Epidemiology And Social Mobilization In Academic Education In Medicine

ABSTRACT

OBJECTIVES: To report the experience derived from the activities carried out from August 2018 to February 2021 in the extension project “EPIMOBS: Epidemiology as an instrument for health action and social mobilization,” developed by medical students.

METHODS: After accessing the database of the Municipal Health Department of Governador Valadares, the extension students developed instruments such as booklets and pamphlets to assist in dialogue with the community and to make communication between the scientific community and the population more dynamic.

RESULTS: There was increased awareness regarding endemic and epidemic diseases in waiting rooms of Primary Health Care Units, beauty salons, long-term care institutions, schools, and adoption fairs. The themes addressed included chronic non-communicable diseases, arboviral diseases, zoonoses, sexually transmitted infections, and breast and prostate cancers. The actions promoted allowed direct contact between students and the community, which enhanced the effectiveness of the activities and the achievement of the proposed objectives, such as social mobilization. With the onset of the pandemic and the consequent actions required to contain the spread of the virus, the project’s mode of operation was changed, and the social network Instagram was used as a means to promote health education for the population.

KEYWORDS: Epidemiology; Health education; Extension project; Public health; Social mobilization.

INTRODUCTION

Over the years, Brazil has undergone profound demographic, epidemiological, and socioeconomic changes. This transformation has occurred through population aging and rapid urbanization. As a result of these changes, health problems with different etiologies, manifestations, and repercussions on public health have emerged. This can be corroborated by data from 2011 showing that both infectious diseases, such as lower respiratory infections, and chronic non-communicable diseases, such as diabetes mellitus and ischemic and cerebrovascular diseases, were among the ten most frequent causes of death in that year (Silva Junior; Ramalho, 2015).

Projections regarding the future epidemiological scenario may be altered by the emergence of highly transmissible infectious diseases (Silva Junior; Ramalho, 2015). Among these conditions is infection by SARS-CoV-2, called COVID-19, which by April 10, 2021 had accounted worldwide for 134,308,070 cases and 2,907,944 deaths, affecting 223 countries, areas, or territories (Strabelli; Uip, 2020; WHO, 2021). In view of the emergence of these infectious diseases, the theory of epidemiological transition has been questioned. This theory argues that, over time, chronic-degenerative diseases replaced infectious diseases as the main cause of mortality. Furthermore, this theory is also challenged by the re-emergence of conditions caused by microorganisms that have adapted to antibiotics, such as pneumonias caused by resistant bacteria (Grisotti, 2010).

Epidemiology can be defined as the study of the causes that determine the distribution and frequency of diseases in human populations, and the objective of this field is to study these conditions in order to control health problems (Rouquayrol; Gurgel, 2018). The control of health problems can be achieved through social mobilization, which is necessary to modify public policies and health practices that have been carried out until then. Thus, social mobilization can be conceptualized as the set of efforts to solve the most diverse challenges of public interest. For these objectives to be achieved, social mobilization advocates the active participation of the individuals involved, that is, their participation in decision-making regarding health problems. This practice is in line with Paulo Freire’s perspective, which defends health education practices that oppose authoritarianism, community passivity, and subordination (Geraldo et al., 2019; Henriques; Mafra, 2006), and it is consistent with the purpose of the EPIMOBS project, whose general objective is to involve and reach the population of Governador Valadares as a whole, in a continuous manner, promoting and collaborating in guiding public health actions in this territory.

In addition, the internet has become an ally in social mobilization, currently playing an important role as a vehicle for information, expanding relationships with the community, and increasing visibility on relevant topics such as epidemiology. Thus, social networks are an excellent tool for participation and social mobilization, aiming to provide a favorable environment for the development of strategies that represent, welcome, and meet the needs and interests of the community regarding health conditions, neglected diseases, ongoing campaigns, and public policies (Nascimento, 2014; Henriques; Mafra, 2006; Amorim et al., 2012).

It can therefore be concluded that collective health is an indispensable field of study in the academic training of health professionals. According to the 2014 National Curricular Guidelines, the field of collective health has become increasingly prominent, with epidemiology presented as an essential tool for obtaining information about the health status of a population, including its particularities and challenges. Thus, the areas of competence of Health Care, Health Management, and Health Education were included in these guidelines, highlighting the need for future professionals to acquire, during their training, experience in primary health care and in the development of projects that assist in understanding the health–disease process (Peixoto et al., 2019).

In this context, the present article aims to present the experiences lived during the EPIMOBS project in Governador Valadares, before and after the coronavirus pandemic, and to relate them to the impact of epidemiology during this period.

METHODOLOGICAL PROCEDURE

This study consists of an experience report derived from the activities carried out from August 2018 to February 2021 through the extension project “EPIMOBS: Epidemiology as an instrument for health action and social mobilization,” developed at the Federal University of Juiz de Fora, Governador Valadares campus, Minas Gerais. The project’s extension activities were carried out through the participation of undergraduate students and faculty members from the Health field, in partnership with the Municipal Health Department of Governador Valadares. The extension students were selected through annual selection processes and were trained in epidemiological data analysis, scientific research, and mobilization actions.

