International Journal Advances in Social Science and Humanities
Available online at: www.ijassh.com
RESEARCH ARTICLE
Health and Traditional Fishing in All Saints Bay, Brazil
Paulo Cesar Alves
1, Leonardo Nascimento
1, Maria das Graças Correia
21Federal University of Bahia, Brazil.
2Federal Education Institute of Bahia, campus Santo Amaro, Brazil.
Abstract
This paper aims to identify the chronic non-transmittable diseases afflicting individuals involved in the traditional fishing system of All Saints Bay (state of Bahia) and the search for treatment for these diseases. Based on research carried out among the fishing communities of three municipalities of All Saints Bay, the paper analyses data collected by means of a small survey (N=127). Fifty-six percent of the respondents suffer from two or even three chronic diseases, which they consider serious. The majority finds that work in fishing and harvesting shellfish, and a lack of medical assistance, are the main causes of their poor health. When asked about treatment the main complaint raised by respondents concerns the poor conditions in which health care units function and the difficulties involved in travel to health care facilities located outside their communities. It is important to note that the health conditions of these traditional fishing communities are likely to further deteriorate due to governmental budget cuts and measures taken by the government to regulate traditional fishing activities.
Keywords:Traditional fishing, ALL Saints Bay (Brazil), Non-transmittable chronic diseases.
Introduction
Defined, as the process of extraction of aquatic organisms for commercial and industrial ends, fishing is fundamental to the economy and an important element for sociocultural aggregation. Fishing production in Brazil is significant: it occupies 24th place on the world ranking
(with approximately 2 million tons in 2014, with 40% being farmed) and 3rd place in
Latin America (below Peru and Chile). It is estimated that it generates a GDP of 5 billion reis, mobilizing around 800 thousand professionals and providing 3.5 million jobs directly and indirectly to the country. According to the United Nations Organization for Food and Agriculture, between 2000 and 2009, the consumption of fish per capita increased by around 30% in Brazil, while that of bovine meat grew 10%. In 2012, the median consumption of 11.7kg was already nearly equal to the minimum established by the World Health Organization, which is 12kg/inhabitant/year.
The North Eastern region occupies 2nd place
in terms of national fish production, and the
state of Bahia (with annual production estimated at 17.686 tons, in 2009), 2nd place
in the NE, and 4th in the country. All Saints
Bay (ASB), with two internal bays, Iguape and Aratu, stands out in the context of Bahia: a surface of 1, 100 km2, with an adjusted perimeter of almost 200km. ASB is characterized by a large number of estuaries, originating in a complex of mangroves that extends for around 10 thousand hectares with an enormous potential for the cultivation of aquatic organisms, such as mollusks and crustaceans. These receive various denominations throughout the approximately 173 fishing communities situated in the area, whose families, for the large part, survive from the harvesting of
chumbinhos (Anomalocardia brasiliana), clams (Cardium edule), sururus (Mytilus falcata), siris (Callinectes spp.), ostras
(Crassostrea spp.), mapés (Pteria radiata), amongst other animals.
shellfish, and crustaceans) serve not only for consumption by the families of the fishermen and shellfish harvesters, but also as a product to be commercialized on a small scale. It is production of a family character, usually carried out by the members of the same family and shared between the residents of the same community. In many of these locations, fishing activities are combined with agricultural work, whose mode of organizing production, according to Diegues, is close to that of traditional farming, while that of the fisherman is closer to a cooperative of workshops.
Traditional fishing in ASB brings together a considerable number of workers. Around 30 thousand people are involved in different ways, in what Correia describes as the “fisheries system” (a collection of activities related to pre-capture, capture, and post-capture processing of goods). In this system, the work is diversified: preparation for the capture of fish (with the maintenance of boats, nets, and other tools); extraction (there are various modes of capture of fish and shellfish); value adding and commercialization of the product. The value adding involves various operations such as evisceration, shelling, smoking, drying, packaging, freezing, and transporting of goods. The commercialization is mainly undertaken for restaurants, bars, hotels, and other clients, principally located in the state´s capital of Salvador and other communities of the Metropolitan Region.
