Abstract

Introduction

Issues that are part of students’ life are not limited to the ways in which they adapt to and develop academic life. Such issues also involve habits and changes related to health, eating patterns, leisure, cultural practices, sexual practices, and students’ relationship with their family. The permanent correlation and interaction between the personal, professional, social and structural dimensions determine and can generate processes related to health promotion and quality of life and, at the same time, destructive processes that affect the student’s physical and mental health¹1. Carmo MC, Polydoro SAJ. Integração ao ensino superior em um curso de pedagogia. Psicol Esc Educ. 2010; 14(2):211-20.

2. Oliveira RA, Ciampone MHT. A universidade como espaço promotor de qualidade de vida: vivências e expressões dos alunos de enfermagem. Texto Contexto Enferm. 2006; 15(2):254-61.-³3. Sampaio SMR. Observatório da vida estudantil: primeiros estudos. Salvador: Edufba; 2011..

It is possible to identify, in the international literature, a number of stressors that contribute to increase the health problems of higher education students, such as: examinations, time demands and financial pressures⁴4. Aherne D. Entendendo o estresse do aluno: uma abordagem qualitativa. Ir J Psychol. 2001; 22(3/4):176-87., changes in sleeping and eating habits, new responsibilities and increased workload⁵5. Ross SE, Niebling BC, Heckert TM. Fontes de estresse entre os estudantes. Coll Stud J. 1999; 33(2):312-7., meeting new people, career decisions, fear of failure and parents’ pressure⁶6. Schafer W. Gerenciamento de estresse para bem-estar. Fort Worth: Harcourt Brace College Publishers; 1996 ..

In a recent literature review about the health of higher education students, the university emerged in the studies as a space that intensifies some health-related problems, like anxiety, depression, poor sleep quality, cardiovascular diseases, increased consumption of alcohol and other drugs, poor eating habits, sexual vulnerability, among others. These studies attribute to students the responsibility for producing health risks. Few studies have problematized the issues involved in students’ health-disease process⁷7. Santana ER. A experiência do adoecimento e a busca por cuidados na universidade: narrativas de estudantes do bacharelado interdisciplinar em saúde da UFBA [dissertação]. Salvador: Universidade Federal da Bahia; 2018..

The education model of the Brazilian universities is a factor to be considered in students’ health-disease process. In this sense, students attending the Interdisciplinary Bachelor’s Degree in Health (Health BSc) of the Federal University of Bahia (UFBA) are inserted in a new proposal for higher education that poses new challenges. The Health BSc is an education program divided in cycles. The first one encompasses the education provided by the Bachelor’s Degree in Health. After completing the first education cycle, which lasts three years, the student can choose to continue his or her academic trajectory in one of the Linear Progression Programs (LPP) in the area of health and/or in other areas, start a third cycle through postgraduate programs, or enter the job market⁸8. Universidade Federal da Bahia. Projeto pedagógico do bacharelado interdisciplinar em saúde. Salvador: UFBA; 2010.. The options of programs offered in the area of health for the second cycle are: Psychology, Biotechnology, Biological Sciences, Nursing, Pharmacology, Physiotherapy, Speech-Language Pathology and Audiology, Gastronomy, Natural Sciences, Veterinary Medicine, Nutrition, Medicine and Dentistry.

Teles carried out a study⁹9. Teles MVAO. A escolha dos estudantes do Bacharelado Interdisciplinar em Saúde da UFBA pela área da saúde [dissertação]. Salvador: Universidade Federal da Bahia; 2015. in which she found that students who start attending the Health BSc are motivated by the strong desire to enter, subsequently, the Medicine program, as it offers higher remuneration, social status and prestige. Today, the process of career choice brings with it conflicts pervaded by the forms of social bonds, under the protection of capitalism, in which the subject aims to meet the demands of immediacy, of professional success, without taking into account his/her identifications, without perceiving him/herself as a subject of possibilities and choices⁹9. Teles MVAO. A escolha dos estudantes do Bacharelado Interdisciplinar em Saúde da UFBA pela área da saúde [dissertação]. Salvador: Universidade Federal da Bahia; 2015..

