In the Gran Chaco region, an area bordering Paraguay, Argentina and Bolivia, Chagas is endemic. The largest parasitic killer in the Americas, Chagas cases number between 10 and 15 million worldwide and cause about 14,000 deaths each year. By the end of 2010, MSF had started implementing a comprehensive health care project in collaboration with the Ministry of Health to fight Chagas in the Boqueron Department, within the Paraguayan Chaco.
In addition to integrating diagnosis and treatment in the health centers, MSF visits remote communities and schools assisting populations unable to reach the clinics. Andrea Marchiol, the former General Coordinator for Doctors Without Borders/Médecins Sans Frontières (MSF) in Paraguay, recently returned from her mission. Here, she speaks about the rationale behind the project.
Why did MSF decide to focus on Chagas in Paraguay?
Because Chagas disease is endemic in Paraguay, the seroprevalence is high, and a comprehensive approach is needed. Paraguay has progressed in its fight against the vector, the so-called vinchuca, the bug transmitting the disease, but a lot more needs to be done in terms of care provision to the affected people.
The choice to work in the Paraguayan Chaco region also involves a humanitarian criteria: lack of access to health care for vulnerable populations, such as the indigenous communities inhabiting this region. Paraguay is a country where development has been unbalanced and inconsistent. In the eastern region, where most of the population lives, social and general services exist, while the western region, like Chaco, has been historically neglected. Access to general and social services is difficult, and the populations are vulnerable and forsaken.
What is our target population?
People affected by Chagas disease are usually people living in poor, rural areas, where housing conditions are unhealthy and precarious, and access to healthcare is very difficult. Three percent of the population in Paraguay lives in the Chaco area, and half of them include indigenous communities. These populations are isolated and are amongst the most vulnerable groups in the country. Yet, in line with our organization’s core principle, the project provides care to everybody living in the Boqueron department.
Their needs are plentiful, including health care, education, land ownership, housing, social rights, and more. As a medical organization, we constantly assess health problems other than Chagas, and we are always ready to intervene when problems arise within the region and the country.
What is MSF’s added value in the fight against Chagas in Paraguay?
Chagas is a very complex disease and it needs to be addressed by fighting various components in a comprehensive way through both a preventative and a medical approach.
Prevention includes the use of a community participation strategy—supporting a Chagas program intervention based on vector control, for example freeing the houses of bugs or vinchucas. Preventative work also deals with seeing to safe blood transfusions and screening pregnant women for Chagas.
Diagnosis and treatment are the added values of the MSF Chagas projects. We have determined that treating [the disease] is not only ethically imperative but also possible. Throughout our nearly 12-year experience in Latin America, we have shown that infected people can be cured through treatment, which also contributes to preventing medical complications.
We are also raising awareness in order to help and improve care and the fight against the disease by using better diagnostic methods, better treatment, and the possibility of developing tests to confirm cure after treatment. Moreover, we are also working on involving health authorities in the comprehensive fight against Chagas, guaranteeing diagnosis and treatment for the populations living in endemic areas.
What are the challenges MSF is facing in the country?
A Chagas intervention invariably involves a component leading to changes, in addition to providing care to Chagas-affected people. Changes in the country and in the region imply Ministries devoting resources to comprehensive care; doctors being trained to diagnose and treat the disease in endemic areas; medical care being linked to vector control; medicines being available; research being conducted to improve currently available treatments; simple, rapid, user-friendly diagnostic methods being made available and being able to count on a laboratory test confirming the cure.