HEMODIALYSIS AND TERRITORIAL INEQUALITIES: A REFLECTION ON INTERMUNICIPAL DISPLACEMENT AND THE PATHS LEADING TO SURVIVAL

uma reflexão a partir do deslocamento intermunicipal e os caminhos que levam à sobrevivência

Abstract

Abstract: Chronic kidney disease constitutes a significant public health problem in Brazil, requiring continuous and highly complex treatments such as hemodialysis, which are often provided in services concentrated in urban centers. This organization imposes long journeys on many users of the Unified Health System, making transportation a largely invisible dimension of health care. This article aims to analyze how travel to hemodialysis treatment is configured as a constitutive part of care and how it expresses territorial and organizational inequalities in access to specialized services. This is a theoretical-reflective essay with a qualitative approach, grounded in a bibliographic review and critical reflection based on the researcher’s social experience in contexts of travel for hemodialysis, understood as a situated lived experience rather than a systematic observation of patients. The discussion articulates literature from Collective Health on access, therapeutic itineraries, territory, and health equity with recurring typical situations in the daily routine of health transportation services. The results of the reflection indicate that travel is integrated into the therapeutic process itself, producing physical, emotional, and social impacts that extend beyond the clinical setting and reveal structural limits of health policies. It is concluded that recognizing transportation as a component of care is essential for strengthening the principle of equity and for formulating public policies that are more sensitive to the concrete living conditions of people undergoing hemodialysis treatment.

Keywords: Collective Health; Hemodialysis; Access to Health Services; Health Inequalities; Health Transportation.