Abstract

With the expansion of the Family Health Strategy in Rio de Janeiro, RJ, Brazil, some health teams are inserted in territories permeated by armed conflicts becoming vulnerable to urban violence. The objective of the study was to analyze the effect these conflicts cause in the health of these workers. This is an intervention research, with qualitative approach, carried out with 13 health professionals in a family health unit located in the city of Rio de Janeiro, using institutional analysis as a theoretical-methodological referential. Stress, anguish, irritability, requests for leave of absence, among other findings, emerge from the speeches of the research participants. Armed conflicts are great tensors among health professionals, service users and management, making negative aspects to emerge, not only in the health of these workers, but also in their relations at work. The risks to physical and mental integrity that these workers undergo are constant and have a profound negative impact on their health.

Keywords:
Armed conflicts; Violence; Worker’s Health; Professional Practice; Primary Health Care

Introduction

The Family Health Strategy (FHS) is a traditional-health-care reorganizing model that transforms the care process, focusing on the family and considering the context in which it is inserted to provide a better understanding and intervention in the health and disease process by health teams (Oliveira; Pereira, 2013OLIVEIRA, M. A. C.; PEREIRA, I. C. P. Atributos essenciais da atenção primária e a Estratégia Saúde da Família. Revista Brasileira de Enfermagem, Brasília, DF, v. 66, p. 158-164, 2013. Número especial. Disponível em: <Disponível em: https://bit.ly/2nJ7mt4 >. Acesso em: 25 mar. 2016.
https://bit.ly/2nJ7mt4... ). FHS, the gateway for many users in the Brazilian National Health System (SUS), has been expanded in Rio de Janeiro, where coverage went from 32.3% in 2010 to 52% in 2016 (Neves et al., 2018NEVES, R. G. et al. Time trend of Family Health Strategy coverage in Brazil, its Regions and Federative Units, 2006-2016. Epidemiologia e Serviços de Saúde, Brasília, DF, v. 27, n. 3, p. 1-8, 2018. Disponível em: <Disponível em: https://bit.ly/396jFHh >. Acesso em: 22 dez. 2019.
https://bit.ly/396jFHh... ).

The Municipal Health Department prioritized the West Zone of Rio de Janeiro, scenario of this study, to begin the reorganization of health services, especially the FHS expansion (Jesus, 2013JESUS, R. V. L. A expansão da Estratégia Saúde da Família na cidade do Rio de Janeiro 2009-2012: estudo de caso na Área Programática 5.3. 2013. Dissertação (Mestrado em Saúde Pública) - Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, 2013. Disponível em: <Disponível em: https://bit.ly/2OgdmJb >. Acesso em: 6 jul. 2018.
https://bit.ly/2OgdmJb... ). This area stands out for having one of the worst economic and social development, marked by violence and a long period of disassistance (Nogueira; Marino; Ferreira, 2016NOGUEIRA, M. A.; MARINO, L. M. M. R.; FERREIRA, C. D. Investimento em atenção primária: uma revolução da saúde na Área Programática 5.3. Revista Saúde em Foco, Rio de Janeiro, v. 1, n. 2, 2016. Disponível em: <Disponível em: https://bit.ly/30GYJ4f >. Acesso em: 18 jun. 2018.
https://bit.ly/30GYJ4f... ). In this perspective, data also indicate the West Zone of Rio de Janeiro has the lowest Human Development Index (HDI) of the municipality, marked by significant social inequality and contrasting realities (Instituto Rio, 2013INSTITUTO RIO. Sobre a Zona Oeste. Rio de Janeiro, 2013. Disponível em: <Disponível em: https://bit.ly/30ESmi1 >. Acesso em: 2 abr. 2017.
https://bit.ly/30ESmi1... ).

FHS expansion causes the allocation of some health teams in highly socially vulnerable territories, being exposed to urban violence.

These territories, which suffer with the State’s absence, concentrate disassistance, unemployment and poverty, and their population, socially vulnerable, has to deal with urban violence on a daily basis, resulting in armed conflicts. Violence, evident in territories marked by poverty, changes family routines and reflects on service relationships in these communities (Costa; Ferreira, 2017COSTA, S. L.; FERREIRA, R. S. Violência urbana e assistência social no âmbito da proteção social básica. Revista de Políticas Públicas e Segurança Social, Teófilo Otoni, v. 1, n. 1, p. 54-76, 2017. Disponível em: <Disponível em: https://bit.ly/2LI8FWT >. Acesso em: 3 mar. 2018.
https://bit.ly/2LI8FWT... ).

