Impacts of attacks to female health care workers in three territories of Colombia.

BACKGROUND: This study explores the impacts of attacks perpetrated in the context of armed conflict, to female health workers in three Colombian territories. METHODS: We conducted a document review of the reports and databases of the Colombian Truth Commission, 17 in-depth semi-structured interviews with experts on the national and regional armed conflict and the medical mission, and 26 female health workers who were victims of attacks. RESULTS: Experts and female health workers reported attacks to health activities, facilities, equipment, and personnel, including attacks to traditional doctors belonging to indigenous communities. The most frequent attacks were threats and retention of health personnel; theft of supplies and medicines; damage and use of infrastructure and means of transport for purposes other than health care; and hinderance of health service provision. The attacks occurred in a framework of structural violence that intersects with poverty, racism, and gender bias. The impacts of these attacks include gender-based violence, significant disruption of the lives of health workers, and physical, emotional, psychological, social, and economic effects on the victims and their families. The government response to protect victims and populations has been absent or insufficient. CONCLUSIONS: Attacks to health care were reported in all the studied territories obstructing adequate health care. Impacts of these attacks affect negatively the professional and personal life of the workers and are aggravated by structural violence and absent or little institutional response.

Salud mental colectiva: una revisión del concepto en la literatura académica de Brasil, Colombia y España / Collective mental health: a review of the concept in the academic literature of Brazil, Colombia, and Spain

Resumen La noción de salud mental colectiva hace referencia a una propuesta alternativa a la perspectiva biomédica y conductual que ha ido adquiriendo centralidad en las publicaciones académicas de Brasil, España y Colombia, especialmente en las dos últimas décadas. Con el fin de comprender el sentido que adquiere dicha noción, se realizó un análisis del concepto desde una revisión narrativa que empleó criterios intencionados para la selección del material. Se identificaron matices particulares en cada país y/o sus problemáticas asociadas, en estrecha conexión con las particularidades históricas y socioculturales de cada escenario. Las violencias relacionadas con las lógicas manicomiales (Brasil, España) y aquellas derivadas del conflicto armado y la violencia política (Colombia) son las problemáticas en las que la salud mental colectiva aporta orientaciones epistemológicas y modelos de prácticas para el acompañamiento en contextos de sufrimiento social. El deslinde entre lo colectivo y lo comunitario es el principal reto conceptual que emerge de la intersección entre la salud mental y la salud colectiva.

Abstract INTRODUCTION: The notion of collective mental health refers to an alternative proposal to the biomedical and behavioral perspective that has been gaining centrality in academic publications in Brazil, Spain, and Colombia, especially in the last two decades. METHOD: In order to understand the meaning acquired by this notion, an analysis of the concept was carried out through a narrative review that used intentional criteria for the selection of the material. RESULTS: nuances were identified in each country and/or its associated problems, in close connection with the historical and socio-cultural particularities of each scenario. Violence related to asylum logic (Brazil, Spain), and those derived from armed conflict and political violence (Colombia) are the problems where collective mental health provides epistemological and practical guidelines for accompaniment in contexts of social suffering. CONCLUSION: the delimitation between the collective and the community is the main conceptual challenge that emerges from the intersection between mental health and collective health.

Teatro-pedagogía, una experiencia de construcción de paz en Antioquia, Colombia. Sus aportes a la salud mental / Teatro pedagogia, uma experiência de construção de paz na Antioquia, Colômbia. Seus aportes à saúde mental / Theater-pedagogy, a peacebuilding experience in Antioquia, Colombia. Its contributions to mental health

Resumen El estudio de la salud mental, en Colombia y en el mundo, ha sido enfocado desde una perspectiva morbicéntrica y conductual. Este trabajo presenta un estudio de caso que tuvo como objetivo comprender de qué manera el proceso de formación en teatro-pedagogía, como iniciativa de construcción de paz, puede aportar a la salud mental. A partir de la confluencia del teatro social, la pedagogía crítica y las experiencias de vida de los y las participantes, se realizó análisis documental, y categorización al diario de campo, entrevistas y grupos de discusión. Participaron personas involucradas en la formación y público asistente en los foros de las presentaciones teatrales. Se encontraron elementos sobre sanación, cuerpo, juego, movimiento y simbolización en relación con salud mental. Se espera que este sea un aporte a la democratización en salud mental en contextos de sufrimiento social. (AU)

