En los medios

Chagas, the neglected disease affecting 1.5 million people in Argentina, 20% of the total of infected people in the world

 

Every year, 1,500 children are born with this disease in the country. Since 2020, COVID-19 has been the main priority for health centres, and the other conditions have been set aside.

During her first pregnancy, when she was 22 years old, Stella Maris Cabral found out she had Chagas disease. At that time, she had a routine analysis and when she got the positive result, she felt hopeless, especially for her baby and the lack of information. Cabral remembers that when she was four, she had drug-induced haemorrhagic gastritis and needed emergency blood transfusion. She assumes that, since that moment, she has lived with that pathology that affects mainly the heart, the digestive tract and the nervous system.

“In 2015 I started treatment, which helps me counteract the consequences that I might have in the future. Neither of my two children got the disease”, said Cabral, who is now 39 years old and lives in Ezeiza, Buenos Aires province. This disease, for which no vaccine exists, produces abnormal growth in several organs, causing different symptoms such as pain, reduced mobility and functional limitations. When the disease progresses, surgery and transplants may be necessary, and even death may occur due to heart failure.

In Argentina, more than 1.5 million people live with this potentially lethal disease, according to a report published by the Civil Association for Equality and Justice (Asociación Civil por la Igualdad y la Justicia, ACIJ) and other organizations. It is the country with highest number of cases in the continent, followed by Brazil, with 1,156,821, and Mexico, with 876,458 cases. In turn, in Spain there are less than 30,000 cases. Argentina stands for 20% of the global estimates made by the WHO; indeed, this organization estimates that more than 7.3 million people live in areas with presence of vincuchas –the vector insect–. Two out of three affected people live in urban areas. In this Latin American country, every year 1,500 children are born with Chagas disease. Of them, only 30% has access to diagnosis and, therefore, to the possibility of receiving the corresponding treatment. Treatment effectiveness in children can reach 95%.

Many people think that this disease is no longer a public health problem. While advances have been made in the control of insect populations in rural houses, there are other transmission routes. The second most important one is mother-to-child transmission, through transplacental route. “Thus, some children are born holding a mortgage on their health”, stresses Marcelo Abril, CEO of Mundo Sano Foundation.

Cabral is part of the group “Living with Chagas disease”, a space created to inform, raise awareness and debunk the myths about the disease. The aim of this group is to promote an approach from an integral perspective. “We meet on Tuesdays, every 15 days, by Zoom due to the pandemic. I like the idea of being able to help others. There, we exchange experiences and fears. We also give talks”, the woman says.

If vincucha is considered the only way of having Chagas, it means that not all the necessary measures to prevent infections are being taken. Special attention should be paid to vertical or transfusion transmission”, adds Mariana Sanmartino.

Wilfredo Pozo Cabrera, 60 years old, is also a member of this group. He found out he had the disease at the age of 16, when he out-migrated from Bolivia to Argentina. “At that time, a blood test was required for obtaining the identity document; thus, I found out I was positive and my mother was negative”, says the 60-year-old man, an informal worker in González Catán, Buenos Aires province.

Between the ages of six and eight, Pozo Cabrera lived in a rural area and worked in a carpentry workshop to help his mother. “I remember that, one day I was strongly bitten by something, but at that moment I didn’t think that it could be the vinchuca. I also didn’t know what Chagas was”, he says. After the analysis that was positive, he started a treatment. Pozo Cabrera assures that he suffered discrimination because of the disease. He says that he was affected at the moment of looking for a job and for this reason, the only option he was left with was working in the street. “This is an invisible situation”, he says.

The group where Pozo Cabrera and Cabral participate, along with other 15 civil society organizations, claim for the need to issue the rules necessary to make effective the egalitarian application of the Act for the prevention and control of all the modes of Chagas transmission, after 13 years of having been passed. All the organizations indicated that “In the country, it is the most widespread endemic condition, but the one neglected by public policies”.

The main transmission route is the vector-borne transmission: the vinchucas can carry a parasite; when the bug bites a person, it defecates on the skin; the parasite may enter the body when the person scratches the bite site. Thus, a person can get infected. But there are other non-vector borne transmission modes, such as mother-to-child transmission during pregnancy, blood transfusions, organ transplant and consumption of contaminated food. It is not transmitted by direct contact with infected persons.

“In the country, it is the most widespread endemic condition, but the one neglected by public policies”, state all the organizations together.

“While the Argentine Congress, through the law, established Chagas disease policies as a priority for the Ministry of Health, its implementation at the federal level is far from being a reality. And access to health and prevention is very different in the diverse provinces”, says Francisco Rodríguez Abinal, member of the area of Economic, Social and Cultural Rights at ACIJ, one of the organizations participating in this claim.

The professor and researcher at the National University of La Plata, Cecilia Mordeglia, is a member of the group “What are we talking about when talking about Chagas disease?” She considers that it is more than a disease, because it is a socio-environmental health problem that requires an integral approach and, to that end, it is necessary to convene and link different stakeholders so that they get involved.

“If the vinchuca is regarded as the only mode of becoming infected with Chagas disease, then not all the necessary measures will be taken to prevent infections. Vertical or blood transfusion transmission should be given special attention”, adds Mariana Sanmartino, researcher at the National Scientific and Technical Research (CONICET) and member of the group.

COVID-19 also eclipses Chagas disease

Lucia Kronhaus is the director of a Centre of the association “Haciendo Camino”. She works in Herrera, a locality of Santiago del Estero province. “Our goal is prevention of child malnutrition, and for that purpose, we support families in different aspects. In the area, we work with about 100 rural families. Although our work is not focused on Chagas, we can’t turn a blind eye because it is an issue among the families in our community. To address it, we seek to articulate with the municipality and specialized organizations”, says Kronhaus.

During a nutritional control, Kronhaus noted that one of the girls had several bites. At first, she did not alarm because those bites might be from any insect. One month later, she visited the family –a couple of 20 years of age, a three-year old girl and an uncle, of about 70 years of age. “On that occasion, they mentioned the presence of vincuchas in the house, which had some mud walls. I contacted municipal authorities to request fumigation for the house, but received no answer. They said it was not possible to fumigate due to the sanitary context”, says the reference person of Haciendo Camino. All throughout 2020, and still in 2021 COVID-19 is the main priority for health care centres. Thus, other conditions have been set aside, and prevention actions have been postponed.

“The health system is in debt for not having detected it on time, either because the vinchuca was there and may have been controlled, or because the pregnant mother, who had to be tested for Chagas disease, was not. The shorter the time elapsed since infection, the greater the probabilities of being cured”, adds Favio Crudo, coordinator of the medical area in the endemic zone at Mundo Sano. Abril, Mundo Sano reference person, is clear: “We should not wait for people to come to a consultation; we should go and find them earlier. It is necessary to be there on time”.

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