It is important to emphasize the familial character of the fishing system in ASB. The members of the same family work together in diverse activities related to pre-capture, capture, and post-capture of the fish. Fishing on the open sea is a male activity, the role of women is mainly destined for shellfish harvesting, value adding, and commercialization of the products captured in estuary areas. But the participation of men in these activates is also common. The parents usually rely on the smaller children to increase the family labor force, principally in the process of value adding to the fish. It is worth noting that the activities related to value adding are undertaken in the interior of the fisherman/shellfish harvester's residence. In this way, it is important to
emphasize that the work of traditional fishing consumes a significant amount of time, and, having in mind the predominately familial organization, free time and work time are not always clearly distinguishable.
The working conditions in the fishing system in All Saints Bay (ASB) are precarious. The regulatory norms in Brazil for the work of fishermen are deficient and do not duly attend to the sociocultural reality of the world of traditional fishing. There is a lack of public policy directed toward the organizations that stimulate fishing activity in the country, as well as in regard to the institutions responsible for health and healthcare vigilance. The members of the fishing system are not just subject to a set of specific risks related directly to the activities of fishing and shellfish harvesting, but are also exposed to a set of factors owing to the growing anthropic activities with the potential for the contamination of water, sediment, atmosphere, and fish stocks.
The ecosystem of ASB has suffered a process of contamination resultant from domestic and industrial waste over the last twenty years (such as “trace metals” and hydrocarbons) from port activities and detritus produced by agricultural activity. In some areas, various biological species (such as ostra, chumbinho, sururu) present concentrations of trace metals that exceed the limits established by Brazilian legislation. The sources of contamination directly affect the sediment, atmospheric particulate material, water bodies, and fauna, provoking irritation and rashes on the skin, and mucous in the eyes; disturbances of the liver; problems with the immune system; in bone tissues and in the nervous system; leukemia, cancer, and tumors.
chronic non-transmittable diseases existent in the fishing communities of ASB? What is the profile of the fishermen and shellfish harvesters that suffer from these illnesses?
What sort of medical assistance is available for treatment? This article has as its aim to contribute to the discussion of these questions. More specifically, it seeks to identify, in general terms, the main health problems commonly experienced by the subjects of the fishing system in ASB and the difficulties encountered for resolving them.
This article is based on research undertaken between January 2013 and July 2015, in four fishing villages: Baiacu (4 thousand inhabitants) and Matarandiba (500 inhabitants) located in the municipality of Vera Cruz; Acupe (7, 500 inhabitants) in the municipality of St. Amaro; and in the municipality of Cachoeira, Santiago do Iguape (including the village of Engenho da Cruz, around 2km distance one from the other), with a population estimated to be around 6 thousand inhabitants. The research united a multidisciplinary team from two institutions, FUBA (Federal University of Bahia), and EIBA (Education Institute of Bahia, campi Salvador and Santo Amaro). It had as its main aim the identification and reporting of experiences of non-transmittable diseases and health complaints in the traditional fishing system of ASB. Beyond systematic observation so as to describe the local and contextualized health measures for fishing and shellfish harvesting undertaken in ASB, and the peculiarities inherent to the ways in which they are carried out, information about health conditions was collected through a small scale investigation (N=127) and 15 interviews. The “survey” was drawn up to collect data about the distribution of traits and attributes related to health and treatment processes.
Through the use of a broad based questionnaire (structured and analyzed via the quantitative analysis program Sphinx Plus), 127 individuals who were carriers of chronic non-transmittable diseases, responded to questions related to health/illness in reference to their, and their
families' health histories when using the health services available in the municipality/state, and in the evaluation of treatment. It also covered hygiene and preventative practices.
Profile of the Population
84 women and 43 men responded to the questionnaire, with an age bracket that varied from 22 to 100 years of age, with the majority of people being between the ages of 40 to 60 years of age (36%) and 60 to 80 (35%). On average, in the four locals chosen, married interviewees had around 5 children (36% up to 3 children; 23% from 4 to 6; 21% from 7 to 10; 12% more than 10). The greater majority (93% resided in their own dwellings constructed from tiles and cinder blocks (72%), with three or four rooms (30% and 23% respectively); 82% of these dwellings had sanitation in the house; 92% had electric light; 78% had piped water coming from the public system; but only 7% had a sewerage system (general network), with 67% using a cesspit for the disposal of feces and urine ...52% are registered with the INSS (National Institute of Health Service).