The trajectory up to the second education cycle for the Health BSc students who want to study Medicine has been permeated by conflicts and afflictions. Entrance into the second cycle depends on the academic performance coefficient that the Health BSc student obtained during the program. Each semester, 200 students start attending the Health BSc in the evening period and 100 students in the daytime period. At the end of the second cycle, only 32 seats are available for the Medicine program of the Salvador campus (16 for racial quota holders and 16 for non-quota holders). In addition, the Vitória da Conquista campus, also in the State of Bahia, opens 6 seats for broad competition. The small number of seats does not match the contingent of students who want to study Medicine. Due to this, students establish tiring study routines, change their eating habits and their practice of physical activities, and reduce their social interaction outside the university, not to mention that conflicts with teachers and peers arise. This way of experiencing the education process can lead students to develop many health problems.

The ways in which individuals or social groups respond to health problems have been analyzed in some studies by means of the analytical category “illness experience”. Generally speaking, studies about the illness experience are materialized by the hermeneutic-phenomenological approach and aim to understand and problematize how individuals undergo an “experience of feeling ill” and how they attribute meanings to this experience¹⁰10. Alves PC. A fenomenologia e as abordagens sistêmicas nos estudos sócio-antropológicos da doença: breve revisão crítica. Cad Saude Publica. 2006; 22(8):1547-54.. The use of this concept can be articulated to an amplified concept of health that involves social determinants of the health-disease process and not only health as the absence of disease. In a broad sense, health results from the person’s conditions of eating, housing, education, income, environment, work, transport, employment, leisure and freedom, as well as their conditions of access to and ownership of land, and access to health services¹¹11. Constituição (1988). Constituição da República Federativa do Brasil. Brasília, DF: Senado Federal; 1988..

In view of what was exposed so far, the aim of this study was to analyze the illness experience of students attending the Interdisciplinary Bachelor’s Degree in Health who became ill during their academic trajectory.

Methodology

This study, guided by the qualitative approach, aims to identify aspects of university life that can affect the health of students attending the Health BSc, and to investigate the senses and meanings attributed to the illness experience. The study derives from a Master’s thesis entitled “The illness experience and the search for care in higher education: Narratives of students attending the Interdisciplinary Bachelor’s Degree in Health of UFBA”, submitted to the Postgraduate Program in Interdisciplinary Studies about the University (UFBA).

Health BSc students who had some health problem during undergraduate education were included in the study. To identify these students, the researchers contacted the administrative office of the Institute of Humanities, Arts and Sciences Prof. Milton Santos, of the Federal University of Bahia, and requested a list containing the electronic mail of all the enrolled students. Based on this list, the first contact with the students was made through an e-mail that explained the objectives of the research and invited them to participate in it. At first, ten students answered the e-mail, showing interest in participating in the research. Then, the researchers contacted those ten people, and only three accepted to participate in the research.

The study was submitted to and approved by the Research Ethics Committee of the Nursing School of the Federal University of Bahia (CAAE: 62335516.2.000.5531), and complied with the provisions of Resolution no. 466/13 of the National Health Council about research involving human beings.

The interviews were conducted from February to June, 2017. The use of an audio recorder was previously authorized by the interviewees. The technique of Narrative Interview (NI) was employed, with the purpose of matching the life histories to the social and historical contexts of the subjects who participated in the study. A script was used to conduct the interviews, containing the following guiding topics: the student’s biography, her admission to university, and the onset of the health problem at university.

The theoretical framework adopted in the study was that of the illness experience. The specialized literature about this concept is based on the premise that people (re)produce medical and non-medical knowledge existing in the sociocultural context in which they are included. This experience, in itself, discloses aspects that are both social and cognitive, subjective (individual) and objective (collective)¹²12. Alves PC. Experiencing illness: theoretical considerations. Cad Saude Publica. 1993; 9(3):263-71..

