Doctor Wilma Chambí has been working on MSF Chagas treatment programmes in her home state of Bolivia for six years. Chagas is a parasitic disease affecting 18 million people in Latin America. If left untreated, it can cause permanent damage to the heart, oesophagus and colon. We talk to Wilma about her experience of these programmes.
MSF teams visit households in search of potential Chagas affected children. Bolivia, 2006.
Juan Carlos Tomasi
What projects does MSF carry out in Bolivia?
After working in Tarija and Sucre, where treatment against Chagas was being provided to children and teenagers, we are now working on a new project in Cochabamba town, where for the first time we are also treating adults. In addition, diagnosis and treatment is now being integrated into health centre services.
What difficulties do you face in treating Chagas?
Currently, the available tools to treat Chagas are few and old. We are still using the two only existing drugs to treat the disease, Benznidazol and Nifurtimox, and there is no research and development in this field. These two drugs are not very effective, particularly not in adults, and cause a considerable number of adverse effects. There are also no paediatric formulations. This means that when treating babies we need to explain to those administering the medicine that they only need to use a quarter of a tablet. The dose also varies depending on the baby’s weight, which means that medical teams need to weigh babies at weekly check-ups and adjust their medication accordingly.
A further difficulty we face is that health teams do not have enough training to manage the disease. This has made it difficult to increase our Chagas diagnosis and treatment programmes.
Does the population know about the disease?
Yes, they know it exists and how the affected people die – mainly of heart or digestive pathologies – but they presume there is no treatment for it. We often have to face patients’ denial. After all, in most cases, they have no symptoms, so can’t believe they have tested positive.
Also, unlike other diseases where treatment makes patients feel better and symptoms decrease, Chagas patients, who don’t feel ill, are put on treatment with potentially horrible side effects – the only way to know if treatment has worked is through tests.
How are the different public bodies dealing with the disease?
Until recently, the Ministry of Health only focused on vector control – checking houses to determine whether they were infested with the vinchuca [the insect that spreads the parasite]. If they are they spray them, but only in areas that they know Chagas to be endemic. The MoH is also treating patients, but not everywhere in the country and only children under 15. Sadly, the Inter-American Development Bank has stopped financing the National Chagas Programme, further hindering the MoH’s capacity to deal with the disease.