“We call Chagas a ‘silent killer’,” says Nicholas Gildersleeve. “There are more than 10 million people around the world who are affected by it, but because people see no symptoms right away, they might not even realize they’re infected for a long time, and then it can be too late.”
Gildersleeve is a Canadian from Frelighsburg, Quebec, who until recently served as Doctors Without Borders/Médecins Sans Frontières (MSF)’s head of mission in Bolivia — a country with the world’s highest incidence of Chagas, which is endemic in 60 per cent of its territory. The disease, which is found almost exclusively in Latin America and is transmitted by triatomine insects (also known as “kissing bugs”), is mostly asymptomatic for the first years of infection, but will often eventually result in debilitating complications that can shorten life expectancy by an average of 10 years. Heart complications are the most common cause of death in infected adults.
- Press release: Press release: MSF delivers its Manual for the Comprehensive Care of Chagas disease in rural areas to the Ministry of Health in Bolivia
Chagas: a difficult disease to manage
For the past 14 years, MSF has been leading a major intervention to diagnose, treat and prevent the spread of Chagas in Bolivia. Now, the organization is winding down its activities and calling on Bolivian authorities to invest in the delivery of comprehensive Chagas care, especially in rural areas.
“Chagas is difficult for places with limited health resources,” says Gildersleeve. “Because the impact isn’t always immediately obvious, it can be hard to make it a priority. That’s why MSF was so involved in responding to Chagas in Bolivia. We were able to invest the time and resources needed to show the way.” Diagnosing patients with Chagas is complicated, requiring laboratory analysis of blood samples. There are currently only two medicines available to treat the disease: benznidazole and nifurtimox, which were both developed over 40 years ago.
Gildersleeve explains that developing a comprehensive Chagas program starts with assessment, followed by treatment programs and prevention measures — through vector control such as spraying, for example. In 2015, MSF partnered with local health institutions in the town of Monteagudo to create a model of Chagas intervention that can be replicated in other areas. That program helped pave the way to the final step of MSF’s involvement: a toolkit to help the country’s health authorities develop and implement their own effective Chagas care programs.
“We made a manual that will serve as a reference for anyone who wants to run a Chagas program, especially in remote settings,” Gildersleeve says. “It takes everything that we learned and developed while responding to Chagas, especially the Monteagudo project over the last couple of years, and turns it into a step-by-step guide book for how to diagnose, treat and prevent Chagas.”
Nicholas Gildersleeve (back row, centre) with his MSF colleagues in Bolivia.
A comprehensive care manual
Despite the fact that Chagas has been declared a national medical priority in Bolivia, no regulations have been created at the federal level to improve access to treatment. Gildersleeve says that MSF sought to facilitate that process by creating the manual, known as the Comprehensive Care Manual for Chagas, on its own, and making it available as a reference for any health authority who needs it.
“The Bolivian health system is similar to Canada’s, and there are different departments, like provinces, who are responsible for healthcare,” says Gildersleeve. “So this is available to them. We partnered with the national government to do a lot of the initial work, but we realized it would be more useful to just publish it on our own and make it so anyone can use it, and let the government use it to develop protocols as it wants.”
In addition to the care manual, MSF also helped develop a technological tool that can help identify Chagas hotspots and act quickly to prevent the disease’s spread. Called eMOCHA, it’s a centralized system that allows users to report triatomine bugs by sending a text message to instantly alert response teams that spraying is needed to remove the insects. The tool makes the process of identifying and removing critical disease vectors fast and trackable — a massive improvement over a system that used to require visits in person to a health office, sometimes taking days at a time.
“The system is ready to go,” says Gildersleeve. “It’s still waiting for final approval, but it has the potential to make a very big difference.” If it proves successful, the eMOCHA system, like the Chagas manual, could give a boost to health authorities still trying to build an appropriate response to the disease.
“The manual is something I am very proud of that MSF did,” says Gildersleeve. “I think it will be a very big help. It really closes the circle of what we started when we first began our Chagas projects, and provides a very useful tool.”
Given that Chagas is a concern in several Latin American countries, both eMOCHA and MSF’s Spanish-language manual could also have an impact beyond Bolivia’s borders. “Chagas is easy to manage if you diagnose and treat it right away,” says Gildersleeve. “But if you wait, it gets much harder, and more deadly. We hope that this is the start of more programs that will help treat it.”