The majority of fishermen and shellfish harvesters interviewed resided in communities where they were born (56% of women and 72% of men); the rest, in neighboring communities. This data indicates a strong tendency for persistence and durability of local family networks. Many of them work in functions that their fathers and mothers exercised or continue to exercise: 83% of the fathers and 60% of the mothers were also fishermen/women and shellfish harvesters.
In this way, the traditional family character in the diffusion of knowledge related to fishing is worth pointing out. In this respect, they feel themselves to be the inheritors of a long tradition in the art of fishing. They inherit tools and instruments for fishing, such as paieiros in Baiacu, a construction originally made from straw or ceramics in which they keep fishing tools. There are also private spaces demarcated in the sea, on the beach, and the port which are passed down within families along the generations. Examples of these would be the camboas, in Santiago do Iguape, enclosures made from
cipo and wood and installed in the water for the procreation of some species such as ostra, whose access at times requires a boat.
Chronic, Long Duration Diseases
Regarding health problems, the questionnaire showed a list of 415 cases of non-transmittable chronic diseases (an average of 3 diseases per person interviewed). It is important to note that the concept of chronic non-transmittable disease used by the questionnaire, refers to diseases and afflictions related by interviewees as those whose health problems affected them on a day-to-day basis.
In other words, they are health problems that create discomfort with, and interfere in routine activities, mainly those related to the work of fishing and shellfish harvesting. They are, therefore, illnesses that require specific attention and care. They become “serious diseases” when, in the perception of the interviewee, they inhibit them from exercising their daily tasks or put their lives at risk. In this sense, the gravity of the health problem is measured fundamentally by the degree of interference in working condition.
Subdividing the respondents of the questionnaire by municipality of the spread
of the research, 22% of the 50 people interviewed in the two communities of the municipality of Vera Cruz, (Baiacu and Matarandiba) are affected by some of the diseases considered to be serious. In Cachoeira (Engenho da Cruz and Santiago do Iguape), of the total of 51 people interviewed, 50% of women and 27% of men related having suffered from serious illnesses. In Acupe (municipality of Sato Amaro), of a total of 26 respondents, 64% of the women and 50% of the men complained of the seriousness of their respective illnesses. In summary, of the 127 interviewees, 72 (56%) of them suffered from two or even three of the diseases considered to be serious, with 22.8% simultaneously reporting hypertension and problems with vision; 37.8% with hypertension and orthopedic problems, and 30% with vision problems and orthopedic problems. Orthopedic problems (66%), arterial hypertension (57.5%) and vision problems (40.2%) are the most recurrent. The orthopedic problems are usually considered to be serious. They occur more frequently amongst men (33%) than women (15%). In the case of arterial hypertension, also classified as serious, it is the women who report the greater number of cases.
The number of men and women who complain of vision problems is similar.
risks to health are more evident, such as over exposure to sun, intoxication from the motor fumes of the boat, burns from the heat of the motor itself, and other dangers of the sea or mangrove. From the perspective of the population, the main cause of arterial hypertension is due to frequent contact with the salinity of the sea and stressful, risks situations experienced during fishing, beyond the preoccupations of day-to-day life.
According to the medic and epidemiologist Paulo Pena, “risk factors which contribute to the development of diseases exist in all phases of the activity of fishing (collection, transport, preparation, and carrying of the shellfish). These result in: a) excess use of parts of the body most involved in carrying out the operative practices such as shoulders, spine, hands, and elbows; b) elevated and above average frequency, relative to other referents, with which fisherman realize their activities (repetitiveness); c) from the biomechanical point of view, traditional fishermen assume postures inadequate for prolonged periods of time when undertaking their tasks; d) increased time frames of accelerated rhythms and absence of pauses owing to socioeconomic functions. (…) There is an intensity of exposure in the work routine, considering that the fishermen work on average 8 to 12 hours a day, adding up to about 54 hours per week. This condition goes beyond the benchmark of 20 hours per week as a means of preventing RSI. (…) Despite the workload with intense exposure to ergonomic risk factors, the fishermen developed osteoneuro-muscular lesions later on, considering that the average fishing career is 38.7 years and begins precociously at around 5 to 7 years of age. This fact can be attributed to the micro-pauses existent in the undertaking of operative practices. This does not signify that the fishermen do not present pain symptoms, especially in the cervical spine, shoulders, and hands, for many years and maintain themselves in activity. (…) Official data does not exist regarding the prevalence of RSI/DORT in fishermen and shellfish harvesters in Brazil, which makes the preventative recognition of this infirmity difficult.
