Tuesday, October 19

Hunting for Chagas or how to combat this tropical disease with screening

“It is the first time that I have a checkup,” acknowledges Martín Bazurco as he presses with gauze on the arm in which blood has been drawn. In a few days, they will give you the result and you will know whether or not you have Chagas, a tropical disease that between 6 and 7 million people in the world suffer, especially in Latin America, and that can lead to serious heart disease. “It is true that many times this disease is not given the importance it has,” he admits.

Less than 15% of people with Chagas disease in Spain are treated

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Bazurco is not just any citizen. He is the consul of Bolivia in Barcelona. And this Tuesday he decided to participate in the screening that a team of health workers from the Vall d’Hebron Hospital has installed in the premises of the Consulate in the Catalan capital. A doctor and two nurses have settled with their utensils in a small office while a community health agent is distributing brochures. He tries to convince all those who have come to the offices to do their paperwork, especially passport renewals, to also undergo the Chagas detection test.

This screening strategy is no accident. Once a month –this is the second–, the members of the Drassanes International Health Unit, in Vall d’Hebron, go to the consulate to do the tests. After more than ten years of actions to detect and treat Chagas in time, they have come to the conclusion that screening is the most useful thing to bring out a disease that is underdetected because it does not give obvious and immediate symptoms. It is estimated that only between 5% and 10% of cases are diagnosed, although a recent survey published by this team in the Journal of Community Health It showed that in Barcelona 45% of the population considered at risk has already undergone tests.

The key: detect the disease early

Chagas is an infection caused by the parasite Trypanosoma cruzi, which transmits an insect very present in rural areas of Latin America, known as vichuca. This bug produces an irritation on the skin through which the parasite sneaks, which from there jumps into the blood. “What it does is undo the muscular and nervous structure and this in the heart can cause heart failure,” summarizes the doctor Jordi Gómez, from the Public and Community Health team of the Drassanes International Health Unit. According to the WHO, up to 30% of chronically ill patients present cardiac alterations and 10% of them can be serious. “Very often when it is said that someone has died of Chagas it is that they have had a cardiac arrest,” explains Gómez.

In Bolivia, but also in other Latin American countries such as Ecuador or Paraguay, the prevalence of this disease has historically been very high. In Catalonia, between 2014 and 2017, the Vall d’Hebron team detected a prevalence in their screenings in the Bolivian community of 16.3%. This was detailed in an article published in Plos One in 2020, where they reported on their screening and awareness-raising actions carried out between 2014 and 2017.

The key to fighting Chagas is early detection. Unlike COVID-19, which has conditioned our way of perceiving infectious diseases, the problem in this case is not uncontrolled transmission. Beyond the insect bite, this disease is only passed congenitally –from mothers to children, although only in some cases– or in transplants and transfusions. There is therefore no fear of its expansion, especially Europe where there is no presence of the vichuca.

The great concern of health workers for Chagas disease is to detect the infection in time to be able to carry out a treatment that directly reduces or eliminates the possibility of suffering from heart disease, which usually appears 20 or 30 years after the infection. “The treatment is short. It takes two months to take some pills and you are treated for life,” Gómez details. In the case of pregnant women, if they have been treated before becoming pregnant, the probability of transmitting it to the baby is reduced to almost zero.

Reluctance to get tested

The problem is that many people are reluctant to get tested. Estefa Choque, a community health agent, is in charge of convincing them during the screenings. She is also Bolivian. “Many listen to me well, but others do not want to be tested because they do not want to know if they have the disease, it scares them,” he explains. It also happens that some are concerned that a diagnosis will lead to problems at work, especially if they are without a contract. “Sometimes their bosses have called us at the health center to find out if Chagas is contagious,” says Choque.

“The disease is still a bit taboo, as if it were part of the past,” says Isabel Claveria, a nurse at the unit. She and the doctor Jordi Gómez are also members of the GT6-IEC technical group that advises the WHO on this disease.

In its fight to detect the disease, this Vall d’Hebron unit began mainly with awareness workshops to attract people who wanted to take the test, but over time they realized that it was much more effective to carry out extractions of blood in situ. With the first, only 40% of those who showed interest in the check-up actually came to have it. With the second, the percentage rises to 100%.

“The screening is what works best and that is why we have decided to put all the meat on the grill,” says Gómez. It refers to the fact that they have intensified these actions in the community. Initially they did tests at parties such as the Bolivian Homeland, on August 6, or even at concerts by well-known groups such as Los Kjarkas, as they did during their visit to Barcelona in 2017. That year they reached a record number of people screened, with a total of 346. But only in 2020, on one day, that of the October 18 elections in Bolivia, 299 people were tested for Chagas –and COVID-19–. That day they deployed a score of troops, something unprecedented until then. In February 2021 they replicated the operation but for the elections in Ecuador.

As the morning progresses in the Bolivian Consulate, the faces that wait in the waiting room are renewed and, from time to time, someone agrees to take the test. This is the case of Lizzet, who underwent the test five years ago, when she became pregnant with her daughter, but has wanted to do it again because she has traveled to her country several times since then. “My great-grandfather had it and he was left with a wound all his life that he could not heal,” he says. “I prefer to know it and have a quick treatment to avoid problems in the future,” he argues.

Míriam Franco and Edson Menacho express something similar, who have been living in Barcelona for fifteen years and who had never felt the need to take the test. “Since they do us the favor of bringing it here, we take advantage of it,” they say.


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