In the analysis of the narratives, thematic analysis, as proposed by Jovchelovitch and Bauer¹³13. Jovchelovitch S, Bauer MW. Entrevista narrativa. In: Bauer MW; Gaskell G, organizadores. Pesquisa qualitativa com texto, imagem e som. Petrópolis: Vozes; 2007. p. 90-113., was adopted. It consists of the gradual reduction of texts, aiming at performing meaning generalizations and condensations, through the following stages: transcription of the interviews and comprehensive reading; creation of three categories, based on the interview script, which will be presented in the discussion; compartmentalization of the narratives into units, taking the meanings, contexts and framings into account, enabling to create codifications in each interview in an individual way; finally, construction of a synthesis based on the interpretation of the entire produced material.

The stories presented below refer to three female students who participated in the study, aged 22 years on average, who were attending the 2^nd, the 5^th and the 6^th semesters of the Health BSc at the time of data collection. It is important to mention that fictitious names were used in order to protect the interviewees’ identities.

Ana: was born in the city of Maceió (State of Alagoas, Northeastern Brazil) and is 22 years old; her father was a bank employee and a teacher, and her mother was a commercial representative. Ana wanted to study Medicine. After one year attending a course that prepares students to pass the university entrance examination, she was admitted to the Health BSc (daytime period). She reports that the first semester was peaceful: despite the nervousness and expectation related to entering the Medicine program on a subsequent date, she succeeded in going to the gym, waking up early, and performing extra-class activities. However, from the third semester onwards, her routine changed and the first signs of pain in the knee and spine, which would later become chronic, started to appear; according to her, due to sedentariness and to remaining seated in the same position for long periods of time.

Lara: was born in an inland city of the State of Bahia, Northeastern Brazil, close to Chapada Diamantina. She is 20 years old and was raised by her mother. Before she was 8 years old, her father moved to São Paulo and when she completed High School, she moved in with her father. In São Paulo, Lara started to work and attended a course to prepare for universities’ entrance examinations, with the objective of studying Medicine; however, she did not pass the exams. Then, she decided to return to Bahia and succeeded in entering the Health BSc (daytime period) through the National High School Exam (ENEM). Lara’s family has few financial resources and, when she started university, she devised some strategies to be able to continue her higher education studies. One of them was to have lunch and dinner at the University Restaurant, which, as time went by, resulted in gastrointestinal discomfort.

Manu: was born in Salvador, the capital of the State of Bahia, and is 22 years old. Her mother is a bank employee and her father works in sales. Her family is evangelical and she has always dreamed about being a missionary and participating in an exchange program. She believed that if she studied Medicine, she would be able to help many people. In the third year of High School, she won a grant from a preparatory course and, through the National High School Exam (ENEM), she succeeded in entering the Health BSc (daytime period). Manu reports that she has always been too hard on herself, as she believes she must be an exemplary daughter and perform all the tasks required at school or at church. Since she was 12 years old, she has had anxiety crises, but her Christian father said that the only psychologist was God and refused to let her undergo treatment for the anxiety crises. According to Manu, the crises worsened when she started university.

Illness experience and health education

The life histories of the students who participated in the study are different regarding the specificity of each one’s trajectory towards higher education, but they are similar in that the interlocutors share the same dream: they want to study Medicine. By sharing the same dream within the same context - the Health BSc -, the students’ illness experience acquires senses and meanings that are mediated by their life at university. To Dewey¹⁴14. Dewey J. Arte como experiência. Ribeiro V, tradutor. São Paulo: Martins Fontes; 2010., “experience” is related to the living being and his or her social environment. Furthermore, an experience has a pattern and a structure because it is not an alternation between doing something and being subject to something; rather, it consists of the two things related to each other. Becoming ill at university does not mean, necessarily, having an experience. The action and its consequence must be joined in perception for it to become an experience.

The narratives below highlight the beginning of the first signs of illness, which appeared when the students started university and began to adapt to the academic routine.