With an estimated population of 281,046 inhabitants in 2020, Governador Valadares is the ninth most populous municipality in the state of Minas Gerais and the most populous in the Eastern Health Macroregion, in which it is located (Brazilian Institute of Geography and Statistics, 2017). Through contact with the Municipal Health Department, the EPIMOBS project gained access to municipal databases on diseases and health conditions, so that the activities promoted would be aligned with the city’s demands. The main areas of action included health units, schools, and fairs. It should be noted that EPIMOBS also maintains a social media account through which content and materials are posted to a fixed audience of 485 people, while also being freely accessible to any Instagram user.

Between August 2018 and December 2019, activities were conducted based on the epidemiological demand of the Eastern Health Macroregion, identified through in-person, semiannual meetings held between the Municipal Health Department and the extension students. Based on the information provided, scientific research was carried out to analyze the data, aiming to support the development of educational booklets and preventive actions for the control of the most prevalent diseases in the territory.

Thus, educational materials were produced addressing the most prevalent diseases in the municipality, such as arboviral diseases, acquired syphilis, sexually transmitted infections, visceral leishmaniasis, sporotrichosis, and breast and prostate cancers. The actions consisted of interactive dialogues combined with the distribution of educational materials in strategic locations such as schools, Primary Health Care Units, and local fairs. At the end of the activities, information was collected to support and improve future actions aimed at health promotion and quality of life improvement.

The activities developed from April 2020 to February 2021 were carried out remotely, in accordance with the safety measures in force during the COVID-19 pandemic in Brazil. For this purpose, the Instagram account epiobs_epimobs_ufjfgv was widely used as a platform for disseminating materials produced by EPIMOBS students. In order to meet the demands of this period, weekly COVID-19 epidemiological bulletins were prepared, in addition to periodic posts explaining social and health problems that worsened as a result of the pandemic.

Other topics addressed included diseases with significant endemic profiles in Governador Valadares, materials clarifying facts and myths in the health field, and literary, audio, and audiovisual recommendations that could provide knowledge in a more engaging way. Furthermore, in January and February 2021, weekly podcasts were produced addressing epidemiological bulletins on arboviral diseases and COVID-19 in the Eastern Health Macroregion. These podcasts were forwarded to the Regional Health Superintendence of Governador Valadares and then distributed to health professionals working under its administration.

The EPIMOBS project was implemented in the years 2019 and 2020, in accordance with the approval of Public Calls No. 003/2018 and No. 012/2019, respectively, issued by the Office of the Vice-Rector for Extension of the Federal University of Juiz de Fora.

RESULTS

The experience in carrying out the project activities took place in two distinct moments. Prior to the current pandemic context, social mobilization actions were conducted within the Family Health Strategy units, meetings were held to discuss and develop projects aimed at intervening in the health situation of the territory, workshops were organized with Local Health Councils, and actions were carried out in schools and with specific population groups. In this way, the project directly supported the institutional spaces of primary health care through articulation among the various components involved in health surveillance and care.

Regarding health education actions, awareness-raising activities on endemic and epidemic diseases were highlighted in waiting rooms of Primary Health Care Units, beauty salons, long-term care institutions, schools, and adoption fairs. The themes addressed included chronic non-communicable diseases, arboviral diseases, zoonoses, sexually transmitted infections, and breast and prostate cancers. The development of the instruments used, which included booklets and pamphlets, allowed extension students to gain greater mastery of the creative processes involved in their production. At the same time, the informative dialogue with the community provided greater dynamism in the interaction between the scientific community and the population.

The actions carried out enabled direct contact between students and the community, which favored the effectiveness of the activities and the achievement of the proposed objectives, such as social mobilization. In addition, entering environments where the students will work in the future, such as Primary Health Care Units, made it possible to better understand the dynamics of how these spaces operate. On the other hand, logistics related to obtaining physical materials, such as printing pamphlets and booklets, and resistance from part of the community to discussing certain topics were identified as barriers to the project’s implementation.

With the onset of the pandemic and the consequent actions required to contain the spread of the virus, such as social distancing measures, the project’s mode of operation was modified. In this context, the EPIMOBS project used the social network Instagram as a means of promoting health education for the population. Two accounts were used on this platform: @epimedgv and @epiobs_epimobs_ufjfgv, aimed at disseminating epidemiological concepts and information about diseases and how to prevent them, respectively. These actions began in August 2020 and ended in January 2021, except for the dissemination of weekly COVID-19 epidemiological data.

