Ethnographic study on homElEss pEoplE in a big urban cEntEr

Homeless people are part of the urban landscape and health professionals cannot be exempted from this process. This study aimed to understand the experience of homeless people in the historical and social context. Ethnography was used as a theoretical reference. Participant observation and open interviews were used for data collection. The saturation criterion was adopted for defining the number of respondents. The population consisted of 17 people. Most had been living on the streets for several years and education levels ranged from elementary school to university education. Initially 21 cultural domains were surveyed, and of these 7 taxonomies emerged. Drug use was considered the cultural theme, because it had been recurrent in various domains and also in 5 taxonomies. It is suggested that further studies on the subject are conducted, because this is about human beings who one day had a structured life.


IntRoductIon
There are increasing number of people excluded from the conventional structures of contemporary society, such as employment, housing and privacy.Living on the streets always assumes precarious life conditions, discrimination, low self-esteem and abandonment from society in general and from their old family bonds. 1 The definition of homeless people is complex due to multiplicity of personal factors that keep them in this condition.Several ways of trying to find solutions given to subsistence and housing difficult formulation of more objective concepts.
:536 People living on the streets are part of the landscape, especially in large urban centers; and the health professionals cannot be insensitive to this process, because the issue of vulnerability inserted therein.It is emphasized that the street scenario is one of the most diverse elements among those, which inhabit the popular imagery of any urban society. 3he absence of stable contacts with the family nucleus (as a base of material and affective support) puts people living on the streets in need of belonging to a group. 4e consider these aspects concerning to health professionals, as they have a critical and reflexive role in regard to the care of people within their social universe.
The literature recognizes the necessity of sensitizing nurses regarding the specifics of homeless people, since the interpersonal act of care requires knowledge and respect for the individuality of the human being. 1 There are several problems which contribute to the increased vulnerability of these people: drug use, diseases resulting from poor quality of life, among others.To handle such situations, the Ministry of Health created the Street Medical Office.This is a strategy of the Emergency Plan for Expansion of Access to Treatment and Prevention in Alcohol and other Drugs in the Unified Health System -PEAD. 5 This way, the link between health professionals and homeless people is officially formalized.However, the responsibility of health professionals is not just providing healthcare to people living on the streets, but mostly of coping strategies that can be built on a larger perspective of appreciation of life and citizenship.In this coping process, knowledge and action must be articulated, in order to enable new forms and new forms of integral care to people.The healthcare practice on the street scenario must incorporate the knowledge, experience and culture of the people who are part of it, and should be construct-ed from an interpersonal relationship based on bond, welcoming and qualified listening. 5hus, this research emerged form the need to study a qualitative perspective of the issue of people living on the streetswho are considered deprived of citizenship -in a historical and social context.What takes people to live on the streets?What are the motivations for such a way of being?The qualitative approach is inherent in the study of human subjectivity, thus ethnography chosen as theoretical framework, as this should be understood as description of a culture.This culture can be a small tribal group in an exotic land, be a class in a school in the suburbs or be many others, it is the task of the ethnographic researcher to understand the way of living in the perspective of the native of the studied culture. 6Therefore, we understand homeless people as the natives of the culture in study.
It is expected to contribute with reflections on people living on the streets, so this reality can be contextualized and approached.

objectIves
Understand the motivations of people living on the streets: what did lead them to live on the streets and what keep them in that situation.
Understand the life experience of these people.

