Angela lives in Genareros, an indigenous community in Arauca region, Colombia. In April 2010, two of her seven children completed their treatment for Chagas, a disease transmitted by an insect common in rural areas where people live in houses made of clay and straw. As Angela’s young children Yosney and Maryeli celebrated the end of their treatment, she found out that another two of her children also had the disease.

Chagas disease is endemic in most Latin American countries. In Colombia, Arauca is one of the most affected regions. The disease is caused by the trypanosoma cruzi parasite and transmitted mainly by the ‘kissing bug’, a blood-sucking insect known in Colombia as ‘pito’. People with the disease may live for years without showing any symptoms. If untreated, however, Chagas can lead to serious health problems − mainly heart and intestinal complications − and even death.

© Mads Nissen

Integrating the fight against Chagas into primary healthcare services

At the end of 2009, Médecins Sans Frontières (MSF) integrated Chagas screening and treatment into its primary healthcare services already carried out though mobile clinics in Arauca, a conflict-affected region bordering Venezuela.  This is the first time that MSF has carried out Chagas treatment in a conflict context. “It is a real challenge, because the treatment requires constant follow up for a period of two months, and there is always the concern that we will be unable to reach a community due to security constraints or because an armed group has  stopped road movements in the region,” said Patrick Swartenbroekx, MSF field coordinator in Arauca.

The first community to undergo screening was Genareros, where Angela lives with her seven children. Out of the 97 blood samples taken from children between nine months and 18 years old, 11 were confirmed positive. “We were surprised to find such a high rate in Genareros. Fortunately, we didn’t find the same rate when we extended the screening to other communities,” said Dr. Rafael Herazo, medical focal point for MSF’s project in Arauca.

Sixty days of treatment

So far, the MSF team in Arauca has collected 1,617 blood samples in 10 different communities and completed laboratory tests for 514 samples. The lab results found that one in 28 people tested positive for Chagas. Confirmed patients are given a medical check-up before they start a two-month long treatment. This is important to check whether the patients have already developed the disease. “If the person has developed a serious cardiac complication, for example, there is little we can do to treat the disease,” said Dr. Herazo.

During treatment, MSF visited Genareros once a week. Because side effects are common, follow-up care and encouraging patients to adhere to their treatment is crucial. “People say: ‘my child was doing fine, then you gave them these drugs that are triggering these skin rashes, this pain in his legs...’ So the health promoters visit patients and their families and stress yet again that Chagas is a deadly and silent disease. They insist that it is important to continue the treatment and that the side effects will go away. If they stop treatment, the child may have serious heart problems later in life; they may be unable to work in the fields, to walk, they will get tired all the time and some may even die,” explained Dr. Herazo.

As first eleven children complete their treatment, other challenges remain

In April 2010, all eleven children diagnosed with Chagas in Genareros completed their treatment successfully. In one year, Yosney and Maryeli will have to do another test to confirm that they are free of the disease. Because they continue living the same ‘pito-friendly’ houses so common in Genareros and other indigenous communities in Arauca, re-infection is a concern. MSF is lobbying health authorities in Arauca to carry out regular spraying of insecticide, an essential vector-control measure to reduce the transmission of Chagas and prevent re-infection. “All 60 days of treatment, all this awareness raising, the side effects and the community visits will have been worthless if the houses still host the pitos and people get re-infected. We are putting pressure on health institutions to strengthen vector-control and at the same time showing that treatment is possible,” said Dr. Herazo.