Resumo O estudo da saúde mental na Colômbia e no mundo tem focado numa perspectiva morbicentrica e comportamental. Este trabalho apresenta um estudo de caso que teve como objetivo compreender de que maneira o processo de formação em teatro pedagogia, como iniciativa de construção de paz, pode contribuir à saúde mental. A partir da confluência do teatro social, a pedagogia crítica e as experiências de vida dos e das participantes, e mediante categorização, realizou-se análise documental, de diário de campo, entrevistas e grupos de discussão. Participaram pessoas envolvidas na formação e público assistente nos foros das apresentações teatrais. Foram encontrados elementos sobre cura, corpo, jogo, movimento e simbolização na relação com a saúde mental. Espera-se que este seja uma contribuição à democratização na saúde mental em contextos de sofrimento social. (AU)

Abstract Research on mental health in Colombia and worldwide has emphasized a morbicentric and behavioral perspective. This article reports a case study that aimed to understand how theater-pedagogy education, as an initiative to build peace, can contribute to mental health. Due to the confluence of social theater, critical pedagogy, and the life experiences of participants, documentary analysis was carried out. Data obtained from a field diary, interviews, and discussion groups was categorized. The participants got involved in the theater-pedagogy and attended forums of theatrical performances. Elements of healing, body, playing, movement, and symbolization concerning mental health were found. This work is expected to contribute to the democratization of mental health in contexts of social suffering. (AU)

Conceptual perspectives in mental health and their implications in the context of achieving peace in Colombia. / Perspectivas conceptuales en salud mental y sus implicaciones en el contexto de construcción de paz en Colombia.

This article presents a critical reflection on the conceptual perspectives in mental health, in the quest for new meanings for this concept and its implications in the context of achieving peace in Colombia. For this, an integrative review of the literature was conducted in seven bibliographic databases and search engines. As a result, five conceptual perspectives of mental health were identified: 1) biomedical and behavioral; 2) wellbeing and its potential; 3) cultural; 4) psychosocial; and 5) based on social determination, the epistemological foundations, contributions, criticisms, and limitations of which are described in each case. Finding more pertinence in the proposal of mental health from collective health/social medicine rather than from the classic public health for achieving peace in Colombia, a comprehensive view of mental health that takes into account its socio-cultural relevance from a critical and socio--historical position is proposed.

Este artículo presenta una reflexión crítica sobre las perspectivas conceptuales en salud mental, en busca de nuevos sentidos para este concepto y sus implicaciones en el contexto de construcción de paz en Colombia. Para esto se realizó una revisión integrativa de la literatura, por medio de siete bases de datos bibliográficas y motores de búsqueda. Como resultado, se identificaron cinco perspectivas conceptuales de salud mental: 1) biomédica y conductual, 2) del bienestar y las potencialidades, 3) cultural, 4) psicosocial y 5) de la determinación social, cuyos fundamentos epistemológicos, sus aportes, críticas y limitaciones se describen en cada caso. Al encontrar mayor pertinencia en la propuesta de salud mental desde la salud colectiva/medicina social que desde la salud pública clásica para la construcción de paz en Colombia, se propone una mirada integral de la salud mental que tenga en cuenta su pertinencia socio-cultural desde una posición crítica y socio-histórica.

Perspectivas conceptuales en salud mental y sus implicaciones en el contexto de construcción de paz en Colombia / Conceptual perspectives in mental health and their implications in the context of achieving peace in Colombia

Resumen Este artículo presenta una reflexión crítica sobre las perspectivas conceptuales en salud mental, en busca de nuevos sentidos para este concepto y sus implicaciones en el contexto de construcción de paz en Colombia. Para esto se realizó una revisión integrativa de la literatura, por medio de siete bases de datos bibliográficas y motores de búsqueda. Como resultado, se identificaron cinco perspectivas conceptuales de salud mental: 1) biomédica y conductual, 2) del bienestar y las potencialidades, 3) cultural, 4) psicosocial y 5) de la determinación social, cuyos fundamentos epistemológicos, sus aportes, críticas y limitaciones se describen en cada caso. Al encontrar mayor pertinencia en la propuesta de salud mental desde la salud colectiva/medicina social que desde la salud pública clásica para la construcción de paz en Colombia, se propone una mirada integral de la salud mental que tenga en cuenta su pertinencia socio-cultural desde una posición crítica y socio-histórica.

