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MSF in Bolivia, 2010
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Chagas disease is one of the leading parasitic killers in the Americas and Bolivia is the country most affected.
If not treated in the early stages, Chagas can cause cardiovascular, gastrointestinal or neurological problems later in life. Diagnosis is complicated, and the Bolivian Ministry of Health does not have adequate financial or human resources to diagnose and treat the disease across the whole country.
The Ministry concentrates on treating young people with Chagas disease because treatment is far more successful with children. For a child under the age of 10, the likelihood of being cured is almost 100 per cent, whereas an adult’s chances could be less than 50 per cent. Children are also more likely than adults to suffer the more severe consequences of Chagas.
Chagas treatment programmes
In the department of Cochabamba, MSF runs free Chagas programmes that are integrated into rural health centres offering basic healthcare. MSF staff diagnose and treat adults, but their main objective is to treat children under 15 years of age and women under 45. Women in this age group are a priority to help prevent the possibility of them passing the parasite to the child should they become pregnant. The side effects of the medication prevent women with Chagas from being treated while pregnant or breastfeeding, so they are monitored and then treated as soon as they finish breastfeeding. More than 1,300 patients started treatment in 2010.
The prevalance of Chagas among women of childbearing age is 70 per cent in some parts of Cochabamba’s Narciso Campero province, and travel to health centres can be difficult. MSF staff screen people for Chagas and provide treatment in 26 rural communities, as well as in Aiquile, Pasorapa and Omereque hospitals. More than 1,450 people were diagnosed with Chagas and 908 began treatment in 2010.
In Cochabamba city, MSF is working in 18 health centres, integrating Chagas care into general healthcare. During 2010, 1,085 people were confirmed to have Chagas and 436 started treatment. The Ministry of Health will take over the project in 2011.
Raising awareness and prevention of Chagas
Besides diagnosis and treatment, MSF is also working on prevention. Chagas is transmitted to humans by the vinchuca beetle and preventing the beetles from re-infecting patients who have finished treatment is vital. Since mid-2009, MSF has been training patients to evaluate the presence of vinchuca beetles in their homes. MSF offers this training while visiting villages and treating patients for the disease.
Another component of MSF’s awareness campaign is the “Chagas bus”, which travelled from the Altiplano region to the eastern lowlands, through the semi-desert of the Chaco and the central valleys. The team on the bus informed people about prevention and encouraged them to seek testing and treatment. They also provided information so that people could educate the rest of their community about the disease and how it is spread. In addition, in the town of Aiquile and the cities of Cochabamba and Santa Cruz, three patient groups have been created to promote education and awareness about Chagas.
In May 2010 the World Health Assembly adopted a resolution on Chagas disease control and elimination, which included many steps advocated by MSF: the integration of the diagnosis and treatment of Chagas into primary healthcare for all patients; the reinforcement of the provision of treatment in disease-endemic countries; and the promotion of operational research on the control of Chagas to promote the development of a valid and accessible test of cure. This step forward at the international level should encourage the improvement of care and treatment for the millions of people infected with Chagas disease.
MSF has worked in Bolivia since 1986.