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MSF in Bolivia, 2011
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Chagas disease is widespread in Bolivia, and it can be deadly. People living in poor housing are most at risk, but they are also less likely to be able to access care.
Chagas is a parasitic disease, transmitted mainly by the vinchuca beetle, which lives in cracks in the walls and roofs of mud and straw housing. Consequently, people living in this type of building are more vulnerable to the disease. Although Chagas can cause serious, even fatal, heart and intestinal problems, people infected with the disease can live without symptoms for many years. Screening is therefore a particularly important component in tackling Chagas. But health services often have to be paid for directly in Bolivia, and many people likely to have the disease are unable to access care.
In April 2011, Doctors Without Borders/Médecins Sans Frontières (MSF) handed over its Chagas program in Cochabamba City to the Bolivian Ministry of Health. Staff had been working in some of the most deprived parts of the city for three years. During this time, of more than 20,000 people screened for the disease, some 3,000 tested positive and more than 1,900 people received treatment.
A team continued to work in the department of Cochabamba, running a programin the rural province of Narciso Campero. Prevalence of Chagas in this province is among the highest in the country. MSF was the first to offer diagnostic and treatment services, bringing healthcare to patients who had not yet developed cardiac or intestinal complications.
MSF staff work directly with patients, but also with the staff from local clinics and health centers. MSF offers training, and collaborates with the authorities to improve Chagas drug supply chains and treatment. The aim is for Chagas prevention, diagnosis and treatment services to be integrated into local health facilities. The teams also engage with the community to raise awareness of the disease and how vector control – controlling the vinchuca beetle – can help reduce transmission. They hold educational workshops with teachers, students, community leaders and patient groups, and take part in a regular radio show.
In 2011, 3,270 people were screened for Chagas in Narciso Campero: 1,270 tested positive and 716 started treatment. In the rural health centers supported by MSF, an additional 1,833 people were screened, and of these 399 started treatment.
There is currently no reliable test of cure for Chagas. MSF is involved in a study with the Drugs for Neglected Diseases initiative (DNDi), which could lead to just such a test. Researchers are testing patients in Bolivia to see whether polymerase chain reaction, a technique that amplifies pieces of DNA, can help to measure accurately patients’ response to treatment.
Shortage of medication
Benznidazole is the most commonly used treatment for Chagas. But in October, shortages of the drug affected treatment programs in several Latin American countries. MSF was forced to suspend new projects it had planned in Bolivia. Among other factors, the shortages were caused by a lack of planning by Brazil’s state-owned laboratory, where the drug is manufactured. MSF urged the Brazilian Ministry of Health to commit to speed up benznidazole production, but at the end of 2011 there were still supply shortages.
Emergency in La Paz
A landslide in Callapa, a neighbourhood in the city of La Paz, left 5,000 people homeless in February. MSF contributed to the emergency response by helping to provide water and sanitation in seven of the temporary shelters to which the homeless were relocated.
At the end of 2011, MSF had 32 staff in Bolivia. MSF has been working in the country since 1986.