Abstract This article presents a critical reflection on the conceptual perspectives in mental health, in the quest for new meanings for this concept and its implications in the context of achieving peace in Colombia. For this, an integrative review of the literature was conducted in seven bibliographic databases and search engines. As a result, five conceptual perspectives of mental health were identified: 1) biomedical and behavioral; 2) wellbeing and its potential; 3) cultural; 4) psychosocial; and 5) based on social determination, the epistemological foundations, contributions, criticisms, and limitations of which are described in each case. Finding more pertinence in the proposal of mental health from collective health/social medicine rather than from the classic public health for achieving peace in Colombia, a comprehensive view of mental health that takes into account its socio-cultural relevance from a critical and socio-­historical position is proposed.

La paradoja de la salud mental en Colombia: entre los derechos humanos, la primacía de lo administrativo y el estigma / Paradox of Mental Health in Colombia: Between Human Rights, the Predominance of the Administrative and the Stigma / O paradoxo da saúde mental na Colômbia: entre direitos humanos, a primazia do administrativo e o estigma

Resumen En las últimas décadas se viene promoviendo en el mundo la reforma de sistemas de salud mental hacia servicios de base comunitaria e integrados en los sistemas locales de salud. Al respecto, se han reportado logros en algunos países latinoamericanos y del Caribe, mas no así en Colombia. Sobresalen en el mundo las brechas en la atención y la confrontación entre derechos humanos-criterios económicos, para la prestación de servicios en salud mental. Se hizo una investigación con enfoque histórico-hermenéutico en la que participaron 23 profesionales de la salud mental en entrevistas y un grupo de discusión; se realizó análisis categorial de la información. Se halló cómo los derechos humanos, la rentabilidad financiera, la calidad de los servicios y el estigma conforman directrices que orientan, de manera contradictoria, la salud mental en Colombia. Se discutió sobre la conveniencia de realizar un análisis ético y político de la política pública de salud mental en el país.

Abstract In the last decades a reform to the mental health system is being promoted all over the world towards community-based services integrated to the local health systems. Some Latin-American and Caribbean countries have reported achievements on this issue, but not Colombia. The gaps in the health care are noticeable worldwide as well as the confrontation between human rights and financial criteria for the provision of health services. A research was carried out based on a historical-hermeneutic approach; 23 mental health professionals took part in it through interviews and discussion groups. A categorial analysis of the gathered information was carried out. It showed how the human rights, financial cost-effectiveness, service quality and the stigma form the guidelines that drive, in a contradictory way, the mental health services in Colombia. A discussion is carried out on the convenience to develop an ethical and political analysis of the mental health public policies in our country.

Resumo Nas últimas décadas tem se promovido no mundo tudo a reforma de sistemas de saúde mental para serviços de base comunitária e integrados nos sistemas locais de saúde. A esse respeito, tem relatórios de sucesso em alguns países latino-americanos e do Caribe, mas na Colômbia não. Destaca-se no mundo a lacuna no atendimento e o confronto entre direitos humanos e critérios económicos, para a prestação de serviços de saúde mental. Uma pesquisa com abordagem histórico-hermenêutica foi feita, na que participaram 23 profissionais de saúde mental em entrevistas e um grupo de discussão; realizou-se análise categorial da informação. Achou-se que os direitos humanos, a rentabilidade financeira, a qualidade dos serviços e a estigma conformam diretrizes orientando, de maneira contraditória, a saúde mental na Colômbia. Foi debatida a conveniência de realizar análise ética e política da política pública de saúde mental no país.

