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MSF in Bolivia, 2004
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MSF has been treating people with Chagas disease in Bolivia's O'Connor province, Tarija department since October 2002. Its teams have found, despite considerable challenges and difficulties that programs to diagnose and treat people with the disease are not only needed, but possible. The Tarija region was chosen because of its particularly high prevalence (28 percent among children under 14), the lack of health care available and the presence of a government program that methodically tracks and kills the insects responsible for the disease's transmission. Controlling the number of insects, and in the long term, their eradication is essential for treatment to be effective as there is no vaccine against Chagas. Even those who are recovering from it can be easily re-infected if no control and surveillance activities are taking place
(read more about Chagas disease here).
MSF's project includes information, education and communication for the general population and for key groups including health personnel and teachers. It also involves active screening of newborns and blood donors in the hospital and for children between 9 months and 14 in the community. Children who test positive for the disease are treated with the drug, benznidazol.
The drug, nifurtimox, is used as a second-line treatment for those who cannot tolerate benznidazol. Both drugs were discovered during veterinary research conducted in the 1970s. Because of the possible side effects, children getting treatment are followed weekly at health centers or schools and whenever needed. At the end of 2003, 89 percent of the targeted children had been screened and a prevalence rate of 20 percent was found.
Sixty-one percent of the newborns delivered in the province's hospitals were screened and no positive cases were identified. Prevalence among blood donors was found to be 25 percent. MSF has treated hundreds of people with the disease since the project started.
MSF's experience in Bolivia underlines the relevance of diagnosis and treatment in the framework of a global approach to Chagas disease. Prevention activities, including information and education, need to be included within Chagas programs and all activities should be performed within primary health care systems under the supervision of a hospital physician.
Further, congenital protocols need to be adapted to rural contexts where hospital delivery is rare. MSF is now asking the Bolivian national Chagas program to prepare and implement a protocol for diagnosis and treatment and to create a system for case notification and drug surveillance. Focusing on a neglected disease Chagas is a neglected disease – there is virtually no research being done to develop a new and effective drug to treat those infected with it. The reason? There is no profit to be made from drugs that treat the poor. MSF doctors have witnessed the lack of life-saving medicines and diagnostic tools available for Chagas. This "empty pipeline" is a direct consequence of the lack of research aimed at finding less toxic and more eï¬€ ective drugs that would enable Chagas patients of all ages to receive better treatment. Today MSF is doing everything it can to ensure Chagas is recognized as an international public health risk, but there is a long way to go before new drug treatments become available. MSF is also working with the newly established Drugs for Neglected Diseases Initiative to find potential new drugs to treat this disease and thereby circumvent the lack of interest shown by the pharmaceutical industry. MSF teams in Bolivia are actively raising concerns related to access to essential medicines and treatments at the national level, particularly those involved in the current negotiation of a free trade agreement between Bolivia and the United States. In May 2004, MSF urged the Bolivian government to exclude intellectual property provisions from the US-Andean free trade negotiations. MSF remains concerned that their inclusion will have a devastating effect on access to medicines for millions of people living in the country and the Andean region.
Under current trade conditions, if a new drug for Chagas were developed, the Bolivian government would be able to issue a compulsory license to overcome the patent barrier and produce the drug locally. (A patent allows only the company holding it to produce the medicine and profit from it. A compulsory license enables others to produce the medicine, usually at a much lower cost, while paying a compensatory fee to the patent holder.) This ability would be lost if Bolivia signed the free trade agreement with the US, because the US wants to limit dramatically the circumstances under which compulsory licenses can be issued. It would also affect the availability of generic drugs by reducing competition in the market. This could lead to a monopolistic situation with devastating effects for access to treatment, making the drug unaffordable for the majority of the Bolivian population, the poorest on the continent after Haiti.
Providing emergency assistance
MSF also provides emergency assistance in Bolivia. In January 2004, torrential rains flooded the town of Trinidad, the capital of Beni province. Floods affected nearly 40,000 people – more than half of the town's population – and approximately 12,000 people had to be evacuated. MSF aided those taken to temporary shelters, donated medicine and organized water and sanitation facilities. The MSF team also worked closely with local health authorities to strengthen the existing epidemiological surveillance network.
MSF has worked in Bolivia since 1987.