Vulnerabilities, responsibility and health care: opportunities and challenges in the practice of a family physician - a narrative.

The narrative of an intricate case, related to the problematic use of drugs, by a family medicine resident, the perspectives and reflections generated from the case and its connections to Community HealthCare and Family Medicine. The narrative tells the story of a female patient, no older than eighteen years old, that has been trying to treat Tuberculosis for over five years. The patient spends more of her time living on the streets, where she´s able to gain some money to buy drugs (and sometimes food) by negotiating sexual favors. The other half of the time she lives with her grandmother, who also uses her own body and her granddaughter’s in exchange for money. The prostitution only being an issue since the patient is HIV positive. With no strong social network, illiterate and unwilling to adapt in a health facility, the patient represents a great challenge for General practice and Public Health. By connecting the narrative with scientific literature related to the field of Family and Community Medicine and Public Health, this work proposes reflections on the challenges and opportunities that family physicians face on the daily practice. In special consideration, the approach of very vulnerable situations, such as the issue of drug abuse, poverty, prostitution and violence that either separate or together are very common in the Primary Health Care context in Rio de Janeiro.