ANALYSIS
It has been echoed again and again- Chagas, a disease of the poor. Dr. James McKerrow from the University of California, San Francisco notes how this fact along with Chagas’ predominance in Latin America, has provided little or no incentive for pharmaceutical companies to develop drugs to fight the disease. Samuel Rice-Townsend, a medical student from Stanford University, expresses the same feeling in regards to Chagas and poverty after experiencing first-hand the reality of the disease through a six week stay in Honduras where he conducted epidemiological research. The reasons for Chagas’ association with poverty are several.
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Latin America is composed of many poor countries, including Honduras. This country is one of the poorest in Central America with over half of the population below the poverty line [18]. In 2005, the per capita income in Honduras was $1,170 U.S. dollars [18]. With a population of about 7.4 million and the richest 10% of the population owning over 40% of the country’s income shares, the poorest 20% are left with an income share of 3.4% [7]. This leaves a disproportionate number of the population in a vulnerable position in terms of medical care, education, lifestyle, etc. According to Yuko Kanai, an expert from the Japanese International Cooperation Agency (JICA), life-style changes among the population are necessary in order to reduce the incidence of Chagas among Hondurans. Poor housing conditions promote the vector insect’s prevalence and give it the opportunity to go unnoticed, until infecting the next victim. However, life-style changes are only possible if the population is sufficiently educated and enough funding is available.
It is impossible to change an individual’s life-style without individual will and sufficient funds. Considering a large part of the population in Honduras is uneducated, a challenge in controlling the disease is educating the public about Chagas. Samuel Rice-Townsend reports the importance of the educational campaigns in the project he participated in. By the time he and his colleagues arrived to test individuals for the disease, the locals had already been informed of Chagas and were compliant to testing. If an individual lacks knowledge of the disease, it is likely he will continue living in an adobe walled house with a thatched roof and not realize the risk of infection. In this case, there is not much that can be done do change the individual’s life style or housing conditions.
Once education takes place, it is also necessary to improve the living conditions of those most at risk. This translates into using different materials for home building which will not house the vector insect. Instead of the thatched roof, metal is used to keep the assassin bug out and the adobe walls are replaced with concrete. These changes require money and money is what the most-at-risk Hondurans lack. However, foreign aid has fortunately filled this gap in the control efforts.
The support provided by various organizations, including World Vision, the Japanese International Cooperation Agency (JICO), the Pan American Health Organization (PAHO), the Canadian Institute of Development Agency (CIDA), the Honduran government and other agencies has been essential in controlling the disease. Considering that in 1998, health expenditures were an insignificant 3% of Honduras’ GDP [7], it is not surprising that additional support is needed to prevent and treat the disease. In an interview with Samuel Rice-Townsend he described the cost of treatment for the disease at approximately $500. The Canadian Institute of Development Agency (CIDA) is one of the agencies that donates medical treatment for Chagas in Honduras [16]. For the average Honduran, the cost of medical treatment is a huge barrier considering it is approximately half of what he makes per year. Furthermore, even when treatment is available, houses are rebuilt, and educational campaigns are underway, continued insecticide spraying is necessary in order to keep the vector insect out of homes. This requires financial support and continued surveillance. Thus, the collaboration among various international agencies and the Honduran government has proven essential in the initiatives taken to reduce infection, morbidity, and mortality of the disease.
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Not only has the collaboration between various international agencies kept the control initiatives going, the local community efforts have also been crucial in the current control efforts[4, 16]. Once educated, communities come together to do their part in fighting Chagas. This includes local Honduran men rebuilding homes. Dr. Rice-Townsend explains:
The houses themselves were being built by the community members and it was really the materials that were being donated by the NGOs. Part of the education was not only to get people to care about Chagas, but they needed to care about it enough that they should pick the time to rebuild their homes in this material or they would run the risk of being infected. Some of these homes weren’t necessarily nicer even though they were different material. The thatched roofs keep huts nice and cool where as metal roofs heat up houses like an oven. Despite that, you would think there would be a lot of resistance, but people where really enthusiastic about it and the communities were really coming together. You would have 15 men working in their spare time to rebuild one of their homes. And then they would move on to the next home.
Being so proactive in their own health and safety aids the control efforts. In addition the community is also involved in the spraying that goes on to kill the vector [4]. Their behavior exemplifies the positive outcome that occurs when education takes place. Thus, collaboration at the community, governmental, and international level is necessary in combating Chagas.
The multifaceted approach in Honduras has proven effective and will continue to save lives, in face of the decentralized health system that exists in this country [4]. Even if the World Health Organization is unsuccessful in eliminating Chagas from Latin American by 2010 [4], there is still room for improvement not only in Honduras, but also in other endemic Latin American countries. Chagas is a disease that mostly infects the poor because of the living conditions that characterize this socioeconomic group. Eradication may be nearly impossible, but Chagas’ control is definitely feasible. By bettering the conditions of those most in need, many neglected diseases not only Chagas, can be more easily controlled. However, continued scientific, medical, and financial support is necessary at the community, governmental, and international level. For example, it is in the Honduran government’s best interest to continue supporting the control and eradication efforts, considering Chagas causes a huge economic loss in disability per year, and it is more cost-effective to spend funds on preventing it [4]. As Honduras prepares itself to present its current situation in the upcoming Geneva WHO conference [8], highlights of what has been achieved will be applauded, but the need for continued efforts and surveillance will be the primary focus.
The strategies set forth by the sub-regional initiatives in the past two decades have the potential to effectively control and in many cases eliminate Chagas Disease from human populations. Vector control through insecticide spraying and house rebuilding campaigns, screening blood donors and inspection of blood banks for the parasite, education of affected communities about the parasite and vector, and continued epidemiological surveillance are all critical approaches to halting the transmission of this disease. Only by educating communities, providing sufficient funding, and having collaboration at all levels will Honduras, and other Latin American countries, achieve control of the disease and come close to eradication. The tie between poverty and neglected diseases will always exist. Chagas Disease is an example of how reducing poverty can effectively alleviate the burden of disease across the globe.
