized through the intentional selection of those who supposedly deserved or did not deserve to receive medical care and to be benefited by the National Plan to Combat COVID-19¹⁶16 Brasil. Ministério da Saúde (MS). Plano de Contingência Nacional para Infecção Humana pelo novo Coronavírus COVID-19. Brasília: Centro de Operações de Emergências em Saúde Pública/COE COVID-19; 2021.. It is structural racism as an element of the social determination of health, the brutal idea that the black body does not need and does not deserve to be taken care of. To show how this happened in practice, we will lend an ear to the quilombolas.

Method

This study was conducted in 2022 in the quilombola community of Mata Cavalo, founded in the 19th century and, in part, recognized and titled by the Palmares Cultural Foundation in 2000¹⁷17 Soares CCA. Educação ambiental na comunidade quilombola de Mata Cavalo: diálogos da arte, cultura e natureza [dissertação]. Cuiabá: Programa de Pós-Graduação em Educação/Universidade Federal de Mato Grosso; 2018.. It is located in the rural area of Nossa Senhora do Livramento, Mato Grosso, which is 52.2 km from the state capital of Cuiabá, and is made up of 6 (six) small communities, each with an association and respective leaders¹⁷17 Soares CCA. Educação ambiental na comunidade quilombola de Mata Cavalo: diálogos da arte, cultura e natureza [dissertação]. Cuiabá: Programa de Pós-Graduação em Educação/Universidade Federal de Mato Grosso; 2018..

In May/2022, interviews were conducted with three quilombola individuals, nominated by the State Coordination of Quilombola Communities of Mato Grosso (CONAQ). After formal authorization, a visit to the community was carried out, guided by an interlocutor to learn about the physical and organizational structure and local social facilities.

The interviews followed a thematic script, took place remotely, and were recorded. Through thematic analysis¹⁸18 Gomes R. Análise e interpretação de dados de pesquisa qualitativa. In: Minayo MCS, Deslandes SF, Gomes R, organizadores. Pesquisa Social: teoria, método e criatividade. 30ª ed. Petrópolis: Vozes; 2011. p. 79-108., we searched for expressions of the syndemic in the empirical material, as interconnections of biological and social elements, using the concepts of repercussions, health, inequities, and necropolitics, always in the context of inequalities and racism so as to also contemplate anti-racist actions.

The project was approved by the Research Ethics Committee (CAAE no. 54707321.6.0000.8124). The people interviewed will not be characterized so as not to reveal their identity. In the excerpts of the speeches, African and unisex names were used, with the following meanings: Ayo (joy, happiness), Eno (gift, present), and Abayomi (born to bring joy and happiness). For the other names mentioned in our study, random letters were used. The results are presented in two articulated topics: the characterization of the quilombo and the repercussions on synergy.

Characteristics of the Mata Cavalo quilombo: affections and precariousness

Mata Cavalo currently has 251 permanent households; most of the houses have straw roofs, dirt floors, and mud walls, 88.77% of which are standard structures¹⁹19 Moreira DL. Território, luta e educação: dimensões pulsantes nos enfrentamentos dos conflitos socioambientais mapeados no Quilombo de Mata Cavalo [dissertação]. Cuiabá: Programa de Pós-Graduação em Educação/Universidade Federal de Mato Grosso; 2017.. Its history is full of struggles, resistance to the oppression suffered by colonial slavery, which crisscrosses time and is reconfigured today, as noted:

The intense and continuous relationship that people have with the body-territory of Mata Cavalo makes us think of it as a space of quilombola identity, as it is physical-material, political, economic, and symbolic²⁰20 Silva SR, Nascimento LK. Negros e territórios quilombolas no Brasil. Cad CEDEM 2012; 3(1):23-37.. So much so that the Mata-Cavalenses build, reaffirm, and perpetuate a strong emotional, physical, and cultural bond with their ancestral land. Let’s listen:

However, in addition to the struggle for title and definitive possession of land, there are other necessary struggles given the structural conditions of life in Mata Cavalo, as witnessed by the visit⁵5 Madureira KG. A sindemia da covid-19 em uma comunidade quilombola de Mato Grosso: repercussões e iniquidades em saúde [dissertação]. Cuiabá: Programa de Pós-Graduação em Saúde Coletiva/Universidade Federal de Mato Grosso; 2023.: unpaved roads, potholed stretches, others full of water (it was a rainy day), without lighting and signage, making quilombolas vulnerable to the risk of accidents and violence. It is a precariousness that makes it difficult to transport local products to be sold nearby or to reach emergency/ambulance care. Although the recognition of the rights of the quilombola is set forth in the constitution, the effective promotion of access and enjoyment of full citizenship faces challenges and barriers, as they claimed, showing the synergy of weakening aspects of existence:

Another pre-existing structural condition refers to insufficient basic sanitation. It is known that in Brazil, 8 out of every 10 people living in rural areas do not have access to it²¹21 United Nations Children's Fund (UNICEF), World Health Organization (WHO). Progress on household drinking water, sanitation and hygiene 2000-2017: Special focus on inequalities [Internet]. 2019 [cited 2023 mar 28]. Available from: file:///C:/Users/Edina/Downloads/JMP-2019-FINAL-high-res_compressed.pdf, and there are about 31 million residents of rural areas in need of sanitation, especially access to water, which is associated with poverty and malnutrition, diarrhea, and other parasitic diseases²²22 Brasil. Ministério da Saúde (MS). Fundação Nacional de Saúde (Funasa). Programa Nacional de Saneamento Rural. Brasília: Funasa; 2019.. In Mata Cavalo, it was mentioned that “our difficulty here is water. We have a huge problem, not only in Mata Cavalo, but in the entire municipality, there is a problem with water [...]” (Eno).

This data is important, as the WHO²³23 Organización Mundial de la Salud (OMS). Agua, saneamiento, higiene y gestión de desechos em relación con el SARS-CoV-2, el virus causante de la COVID-19: orientacion es provisionales [Internet]. Ginebra: OMS; 2020 [acesso 2023 mar 28]. Disponível em: https://apps.who.int/iris/bitstream/handle/10665/333807/WHO-2019-nCoV-IPC_WASH-2020.4-spa.pdf. established hand hygiene as a strategy to combat and control COVID-19 and provided guidance on basic sanitation. In addition, it is essential to promoting the health of the population and its absence, in a peripheral context, generally occupied by black and poor people, reveals structural racism. In this way, quilombolas have their phenotype and rurality “transformed both into the mark and the cause of their poverty, humiliation, oppression”²⁴24 Nyerere JK. Speech to the Congress. Black Scholar 1974; 5(10):16-22., accentuated in the poorest regions where the black population is the majority³3 Nascimento A. O Quilombismo. São Paulo, Rio de Janeiro: Editora Perspectiva, IPEAFRO; 2019.. These are not representations of isolated precariousness, but rather combined and intersected examples that synergistically enhance the weakening of life in a black territory. It is necropolitics operating through the social inequalities experienced by quilombolas in which the State, through the exercise of power and structural violence, has relegated the black population to the periphery of access and health care and decent living conditions.

One aspect to highlight is the mobilization of knowledge from other therapeutic systems, which becomes problematic when imposed by the insufficiency of official health services and access problems, as reports suggest. Ethnobiology²⁵25 Diegues ACS, Arruda RSV, Silva VCF, Figols FAB, Andrade D. Saberes tradicionais e biodiversidade no Brasil [Internet]. Brasília, São Paulo: MMA, USP; 2000. [acesso em 28/3/2023]. Disponível em: http://livroaberto.ibict.br/bitstream/1/750/2/Biodiversidade%20e%20comunidades%20tradicionais%20no%20Brasil.pdf. encompasses knowledge and ways of knowing how to perform certain actions that are transmitted orally and culturally characterize a traditional community. This is the case with the use of plants, herbs, roots, medicinal oils, and even practices by healing specialists (healers, herbalists, pais-de-santo, healers), not restricted to rural, traditional, isolated, or backward areas²⁶26 Loyola MA. Medicina popular: rezas e curas do corpo e de alma. Rev Cien Hoje 1987; 6(35):34-43., as they occur of comprehensive understanding of the health-disease-life-territory process that does not dissociate Nature/Culture:

Another ancestral practice is family farming, which is key to the economy of Mata Cavalo for subsistence and commercialization at fairs, on the roadside, or in small intermediate establishments. This contrasts with the logic of large-scale agriculture and monoculture, which prevails in Mato Grosso. The first guarantees food on citizens’ tables, while the second turns products into commodities and intensifies the environmental impacts that result, primarily from human action linked to agriculture guided by the agribusiness model, hegemonic in Mato Grosso²⁷27 Pignati WA, Montanari-Correa ML, Leão LHC, Pignatti MG, Machado JMH, organizadores. Desastres sócio-sanitário-ambientais do agronegócio e resistências agroecológicas no Brasil. São Paulo: Outras Expressões; 2021.. State institutional support for these two models is historically disproportionate (it has color!), expresses neglect, and, with the black population being the most affected by environmental degradation, reverberates as environmental racism, as discussed by Tavares et al.²⁸28 Tavares JR, Silva CG, Guimarães CFE, Costa RS. Racismo ambiental, esquecimento e seletividade estatal: Quilombo Vidal Martins e o Parque Estadual do Rio Vermelho/SC. Rev Politicas Publicas 2021; 25(2):701-719., correlating it with forgetfulness and state selectivity. Our interlocutors provide clues about a more sustainable local relationship with natural resources:

With few job opportunities in the rural area, in Mata Cavalo there are inhabitants who live in the community and in larger municipalities, with older people remaining in the area, as Ayo explains: “the majority of those who live here are elderly”. Rural work demands difficult physical efforts as people age, generating dependence on social programs, as Abayomi said: “there are those who live on retirement, you know. There are those who live on family grants (Bolsa Família)”.

Under these conditions, COVID-19 will arrive, configuring the syndemic discussed below.

Repercussions in synergy: the coronavirus syndemic in Quilombo Mata Cavalo

Colonial interests and entrails led the Brazilian State to anchor the Policy for Combating COVID-19 in biological and individualized factors. Disregarding the social inequalities that make COVID-19 operate differently in social groups makes the intentional extermination of the poor, black, and rural population explicit (Necropolitics!).

It is necessary to first consider social and biological processes in order to understand the production of diseases in the community, analyzing the determining elements, expanding the causal explanation⁹9 Bispo Jr JP, Santos DB. COVID-19 como sindemia: modelo teórico e fundamentos para a abordagem abrangente em saúde. Cad Saude Publica 2021; 37(10):e00119021.^,2929 Laurell AC. A saúde-doença como processo social. Rev Latino Am Salud 1982; 2:7-25.. In this sense, we agree that race/color, social class, gender and generation are structuring factors in society, interfering in the outcomes of health, illness, care, and deaths¹³13 Werneck J. Racismo institucional e saúde da população negra. Saude Soc 2016; 25:535-549.^,3030 Goes EF, Ramos DO, Ferreira AJF. Desigualdades raciais em saúde e a pandemia da Covid-19. Trab Educ Saude 2020; 18(3):e00278110.^,3131 Lopes F. De volta aos primórdios: em defesa do SUS como uma política antirracista. Bol Análise Político Institucional 2021; 26:9-19.. It thus allows us to affirm that COVID-19 is not a democratic disease, and it is not a pandemic (biological, common to all), but rather a syndemic, in which conditions and states combine and enhance that have an impact on the health-disease process⁸8 Horton R. Offline: COVID-19 is not a pandemic. Lancet 2020; 396(10255):874.^,99 Bispo Jr JP, Santos DB. COVID-19 como sindemia: modelo teórico e fundamentos para a abordagem abrangente em saúde. Cad Saude Publica 2021; 37(10):e00119021.. The deaths related to COVID-19 mentioned below are attributed to comorbidities; however, we understand that there are synergistic interactions with living conditions in the context of racial inequalities, showing a production of meanings about those deaths that borders on naturalization.

The black population has a higher prevalence of pre-existing chronic illnesses, such as high blood pressure and diabetes³²32 Brasil. Ministério da Saúde (MS). Política Nacional de Saúde Integral da População Negra: uma política para o SUS. Secretaria de Gestão Estratégica e Participativa, Depto de Apoio à Gestão Participativa e ao Controle Social. 3ª ed. Brasília: Editora do Ministério da Saúde; 2017., which are most related to deaths from the new coronavirus. Remembering that in Mata Cavalo “the majority of those who live here are elderly”, the susceptibility is compounded by the fact that black people compulsorily hold the monopoly on social marginalization, suffering, exclusion, deprivation of rights, and fundamental freedoms³³33 Azevedo E. A escravatura atual chama-se fome [Internet]. Le Monde; 2021 [acessado 2023 mar 28]. Disponível em: https://diplomatique.org.br/a-escravatura-atual-chama-se-fome/.
https://diplomatique.org.br/a-escravatur... . Hence, synergies.