Based on the narratives, it is possible to notice there are three distinct elements that triggered the students’ illness process: Ana tries to balance the practice of physical activity with an academic routine that is unstable; Lara addresses the financial difficulties that prevent her from choosing what to eat; and to Manu, the central issue is the amount of material she needs to study to correspond to what she demands from herself. Alves¹²12. Alves PC. Experiencing illness: theoretical considerations. Cad Saude Publica. 1993; 9(3):263-71. argues that the conscience of feeling ill is always a “conscience in situation” and is related to specific projects and existential contexts. The context in question is the process of transition and adaptation to higher education, which is complex and multidimensional, dependent on personal and contextual factors, that is, this process is marked, on the one hand, by students’ exchange of expectations, skills and characteristics and, on the other hand, by the university, its community, structure and organizational elements¹⁵15. Almeida LS, Soares AP. Os estudantes universitários: sucesso escolar e desenvolvimento psicossocial. In: Mercuri E, Polydoro SAJ, organizadores. Estudante universitário: características e experiências de formação. Taubaté: Cabral; 2003..

In the reports above, when the students are asked how the health problems started, they begin their narratives by trying to justify the causes of the illness, revealing a feeling of guilt in relation to their actions and their consequences. This feeling became even more present in the narratives below:

Ana and Manu experience a conflict between their desire to take care of their health and the need to complete the academic activities. According to Dewey¹⁴14. Dewey J. Arte como experiência. Ribeiro V, tradutor. São Paulo: Martins Fontes; 2010., in the process of lived experience, what we observe and what we think, what we desire and what we get may disagree. When these disagreements addressed by the author happen, the students start to feel guilty. According to Ayres¹⁶16. Ayres JRCM. O cuidado, os modos de ser (do) humano e as práticas de saúde. Saude Soc. 2004; 13(3):16-29., wondering why, how and to what extent you are responsible for something is like wondering who you are and what place you occupy before the other. The feeling of guilt is associated precisely with who one is and what is expected from a student in the field of health. Demanding that students should adopt healthy habits and putting the blame on them when they do not adopt those habits are present in common sense and in scientific studies¹⁷17. Domingues MPS, Brandt GP, Oliveira APR, Souza SJP, Ramires MG, Burci LM. Automedicação entre os acadêmicos da área de saúde. Visao Acad. 2017; 18(2):4-11.

18. Lessa SS, Montenegro AC. Avaliação da prevalência de sobrepeso, do perfil nutricional e do nível de atividade física nos estudantes de medicina da Universidade de Ciências da Saúde de Alagoas - UNCISAL. Rev Soc Bras Clin Med. 2008; 6(3):90-3.

19. Marcondelli P, Costa THM, Schmitz BAS. Nível de atividade física e hábitos alimentares de universitários do 3º ao 5º semestres da área da saúde. Rev Nutr. 2008; 21(1):39-47.-²⁰20. Zubaran C, Lazzaretti R. Uso de moderadores de apetite entre estudantes da área da saúde na Região Sul do Brasil. Einstein. 2013; 11(1):47-52.. In these studies, the senses and meanings of the adoption of practices that are considered inadequate have not been problematized and are reduced to blaming the subject for the adoption of a conduct that is not expected from a student in the field of health. It is believed that attending a health education program is sufficient for students to adopt healthcare practices. These studies do not take into account that university life and the educational trajectory are dynamic spaces, permeated by conflicts and full of contradictions, as they are not isolated from the world and from people’s life experiences, which are different from one another. This dynamics of life is revealed in the histories of the students who were part of our study. They undergo financial difficulties to continue studying at university, must choose between sleeping and completing the academic activities, and are pressed to have a good performance. Such factors make them neglect care and concentrate on other demands:

When the pain Ana feels is considered part of her, the conception that there are psychological and social “components” in the form people feel and experience pain comes to the surface. This conception, however, implies that pain is a previous bodily experience to which psychological and cultural meanings are added²¹21. Sarti CA. A dor, o indivíduo e a cultura. Saude Soc. 2001; 10(1):3-13.. Studying and living with pain are experiences that take place within different fields of meanings, in which the completion of academic activities assumes greater importance, to the detriment of the body’s wellbeing.