Methods
An ethnographic study was conducted, since it is adequate to understand the complexity of cultural phenomena. 7,8he fieldwork begins when ethnographic questions arising from the social situation under study are made. 7he research subjects were homeless people in the city of Belo Horizonte, which were approached grouped or alone.An open interview with the question: "could you talk about your current life situation?"was the instrument for data collection.The interviews were recorded and transcribed manually.The sample size was defined by the criteria of saturation.
Besides the open interview, a participant observation was used.For a few days -prior to the start of interviews -the researchers visited a park and two public squares where these people usually stay, the study scenarios.Observing the scenarios, it was able to recognize their routines, habits and how they spend their days: how they eat, with whom they live and with whom they share their daily lives.Some refused to listen the presentation and left, maybe feeling invaded.Another two refused to participate in the research.Those who talked, shared with us the context of their experiences and did it naturally.
Data collection occurred during the months of October and November 2011.These two months were sufficient to ceive that, in the groups, usually one of them assumes the leader position.They talk, laugh and share food and drinks.
As for ethnographic analysis, 21 culture domains were initially raised: types of reported drugs; consequences of drug use; profile of the person living on the streets; ways of expressing feelings about life; causes that led the person to live on the streets; forms of explaining early aging; causes of early maturing; type of street activities; causes of drugs relapse; ways of facing the reality of the streets; types of sense of loss in the living on the streets situation; types of expectations for the future; ways of expressing the living on the streets experience; types of difficulties at work; type of feeling toward the family; ways of expressing religiosity; types of activities before living on the streets; sources of support for people living on the streets; types of self-perception of the homeless; time lived on the streets; reasons that keep the person living on the streets.
From these domains, eight taxonomies were built, with their respective subdivisions: achieve saturation, which occurred during the 18 th interview.We seek these people in daytime.After clarification, these were invited to participate of the study.The research project was approved by the Ethics in Research Committee of UFMG (COEP), under registration 0586.0.203.000-10, on March 2 nd 2011.The names of interviewees were not disclosed.They all signed the Informed Consent form (IC).
For ethical reasons, the interviewees' names were replaced by numbers ranging from I (interviewee) 01 to I 18.
The analysis of ethnographic data is a continuous process, cyclical and simultaneous to data collection, through which cultural meanings are identified. 7The ethnographic questions arise from analysis of data from interviews and observations.Thus, the data analysis was interspersed with the fieldwork in a cyclic process.Domain analysis is the first type of ethnographic analysis.Its objective is to identify cultural domains that are categories of cultural meanings.From domain analysis, questions that seek to understand the cultural organization appear.This is the taxonomic analysis of the ethnographic data.The taxonomy establishes the relationship between the terms included in a cultural domain, showing its internal organization.A wider vision of the culture is obtained through identification of recurring themes, starting with the process of immersion in the data and validation with the respondents. 7he ethnographer searches both the details of a culture (analysis of domain, taxonomy and componential), and maps the broader aspects of the cultural scenario in study (thematic analysis).The search for themes involves identification of cognitive principles that appear recurrently.
The main strategies for performing thematic analysis are immersion in the data and elaboration of diagram systems of the cultural scene.From there, the ethnographer can identify universal themes.In the present study, analysis of domains and taxonomies were conducted, in addition to identifying a cultural theme. 7

Results
The study population consisted of 18 people, being 17 men and one woman.Most of them have been living on the streets for several years, although two referred have assumed the homeless position only a few days ago.The educational level ranged from elementary school to college degree.There were not illiterate people in the sample.Regarding lifestyle, almost the entire sample have a settled sleeping accommodation, which may be one of the city hall homeless shelters or a place on the street, like under a bridge or in a park bench.
During the participant observation step, it was possible to notice that many of the homeless people live in groups.A few remain alone in their daily routine.It was also possible to per-