Faced with the conditions that render the population vulnerable, CONAQ, the Government, and the Mata Cavalo Associations, in alliances, political and social solidarity, and mutual aid joined forces to mitigate the consequences of the syndemic, as they explain:

We reiterate that Mato Grosso stands out in soybean planting and has the largest cattle herd in Brazil³⁴34 Instituto Brasileiro de Geografia e Estatística (IBGE). Cidades e Estados. Nossa Senhora do Livramento-MT [Internet]. [acessado 2023 mar 30]. Disponível em: https://www.ibge.gov.br/cidades-e-estados/mt/nossa-senhora-do-livramento.html.
https://www.ibge.gov.br/cidades-e-estado... . However, such crops are not intended to feed the people, as they are goods, commodities²⁷27 Pignati WA, Montanari-Correa ML, Leão LHC, Pignatti MG, Machado JMH, organizadores. Desastres sócio-sanitário-ambientais do agronegócio e resistências agroecológicas no Brasil. São Paulo: Outras Expressões; 2021.. The food shortage, evident in Mata Cavalo, has always been a colonial enterprise linked to the private interests of agribusiness and the economy, aggravated and made visible by the COVID-19 syndemic. It is an exacerbation of chronic problems that go beyond the scope of health, reaching economic, political, and structural situations, overlapping racial inequalities, accentuating a place of shortcoming for the black population, on the margins of public policies³⁵35 Santos ER. Necropolítica, coronavírus e o caso das comunidades quilombolas brasileiras. Rev CEAM 2020; 6(1):114-124..

The rates of illness and death from COVID-19 have been higher in the black population than in the white population, explained by the social determination of the health-disease binomial, the interaction with prevalent chronic diseases, and differences in access to appropriate services³⁶36 Araujo EM, Caldwell KL, Santos MPA, Souza IM, Santa Rosa PLF, Santos ABS, Batista LE. COVID-19 morbimortality by race/skin color/ethnicity: the experience of Brazil and the United States. Saude Debate 2020; 44(n. esp. 4):191-205. - a clear expression of institutional racism!

And then the virus arrived in Mata Cavalo. The uncertainties and poor scientific knowledge about the disease, the presence of positive cases in the community, combined with structural and service difficulties, generated insecurity, fear, and despair, that is, it had an impact on the mental and emotional health of the people of Mata-Cavalo, as can be seen in the following testimonials:

In this context of syndemic, the fear of becoming ill and dying, anguish and sadness, feelings of impotence and fear of losing subsistence conditions are common³⁷37 Noal DS, Passos MFD, Freitas CM, organizadores. Recomendações e orientações em saúde mental e atenção psicossocial na COVID-19. Rio de Janeiro: Fiocruz; 2020.. In Abayomi’s speech, it is clear that symptoms are heightened when social markers of (in)difference make subjects and groups more or less vulnerable to illness; therefore, psychological suffering reverberates singularly in the lives of the black population.

Another repercussion on the mental health of quilombolas was the isolation and distancing measures. This clashes with the way of life there, which cultivates relationships, the collective, consistent with ancestral practices²⁰20 Silva SR, Nascimento LK. Negros e territórios quilombolas no Brasil. Cad CEDEM 2012; 3(1):23-37.. Abayomi spoke of the decision that “we are going to enclose ourselves, we are going to close our houses even to relatives who come from the city”, and Eno explained, “we tried to avoid the presence of our relatives and our daughter as much as possible. We were isolated”. Isolation had an impact on the commercialization of local products, affecting mental health due to the threat to material survival because, as Abayomi said, “many families live specifically by selling their products and without leaving the community, without receiving people in the community, how would they produce?”.

Symptoms of confinement, such as anxiety, depression, the harmful use of alcohol, lower mental well-being, and quarantine, including boredom, loneliness, and anger³⁸38 Ahmed MZ, Ahmed O, Aibao Z, Hanbin S, Siyu L, Ahmad A. Epidemic of COVID-19 in China and Associated Psychological Problems. Asian J Psych 2020; 51:102092., result from the interaction of factors experienced by everyone during the syndemic, such as human finitude, the severity of the disease, misinformation, fake news, the fragility of life, and the precariousness of health services. However, with the insufficiency of health services, vulnerability and aggression due to pre-existing cultural prejudices, the psychosocial repercussions were exacerbated in Mata Cavalo, causing them to experience pandemonium, a climate of tension, fear, and horror, as can be seen. In other words, the health, social, and economic effects impact the entire population of the syndemic, but some groups experience it more acutely³⁷37 Noal DS, Passos MFD, Freitas CM, organizadores. Recomendações e orientações em saúde mental e atenção psicossocial na COVID-19. Rio de Janeiro: Fiocruz; 2020.:

This fear affected us day and night, because when we saw the death of children with COVID, worsening the number of hospitalizations, infections, and then a lot of people ended up getting sick and even aggravating a certain type of disease due to the fear of getting sick, of getting serious due to fear, of not having service, because most people don’t have the resources for private care. I think this fear made us more sick than COVID itself [...] we couldn’t have that contact, and the children here come in and hug, they want to give blessings, there’s a lot of this issue of touch, it was a lot of suffering to see the child and not being able to touch her, get close, having to wear a mask [...] it was a very tense, very difficult moment [...] here everyone really isolated themselves because they were very afraid [...] we suffered from this fear (Abayomi).