Corroborating this statement, a study conducted in a community in Rio de Janeiro, which accompanied the treatment of individuals in primary care under the context of urban violence, was affected by the troubled social context and the field research was delayed for months because of armed violence (Ferreira; Engstron, 2017FERREIRA, J. T.; ENGSTRON, E. M. Estigma, medo e perigo: representações sociais de usuários e/ou traficantes de drogas acometidos por tuberculose e profissionais de saúde na atenção básica. Saúde e Sociedade, São Paulo, v. 26, n. 4, p. 1015-1025, 2017. Disponível em: <Disponível em: https://bit.ly/2IeTxOL >. Acesso em: 16 jul. 2018.
https://bit.ly/2IeTxOL... ).

This panorama reflects the need to discuss the theme of violence from a complex and intersectoral point of view, which comprehends its diverse perspectives and the multiple sectors involved, such as health, safety and public policies, considering that the various aspects involving this phenomenon strongly impact public health, either by the number of direct victims, or by the mental and emotional injuries of those involved, negatively impacting on the quality of life of individuals and collectivities (Cardoso et al., 2016CARDOSO, F. L. M. G. et al. Homicídios no Rio de Janeiro, Brasil: uma análise da violência letal. Ciência & Saúde Coletiva, Rio de Janeiro, v. 21, n. 4, p. 1277-1288, 2016. Disponível em: <Disponível em: https://bit.ly/2oM749y >. Acesso em: 16 jul. 2018.
https://bit.ly/2oM749y... ).

From the above, it is evident that urban violence has a great magnitude and its discussion has been increasing in the field of public health. This study stands out its armed manifestation as a complex phenomenon that has impacted the work of FHS teams.

As the teams are mostly inserted in socially vulnerable territories, and consequently in permanent contact with their manifestations, to discuss violence as armed conflict is important, in the context of the health of FHS workers under these circumstances to better understand this phenomenon and intervene appropriately in its determinants in the health work process. Thus, this study aims to analyze the impacts of violence as armed conflict, on the health of higher-educated FHS professionals.

Notably, one of the investigation objectives was to identify the content on urban violence addressed in the higher education training of health professionals. Thus, professionals of technical training and community health agents were left out of the study, though recognizing their proximity to urban violence in the territory.

Method

This is an exploratory study with a qualitative approach, with institutional socioclinical design.

Institutional analysis (IA) began in the 1960s in France, spreading in Brazil in the following decade and having as French institutionalism references the authors René Lourau, Georges Lapassade and Félix Guattari, responsible for constituting the foundations of institutional analysis and socio-analysis. “IA arose from the articulation between intervention and research, between theory and practice” (L’Abbate, 2012L’ABBATE, S. Análise institucional e intervenção: breve referência à gênese social e histórica de uma articulação e sua aplicação na saúde coletiva. Mnemosine, Rio de Janeiro, v. 8, n. 1, p. 194-219, 2012. Disponível em: <Disponível em: https://bit.ly/2MbK1Nj >. Acesso em: 5 nov. 2015.
https://bit.ly/2MbK1Nj... , p. 197-198).

Institutional analysis in the institutional socioclinical aspect, proposed by Gilles Monceau, was used in this study for being considered an effective method to construct dialogues and to provoke collective reflections and debates on urban violence and its nuances in violent territories. Socioclinical intervention was carried out in two meetings coordinated by the main researcher with the aid of the research advising researchers, who had experience in conducting a socioclinical-institutional group. Noticeably, this is an intervention with institutionalist orientation, intervention research that proposes non-separation between subject/object, considering the researcher’s implications and emphasizing his/her non-neutrality in the knowledge production (Romagnoli, 2014ROMAGNOLI, R. C. O conceito de implicação e a pesquisa-intervenção institucionalista. Psicologia & Sociedade, Belo Horizonte, v. 26, n. 1, p. 44-52, 2014. Disponível em: <Disponível em: https://bit.ly/2IkcijA >. Acesso em: 23 abr. 2016.
https://bit.ly/2IkcijA... ).