dIscussIon taxonomy 1: causes that led the person to live on the streets
The family disagreements appeared significantly.It is possible to reinforce the idea of broken family bonds: "Then it began, one put the blame on me, the other also.I was showering, someone kept knocking on the door.If I was doing the super-market, someone always said: it is not enough.Then it began.Everyday.It filled my head, my head, my head!" (I3) Death of family members, especially the mother, is the cause of disruption of some family bonds.This leads to reflection about the strong maternal role in a family, since, for the interviewees, going to the streets happened after the death of a family member: "After the death of my mother… it was after" (I2).Mourning, as it is not a linear process, has no end date.It can last for months and years or never end; it depends directly of the individual personality traits and of the level and intensity of the relationship with the deceased. 9he chemical and alcohol dependence appears in several reports as causative agents of the current situation: "My family always told me to live the house, because of the drugs" (I1)."As I always drank too much, I ended up destroying my marriage" (I15).
It is observed that the use of drugs and alcohol not only leads to the process of social exclusion and of living on the streets, but also keeps the person in this situation.The following statement illustrates this reality: "I came to the street because I am user of alcohol and crack" (I18).
The use of crack by people living on the streets can be explained by its relative low price, easy availability and strong effect.Although the use of this substance have crossed different social classes, the association between its use and poverty, or even, with being a homeless person and being a crack user is still hegemonic. 10n the other hand, alcoholic beverages -mainly cachaças -are easy to purchase and consumed at anytime of the day.
Among the causes related to affective life, reports of betrayal of former mate drew attention, describing the occurrence of marital infidelity: "I said that I was going to travel, and I manage catching her with another man, do you believe it?"(I9).
A study about aspects of masculine identity in post-modernity 11 addressed the man's reaction facing the betrayal of his mates.A large amount of the interviewees considered a woman's betrayal "a hit unleashed directly to their masculinity".In many answers, the author perceived that some men blame themselves for the woman's betrayal and feel diminished as men in these situations.taxonomy 2: Profile of the person living on the streets Again, alcohol and drugs appear as components of the profile of many homeless people.Our data corroborate research on people in the same situation 12 , in which the authors consider alcoholism as one of the elements that characterize people living on the streets, being the determining agent for the process or, even, effect of the same.
The use of drugs, mostly crack, was observed in this study.This finding was also found in an ethnographic study about Concerning expectations to the future, we observed that there are positive expectations related to hope for a better life.Some intend to return to their homeland, in order to begin their life differently.taxonomy 4: types of expectations for the future This aspect refers to Brazilian social issues, where many still leave their native land in the expectation of a better life.Generally, migration is motivated by socioeconomic factors, for the lack of resources, labor, food and living conditions, which provide motivation to seek in other lands what it is not found in the homeland. 16Unfortunately, the result is not always as expected, as this study suggests.
Some of the participants expect to retire, because they crave to have a continuous income that guarantees a better life, and others dreams of returning to the job market: "And I am sleeping here until I reach the age for retirement […]" (I14) "[…] What I am really looking for is to go back to the job market and not be on the street" (I9).
If we think about the high number of people unemployed, it is necessary to make a reflection about the psychological and social issues resulting from this condition.The unemployed person carries labels such as: "lazy, irresponsible".The dream of returning to the job market may be a rescue their citizenship.
Drugs once again appear as included terms, since the desire to quit them is verbalized by some interviewees: "[…] I wanted to quit drugs, free myself of this addiction" (I13).The statements reiterate what is already public knowledge, the difficulty of recovering from drug addiction.
There is also negative expectations, in which the person has no hope of getting out of the streets, characterizing utter dismay: "[…] I think I am going to die this way, I don't know how […]" (I15).
Being considered unnecessary, nuisance and threatening, often implies becoming subject of elimination, symbolic or physical. 12We believe that this symbolic elimination of the homeless is not only awakened in the domiciled, but also in the group of the people living on the street, who may feel self-pity, resulting in discouragement and a lack of representative life expectancies.
Paradoxically, in this study we observed that the causes, which keep people on the street are linked to the benefits in favor of the same, as the State aid (homeless shelters and food) or even the help from others.

