Chagas disease is caused by a parasite called Trypanosoma cruzi and is endemic to the Americas. It affects an estimated 14 to 16 million people and causes the death of between 20,000 and 50,000 people each year. Most common among the poorest and most vulnerable populations, Chagas is a neglected disease despite the magnitude of the problem. Virtually no research is being done to develop new and effective drug treatments for those infected because there is no profit to be made from drugs almost exclusively for the poor. The photographs presented here are all from Bolivia, home to the world’s largest number of people suffering from Chagas, with 1.8 million already infected and 3.7 million at risk. Chagas is responsible for 13 percent of Bolivia’s total deaths.'); addPhoto('images/2.jpg','MSF team members work together with local professionals taking blood samples for Chagas diagnostic tests. Photo © MSF','MSF Working with Chagas
Doctors Without Borders/Médecins Sans Frontières (MSF) has been working with patients suffering from Chagas since 1999 and currently provides medical care in Bolivia, Guatemala, and Honduras. In addition, MSF strives to ensure Chagas is recognized as an international health risk. Through its work in Latin America, MSF aims to show that treatment is not only possible but imperative. MSF is also a founding partner of the Drugs for Neglected Disease initiative (DNDi), which strives to find potential new drugs to treat this disease, circumventing the lack of interest shown by the pharmaceutical industry.'); addPhoto('images/3.jpg','A group of children from the San Josecito Norte community examine the vinchuca growth cycle so that they can learn to recognize it. Photo © MSF','Transmission of the Disease
Today between 50 to 100 million people in Latin America are at risk of contracting Chagas. The main preventative efforts are centered on the control and eradication of the main source of transmission, bites from the wild bed bug, known locally as the vinchuca, which carries the disease causing parasite. It is estimated that 80 percent of transmission is produced by bites from the vinchuca. The disease is also commonly transmitted from mother to child during pregnancy and via infected blood transfusions. The parasite invades the internal body tissue causing irreversible damage to the heart, esophagus, colon, and the nervous system of around 40 percent of those infected. “Chagas is not an insect-induced disease; rather, it is the consequence of poverty.” Janire Chirapozu, MSF official responsible for vector control in Tarija, located in southern Bolivia.'); addPhoto('images/4.jpg','A fumigator from the Chagas National Plan prepares to enter a house for spraying. Photo © MSF','Vector Control
Vinchucas makes their nests in the cracks, crevices, and dark spaces of poor households. They thrive in huts with roofs made of straw or a similar material and bare adobe walls. When vinchucas are detected families remove their belongings from their homes before they are fumigated. Housing improvement and health education, together with insecticide spraying programs, are the main tools used to eliminate vinchucas from homes. “Patients have a right to therapy, but a basic component when it comes to guaranteeing successful treatment is vector control.” Víctor Saíz, an MSF logistician in Tarija.'); addPhoto('images/5.jpg','MSF aid workers run an information, education, and communication course in the El Pescado community. Photo © MSF','Education to Prevent the Spread of the Disease
Even after vinchucas are removed from homes, they are still present in their natural habitat. Constant surveillance is necessary to avoid reinfestation. In addition to medical treatment, MSF works to inform local people of the causes of Chagas, its possible consequences, and how it can develop. “It is inconceivable to give in to inaction. On a daily basis the children and their families show us their great desire to be cured, to shake off this disease.” Fernando Parreño, an MSF pediatrician in Tarija.'); addPhoto('images/6.jpg','Most people are afflicted with Chagas disease are unaware they are infected. In fact, many die of the disease without even knowing they had it. Photo © MSF','Diagnosing Chagas
The acute phase of Chagas, during which laboratory diagnosis is comparatively simple, appears shortly after infection and only lasts a few weeks. But very few people associate the observed symptoms during this stage, such as fever, general malaise, and loss of appetite, with Chagas disease and do not seek medical attention. Symptoms disappear shortly and people’s lives return to normal. The chronic indeterminate stage may last for years or decades and diagnosis now requires multiple, complex laboratory tests. Symptoms such as damage to vital organs are hidden to the patient. A quarter of the infected end up developing irreversible damage to the heart, esophagus, and colon. “Most patients do not even suspect their condition and most of them feel strong and healthy. Why would they come forward for Chagas tests if they do not have any symptoms? When they do, it is usually too late,” says Julio Urízar, an MSF biochemist in Tarija.'); addPhoto('images/7.jpg','Gabriel Sánchez, MSF field coordinator, explains the correct dosage and times to take his medicine to a person living with Chagas. Photo © MSF','Treatment of the Disease
Treatment for Chagas disease with currently available drugs is effective only during the acute phase, or early stage, of the disease but ineffective for chronic patients. Common side effects of the available drugs include nausea, vertigo, and weight loss but more serious pain, mental changes, and skin rash have been observed. Side effects increase in frequency and severity for adults, therefore treatment is usually restricted to children under 15 years old. Often the side effects force patients to abandon treatment. Today there is no pediatric dose or formulation available. Another difficulty is the logistical problem in rural areas: people often have no way to reach diagnostic or treatment centers.'); addPhoto('images/8.jpg','Chagas disease has been absent from research and development programs for decades. Photo © MSF','Lack of Drug Access
The only effective treatments for Chagas disease are nifurtimox and benznidazole, the same drugs that have been used for the past 30 years. Cure rates are only 60-90 percent in the acute phase and less for chronic cases. Side effects are common and occasionally severe. The laboratory manufacturing nifurtimox has stopped marketing the drug and only donates supplies in limited quantities. The pharmaceutical industry claims that neither production nor distribution of the drug can be justified on the grounds of low demand; and the development of programs to research new molecules is even less attractive to them. Neither has generic drug companies shown any interest in taking over its production or securing its supply. MSF is a founding partner of the Drugs for Neglected Disease initiative (DNDi), which is currently exploring promising new treatments for Chagas.');