During the institutional socioclinical intervention, the researchers and the study participants experienced different moments, which can be translated from the methodology perspective into the institutional socioclinical characteristics proposed by Monceau, which can be achieved at the time of socioclinical intervention. These characteristics are: analysis of the order and demands; the subjects’ participation in the devices; the analyzers’ work; analysis of transformations as work progresses; application of restitution modalities; work of primary and secondary implications; intention of knowledge production; attention to institutional contexts and interferences (Monceau, 2013MONCEAU, G. A socioclínica institucional para pesquisas em educação em saúde. In.: L’ABBATE, S.; MOURÃO, L. C.; PEZZATO, L. M. (Org.). Análise institucional & saúde coletiva. São Paulo: Hucitec, 2013. p. 91-103.).

This methodology is not limited to protocols, but aims to start connections with social and, consequently, professional issues, allowing a relationship between the research subjects and the object to approximate them of the situations experienced by the participants, thus enabling the understanding of their implications and the institution dynamics (Monceau, 2013MONCEAU, G. A socioclínica institucional para pesquisas em educação em saúde. In.: L’ABBATE, S.; MOURÃO, L. C.; PEZZATO, L. M. (Org.). Análise institucional & saúde coletiva. São Paulo: Hucitec, 2013. p. 91-103.).

This study was conducted in 2017 in a Family Clinic located in the West Zone of Rio de Janeiro, which, at the time, consisted of seven teams, all working in violent territory. Each health team monitored an average of 3,000 to 4,000 users, with a total of 19,987 users registered in the Family Clinic at the time.

This article shows the results of institutional socioclinical meetings, which occurred in the meeting room of the family clinic in the afternoon, after the team meeting. The study included 13 higher-educated health professionals who performed their activities on site at the time of data collection and made themselves available to participate, being: seven nurses, four physicians and two dentists from the clinic’s family health teams.

In these meetings, a script was used to collectively conduct the discussion on the theme and the data were digitally recorded. The script brought questions related to the process of the work developed by the professionals in the midst of a territory permeated by armed conflicts and issues related to the training process. Given this text dimensions, we will consider the results obtained in the following question of the script: “In the group’s opinion, what is it like to work in a place with episodes of armed violence?” Other issues related to urban violence expressed as armed conflicts do not meet the scope of this production but are just as important.

This study followed the ethical precepts of research with human beings, obtaining a favorable opinion from the Ethics and Research Committee of the proposing and co-participant institution in the first half of 2017.

Results and discussion

Armed conflict is a reality frequently manifested in the state of Rio de Janeiro and remarkable in vulnerable territories (occupied by the poorest population), where the State’s inefficient performance is evident. Health establishments inserted in these territories have suffered the consequences of these conflicts.

Conceptually, work-related violence is pointed out as “all voluntary action of an individual or group against another individual or group that will cause physical or psychological harm, occurred in the work environment, or involving relationships established at work or activities related to work” (Oliveira; Nunes, 2008OLIVEIRA, R. P.; NUNES, M. O. Violência relacionada ao trabalho: uma proposta conceitual. Saúde e Sociedade, São Paulo, v. 17, n. 4, p. 22-34, 2008. Disponível em: <Disponível em: https://bit.ly/2VckFDq >. Acesso em: 3 ago. 2018.
https://bit.ly/2VckFDq... , p. 30). A study conducted with FHS workers identified that the violence felt by them is expressed by fear of the risk of exposure, of threatening their integrity and of reprisals (Lancman et al., 2009LANCMAN, S. et al. Repercussões da violência na saúde mental de trabalhadores do Programa Saúde da Família. Revista de Saúde Pública, São Paulo, v. 43, n. 4, p. 682-688, 2009. Disponível em: <Disponível em: https://bit.ly/2pIoogd >. Acesso em: 3 ago. 2018.
https://bit.ly/2pIoogd... ).

This investigation shows aspects related to the work of FHS health professionals from the perspective of the impacts on these subjects’ health when experiencing urban violence expressed as armed conflict in their daily work. Analyzing the participants’ statements emerged during the institutional socioclinical meetings, it was possible to notice how armed conflicts influence their health.

In this sense, based on their statements, we will analyze the risks to the physical and psychological integrity of these health workers, whose condition triggers great concerns as a result of the tensions generated between users, health workers and local management, resulting from crossings in their practices. Such tensions are big stress generators for these health workers, risking psychic integrity in many of them.