taxonomy 5: Reasons that keep the person living on the streets
The following reports show that, according to the subjects, homeless shelters and food are benefits offered to peo-young people living in streets of two big Brazilian cities.The authors report that the vast majority of the respondents had a pattern of compulsive drug use, especially crack. 10ne interviewee, when reporting that "And on the street is the same way, it does not change anything… I am still using crack, I keep using cocaine…" (I18), seems to consider the crack something inherent in his own life.
An important fact in the interviewees' profile is that many of them had a socially structured life, with family, employment and assets: "[…] I've had my little car, I have had a driver's license, a car" (I9).The gradual familiarization with the street environment seems to contribute to the acceptance of this new routine, where the relations with "the other side" are being replaced, but almost never forgotten.These people had a house, family, employment, possessions; they were part of a social group from which they were excluded or even excluded themselves.
People living on the streets, in their majority, have as trajectory referring to their having had done some work, which was important in the formation of their social identities.At some point, a misfortune struck their lives, such as a loss of employment, breaking some emotional bond, making them gradually lose their perspective of life plan, and start using the street space for survival and as housing. 13axonomy 3 presents the ways of facing the street reality, related to sleep and comfort, food, daily life on the streets and lack of money.

taxonomy 3: Ways of facing the reality of the streets
The forms of facing reality of the streets appear configured in the struggle for natural survival instinct, where the search for supplying extreme basic needs, as food and place to sleep, constitute the day-to-day lives of these people."There is a shelter up there, in which they give shelter, you see?" (I12).
Once again we observe the search for alcohol, this time as a way of facing the street reality.Some admit that alcohol is essential for them to continue living: "Alcohol is an encouragement for me, for life to keep going" (I15).Alcohol, for being a legal drug, is normally accepted by society 14 , although it is known to be harmful.
The situation of begging, in this study, is not presented totally unrelated to lack of work, as in the society imagines.Some of the homeless people work as recyclable waste collectors or have some employment contract: "Then I got a job, I have my job, have my job, so…the I got a job in the cooperative" (I10).
Others survive by begging: "Ask for spare changes from one and another, some have a good heart and help" (I11).
The act of giving change can have different meanings.To give food, clothes and pay a snack, can be not understood as giving change, but as alternatives to this practice. 15he issue of help from others (institutions or individuals) was recurrent, also appearing as a cause which keeps the person living on the street: "Well… you eat, drink, get drunk and do not have to work, or am I lying?" (I15) "Because here's the deal, on the street you have food, money, alcohol, even get involved with women from the street […]" (I16).We recall that remain policies addressing poverty in Brazil, conceptions and assistentialism, clientelism and patrimonialism practices. 19The assistentialism can be considered an exclusion policy that aggravates misery. 20ttention to people living on the streets comes from various sources.There are references to NGOs, state aid, charity and religious help.We consider it interesting the aspect of professionalization, referred by some interviewees, constituting taxonomy 6.For them, these sources of support "are with us to help…and…to put us, homeless people…to work, they want to open the doors of their businesses for us to work" (I9).
The interviewees suggest during the study forms of supporting people living on the street.taxonomy 6: sources of support for people living on the streets Once again, benefits as homeless shelters and food are cited.There are questions about the objectives and results of the works considered "assistentialism", because while thinking in social assistance as transferring resources, it will always be dealing with finite resources to an infinitive demand. 20harity is also cited as having many roles: "there are very good people on the street passing at night giving blankets for you to sleep" (I18).This responded cities "very good people on the street", indicating existence of solidarity, even in an environment permeated by violence, as the street.
There are people on the streets, who have negative selfperceptions, but there are also positive self-perceptions.