A large part of the respondents (40%) point toward work with fish/shellfish, and a lack of
medical assistance, as the main causes for their diseases. There is a belief that chronic illness is a type of inexorable event, whose occurrence is independent of human intervention as being able to alter it. From the perspective of the interviewees, the principle problem for chronic illness is in its aggravators: a lack of material resources and deficient conditions in the health assistance services. These are the two main factors that increase the seriousness of chronic diseases.
From the total of 127 interviewees, 28 (22%) of them considered that an improvement in health, for the population in general, would depend on the greater availability of employment. That is to say, on other activities which generate income. The individuals could reduce (or even eliminate) their dependence on fishing work and, with this, diminish the tendency of acquiring chronic diseases. However, 80% indicated an improvement in the medical assistance services as the most important factor for achieving good health. For these subjects, improvement of these services would mainly signify the increase of material resources and the availability of doctors. In the opinion of 55.7% of the interviewees, the health services of the community where they lived improved in the last ten years.
The Search for Treatment
One of the options for the treatment of health problems is provided by the 'folk' sector of the medical system: 62.2% of those interviewed, know some type of traditional healer where they live and 38% already sought their services. Asked about the efficiency of the prayers, teas, and directives indicated by the healers: 40.2% positively evaluated these services; 12.6% believed that it had little effect and 21.2% negatively evaluated the services. Very few people however, sought out the folk sector for the treatment of chronic non-transmittable diseases.
For the treatment of their diseases, the subjects predominately sought health services offered by the National Institute of Health Service (SUS) and, in the last instance, undertook low cost exams with private entities located in the headquarters of the municipalities. Approximately 63% of men and 50% of women interviewed regularly used, at least once a month, the services of community health centers and units. Around 30% had recourse to at least two health services: centers and hospitals.
In all of the researched communities, there exist community health care centers and units. These units are principally used for the acquisition of medications distributed without charge by the SUS. The medical consultations are usually realized in hospitals. Factors such as a lack of resources, scarcity of healthcare professionals and a high turnover of medics (or long intervals of service for general practitioners and specialists in communities), explain the reduced incidence of use of health services for clinical consultations. The medics and health professionals at the local units work on a rotating basis, that is to say, they are contracted by the municipalities and attend once a week or every fifteen days in the communities. There are frequent contractual problems with the municipal entities, creating in this way discontinuity in the provision of services, and as such, a reduction in the possibility of accompanying the evolution of the treatment.
The search for treatment in the professional health care sector, in situations of urgency and emergency, usually require the
individual to travel from their community to the outside, even to other municipalities. In these cases, it is principally the local hospitals in the municipal headquarters which are sought, which are around 30 to 50 kilometers distance from the communities. However, having in mind the deficient character in the number of professionals and medical equipment of these hospitals, patients in a very serious state are sent to Salvador or other localities that possess these resources. In this manner, it is necessary to pass through inter-municipal circuits until medical assistance is encountered, which makes the search for treatment a difficult and expensive task in the local context. Travel is usually problematic due to the infrastructure of the means of transport and the conditions of the highways. Owing to this, having in mind the difficulties created for access to treatment, it is necessary for the patient to plan their expenses, given that two factors are determinant: distance and time. In general, the patient, requires a companion, at times their partner or a close relative, who is also active in fishing duties.
To arrive in Salvador it is necessary to take a boat, whose trip of 13km takes about 50 minutes. The voyage depends on tides and, in the case of a low tide, the wait can take up to 4 hours. A second option is getting to Salvador on the ferryboat system. In this case, they would have to go to the Bom despacho terminal, at 10km distance from Mar Grande. The trip to Salvador is regular and takes about one hour.
