Don't write off the sick!

The medical humanitarian organization Doctors Without Borders (MSF) has just launched its 'Chagas: time to break the silence' campaign. The organization is appealling to the governments of affected countries not to write off the sick, but to concentrate on the diagnosis and treatment of persons affected, rather than focusing only on eradicating the insects which carry the disease. MSF is also calling for greater effort in research and development of new drugs, rapid diagnostic tests adapted for use in remote environments, and better evidence of healing for one of the most neglected diseases in the world.

Chagas disease is an 'invisible disease', yet it causes 14,000 deaths each year. This disease is endemic in several Latin American countries, where it is present from Mexico to Argentina, but increasingly more cases are also being reported in the United States, Europe, Australia and Japan.

While it affects 15 million people worldwide, very few know about it. Experts argue that this is because the symptoms are not noticed at the onset of the disease and that it disproportionately affects the poor - Chagas is defined as the 'disease of poverty'.

Despite being a potentially fatal disease, Chagas national programmes have focused only on preventing and combating the vector (the insect that transmits the disease), and neglected to deal with the treatment of patients. The integration of Chagas care into primary health structures would facilitate patient access to treatment that could save their lives.

Chagas disease is caused by the parasite Trypanosoma cruzi. In most Latin American countries, the main route of transmission is through insects, although it can be transmitted from mother to child, or via blood transfusions, organ transplants and contaminated food. For years, patients may have no symptoms, but in the chronic phase (which affects a third of those infected) serious problems can arise - primarily heart disease and digestive disorders - which can result in death.

'One of the main problems we have faced for years is that patients have no symptoms and are unaware they are ill and not treated. It is vital to work on active case detection to find and treat those infected,'explains Dr. Nines Lima, of MSF.

The sooner the infection is detected, the more likely that treatment will be effective. The only two drugs that currently exist, benznidazole and nifurtimox, were developed over 35 years ago and are not specifically designed for Chagas disease.

Although these drugs are very effective in newborns and infants, adolescent and adult cure rates are only around 60 or 70 per cent. In addition, older patients are more likely to suffer side effects. 'Doctors do not treat children, much less adults, for fear of side effects. But we have demonstrated that these effects are manageable in both cases. It is unethical to leave them untreated,' said Dr. Tom Ellman, MSF General Coordinator in Bolivia.

In recent years very little funding ($10 million in 2007) has been allocated to research and development programmes and the issue has not been on government agendas.

In 2002, MSF began its first Chagas disease project in Bolivia, the country with the highest incidence of the disease in the world. For four years, the organization worked in the rural area of Entre Ríos, in the province of O'Connor, in the Tarija region, treating patients up to the age of 15. Following this, MSF increased treatment up to the age of 18 in a new project, this time in suburban zones in two districts of Sucre, also in Bolivia.

Currently MSF is working in three suburban districts of the city of Cochabamba. The work is carried out in conjunction with the Bolivian Ministry of Health and involves five primary care centres, which treat and diagnose children and adults up to age 50. By the end of 2008, over 60,000 people had been tested for Chagas and 3,100 patients treated, of whom approximately 2,800 completed treatment successfully.

MSF has launched a microsite for the Break the Silence campaign. There is also a Facebook page where the users are invited to subscribe to spread the word about Chagas disease.

The pictures you see in this post are part of the photo exhibition 'Chagas: time to break the silence' which was held from 3 - 8 November in Centro Cultural Recoleta, Junin 1930, Buenos Aires, Argentina.

Photo credits:

1) Girl being tested for the disease © MSF / Anna Surinyach

2) Girl showing treatment pills to the camera: © MSF / Juan Carlos Tomasi

3) Woman having blood taken: © MSF / Anna Surinyach