Encerrado a oscuras: significado de vivir con esquizofrenia para diagnosticados y sus cuidadores, Medellín-Colombia / Locked in Darkness: What Living with Schizophrenia Means to Diagnosed Patients and their Caregivers. Medellín - Colombia / Envolto na escuridão: significado de viver com esquizofrenia para os diagnosticados e seus cuidadores, Medellín, Colômbia

RESUMEN Vivir con esquizofrenia representa un enigma para todas aquellas personas que no presentan la enfermedad o conviven con alguien que la padece. Objetivo: comprender el significado de vivir con esquizofrenia para personas que presentan la enfermedad y sus familiares, quienes acudieron a una institución estatal para la atención de problemas de salud mental de alta complejidad en Colombia durante el 2014 y 2015. Materiales y método: se utilizó un enfoque cualitativo y la información fue analizada por medio del método de la teoría fundamentada. Las técnicas de recolección de información fueron ocho entrevistas a profundidad y dos grupos focales, con una participación de 21 personas diagnosticadas y sus cuidadores. Resultados: por medio de la codificación, el muestreo teórico, la comparación constante y los memos analíticos, se llegó a la categoría "Vivir con esquizofrenia es vivir encerrado, a oscuras y con los sueños truncados". Conclusiones: para los pacientes, la familia y para los cuidadores, vivir con esquizofrenia conlleva una sensación de encerramiento que afecta el proyecto de vida de unos y otros.

ABSTRACT Living with schizophrenia is an enigma to all who do not have the disease or live with someone who does. Objective: The purpose of the study was to understand what living with schizophrenia means for people with the disease and their relatives, specifically in the case of patients who sought help during 2014 and 2015 at a state institution in Colombia that is dedicated to handling highly complex mental health problems. Materials and method: A qualitative approach was employed and the grounded theory methodology was used to analyze the information, which was gathered through eight in-depth interviews and two focus groups. Twenty-one individuals took part, including xx diagnosed with schizophrenia and their caregivers. Results: Through coding, theoretical sampling, constant comparison and analytical memos, a category was established; namely, "Living with schizophrenia is living locked up and in the dark, with curtailed dreams". Conclusions: For patients, their families and caregivers, living with schizophrenia leads to a sense of confinement that affects all their lives.

RESUMO Viver com esquizofrenia representa um enigma para todas aquelas pessoas que não apresentam a doença ou convivem com alguém que a padece. Objetivo: compreender o significado de viver com esquizofrenia para pessoas que apresentam a doença e seus familiares, que recorriam a uma instituição estatal para o atendimento de problemas de saúde mental de alta complexidade na Colômbia durante 2014 e 2015. Métodos: foi utilizada uma abordagem qualitativa, e a informação foi analisada por meio do método da teoria fundamentada. As técnicas de coleta de informação foram oito entrevistas a profundidade e dois grupos focais, com a participação de 21 pessoas diagnosticadas e seus cuidadores. Resultados: por meio da codificação, da amostragem teórica, da comparação constante e dos relatórios analíticos, chegou-se à categoria Viver com esquizofrenia é viver preso, às escuras, e com os sonhos interrompidos. Conclusões: para os pacientes, para a família e para os cuidadores, viver com esquizofrenia implica uma sensação de encerramento que afeta o projeto de vida de todos.

El valor de los apoyos para el bienestar subjetivo al vivir con esquizofrenia / The value of supports for subjective well-being to live with schizophrenia

Este artículo es el resultado de una investigación cualitativa que se realizó con la participación de un grupo de personas con esquizofrenia y sus familiares, en Medellín (Colombia). El objetivo fue comprender los aspectos que promueven la salud mental en las personas con esquizofrenia y sus familias, teniendo en cuenta su experiencia subjetiva. Se realizaron ocho entrevistas en profundidad y dos grupos focales para la recolección de la información, la cual se analizó bajo los planteamientos de la Teoría Fundamentada de Strauss y Corbin. La categoría interpretativa que surgió durante el análisis fue «El valor de los apoyos, un punto subjetivo en la experiencia de vivir con esquizofrenia», la cual revela la importancia que tiene, para quienes viven y conviven con la enfermedad, el fortalecimiento de los apoyos personales, familiares y sociales disponibles, pues estos favorecen la sensación de bienestar y el camino hacia la recuperación

This article is a result of a qualitative research that was conducted with participation of a group of people with schizophrenia and their families in Medellín (Colombia). The objective was to understand aspects that promote mental health in people with schizophrenia and their families, considering their subjective experiences. Eight in-depth interviews and two focus groups were conducted to collect information, which was analyzed under the approach of Strauss and Corbin's Grounded Theory. The interpretive category that emerged during the analysis was «The value of supports, a subjective point in the experience of living with schizophrenia», that reveals as different supports are valued by who are living with this disease and their families, and as these favor well-being sense and their road to recovery

Medellin youth experiences before, during and after belonging to an illegal armed group, 2005. / Experiencias de jóvenes de Medellín antes, durante y después de pertenecer a un grupo armado ilegal, 2005.