To anthropology, a disease is not merely a “biological entity” that should be treated as a thing; it is an experience that is constituted and acquires meaning in the course of interactions between individuals, groups and institutions²²22. Rabelo MC, Alves PC, Souza IMA. Experiência da doença e narrativa. Rio de Janeiro: Fiocruz; 1999.. Universities are institutions where many people live and experience different aspects of their lives; therefore, they have great potential for protecting students’ health and promoting their wellbeing²³23. Mello ALSF, Moyses ST, Moyses SJ. A universidade promotora de saúde e as mudanças na formação profissional. Interface (Botucatu). 2010; 14(34):683-92.. However, Ana draws attention to the fact that “no health student is healthy”:

To Ana, the fact that students eat when they can fit it in their schedules, do not sleep well, feel pressed to have a good performance and good grades, feel tired and use medication and coffee to meet all the demands, means they do not have good health. Therefore, it is necessary to question the education model of the Brazilian universities, which is a factor to be considered in students’ health-disease process. It is known that projects which aim to implement changes in the university, like the project of education in cycles represented by the Interdisciplinary Bachelor’s Degrees, point to a more humanized dimension of personal relationships that takes into account the multidimensionality of subjects²⁴24. Lima JRN, Pereira AKAM, Nascimento EGC, Alchieri JC. Percepção do acadêmico de enfermagem sobre o seu processo de saúde/doença durante a graduação. Saude Transform Soc. 2013; 4(4):54-62.. However, what we see is an education process that is still much influenced by little humanized techniques, emphasizing the intellectual or cognitive dimension to the detriment of the emotional and social dimensions, without considering students’ experiences of life, health and illness in their educational trajectory.

Afflictions triggered by the desire to study Medicine

In a study developed by Pimentel²⁵25. Pimentel AC. O bacharelado interdisciplinar em saúde: um novo modelo de formação acadêmica ou uma via de acesso ao curso de Medicina [dissertação]. Salvador: Universidade Federal da Bahia; 2018. that aimed to investigate the factors that affect the decision-making process of first-semester students regarding their choice for UFBA’s Health BSc, it was found that 66% of the students who started university in 2016 informed they intended to study Medicine. Admission to the second education cycle after the Health BSc, represented by the desire to study Medicine, is permeated by different afflictions:

Anxiety emerges in the narrative as a collective feeling caused by the uncertainties regarding admission to the second education cycle in the Medicine program. According to Kleinman²⁶26. Kleinman A. The illness narratives: suffering, healing & the human condition. New York: Basic Books; 1988., in an anthropological perspective, disease is polysemic and multifaceted; the experiences and events related to it irradiate or hide more than one meaning. In this sense, studies²⁷27. Ferreira CL, Almondes KM, Braga LP, Mata ÁNS, Lemos CA, Maia EMC. Universidade, contexto ansiogênico? Avaliação de traço e estado de ansiedade em estudantes do ciclo básico. Cienc Saude Colet. 2009; 14(3):973-81.,²⁸28. Leão AM, Gomes lP, Ferreira MJM, Cavalcanti LPG. Prevalência e fatores associados à depressão e ansiedade entre estudantes universitários da área da saúde de um grande centro urbano do nordeste do Brasil. Rev Bras Educ Med. 2018; 42(4):55-65. carried out with students in the field of health have shown that anxiety is present among students and takes on various meanings. Ferreira et al.²⁷27. Ferreira CL, Almondes KM, Braga LP, Mata ÁNS, Lemos CA, Maia EMC. Universidade, contexto ansiogênico? Avaliação de traço e estado de ansiedade em estudantes do ciclo básico. Cienc Saude Colet. 2009; 14(3):973-81. analyzed anxiety traits in students from different areas of knowledge (technology, health and humanities) and found that the area of health was the one that most caused anxiety. In comparison to the other studied areas, health students had more intense academic demands, deriving from the daily classes that they attend in two periods, from monitoring activities, and from extra classes offered on weekends.

Leão et al.²⁸28. Leão AM, Gomes lP, Ferreira MJM, Cavalcanti LPG. Prevalência e fatores associados à depressão e ansiedade entre estudantes universitários da área da saúde de um grande centro urbano do nordeste do Brasil. Rev Bras Educ Med. 2018; 42(4):55-65.estimated the prevalence and factors associated with depression and anxiety in university students in the area of health and concluded that the prevalence of anxiety and depression among these students was higher than that of the general population, due to reasons that were already presented in the study conducted by Ferreira et al.²⁷27. Ferreira CL, Almondes KM, Braga LP, Mata ÁNS, Lemos CA, Maia EMC. Universidade, contexto ansiogênico? Avaliação de traço e estado de ansiedade em estudantes do ciclo básico. Cienc Saude Colet. 2009; 14(3):973-81..

