“Many years ago they told me that: I just have Chagas, that nothing can be done”
What??…is there a treatment for Chagas disease?”
“I have Chagas but I don’t know how I caught it… I clean my house everyday”
“I had my baby, but they didn’t tell me that I had Chagas”
“I have never been tested for Chagas”
These are some of the statements that are heard in the Chagas Disease Programme in San Juan every day. The greatest challenge is to combat misinformation about the disease in the general community, but mainly among members of the health team.
This disease is endemic in the province of San Juan; 4,200 chronic Chagas disease cases were recorded since 2018, and four vector-borne acute cases were detected between 2016 and 2020, with the particular characteristic that three of these cases occurred in urban areas of the province and one in the rural area. In addition, 28 cases of vertical transmission of Chagas disease were detected between 2016 and 2022.
It should be noted that, since 2018, the Provincial Programme for the Control of Vector-borne Diseases (PPCETV in Spanish) has implemented the active search in children born to mothers serologically positive for Chagas disease. This is how 50% of diagnosis of Chagas disease of vertical transmission were made and, at the same time, 40 cases of relatives of the children detected through active search were studied and detected (“active search” refers to the formation of a work team composed of a laboratory technician, a social worker and a driver, who travel across the province to do blood tests to the children).
The detection and diagnosis of people infected with Chagas disease are performed in several spheres:
- Population studies: at schools, sports clubs, prison inmates, territorial approaches, etc.
- Through screening of pregnant women
- Families that take the vinchucha they find in their house to the notification centre for analysis.
- Through the Provincial Haemotherapy Institute (IPHEM)
- And through the diversity office.
Diagnosis is made in all the government-operated laboratories of the province (31 laboratories distributed across the territory, with two reference laboratories and one in the programme’s office).
Now, what shall we do with the positive result of this study?
Although the programme has an office where the patients with Chagas disease receive etiological treatment and cardiac follow-up, decentralized treatment through doctors treating the infection at the health care centres is encouraged. There are different communication channels (telephone, email, WhatsApp and telechagas, through telemedicine) to request the medicine, which is sent almost immediately to the health centre. This strategy allows articulation with the network of pharmacists. Treatment and post-treatment follow-up should be conducted in the same health care centre.
To achieve decentralization, the programme provides training courses about the topic to the health teams and makes visits to the health centres with the aim to raise awareness among actors, thereby engaging professionals (social workers, physicians specialized in infectious diseases, paediatric nurses, biochemists, pharmacists, health agents, etc.) and generating networks. This strategy reinforces the approach and comprehensive care of patients, and also includes professionals with healthcare management positions (chiefs of programme areas, chiefs of sanitary areas, heads of hospitals and other programmes). In the last five years (2017 to 2022) etiological treatments tripled in the province.
The strategies used to disseminate information are varied and include tools like workshops, lectures, and dissemination through the media: radio, TV, social networks, etc.
At present, we are strengthening and disseminating community surveillance, which allows us to address the problem of urban Chagas disease using those tools. People who find vinchuchas in their houses must report them at a notification centre, where work will be coordinated with the spraying brigades. The vector is studied to know if it is infected with Tripanosoma cruzi and, thus, evaluate the risk for the exposed family.
Addressing Chagas disease poses multiple and diverse challenges; we are dealing with an asymptomatic disease, which is therefore silent, but it is also silenced, since there is a lack of dissemination of the new scenarios that Chagas presents today. At present, to be able to coexist with Chagas disease, an infected person must be supported by health teams, monitored, treated with medicines and informed.
Liliana Salva
Head of the Provincial Programme for the Control of Vector-borne Diseases
Ministry of Health of the Province of San Juan