taxonomy 7: types of self-perception of the homeless
One of the interviewees affirms, "my name is cleared" (I10), what can be interpreted as "a condition of not owing anything to anyone".Some are proud of being workers, what give them honor.
Assessing the negative self-perceptions, we infer that any social work which is directed to people on the street, necessarily implies recovery of self-esteem.Many of them are ashamed of the situation, comparing himself or herself to "a dog" (I11).Some verbalize feelings of sadness stamped in their facial expression, trying even to hold back the tears: "[…] I am a lonely guy, sad, I am not worthy to look at beautiful women like you, because we're ugly" (I15).
ple who live on the street: "how many people took the housing benefit that the State gives and then go back to the streets?How many are in the homeless shelter and took the housing allowance and even though continue living in the homeless shelter?Right?So we can not even complain."(I7)."Now, the society gives you homeless shelter for sleep, gives you food to the cost of two reais, and you want to work for what?" (I15).We believe that the benefits should not occur alone, but linked to educational programs, which are intended to redeem self-image, self-esteem and willingness to reintegrate into society, because: […] even with the existence of sincere piety, the pernicious aspect that acts underlying this conception, is of contributing for the construction of the individual's living on the street identity as someone inferior and pitiful for their ills, besides being a belief, which creates difficulties creation of possibilities to these individuals to succeed their exit from the streets.:51) Some interviewees refer to Belo Horizonte as the ideal city for people living on the streets."And here, Belo Horizonte is a very good city for such things, you know?" (I1).This finding can be justified by the size of the city Belo Horizonte -a metropolis, which would create conditions seen as "ideal" for people living on the streets.
The continued use of drugs, in this taxonomy, appears desirable, since some of the interviewees report not wanting to quit them: "here nobody wants to stop using drugs" (I7).Unquestionably, the pursuit of pleasure through use of drugs is a risk, due to the downside of the desire to obtain pleasure from the use of drugs being the risk that he runs of becoming addicted and falling to perform normal daily tasks. 17ther interviewees simply verbalized that they do not want to return to their homes: "And I do not want to go back!My father already called me to go back home three times.I don't want to!" (I11), a fact already observed in the literature in a study describing that sometimes, the person living on the street chooses to continue in this situation, even having a chance to return to his or her home. 18e emphasize that the option of staying on the street was verbalized by several respondents.These brought with them stories of serious family disagreements and drug use.This finding leads to reflection that family is not always considered a safe haven.
The taste for complete freedom appears to be strongly linked to the causes of maintaining a life on the street: "Then when I met the world for the first time, ah, this is what I want, this freedom" (I1).One of the interviewees reports that "[…] I fell in love here, this municipal park is too good to be true!" (I10).The current housing seems to even surpass the comfort at home.The consumption of drugs on the street is considered a factor of sociability, an element of creation of groups and object of solidarity, as well as of disputes and conflicts. 10e realize that the use of drugs specifically among homeless people, showed up sometimes as the cause of the current situation, occasionally as a consequence, and sometimes as both.Some interviewees even verbalized, "[…] no one wants to stop using drugs" (I8).
Alcohol, besides widely quoted, showed itself very prominently in these people's lives, since we witnessed its use at various moments.It is consumed in groups or individually.Some of the participants cite it as a reason for his/hers "fall" in the trajectory of their lives: "I fell due to the excessive consumption of alcohol…" (I9).
We realize that drug consumption and living on the streets are themes that converge with each other, making it difficult to study them apart.In the context of the street, drugs are part of the everyday life.This leads to reflections on the issue of people's quality of life.It is remembered that themes involving quality of life are otherwise researched in an international context. 22

FInal consIdeR atIons
For weeks we attended the scenario of the streets and we could live with some of its residents.Each of them brings their own life story, but many are similar in relation to causes, option (or lack of it) and reasons for making the streets their "homes".
Uncovering the experience of living on the streets proved to be a challenge, favoring the breakdown of prejudices.We consider that the objectives of this study were partially achieved, as we were able of understanding some of the motivations of this cultural group, as well as the life experiences of its actors.
The role of the health professional is not limited to intervening in the grievances, but plays a crucial role in preventing them.The "homeless process" can be considered a social disorder, due to being a tangle of causes and consequences: drugs, family conflicts, failed relationships, unemployment, thus, motivations that deserve a special look of health and social sciences professionals, as well as of the government.
We recommend that more primary studies are conducted, with new perspectives about the theme, because it is not simply about labels (beggars, vagabonds), but about human beings who had a permanent address one day.

