I have developed almost my entire professional career in hospital settings, working with critical patients. However, working with NGOs has been the most rewarding part of my vocation for nursing. I feel most comfortable working with vulnerable populations. For 20 years now, I have worked in close collaboration in a health project with indigenous communities of the Bolivian Amazon. I have participated in the training of health promoters, in Leishmaniasis campaigns, in programmes to combat child malnutrition… Little by little, I have acquired knowledge about tropical pathology.
In 2021, I took the Master's Degree in Tropical and Health Medicine from the Autonomous University of Mad Master (UAM) and I was particularly struck by Chagas disease. Consequently, I started to think of how, as a nurse at emergency primary care services in Mallorca, I could collaborate in the early diagnosis of this NTD in my community, where there was no awareness of what it meant.
Early in 2023, we had the opportunity to meet María Flores at a congress. She is a researcher at Mundo Sano Foundation (MSF) and Carlos III Institute of Health (ISCIII). We told her about the project we had in mind, which we thought would not come to life. To our surprise, she considered it a pioneering idea and was willing to support it: Nursing + Primary Care + Chagas disease in a non-endemic area. That is how we implemented the research project at my service unit, with the collaboration of the National Centre of Microbiology (CNM-ISCIII), the MSF and the WHO: “Early detection of Chagas disease: use of a rapid test in an emergency primary care service of Mallorca as a strategic opportunity for systematic integration.”
Since the beginning, MSF, ISCIII and the WHO offered great technical and scientific support by designing the communication material and collaborating in the organization of different meetings about Chagas disease in Mallorca. These events were a success and several prestigious experts participated.
In this study, when patients or their companions coming from Chagas disease endemic areas went to emergency service for any reason, we took the opportunity to inform them about Chagas disease. We offered them a rapid test, access to early diagnosis and referral to specialized care. When the result was positive, the nursing unit generated an appointment for sample collection; then the sample was sent to the Microbiology service for analysis. If diagnosis was confirmed, the patient was referred to the Tropical Medicine Unit to receive treatment, if it was indicated. Coordinating/linking Primary Care with specialized health care and gathering a multidisciplinary team were essential steps to facilitate the development of the project.
With the aim to reduce fear and stigma, my nurse colleagues and I explained to the patient what the result implied. Contact with a referent nurse or a nurse case manager (in this case, I was in that position) was established since that first moment. Close and personalized accompaniment of individuals affected by Chagas disease facilitated the care route. We cleared up doubts and ensured the correct adherence to treatment; we managed to overcome the cultural and social barriers associated with the profile of these patients. As a result, 100% of the diagnosed patients completed treatment. We overcame the barriers associated with this disease.
When we designed the study, we most frequently heard: “diagnosing is easy, what is not easy is that patients complete the treatment, for several reasons, they abandon treatment.”
In Spain, the “typical” patient infected with Chagas is a migrant, mostly from Bolivia, whose priority is to work to get ahead; an asymptomatic disease like Chagas is usually not a priority issue. Although both the patients and the health system are responsible, we can support them. At present, there are tools available, like WhatsApp, which is key to ensuring active communication and internal coordination with all the units involved in care. Above all, this tool helps the patients to have rapid and close access to the referent nurse. Patients were given the opportunity to confidently contact us for any reason at any time; we sent them the pre-treatment dietary recommendations, we reminded them of their scheduled appointments; sometimes we rescheduled appointments according to their convenience; we cleared up doubts about the dosage and side effects. Very often, they did not understand the doctor’s indications nor did they dare to ask questions during the visit, but they did ask the referent nurse. They were very grateful, once they even gave us some “empanaditas” (small pasties).
The nurse case manager or referent with training in NTDs can facilitate communication between different care levels, participate in screening and community education programmes, promote adherence to treatment, ensure integral and continued care of the patient … overall, the nurse case manager can improve patients’ life quality, ensuring a holistic approach that goes beyond medical treatment.
Isn’t it wonderful that, after 25 years of professional work, I am motivated again and can work in NTDs in my own country? We still have a lot to do and it is clear that we can achieve more as a team, so let’s do it!