Chagas disease in Bolivia

Benicio Segundo is the village elder in Palmarito, a Bolivian community of the Guarani ethnic group. Here a simple farming lifestyle has not changed much in hundreds of years. Water is still collected and carried by hand, there is no electricity, and the homes are simple mud hut structures. People depend on chickens and pigs for food, and they keep them close.

But this lifestyle is in danger from a small bug called a triatomine, or “el timbucu” as the locals call it, Photo which transmits a parasite to animals and people. It hides in the cracks of mud walls, under mattresses and in the fur of animals.

Just like the insect, the illness, which is called Chagas disease, is hard to detect. And that is the problem. People can be infected for years without knowing it – there may be no symptoms as the parasite reproduces inside the person, slowly damaging the heart, brain and intestines. Many people lose the ability to breathe easily and to walk, eventually dying of heart disease. In these communities, 30-40 percent of children under 15 years old are infected, and the levels are even higher In adults. There is treatment, but these communities often do not have the diagnostic tools or medications available. However, they do have a powerful weapon, and that is prevention, which is providing hope to this community.

A unique research programme is being carried out in Palmarito and three other villages in Bolivia. The goal is to develop environmental and educational tools to help the community reduce the numbers of the insect and control the infection.

Getting rid of nesting sites

Each village selects volunteers to work with the medical doctor to visit homes and teach people how to protect themselves. They are shown how to put articles away neatly and to check their mattresses regularly for nests, to keep their dirt floors inside and out clean of leaves and debris, and to move their farm animals and pens further away from the house, since the bugs nest in the animals’ fur. The bugs will even live in the cracks of the mud huts, so these are promptly covered with new layers of the mud and straw mixture.

Dr Daniel Arroyo, the Palmarito doctor, says, “With this project, we are teaching the community how the insect behaves, where it hides inside their houses and what it does to their health. As a first step, they are learning what to do with their domestic animals, that their livestock must live outside of the house. They are also learning that they should keep their houses clean and even how to fix their houses.”

Benicio Segundo has been recruited by the research project to be a community volunteer. He organizes meetings, distributes leaflets and informs the community about the risks of Chagas disease. His enthusiasm is reinforced by the fact that he and two of his five children are infected with Chagas.

He says, “First you have to know the community. Later you start with the training, talking to the group of mothers and speaking in community gatherings as well. My interest is to serve my people and that is the reason that I keep working here for so many years.”

The local government provides regular insecticide screening of walls both inside and out, but the most important factor in all this is the education and empowerment of the community to keep their homes free of bugs.

Dr Fréderic Lardeux, the research principal investigator, says, "At present, the strategy is based on the spraying of insecticides and although there are some positive results, they are clearly insufficient. There are resistance problems, as even when the houses are sprayed, the insects re-colonize very rapidly. So the public health authorities will be observing the results that we hope to achieve with our study, and they are now thinking of introducing an eco-bio-social element in their strategies."

Nestor Suarez, the heath supervisor of the broader Santa Cruz region in which Palmarito sits, reinforces this. "This is a pilot programme that we could replicate in other communities,” he says, “and in this sense is helping us a lot. It would be nice if we could replicate it in every community of the endemic zone.”

The future is looking much brighter for this community. The research is finished, and the people living here are continuing this approach, having seen the positive impact it has made in their lives.

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