In addition to anxiety, in the narrative below, Manu reports the pressure she puts on herself because she is already an adult and the responsibility she now has for her life in terms of her professional career.

According to Feodrippe et al.²⁹29. Feodrippe ALO, Brandao MCF, Valente TCO. Qualidade de vida de estudantes de Medicina: uma revisão. Rev Bras Educ Med. 2013; 37(3):418-28., the medical career begins before any professional practice: it begins in the competitive selection process (as it is still considered a well-remunerated program of high social prestige), in the family’s pressures and in the need for self-affirmation in relation to choices that lead the individual, early in life, to deprive him/herself of many pleasures to fulfil a greater objective: entering the Medicine program. However, this student’s anguish does not end with the conquest of a seat at university. On the contrary: during the courses, this student’s quality of life can be even more affected to meet the need of a good theoretical-scientific-practical education²⁹29. Feodrippe ALO, Brandao MCF, Valente TCO. Qualidade de vida de estudantes de Medicina: uma revisão. Rev Bras Educ Med. 2013; 37(3):418-28..

Lara, who came from a State school^d, reports that attending the Health BSc with the expectation of studying Medicine has made her feel stressed:

In addition to the issues that involve the dynamics in relation to the Health BSc and the entrance to the Medicine program, Lara questions low-income people’s access to and permanence in higher education. Entrance does not guarantee permanence in higher education, mainly of low-income students and students belonging to ethnical minorities, who face economic, pedagogical and symbolical-subjective difficulties. For students like Lara, who came from a State school and does not have a solid educational base to face the challenges imposed by higher education, this path can be even more difficult and generate a series of feelings. The pedagogical difficulties are related to the fact that low-income students have a smaller cultural and social capital, as many of them come from medium-level State schools that have a deficient infrastructure and lower quality when compared to elite schools. These students are not prepared to face the challenges of university programs. The same space can be considered an inclusion or an exclusion space, as it discriminates and expels students who are different from the cultured and elite standard that is still required by federal universities³⁰30. Paula MFC. Políticas de democratização da educação superior brasileira: limites e desafios para a próxima década. Avaliação (Campinas). 2017; 22(2):301-15..

In the narratives below, Manu and Ana present aspects of relationships established in the Health BSc that, in some way, contributed to make the final stage of their trajectory and the arrival at the Medicine program even more difficult and afflictive.

Ana and Manu report the difficulty they have in trusting their peers due to competitiveness, which is stimulated by the system of entrance to the Medicine program. In light of this, it is possible to perceive that personal relationships interfere in the way of experiencing the education process and hamper the path that leads to the Medicine program. Ana clarifies the extent to which these relationships are capable of affecting students’ health. In this sense, some studies have analyzed the relations between populations’ health and the development degree of the weave of bonds and associations among individuals and groups. These studies identify the wear of the so-called “social capital”, that is, of solidarity and trust relationships between people and groups, as an important mechanism that causes a negative impact on people’s health³¹31. Buss PM, Pellegrini Filho A. A saúde e seus determinantes sociais. Physis. 2017; 17(1):77-93..

The transformation of the educational trajectory into self-knowledge

According to Alves¹²12. Alves PC. Experiencing illness: theoretical considerations. Cad Saude Publica. 1993; 9(3):263-71., the point of departure to understand the disease is that it is necessarily tied to an experience. It is the experience of feeling ill that, on the one hand, originates, by itself, representations of the disease and, on the other hand, puts in motion the capacity to transform this experience into self-knowledge. Even with several situations that contribute to the wear and tear of relationships, due to the high competitiveness that exists in the Health BSc, Manu manages to find teachers who make her reflect on the education process, on the experience of feeling ill, and on healthcare:

Manu’s interpretation of the illness experience is a construction beyond institutions and biomedical knowledge. According to Alves¹²12. Alves PC. Experiencing illness: theoretical considerations. Cad Saude Publica. 1993; 9(3):263-71., the interpretation that people give to a certain illness experience is the result of the different means through which they acquire their medical knowledge. However, based on Manu’s narrative, it is possible to think of the construction of knowledge to deal with illness beyond biomedical knowledge, which is not the only one that is capable of explaining the health-disease and care process.