The trip becomes even more problematic due to problems of availability of public transport in Baiacu. There is no regular system of transport for passengers. The local population depends on taxis that, though they have public concessions are not scheduled, being available only on non-specified days and hours. The most usual means of transport is private cars that provide carrier services: the motorists wait for a certain number of passengers and randomly decide when to depart. As such, there is no regular schedule for this service, and in the late afternoons, rainy days, holidays, or on weekends, it is only possible to find transport with difficulty. The cost is relatively high for this type of transport, taking into account the distance covered, beyond the uncertain wait time. The fare is R$3.00 for the stretch from Baiacu to BA-001; to Mar Grande, the fare costs R$6.00. Therefore, a return trip to Mar Grande is R$18.00. If the destination is Salvador (to the maritime terminal), the cost is twice as much, without taking into account the expenses for transit within the city. We should also remember that the patient rarely travels alone. In other words, the value spent for just an individual return trip between Baiacu and Mar Grande, corresponds to 1.5% of the current minimum salary (2015), or up to half of the value charged for 1kg of siri, packaged, frozen, shipped, and ready for sale (result of 6kg of
siri harvested). It therefore becomes costly to leave the community and the costs are quite high for the population of fishermen and shellfish harvesters. In this sense, the effort required to reach health care assistance is something to be duly taken into consideration.
In this respect we can see for example, the travails of D. Jaci in her own search for
treatment. The owner of a small store that sells food, fish, and seafood taken from the sea at Santiago do Iguape (municipality of Cachoeira), Dona Jaci suffered an AVC in 2013 needing rapid medical assistance. With the health unit closed, her daughter asked a neighbor for help and was given a lift to Cachoeira. At the São Felix Hospital, she stayed some days in observation and was transferred, through the intervention of another daughter who is a nursing technician, to the hospital of São Francisco do Conde, where she received the necessary treatment, needing to be hospitalized in the Intensive Care Unit. Dona Jaci had difficulty walking with the left leg compromised and required regular physiotherapy sessions. However, she could only undertake the sessions once a month as the local healthcare unit does not offer physiotherapy services to attend to cases like hers. In this way, to obtain treatment, Dona Jaci had to go once a month to the São Francisco do Conde Hospital, 70km from Santiago do Iguape.
in Salvador, to help his mother. D. Maria took on some of the activities exercised by her husband, such as taking care of embarking, normally the domain of the husband, contracting the team of fishermen, mending nets, as well as selling the fish. The help of family and neighbors is a significant factor as a support network for D. Maria. The illness of Seu Zé brought significant changes in the status and role that he played at the heart of the family and community. For example, D. Maria became the provider for the home, who negotiated the business, while her husband passed his days seated in front of the house, conversing with the locals.
Conclusion
The questions of health in fishing communities are generally significant with the case of ASB seeming to be expressive in this respect. Beyond the quality of life, and deficiencies in common rights for the country's fishing population, the fishermen of the ASB currently face changes in the ecosystem due to processes of contamination resultant from domestic and industrial waste. Such changes threaten not only the production of fish, but also conditions of health and food security for the fishermen. Orthopedic problems (mainly in the spine), of vision, cardiovascular, hypertension, and diabetes, are the most frequent problems in fishing communities of ASB. According to the perspective of this population, these problems are aggravated mainly by the relative inaccessibility of the healthcare system. In summary, the Brazilian State has not given due consideration to the rights of the fishing communities. Despite the undeniable achievements in social rights attained by the fishermen and shellfish harvesters, overwhelmingly due to the
action of the Fisherman's and Traditional Fisherman's Movement (FTM), their current life conditions are particularly difficult and tend to be aggravated given budget cuts by the government in essential areas such as health, education, and social security. The Decree 8.425, published in April of 2015, by the President of the Republic, is a significant example, establishing rules for the definition of the identity of fishermen and traditional fishermen, starting from the ways of functioning and living, of the fishing communities. The law no. 13.134, of June, 2015, changed the rules of access to the secure-defense. This may have been motivated by suspicions of irregularity in the registering of fishermen, because according to this law a fisherman/shellfish harvester is only considered as such when working in the capture of fish. Therefore, to be able to receive benefits one will have to work in an uninterrupted manner in the activity of fishing, and not have income from any other source. It is important to note that such mechanisms are connected to a rigorously regimented conception of fishing, mainly in respect of the capture of the fish, ignoring an essential aspect of the traditional fishing system: the familial and collective character of this system. As seen above, the practice of fishing is intimately involved with family histories and in the quotidian life of communities [1-15].
Acknowledgements
We would like to express our thanks to Joseína Tavares, Jaiana Menezes, Flavio Catão, Robson Costa, Rebeca Cunha e Julia Barata, at the Nucleus of Studies in Social Sciences, Environment, and Health (ECSAS) at the Federal University of Bahia, to the CNPq for the productivity grant to Paulo Cesar Alves and to FAPESB for the financial assistance.
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