A better understanding of the experiences of young people before, during and after belonging to an illegal armed group (IAG) can provide information to promote their reintegration into urban settings in Colombia and to help prevent violence. A qualitative study with a hermeneutic historical approach was performed to examine these experiences from the perspective of direct or indirect participants in the armed conflict. Fifty individuals aged 14-24 years (7 women and 43 men) with low socioeconomic status from Medellín were interviewed; 26 of them had a history of direct experience with IAGs. What stands out in their stories are descriptions of obstacles to progress in their lives; lives marked by stigma, poverty, violence and inequality; the differences of opinion among these young people regarding whether to belong to these illegal groups; how becoming an active member of an IAG creates both an opportunity for the present and an additional obstacle for the future, which adds complexity to the risk behaviors they assume; and how the reintegration process offers new expectations regarding access to educational and employment opportunities and social recognition. All of these factors point to the need for not only a comprehensive reintegration process but for more inclusive and equitable social policies, in this case for children and young people.

Towards a community mental health care for people with schizophrenia in Colombia. / Hacia una atención comunitaria en salud mental para personas con esquizofrenia en Colombia.

Mental health care based on the community has shown to be effective and successful for the health care service to people with severe mental disorders such as schizophrenia, evidence that is less clear in the health care system in Colombia, where weaknesses are present, both for prevention and rehabilitation, although national guidelines give importance to the social context in relation to the disease. As a contribution to the discussion on providing care for people living with schizophrenia, a topic review was conducted with the aim of identifying experiences in community mental health care services, in relation to their relevance to these people at the national level. Articles were searched on Scientific Electronic Library Online (SciELO) Medline with Full text, Science Direct and documents of the World Health Organization, Pan American Health Organization and the Colombian Ministry of Health and Social Protection. Few experiences in community care for people with schizophrenia in Colombia were found and given its importance to public health worldwide, a call for attention is made towards the construction and implementation of these models in the Colombian context.

Hacia una atención comunitaria en salud mental para personas con esquizofrenia en Colombia / Towards a community mental health care for people with schizophrenia in Colombia

Resumen La atención en salud mental con base en la comunidad ha mostrado ser eficaz y acertada para el servicio de salud a personas con trastornos mentales severos como la esquizofrenia, evidencia que es menos clara en el sistema de salud de Colombia, donde se presentan debilidades, tanto en la prevención como en la rehabilitación, a pesar de que directrices nacionales le dan importancia al contexto social con relación a la enfermedad. Como aporte a la discusión sobre la atención para personas que viven con esquizofrenia, se realizó una revisión de tema con el objetivo de identificar experiencias en servicios de salud mental comunitaria, en relación con su pertinencia para estas personas en el ámbito nacional. Se buscaron artículos en Scientific Electronic Library Online (SciELO), Medline with Full text, Science Direct y documentos de la Organización Mundial de la Salud, Organización Panamericana de la Salud y Ministerio de Salud y Protección Social. Se hallaron pocas experiencias en atención comunitaria para personas con esquizofrenia en Colombia y teniendo en cuenta su importancia para la salud pública a nivel mundial, se realiza un llamado de atención hacia la construcción e implementación de estos modelos en el contexto colombiano.

Abstract Mental health care based on the community has shown to be effective and successful for the health care service to people with severe mental disorders such as schizophrenia, evidence that is less clear in the health care system in Colombia, where weaknesses are present, both for prevention and rehabilitation, although national guidelines give importance to the social context in relation to the disease. As a contribution to the discussion on providing care for people living with schizophrenia, a topic review was conducted with the aim of identifying experiences in community mental health care services, in relation to their relevance to these people at the national level. Articles were searched on Scientific Electronic Library Online (SciELO) Medline with Full text, Science Direct and documents of the World Health Organization, Pan American Health Organization and the Colombian Ministry of Health and Social Protection. Few experiences in community care for people with schizophrenia in Colombia were found and given its importance to public health worldwide, a call for attention is made towards the construction and implementation of these models in the Colombian context.