acknoWledgeMents
We thank the Foundation for Research Support of Minas Gerais (FAPEMIG), for having funded this research.
There are pejorative social representations regarding the homeless population, which materialize in the social relations.They are common designations to the same names: "bum, lazy, drunk, dirty, dangerous, poor man, beggar" 4 .Thus, feeling excluded is a real sentiment and is reinforced by the own society.
The following statement portrays feelings of social exclusion, reinforced by the adjective "ridiculous": "And I feel…out of the society.I feel like a guy, huh… ridiculous" (I2).
The forms of expressing the living on the streets experience are shown linked to the feelings and struggle for survival, described in the taxonomy 8.

taxonomy 8: Ways of expressing the living on the streets experience
The sadness was verbalized by some interviewees: "I feel sad.It is because they already have tried to help me several times, you know… it was many times, not a few one, they already tried to help me, but I could not see the result…" (I12).
The difficulty was expressed in several situations.It was found that the street life is manifested through the struggles linked to survival and living with the stigma of "homeless"."Because life on the street is very hard, you have to face that… is trouble" (I18).
The fatigue and suffering can be attributed to poor conditions of subsistence, to the concern of not knowing how tomorrow will be and also to the tangle of feelings connected to the past, to the present and to the future."The face is getting like an old person's, the sun, too much sun in the face, so, it punishes a lot, right?" (I1).From all the statements in this taxonomy, feelings related to difficulties linked to emotional or conditions for survival emerge.

the cultuR al theMe: use oF dRugs
The use of drugs (legal and illegal) was considered a cultural theme of this study, since it constituted a recurrent concept in many domains and also in the taxonomies 1,2,3,4 and 5.
Drug addiction, chemical dependency, there are various terms used to denominate the use of drugs.The fact is that these are deeply inserted in the society, as shown in the media, the day-to-day life of big cities and now this study, among others.To discuss and care of chemical dependency today is to approach it within the biopsychosocial health model, considering the person as a whole, viewing him or her as an active being in the health/disease process. 21t was possible to detect that, from all the illegal drugs, the most reported was crack: "[…] I work in order to keep my addiction.It is the crack" (I13).

taxonomy 1 : 2 :taxonomy 3 :
causes that led the person to live on the streets l familiar causes: family disagreements; death of family members; l safety issues: risk of death; l financial conditions: loss of employment; impossibility of buying a home; l drug addition: chemical dependence; alcohol addition; l causes related to affective life: relationships that did not work out; betrayal.taxonomy Profile of the person living on the streets l suffering from an addiction: drug users.l coming from other places: from countryside of Minas Gerais; from other states.l had an organized life: had a structured family; had possessions.Ways of facing the reality of the streets l related to sleep and comfort: searching for hygiene facilities; sleeping in the hostel; sleeping on the street; l related to food: strive for lunch; begging for food; l related to daily routine on the streets: wandering without regardless the direction; seeking support from people; consuming alcohol; l related to gaining money: working; begging for passersby.

taxonomy 4 :
types of expectations for the future l positive expectations: return to homeland; retire; returning to the job market; quit drugs; turn things around; l negative expectations: displays utter dismay.

taxonomy 5 :
Reasons that keep the person living on the streets l benefit from the state: homeless shelters and food; l related to the city: Belo Horizonte is a good city for homeless people; l option: the person does not want to go back; does not want to quit drugs; wants freedom; l support from other people: help from others.taxonomy 6: sources of support for people living on the streets l nongovernmental organizations (ngos): professionalization; food supply; l state: homeless shelters; benefits/metro card; l charity: donations of food; cash assistance; l religious help: church.taxonomy 7: types of self-perception of the homeless l positive self-perceptions: considers his/her name cleared; is hardworking; feels like a human being; l negative self-perceptions: considers himself/herself a beggar; is ashamed of the situation; compares himself/herself to a dog; verbalizes sorrow; feels ridiculous; feels excluded.taxonomy 8: Ways of expressing the living on the streets experience l expressions related to emotions: sadness; l expressions related to survival: difficulty; exhaustion; suffering.