When life goes back to normal: health and adaptation in the Brazilian Amazon frontier

In the Amazon frontier, as well as in other regions of Brazil, illnesses' risks are similar. Dengue, parasitic diseases, cancer and cardiovascular diseases are common here and there. A reality significantly different from that faced in the period of colonization: malaria, respiratory diseases, accidents, violence, etc. The migrants' discourses are loaded with memories and representations of events of these risk situations. Studying these trajectories and memories allows us to understand the potential of the community to adapt to shocks and modify reality. This was the aim of this study. We conducted nine semi-structured interviews with pioneers of colonization and four focus groups with 24 health professionals from the municipalities of Alta Floresta, Carlinda and Paranaíta, State of Mato Grosso, Brazil. Each focus group built a timeline, which was used as a tool to discuss environmental-health relationships over six phases that define the region's colonization and development: deforestation, mining, family farming, ranching, timber extraction, environmental supervision and construction of dams. The generative themes that triggered debate were: diseases, health, environment, socioeconomic conditions and lifestyles. A set of multiple and dynamic factors appear as a determinant of health problems. On one hand, they have their origin in the ecosystem (agents and vectors of malaria) and human action on it: deforestation (accidents) and forest burnings (respiratory diseases). On the other, they derive from socioeconomic factors: conflicts over land and gold (violence) and poverty (parasitic diseases and infant mortality). In both cases, the intensity of migration, lack of preventive information and shortcomings of health and safety, exacerbated illness risk. The end of the malaria epidemic (2006) was associated with the closure of mines (1992), the intensification of health services (1990s) and control of deforestation (2000s). The latter also had an impact on the occurrence of respiratory diseases. There was transition in accidents (work for transit) and the violence and poverty diseases (from rural to urban). In the current phase, prevalent diseases are associated with cumulative exposure to pesticides and mercury (cancer and chronic diseases) and lifestyle (obesity, cardiovascular disease, etc.). Changes result from public policies (health, education, safety, social security and social programs - Bolsa Família and retirement) and adaptation processes, strengthening and transformation within the community, as well as in local institutions. The attributes inherent in the adaptive process are: (i) heterogeneous identity: allowed to aggregate a variety of knowledge; (ii) education: offered better communication, learning and producing responses; (iii) social cohesion: engagement, collaboration and action in community - spurred by the Church; (iv) appropriation of space: an interest in setting up and taking on commitments to the region; (v) the assimilation of the future: commitment to building the desired environment for the children. These qualities enhance community's resilience to manage, affect or adapt to future risky situations. The initial phase of construction of dams has shown the learning process, appropriation and resilient adaptation of these communities exposed to historical adversities and cycles affecting social-ecological systems, health and wellbeing in the Amazon frontier. (Texte integral