Experiencias de jóvenes de Medellín antes, durante y después de pertenecer a un grupo armado ilegal, 2005 / Medellin youth experiences before, during and after belonging to an illegal armed group, 2005

Resumen Una mayor comprensión sobre las experiencias de jóvenes antes, durante y después de pertenecer a un grupo armado ilegal (GAI), busca aportar elementos sobre la reintegración en contextos urbanos en Colombia, que orienten la prevención de la violencia. Se hizo un estudio cualitativo desde un enfoque histórico hermenéutico para entender estas experiencias desde la perspectiva de los participantes, como actores directos o indirectos del conflicto armado. Se entrevistaron 50 jóvenes de 14 a 24 años, de estrato socioeconómico bajo de Medellín, 7 mujeres y 43 hombres, 26 de ellos con experiencias directas en GAI. Sobresalen en sus relatos los obstáculos de progreso en la vida, marcados por estigma, pobreza, violencia e inequidad; la diferencia de opiniones entre los jóvenes para decidir la pertenencia o no a estos grupos; ser miembro activo de un GAI, una oportunidad en el presente y un obstáculo más en el futuro que complejiza las conductas de riesgo y el proceso de reintegración como una nueva expectativa de acceder a oportunidades educativas, laborales y reconocimiento social. Todo ello confluye en la necesidad no solo de un proceso de reintegración integral sino de políticas sociales más incluyentes y equitativas, en este caso, para niños, niñas y jóvenes.

Abstract A better understanding of the experiences of young people before, during and after belonging to an illegal armed group (IAG) can provide information to promote their reintegration into urban settings in Colombia and to help prevent violence. A qualitative study with a hermeneutic historical approach was performed to examine these experiences from the perspective of direct or indirect participants in the armed conflict. Fifty individuals aged 14-24 years (7 women and 43 men) with low socioeconomic status from Medellín were interviewed; 26 of them had a history of direct experience with IAGs. What stands out in their stories are descriptions of obstacles to progress in their lives; lives marked by stigma, poverty, violence and inequality; the differences of opinion among these young people regarding whether to belong to these illegal groups; how becoming an active member of an IAG creates both an opportunity for the present and an additional obstacle for the future, which adds complexity to the risk behaviors they assume; and how the reintegration process offers new expectations regarding access to educational and employment opportunities and social recognition. All of these factors point to the need for not only a comprehensive reintegration process but for more inclusive and equitable social policies, in this case for children and young people.

Disponibilidad y efectividad de relaciones significativas: elementos claves para promover resiliencia en jóvenes / Availability and effectiveness of meaningful relationships key elements to promote resilience in young people

Objetivo: Comprender la interacción entre contexto, recursos, redes de apoyo y características de los jóvenes de la ciudad de Medellín para la promoción de la resiliencia. Metodología: Investigación cualitativa, mediante teoría fundamentada, con 48 jóvenes. Resultados principales: El vínculo con personas significativas, quienes brindan tanto apoyo emocional, orientación moral y seguridad personal, como recursos relacionales, sociales, económicos, educativos y espirituales, permiten al joven una serie de experiencias, en donde aprende a usar estos recursos de manera personal, social y culturalmente válida, proceso que da lugar al aprendizaje resiliente. Estos adultos son valorados por los jóvenes, por su capacidad para resolver problemas, gestionar recursos, y poner límites. Conclusión: Las relaciones significativas con adultos, posibilitan al joven recursos afectivos y materiales, que a su vez le lleva a experiencias en las que emergen conductas resilientes, acordes tanto a su bienestar subjetivo como social

Objective: To understand the interaction between context, resources, support networks and characteristics of Medellin´s young people to promote resilience Methodology: Qualitative research, grounded theory, with 48 young people. Results: the relationship with significant others, who provide emotional support, moral guidance and personal security and the social, economic, educational, spiritual, relational resources, which is conducive from these relations and are used socially and culturally valid by young serve to promote resilience. These adults are valued by young people, in their ability to solve problems, manage resources, and set limits. Conclusion: The meaningful relationships with adults, enable the young affective and material resources, which in turn, leads to experiences that emerge resilient behaviors and learn to use them, socially and culturally valid