Frequently, I have been told by doctors that the disease is not a problem in the United States because it does not appear in clinical records. It may well be, however, that Chagas’ disease is more prevalent in America than clinical records show, because doctors are not looking for it. “If you are in America and hear hoof beats, you don’t look for zebras,” one doctor told me. However, parasites and bugs are able to travel from one continent to the other much faster than zebras. Also, diagnostic tests for Chagas’ disease are rarely called for in the United States, if they are available at all, although ELISA tests are used to detect Chagas’ antibodies throughout Bolivia.
The first indigenous case of Chagas’ disease reported in the United States was a ten-month-old white female child from Corpus Christi, Texas, on July 28, 1954 (Woody and Woody 1955). The disease had spread through triatomine bugs and opossums. This case shows that Trypanosoma cruzi, naturally occurring in animals and triatomine bugs in this area, are infective for humans, and it implies that unrecognized cases are probably present in the area. Since the mid-1970s, large numbers of immigrants have entered the United States from regions in Latin America where Chagas’ disease is common (Ciesielski et al. 1993, Kirchhoff et al. 1987). Epidemiological evidence suggests that many of these people are infected with Chagas’ disease (Kirchhoff 1993). Because Chagas’ heart disease is frequently overlooked, Hagar and Rahimtoola (1991) studied the records of forty-two patients with Chagas’ heart disease seen at one southern California institution since 1974. Eighteen out of twenty-five patients treated for presumed coronary artery disease or dilated cardiomyopathy had gone for as long as 108 months before the diagnosis of Chagas’ disease was considered. Chagas’ heart disease is not rare in the United States among persons from endemic areas but still may be underdiagnosed. Chagas’ disease has also spread to the United States through blood transfusions from Latin American donors with this disease (Kirchhoff 1989; Schmufiis 1985, 1991, 1994).
The medical profession is slowly becoming aware of Chagas’ disease, but, as it first did for AIDS, sees it as restricted to certain social groups and areas. At a recent national conference for tropical medicine in New Orleans, experts were warned of the increase of Chagas’ disease in the United States and provided with a course on the disease to review for their certification exams. This book contributes to this growing awareness by providing a unique holistic perspective of Chagas’ disease and by calling attention to the seriousness of the Chagas’ epidemic in Bolivia and Latin America. The perspective is structural and views the elements of Chagas’ disease within a contextual relationship rather than exclusively focusing on some aspect. However, there are focused perspectives within the chapters. Accounts of a number of interesting individuals tell something important about Chagas’ disease. The disease is viewed from their perspective—how they experience, interpret, prevent, and treat it. This book interrelates microbiology and medicine with social, economic, and environmental factors to show how Chagas’ disease can be prevented.
This book also views Chagas’ disease as related to the political economy. This interdisciplinary view relates economics to biology, culture, community ecology, and politics. It is essential to adopt a broad perspective that includes many factors before attempting preventative actions.
Another focus is upon housing, where parasites, insects, and humans interrelate. Houses are centers of peasants’ land, livestock, and base economy. Negative factors affecting the household are migration, abandonment, and loss of land. Houses are cultural institutions, symbols and refuges from the outside. Houses also are containers of parasites, insects, animals, and people. This book concerns the anthropology of the house.
Even though this book deals with houses infested with parasites and insects, one cannot help but think of the homes of the “homeless”—shacks, bridges, cars, tents, and streets—which shelter the mass of generally shifting populations in Bosnia, Ruwanda, the United States, Latin America, and elsewhere. It is hoped that readers of this book will become more active in support of building homes for the homeless and in protecting the wild homes of animals, insects, and plants while supporting the treatment of people sick with Chagas’ disease.
From the Microscope to the Telescope
The viewpoint of the chapters is similar to an optical device that begins as a microscope and ends as a telescope, going from the infinitesimal parasite to humans, communities, nations, and continents. The world of microbiology is an amazing universe continually being newly discovered. Chapter 1, Discovering Chagas’ Disease, reveals the medical history of this disease. Chapter 2, An Early Andean Disease, contains its history in the Andes. Chapter 3, Jampiris and Yachajs: Andean Ethnomedicine, looks at how Bolivian curanderos treat its symptoms. Chapter 4, The Crawling Epidemic: Epidemiology, deals with infestation by vinchucas, means of infection, and the extent of the epidemic. In Chapter 5, Cólico miserere: Enlarged Colon, and Chapter 6, Bertha: Mal de Corazon, one reads about the illness in its chronic stages of megacolon and heart disease. This is presented through the lives of people from two Bolivian families.
Reversing the microscope into a telescope to examine the environment relating to Chagas’ disease, Chapter 7, Cultural and Political Economy of Infested Houses, deals with the relationship of cultural and political-economic factors in bringing into physical proximity parasites, vectors, and hosts.
What can be done to prevent Chagas’ disease is considered in the last chapters. Housing improvement projects are described in Chapter 8, Pachamama Snatched Her: Getting Involved, and Chapter 9, Sharing Ideas. Chapter 10, A Culture Context Model, presents a model for future health projects. The concluding chapter, Solutions, contains answers to punctuated approaches, economic causes, and environmental issues precipitating Chagas’ disease. Humans have created the social and environmental context for the spread of this debilitating disease, and it is to be hoped that they can be as successful in eliminating such diseases as they are in proliferating them.
This book includes appendices to learn more about biomedical aspects of Chagas’ disease. These appendices provide information in the forms of tables and charts concerning the vector species and hosts of T. cruzi in the Americas. It includes a discussion of the strains of T. cruzi, vaccine development, and an important section of the immune response, coauthored with the noted parasitologist Dr. George Stewart.
The perspective of Kiss of Death: Challenging Chagas’ Disease is to look at the relationship of many factors, almost as if one were looking at it from a galactic point of view, with the details of the puzzle examined in Bolivia, a small country with a small population (seven million people) and a high rate of Chagas’ disease, a variety of climatic and geographic featurestropical forests, high plateaus, and still higher mountainscontaining varied ethnic groups, social classes, and economic systems. Bolivia gives us the gift of the dervish in A Thousand and One Nights who claimed the power of seeing all the world at once, or that of Jorge Luis Borges’s Aleph, the diameter of which “was only two or three centimeters, but the whole of space was in it, without sacrifice of scale” (Borges 1977:625, Fernández-Armesto 1995:19).