FHS, because it is inserted in a highly vulnerable territory, is more exposed to violence (Lancman et al., 2009LANCMAN, S. et al. Repercussões da violência na saúde mental de trabalhadores do Programa Saúde da Família. Revista de Saúde Pública, São Paulo, v. 43, n. 4, p. 682-688, 2009. Disponível em: <Disponível em: https://bit.ly/2pIoogd >. Acesso em: 3 ago. 2018.
https://bit.ly/2pIoogd... ); health workers developing their activities in these places are more conducive to confronting urban violence in their different facets, since they constantly experience the territories dynamics (Benicio; Barros, 2017BENICIO, L. F. S.; BARROS, J. P. P. Estratégia Saúde da Família e violência urbana: abordagens e práticas sociais em questão. Sanare, Sobral, v. 16, n. 1, p. 102-112, 2017. Disponível em: <Disponível em: https://bit.ly/2IjWSvL >. Acesso em: 4 ago. 2018.
https://bit.ly/2IjWSvL... ).

Velloso et al. (2005)VELLOSO, I. S. C. et al. A visão dos profissionais de saúde sobre a violência no cotidiano de trabalho em uma unidade básica. Reme: Revista Mineira de Enfermagem, Belo Horizonte, v. 9, n. 4, p. 302-08, 2005. Disponível em: <Disponível em: https://bit.ly/2IfmXwb >. Acesso em: 17 mar. 2016.
https://bit.ly/2IfmXwb... point out that, in general, the professionals feel more protected inside health units, but that this feeling is shaken when shootings occur, exposing these people’s vulnerability in the face of confrontations external to the unit. The following statements allow us to understand how these health workers, even developing their activities within the Family Clinics, have their physical and psychic integrity at risk:

Armed violence killed 44,861 people in 2014, with an increase of 415.1% since 1980. Although considering population growth of 65% in this period, mortality by firearms is very significant and stands out for its magnitude. Homicides account for 95% of this number, with mostly young, black and male victims (Waiselfsz, 2016WAISELFSZ, J. J. Mapa da violência 2016: homicídios por armas de fogo no Brasil. São Paulo: Flacso Brasil, 2016. Disponível em: <Disponível em: https://bit.ly/2N0jWzK >. Acesso em: 4 ago. 2018.
https://bit.ly/2N0jWzK... ). Its distribution is related to the populations’ social living conditions and the lack of access to social policies (Benicio; Barros, 2017BENICIO, L. F. S.; BARROS, J. P. P. Estratégia Saúde da Família e violência urbana: abordagens e práticas sociais em questão. Sanare, Sobral, v. 16, n. 1, p. 102-112, 2017. Disponível em: <Disponível em: https://bit.ly/2IjWSvL >. Acesso em: 4 ago. 2018.
https://bit.ly/2IjWSvL... ).

Violence is considered an obstacle to the population’s access to health services and, at the same time, to health professionals’ access to the community, blocking home visits and influencing in the routine of services and in planning work processes (Benicio; Barros, 2017BENICIO, L. F. S.; BARROS, J. P. P. Estratégia Saúde da Família e violência urbana: abordagens e práticas sociais em questão. Sanare, Sobral, v. 16, n. 1, p. 102-112, 2017. Disponível em: <Disponível em: https://bit.ly/2IjWSvL >. Acesso em: 4 ago. 2018.
https://bit.ly/2IjWSvL... ). The participants’ statements reveal that the risks to the FHS workers’ physical integrity are potentiated when they need to perform their activities outside the clinic, becoming more vulnerable inside the territory. The following statement portrays a moment when a participant is surprised during a home visit and finds herself in the midst of an armed conflict:

In addition to the risks to physical integrity, Machado and Daher (2013)MACHADO, C. B.; DAHER, D. V. Violence in the area and its repercussions upon health care actions: descriptive-exploratory study. Online Brazilian Journal Nursing, Niterói, v. 12, p. 674-676, 2013. Disponível em: <Disponível em: https://bit.ly/2M9AdUj >. Acesso em: 27 mar. 2016.
https://bit.ly/2M9AdUj... highlight that health professionals working in dangerous territories coping with adverse realities is a complex phenomenon, which brings psychological problems due to constant stress, generating emotional exhaustion and impairment in different areas of personal and professional life, with a marked decrease in professional satisfaction in the work environment. The following statements portray this situation:

The World Health Organization (WHO, 2008WHO - WORLD HEALTH ORGANIZATION. PRIMA-EF: guidance on the European Framework for Psychosocial Risk Management: a resource for employers and worker representatives. Genebra: World Health Organization, 2008. (Protecting Workers’ Health Series n. 9).) warns of the high prevalence of psychosocial risks to which health workers in Europe are exposed, responsible for increasing problems such as work-related stress, violence, harassment and bullying in the workplace. Regarding violence, a survey conducted in two vulnerable territories in the municipality of Rio de Janeiro identified, in the participants’ statements, urban violence as a permanent challenge that interferes in the management, in the professionals’ work, and in the care of health system users (Prata et al., 2017PRATA, N. I. S. S. et al. Saúde mental e atenção básica: território, violência e o desafio das abordagens psicossociais. Trabalho, Educação e Saúde, Rio de Janeiro, v. 15, n. 1, p. 33-53, 2017. Disponível em: <Disponível em: https://bit.ly/30Krm0y >. Acesso em: 3 ago. 2018.
https://bit.ly/30Krm0y... ).

The same survey refers to processes of sickening of professionals and patients, triggered by daily violence, highlighting greater vulnerability of professionals and reports of episodes of tension, stress and even cases of psychiatric symptoms and psychotic breaks. The authors affirm that “in the teams’ report, we found the centrality of violence as a factor of illnesses and vulnerabilities production” (Prata et al., 2017PRATA, N. I. S. S. et al. Saúde mental e atenção básica: território, violência e o desafio das abordagens psicossociais. Trabalho, Educação e Saúde, Rio de Janeiro, v. 15, n. 1, p. 33-53, 2017. Disponível em: <Disponível em: https://bit.ly/30Krm0y >. Acesso em: 3 ago. 2018.
https://bit.ly/30Krm0y... , p. 47).

Because of armed conflicts, it is common for the units to terminate their activities in the territories covered by FHS. This, in practice, becomes a great problem for users, who lose their scheduled appointments. This situation generates conflict between users and health workers, often a source of discussion and stress. Frequently, users’ insistence on keeping the clinic open even in the face of armed conflicts produces in workers a sense of anguish because they understand this as trivializing episodes of gun violence. The following statements demonstrate the above:

The varied manifestations of violence in the work process of nurses and other health professionals reverberate in different areas, but mainly on mental health. As they feel threatened in a work environment affected by armed conflict, levels of psychological distress rise. These repercussions exceed workplace aspects, since health-damaging events also reverberate on the worker’s social and family life, bringing feelings of irritability, crying crises, anguish, sadness, with deep implications on health (Bordignon; Monteiro, 2016BORDIGNON, M.; MONTEIRO, M. I. Violence in the workplace in nursing: consequences overview. Revista Brasileira de Enfermagem, Brasília, v. 69, n. 5, p. 939-942, 2016. Disponível em: <Disponível em: https://bit.ly/2LKLMSN . Acesso em: 23 abr. 2017.
https://bit.ly/2LKLMSN... ).

In the following statements, the consequences of violence in its armed manifestation in the family segment of the participants are evident, showing itself as a great cause of tension.

A study conducted in the municipality of Belém, PA, Brazil, aiming to analyze how territorial violence impacts the work process of nurses working in FHS, showed that precarious working conditions that endanger workers’ lives and the lack of minimum logistics supply are considered violence to workers and negatively impact not only on the work production, but also on the professionals’ health (Polaro; Gonçalves; Alvarez, 2013POLARO, S. H. I.; GONÇALVES, L. H. T.; ALVAREZ, A. M. Enfermeiras desafiando a violência no âmbito de atuação da Estratégia Saúde da Família. Texto & Contexto Enfermagem, Florianópolis, v. 22, n. 4, p. 935-942, 2013. Disponível em: <Disponível em: https://bit.ly/331cpbT >. Acesso em: 5 jul. 2018.
https://bit.ly/331cpbT... ). The following statement points to the professional’s mental suffering, caused by intense shooting in the territory, and then it comments how this affects his productivity at work.

Gonçalves, Queiroz and Delgado (2017)GONÇALVES, H. C. B.; QUEIROZ, M. R.; DELGADO, P. G. G. Violência urbana e saúde mental: desafios de uma nova agenda? Fractal: Revista de Psicologia, Niterói, v. 29, n. 1, p. 17-23, 2017. Disponível em: <Disponível em: https://bit.ly/32Xbp8E >. Acesso em: 3 maio 2018.
https://bit.ly/32Xbp8E... report that urban violence and its dimensions are little debated in the psychosocial field, making it necessary to pay attention on the important consequences of the impact of violence on mental health not only of users, but also of professionals working in these services.

