Paraguay: Standing up to Chagas

July 7, 2014

Chagas is a neglected disease that affects between eight and ten million people, mainly in Latin America. Doctors Without Borders/Médecins Sans Frontières (MSF) works in Paraguay's rural Chaco region, going into isolated communities to educate people about the disease and screen them for it. Internationally, MSF fights to improve access to diagnosis and treatment for the disease and advocates for more research and development into its treatment.

All photos by Anna Surinyach

Paraguay’s rural Chaco region spreads across plains and swamps, and its largely indigenous inhabitants make up some three percent of the country’s population. Most live in very remote communities that become further isolated when rains wash out the few roads that connect them.

Paraguay 2012 © Anna Surinyach/MSF

Pedro Rojas, 48, lives in Santa Elena, a small Guarani community in the Paraguayan Chaco. In late 2011, he was diagnosed with Chagas disease, a parasitic disease that is endemic in the region and usually affects the heart and the digestive tract.

Paraguay 2012 © Anna Surinyach/MSF

Since November 2010, MSF has been running a Chagas disease diagnosis and treatment program in Boquerón, one of Chaco’s three departments. The project is based in Boqueron’s capital, Mariscal Félix de Estigarribia, a town of approximately 3,000 inhabitants.

Paraguay 2012 © Anna Surinyach/MSF

MSF’s intervention strategy, which is carried out in collaboration with Paraguay’s Ministry of Health, focuses on bringing Chagas diagnosis and treatment closer to the most isolated communities and building the capacity of health workers so they can recognize the needs of affected people.

Paraguay 2012 © Anna Surinyach/MSF

Chagas is an infectious disease caused by the Trypanosoma cruzi parasite. Endemic in several Latin American countries, it is most often transmitted through the so-called vinchuca, a bug that is infected with the parasite. Approximately 30 percent of people who contract Chagas disease will develop potentially fatal heart lesions, and another 10 percent suffer irreversible and potentially fatal gastrointestinal damage.

Paraguay 2012 © Anna Surinyach/MSF

Despite the fact that it affects hundreds of thousands of people in South America and elsewhere, Chagas disease has long been what the World Health Organization calls a “neglected tropical disease,” and the vast majority of affected people lack access to diagnosis and treatment. Emilio Abraham had heard about Chagas but he only learned he had the disease when MSF arrived in the community a few months ago. “Before, I felt my heart ached, when I ate something salty, when I walked,” he explains, but he did not know why.

Paraguay 2012 © Anna Surinyach/MSF

The first step in fighting Chagas is raising awareness amongst the population. The disease can remain asymptomatic for years, so many infected people do not know they are carrying it. MSF is working with health staff and community leaders throughout Chaco to explain what Chagas is to the population.

Paraguay 2012 © Anna Surinyach/MSF

María Gumersinda Guener is a community health worker in Pedro P. Peña, near Paraguay’s borders with Bolivia and Argentina. She supports MSF by raising awareness amongst her neighbours about the need to be diagnosed and treated. “Now, the community is much more aware about the disease and asks us how they can fight it,” she says.

Paraguay 2012 © Anna Surinyach/MSF

After carrying out public awareness campaigns, MSF teams return to the communities to actively screen for the disease. From the onset of the project in Paraguay through December 2011, more than 3,593 people had been screened by MSF, and 442 tested positive to Chagas.

Paraguay 2012 © Anna Surinyach/MSF

When the MSF team screened people for Chagas in Campo Loa, community inhabitants were first registered and provided with information about the disease before being tested in a manner that offers preliminary results after 20 minutes.

Paraguay 2012 © Anna Surinyach/MSF

The rapid diagnostic test for Chagas that exists today is an inadequate tool to diagnose the disease; Initial positive results must be reconfirmed by two more laboratory blood tests that can take another 15 days.

Paraguay 2012 © Anna Surinyach/MSF

The lack of well-equipped laboratories run by staff trained to diagnose Chagas severely limits the provision of proper care and rapid treatment for Chagas patients in primary health care facilities.

Paraguay 2012 © Anna Surinyach/MSF

“I am concerned because I feel tired, I have chest pain and breathe badly,” said Pedro Rojas on the day he began treatment for Chagas disease. Before he started the regimen, though, he had to have a medical check up to make sure the disease had not already damaged his heart to the extent that he would be unable to endure the treatment.

Paraguay 2012 © Anna Surinyach/MSF

Chagas treatment lasts over two months and patients need to take medication in the morning and in the evening. Saturnino Gómez lives in Santa Teresita and is half way through his treatment. “I feel better than I did before I started taking the medication,” he says.

Paraguay 2012 © Anna Surinyach/MSF

Chagas treatment may cause side effects—mostly amongst adults—meaning that patients must have follow-up consultations every fortnight. When Cristina Cruz of La Princesa started her treatment, she felt itchy and experienced headaches. Now, though, as she nears completion of her treatment regimen, she feels much better.

Paraguay 2012 © Anna Surinyach/MSF

Until not long ago, doctors were reluctant to treat Chagas because of the potential side effects that came with the treatment. However, in the past few years, they have proven to be manageable. MSF now also leaves medicines to treat the common side effects—headache, skin irriation, and so forth—at referral health posts in the communities.

Paraguay 2012 © Anna Surinyach/MSF

At the referral hospital laboratory in Boquerón, Dr. Marta Terol keeps a serologic sample of all the patients. Currently, there is no reliable test–of–cure for Chagas so affected people need to wait years before they can be confirmed as parasite–free.

Paraguay 2012 © Anna Surinyach/MSF

In addition to providing care to patients, MSF also supports SENEPA, the Paraguayan national programme that carries out vector control activities. After finding vinchuca at home, Saturnino Gómez and his wife, María Justa González, wait for SENEPA to spray their house.

Paraguay 2012 © Anna Surinyach/MSF

María Delia lives in Pedro P. Peña and has already completed her treatment. She was diagnosed with Chagas in 2001, a time when there was no chance of getting treatment in her community. Now she is encouraging her neighbours: “It is important for your health you stick to the treatment,” she tells them. “Don’t be scared.”

Paraguay 2012 © Anna Surinyach/MSF