Manu’s narrative carries a subjective-reflective dimension of the subject that emerged in the classroom, intermediated by a social sciences teacher that is not a health professional and was not even requested to subsidize the care. Based on this, it is possible to think about “existence as a form of self-care”; likewise, in the existential analytic developed by Heidegger in “Being and Time”³²32. Heidegger M. Ser e tempo. Parte I. 8a ed. Cavalcante MS, tradutor. Petrópolis: Editora Vozes; 1999., he investigates man’s way of being, which he calls “existence”, “being-in” and “being-in-the-world”. The existential-ontological unit of the being-in is called “care” by Heidegger.

The experience of care can occur in a dialectic between knowledge, recognition, estrangement and discovery: only in this way can it be apprehended and integrated into life³³33. Rabelo MCM, Souza IMA, Alves PC. Trajetórias, sensibilidades, materialidades: experimentações com a fenomenologia. Salvador: EDUFBA; 2012. p. 9-44.. In this sense, the program provided a better understanding of her illness process and Manu starts to understand health in an amplified way. Understanding the field of health as a field of knowledge and practices³⁴34. Almeida Filho N. O que é saúde? Rio de Janeiro: Fiocruz; 2011., universities and other education institutions have been considered a fundamental space for a paradigmatic change in which health is seen in an amplified perspective, and this is one of the objectives of the Health BSc. According to Teixeira et al.³⁵35. Teixeira CFS, Coelho MTÁD, Rocha MND. Bacharelado interdisciplinar: uma proposta inovadora na educação superior em saúde no Brasil. Cienc Saude Colet. 2013; 18(6):1635-46., the Health BSc is a university education space that provides an introduction to the field of health, emphasizing knowledge appropriation and the development of skills and values that enable to understand the historical and social dimension of health conceptions and practices, thus contributing to enrich, humanize and improve future education in this area. Moreover, it enables students to situate themselves and become aware of the social determinants of health problems. These issues are present in Manu’s narrative and also in Lara’s:

In addition to the knowledge acquired during the program, Lara reports a maturation process during university education: the care that used to be mediated by the family has become her responsibility. Silva et al.³⁶36. Silva IJ, Oliveira MFV, Silva SED, Polaro SHI, Radünz V, Santos EKA, et al. Cuidado, autocuidado e cuidado de si: uma compreensão paradigmática para o cuidado de enfermagem. Rev Esc Enferm USP. 2009; 43(3):697-703.argue that self-care is only questioned or valued and perceived as essential to the human being when people become aware of their right to live and of the lifestyle they have.

Final Remarks

The experience of illness and care is part of the human being’s existence and can be experienced in different ways and contexts. In the present study, this experience is mediated by health education and by the university institution, which plays two roles: it is the place where illness takes place, but it also opens the possibility to learn about this process and reflect on it.

This study did not aim to exhaust the complex relationship that involves students’ illness experience at university; rather, its objective was to provide an initial reflection, exploratory and panoramic, on the current situation, proposing that illness and care should be dealt with in places other than the formal healthcare institutions. We hope that further studies stimulate reflections on the challenges of health education, approaching the issues of students’ illness and care, either in traditional courses or in innovative models like that of the Interdisciplinary Bachelor’s Degrees.

The transformation of the health sector begins with subjects’ education. The university needs to be constructed and analyzed beyond the status of educational institution and field of scientific knowledge. It is necessary to foster a university that promotes health and care and prioritizes the subjects who study and work in it.

Acknowledgments

The sudents who shared their life stories and the Graduate Program in Interdisciplinary Studies about the University, from the Federal University of Bahia, which provided financial assistance for the translation of this article

References

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