By Marc Bosch, MSF Program Manager for Bolivia
Bolivia is the country with the highest prevalence of Chagas disease in the world. According to Chagas Coalition data, over 600 thousand people live with the infection and it is expected that there is an annual average of over eight thousand new infections due to being bitten by the Triatoma infestans, the carrier insect of the Trypanosoma cruzi parasite.
Those suffering from Chagas, who do not have access to the treatment, are forgotten about and die in silence. This is because this disease doesn’t usually display symptoms until the critical phase, years after the sting takes place and when the disease can no longer be treated etiologically by attacking its causes. The endemic areas of Chagas in Bolivia largely coincide with the most deprived areas. Early treatment can reduce the risk of developing heart or digestive problems in people who have contracted this illness. Care for these patients should be provided through the social security system and the universal health care system, with free coverage even reaching rural areas.
Education and information about the disease also play a vital role in combatting it, as many people are unaware of the positive effects of the treatment. Rather, there is a certain resignation to suffering the disease in silence. Stories of men and women dying prematurely without knowing that they had Chagas are commonplace. It is fundamental to ensure that the Bolivian population are sufficiently informed about the importance of getting a diagnosis, allowing them to access treatment before it is too late.
Despite the fact that over 10 years ago the Bolivian Law 3374 declared Chagas disease as a national priority in all of the country’s departments, there are still no regulations that extend access to treatment across the whole population, including congenital Chagas or managing the complications of this disease. It is worrying that, according to data from the National Chagas Programme (PNCH), 31,666 people were diagnosed in 2015, of which only 11% started treatment. Additionally, only 57 per cent of confirmed cases in newborns were treated.
Over the past fourteen years, Médecins Sans Frontières (MSF) teams in Bolivia have helped to fight this disease through prevention and vector control activities, developed in parallel with free diagnosis and treatment services for those suffering with the disease. More than eight thousand patients were treated in some of the structures managed or supported by MSF.
In the last two years, MSF teams provided technical support for the implementation of a Comprehensive Care Model in the town of Monteagudo, Chuquisaca department. Through raising awareness in the population, training health personnel and providing direct support to the town’s health structures, it managed to integrate diagnosis and treatment into the town’s 17 health structures, including the main hospital and the more remote rural health centres. During this procedure 2,259 new cases were detected, of which 810 had already started treatment with Benznidazole, a medicinal product which treats the disease.
Thanks to work coordinated between MSF, the Ministry of Health, the Departmental Health Service (SEDES), the National and Departmental Chagas Programmes (PNCH and PDCH), and the Monteagudo town council, it was proven that diagnosis and treatment can be ensured on a primary care level in rural areas, just as is the case with the other diseases commonly managed in the primary care structures. For this to be a possibility, a strong political will and the necessary resources are required in order to ensure continued access to diagnosis and treatment, in addition to the initial investment needed to train health professionals and establish the basic care protocols.
MSF's experience coordinating with health authorities has allowed us to standardise the lessons learned in a Comprehensive Chagas Care Model in rural areas, which must be used as a reference tool to implement similar problems in other endemic areas in the country. This reference model concludes our care project for the Chagas disease in Bolivia.
Now it is the turn of Bolivian health authorities, who need to address the need to place Chagas disease in the centre of the public health agenda as a matter of priority. It is essential that each of these departments have more trained staff who know how to respond accordingly to the control and management requirements of the disease, with a budget adapted according to the number of people living with the disease.
However, having finished our work on Chagas in the Plurinational State of Bolivia,MSF reiterates its commitment to providing the country’s authorities with the experience acquired through years of fighting the disease. We reiterate once again that this illness can be fully treated, even in the most remote and vulnerable communities, but only if the necessary resources are allocated and if there is an interest from the health authorities to fight it. In this way, we can ensure that Chagas stops being a silent assassin.