Among the topics addressed on @epiobs_epimobs_ufjfgv, diseases such as arboviral diseases, syphilis, leprosy, schistosomiasis, leishmaniasis, sporotrichosis, tuberculosis, HIV, and hepatitis stood out. Flashcards, fact-or-fake dynamics, polls, and quizzes were used. In addition, posts were made addressing issues related to the COVID-19 pandemic and its implications in Brazil and worldwide, including updated epidemiological data, the relationship between social isolation and increased domestic violence, and mental health during the pandemic. Furthermore, for moments of relaxation, cultural recommendations were shared, including books, films, and podcasts with diverse health-related themes.

On the @epimedgv account, posts related to epidemiology were developed, highlighting its concept and history; evidence-based medicine; epidemiological, environmental, and occupational health surveillance; collective health measures; descriptive and analytical studies; measures of association; biases; research projects; primary and secondary health care; demographic and epidemiological transition; pharmacovigilance; and health education.

With the aim of making the information contained in epidemiological bulletins more dynamic and accessible to the general population, the project began producing weekly podcasts in January 2021. The topics addressed were related to epidemiological bulletins on arboviral diseases and COVID-19 in the Eastern Health Macroregion of Minas Gerais, and also included the importance of preventive measures for these diseases. The development of the podcasts enabled the team to become aware that knowledge can be transmitted in a fast, simple, and effective manner.

As a result of the methodological changes required by the new reality imposed by the pandemic, positive aspects were identified, such as the greater reach of information shared on social media, which can be easily disseminated through networks; convenience in communication and planning among project members; and the diversity of tools available for exploration. According to one of the extension students, “producing the podcast was interesting as a way to reinvent oneself in the academic environment, especially regarding the development of skills such as public speaking,” while another stated that “researching content for social media allowed for greater mastery of the impacts generated by the pandemic.”

Conversely, difficulties arising from the exclusive use of the virtual environment to carry out health actions were identified, since a considerable portion of the population does not have access to social media, which prevents access to information. Moreover, there was a loss of close contact with the community, impairing the construction of trust, which is fundamentally important for the effective sharing of health guidance.

It is known that, given the reality imposed by the pandemic, social media became one of the few available tools that allowed the continuation of the project’s activities. However, some negative impacts were observed, as remotely conducted actions made it difficult to build an effective bond between the population and health students, which to some extent compromised the achievement of part of the objectives initially proposed.

Despite the difficulties faced during the execution of the project in 2020 and 2021 and the need for changes in its approach to ensure a truly positive impact on society, the project contributed significantly to the development and improvement of the extension students’ skills. The professional experience acquired was due to greater mastery of public speaking, rhetoric, and proficiency in conducting scientific research.

DISCUSSION AND FINAL CONSIDERATIONS

The present project aims to promote the training of generalist professionals capable of integrating health information into their technical practice, considering an interdisciplinary and multidisciplinary perspective in solving problems that affect society. In this sense, collective health plays a role in linking theoretical content to the prevailing social and technological context, understanding the importance of applied epidemiological knowledge (Custódio et al., 2019). University extension activities are therefore fundamental to contextualized and, above all, humanized professional training, given their role in recognizing human beings as social beings. This contributes to the incorporation of the social sciences into public health, reshaping epidemiology, politics, health management, and planning (Silva, 2018).

In light of these perspectives, medical academic training has been highlighted as a central aspect for achieving and implementing public health policies, since the traditional, biologicist, and hospital-centered teaching model no longer meets current social demands (Oliveira et al., 2021). In this context, the project “Epidemiology as an instrument for health action and social mobilization” integrates extension and research activities that allow the application of scientific epidemiological knowledge to collective reality, promoting intervention strategies aimed at social transformation (Moita; Andrade, 2009).

In addition to EPIMOBS, other projects aimed at transforming social reality can be observed, such as the project supporting telemonitoring of suspected and confirmed COVID-19 cases in Rio Branco, Acre. Through telemonitoring, this project evaluated COVID-19 cases in terms of risk and severity, thus determining the appropriate course of action (Silveira et al., 2021). Therefore, actions that focus on health education enable the population to better understand the epidemiological situation through the dissemination of reliable information, generating greater self-care and fostering a leading role for the population in the process of improving collective health (Silva et al., 2020).

Furthermore, it is evident that the integration of health surveillance with primary care represents a challenge for the Brazilian Unified Health System (SUS) at all levels of management (Brazil, 2018). Thus, discussing the components of health surveillance and health care is an opportunity provided by the project, in addition to enabling experiences related to health protection, promotion, and recovery at the collective level.

Finally, it is worth emphasizing that collective health is an essential instrument in academic training. Epidemiology is one of the pillars of Social Medicine and plays a role in denouncing inequalities and inequities in health, helping to restore solidarity and ethics in the field of public health. In this regard, collaborative work and shared protagonism between the university and the community strengthened the principle of comprehensive care and enhanced students’ capacity to deal with human complexity and its institutions.

CONFLICT OF INTERESTS

The authors declare that there were no conflicts of interest in the development of this study.

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