The lack of discussion on the theme in the spaces of services and reception, and the lack of management for the above seems to be a cause of suffering for these workers, who care for health but do not feel cared for. To disregard the territorial peculiarities and not to take care of the workers’ mental health reflect negatively on the process of caring for these teams in relation to the community, since they can request dismissal, transfer, or even have a leave of absence for health treatment, due to the impacts on their mental health, discontinuing care. The following statements corroborate this idea:

Notably, situations of violence promote high turnover of staff, influencing the discontinuity of work processes and breaking the bond between user and professional (Benicio; Barros, 2017BENICIO, L. F. S.; BARROS, J. P. P. Estratégia Saúde da Família e violência urbana: abordagens e práticas sociais em questão. Sanare, Sobral, v. 16, n. 1, p. 102-112, 2017. Disponível em: <Disponível em: https://bit.ly/2IjWSvL >. Acesso em: 4 ago. 2018.
https://bit.ly/2IjWSvL... ).

Despite the above, it is important to emphasize that work is not essentially a source of suffering, for workers can build their identity and express their subjectivity by it. This results from the interaction of the subject with the dimensions of the work context-social relationships of work, working conditions, and work organization-, constituting a dynamic relationship, in which health at work materializes in the search for physical, psychic and social integrity (Ferreira; Mendes, 2003FERREIRA, M. C.; MENDES, A. M. Trabalho e riscos de adoecimento: o caso dos auditores-fiscais da Previdência Social Brasileira. Brasília, DF: Ler, Pensar, Agir, 2003.).

In this group of workers, socio-professional relationships act as mediators of the suffering they face on a daily basis, with reports of professionals who, after being transferred, returned to the unit, despite the permanence of the episodes of violence, because of established relationships.

In this context, these relationships constitute defensive strategies, as defined by Dejours (1994 apud Mendes, 2007MENDES, A. M. (Org.). Psicodinâmica do trabalho: teoria, método e pesquisas. São Paulo: Casa do Psicólogo, 2007., p. 38), “rules of conduct constructed and undertaken by men and women vary according to working situations and are marked by subtlety, ingenuity, diversity and inventiveness, helping workers to support suffering without falling ill.” Dejours points out the risk of these defensive strategies become a defensive ideology, no longer strategies to be the worker’s own goal, leading to the risk of alienation, that is, at the same time that they enable coexistence with suffering, they lead to the alienation of their true causes (Dejours, 1994 apud Mendes, 2007MENDES, A. M. (Org.). Psicodinâmica do trabalho: teoria, método e pesquisas. São Paulo: Casa do Psicólogo, 2007.).

A study conducted in Southern Brazil at a similar circumstance points out that good relationships at work contribute to the worker’s well-being (Ferigollo; Fedosse; Santos Filha, 2016FERIGOLLO, J. P.; FEDOSSE, E.; SANTOS FILHA, V. A. V. Qualidade de vida de profissionais da saúde pública. Cadernos Brasileiros de Terapia Ocupacional, São Carlos, v. 24, n. 3, p. 497-507, 2016. Disponível em: <Disponível em: https://bit.ly/32YJFR1 >. Acesso em: 10 nov. 2018.
https://bit.ly/32YJFR1... ). Based on it, we can infer that working in a territory permeated by armed conflicts enabled these professionals to establish a group identity, strengthening their personal relationships, which, in this context, was significantly favorable to cope with the tensions caused by armed violence in the territory.

Final considerations

The risks to physical and mental integrity to which these workers are subjected when working in territories permeated by armed conflicts are notorious. The constant stress caused by urban violence in its armed manifestation triggers feelings of anguish, fear, irritability and sadness, producing mental exhaustion and directly affecting their satisfaction at work.

The studied territory is affected by constant conflicts between dealers and police, which makes urban violence not only a great creator of obstacles to the practices of family health teams, but also a generator of large risks to the physical and psychological integrity of the workers who carry out their activities there.

To investigate the dimensions and effects of urban violence expressed as armed conflicts is relevant because it reveals how it impacts on the health of health workers acting in violent territories. Thus, to bring this discussion to the workspaces and to consider intervening in the effects of armed conflicts to mental health and in the possible damage to these professionals’ physical integrity are necessary.

One of the strategies for dealing with this reality could be to offer psychological support and monitoring services to workers from violent areas. It is also relevant to discuss and improve existing tools, such as safer access in coping with urban violence, and to search new ways to produce protective measures for these workers, collectively involving professionals, users, managers, and other sectors of society.

References

Publication Dates

History