The international humanitarian organisation Médecins Sans Frontières (MSF) has started to diagnose and treat people affected by Chagas disease in Arauca department, in northeastern Colombia. The region has one of the highest prevalence rates of Chagas in the country, with nearly an estimated eight percent of the population is infected.
Caused by a parasite, Chagas disease can lead to serious health complications and even death. Yet, to date treatment is not available in the country and, without screening programmes, many do not even know they are infected.
MSF has integrated Chagas screening and treatment into its primary healthcare services already carried out in the region. Through mobile clinics, MSF offers free medical consultations, mental health support, family planning, and antenatal care to people mostly living in isolated villages without access to healthcare.
The team also provides information about the risks of Chagas and encourages people to take a Chagas diagnosis test. After a patient is confirmed to have Chagas disease, they are given a medical check-up and started on a two-month long treatment. The MSF team carries out periodical medical follow up to check for side effects and any difficulties with complying with the treatment. Even though there is a possibility of side effects from the drugs used to treat the disease, MSF experience shows that these effects are manageable.
Chagas disease is endemic in most Latin American countries. It is caused by the trypanosoma cruzi parasite and transmitted mainly by the ‘kissing bug’, a blood-sucking insect common in rural areas and city outskirts where people live in adobe houses made of clay and straw bricks. Transmission is also possible from mother to child, through blood transfusions, organ transplants, and contaminated food. Patients with Chagas disease may live for years without presenting any symptoms. If untreated, however, the disease can lead to serious health problems, mainly heart and intestinal complications, and even death.
“Throughout our work in Arauca, we have seen people with serious cardiac complications related to Chagas,” explained Oscar Bernal, MSF’s medical coordinator in Colombia. “At that stage, however, there is little we can do to treat the infection, as there is no clinical evidence that treatment against the parasite at such an advanced state of the disease is effective. That is why we have to start actively diagnosing and treating the disease, so we can detect it early. By doing active screening, we are able to detect the disease before the patient starts showing signs, when the treatment is more likely to be effective.”
People with Chagas disease in Colombia have little alternative to find treatment, and many will die in silence. The fight against the disease is focused on vector control, with programmes to eradicate the insect that transmits the disease. Though prevention is important, health authorities must not ignore the needs of those who are already infected. In July 2009, MSF launched an international campaign calling on endemic countries to end neglect of Chagas sufferers and support diagnosis and treatment for affected people.
“By starting offering treatment in our project in Arauca, we hope to promote a national debate about Chagas and stimulate authorities to recognise Chagas as a public health problem and engage in screening and treatment programmes,” said Oscar Bernal.
MSF has provided diagnosis and treatment to people suffering from Chagas in Honduras, Nicaragua, Guatemala, and Bolivia, since 1999. At the end of 2008, MSF had tested more than 60,000 people for Chagas and diagnosed 3,100 patients, of whom 2,800 successfully completed their treatment.
MSF experience shows that diagnosing and treating Chagas in limited resource settings and remote areas is feasible. More information on MSF’s Chagas campaign is available at: www.chagas-break-the-silence.com.