The above scenario reveals the relevance of mental health care during the syndemic, concomitant with its absence in the actions of the National Policy to Combat COVID-19¹⁷17 Soares CCA. Educação ambiental na comunidade quilombola de Mata Cavalo: diálogos da arte, cultura e natureza [dissertação]. Cuiabá: Programa de Pós-Graduação em Educação/Universidade Federal de Mato Grosso; 2018.:

Body and mind are inseparable. In the narratives, there is a lack of massive actions to embrace the feelings raised in/by the syndemic, without using psychiatry on them, converging with the principles of integrality and equity provided for in SUS and the Brazilian Psychiatric Reform.

Another extreme repercussion was death from complications due to COVID-19:

The death of a quilombola individual has qualitative importance, going beyond physical death, as it is replete with meaning, symbolism, powerful meanings, especially of elderly people who carry the story in their memory, (re)told orally in intergenerational sociability. Such deaths mean the political, cultural, linguistic, religious, and ancestral extermination of a people³⁵35 Santos ER. Necropolítica, coronavírus e o caso das comunidades quilombolas brasileiras. Rev CEAM 2020; 6(1):114-124.:

We thus noted the reflection of how the colonial system is ingrained in Brazilian structural relations so that quilombolas continue their struggles for existence and promotion of the right to a dignified life. To paraphrase Millôr Fernandes, “Quilombo Mata Cavalo has a long past ahead of it”, so it is necessary to resist. Diffuse and persistent racism, its consequences and repercussions, is not a finished process; therefore, non-passivity mobilizes anti-racist confrontations. We need to follow the abolitionists!

Final considerations

Considering the COVID-19 syndemic and its repercussions made it possible to understand part of the fight against the coronavirus, unmasking the underlying values of the State in treating the phenomenon as a pandemic and a democratic disease. This understanding was based on reports with all the strength, authority, and legitimacy of the experience of interlocutors who echo voices.

Quilombolas consist of the black population and were uniquely exposed to the virus, with emphasis on the psychosocial repercussions, explained by the historical awareness that precariousness and racial prejudice are important filters for access to care, materializing the institutionalized face of racism.

It is the present/future repeating the past. For 523 years, racism and the extermination of the black population have been part of our reality. In the end, Brazil was built through/on the blood and sweat of the black people spilled on this ground. Enslaved Africans arrived in the land of gold and brazilwood without luggage, without accommodation, without rights, and without health care. Health disparities and racial/social inequality are historic, and the black population has been encaged in a situation of poverty and vulnerability - a process that the new coronavirus syndemic has highlighted and heightened.

In Brazil, the abolition of slavery was incomplete, as “freed” black bodies remained outside the focus of the State, lacking public actions and services in areas considered key to human development.

The syndemic perspective is appropriate for a non-fragmented understanding of complex and structuring problems, such as racism and racial inequalities with the intersectionalities placed in micro, meso, and macrosocial interactions, and are reflected in the existence of the black population. In coherence, it can support comprehensive, multisectoral, and integrated responses that are, above all, anti-racist.

An anti-racist and counter-hegemonic proposal in health policy basically consists of two aspects. First, repair rural sanitation, and the precarious infrastructure of homes, roads, and the economy, that is, pay off the State’s historic debt to the black population. Second, overcome the historical absence of dialogue with the quilombola peoples, given the sepulchral silencing imposed upon their experiences, way of life, and worldview. This movement intends to transform them from poor and peasants into valuable people, where their civilizing values, experiences, and collective ways of organizing and dynamizing life, as well as their medical knowledge and ancestral practices, are respected and valued in an attempt to contemplate and implement health actions in its territory.

It is necessary to strengthen and implement existing actions, such as the Statute of Racial Equality and the National Policy for Comprehensive Health of the Black Population (Política Nacional de Saúde Integral da População Negra, PNSIPN), as well as to develop policies and create institutions based on social and cognitive (epistemic) justice - a universe of dialogue where silenced voices can be heard, an alternative to westernized and colonized knowledge. In health, this requires producing white-centered, black-centered, indigenous-centered, and quilombola-centered knowledge, that is, knowledge from specific points of view and the promotion of worthwhile encounters.

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