Chagas disease is listed by the WHO as a neglected tropical disease, and it is estimated that between 6 and 7 million people worldwide are infected with T. cruzi, causing approximately 12,000 deaths each year. 

However, when one travels to places where Chagas is rampant, it becomes immediately apparent that what is neglected and forgotten is not the disease itself but the people and communities who live there. 

The Chaco region is one of those places, a red pin on the Chagas map. This is why we work in this region, both in Paraguay and Bolivia, in collaboration with ISGlobal and Nor Sud, respectively. At Probitas, we have been working for years to reduce the prevalence of the disease, which in some places reaches catastrophic levels. In some communities in the Bolivian Chaco, studies show that more than half of the population over 15 years old is infected with the Chagas parasite. 

“If you don’t have Chagas, you’re not a Chacoan” 

“This is the saying we have here,” the head of vector control in one of the communities told us during our trip to the Bolivian Chaco last June. 

The population’s lack of knowledge about the severity of the disease, the mode of transmission, and the possibility of receiving treatment and being cured are barriers to seeking healthcare. Geographic isolation and the dispersion of the population do not favor access to health centers distributed throughout the territory, further hindering universal access to health. 

Even in places where communities are aware of the disease, there is a sort of acceptance of “fate,” an immutable destiny that leads the population to suffer from the burden of Chagas generation after generation: “If you don’t have Chagas, you’re not a Chacoan.” 

This phrase becomes our mantra, driving us to work and make changes until those words fade from the memory of the elders. To achieve this, we have started with the children, from the ground up, in schools. In Pozuelos, Yaconal, and Pampa Heredia, we attended performances and plays where children from different communities showed us what they had learned about Chagas. The project trains teachers who then raise awareness and teach the entire school. 

Now they know the importance of cleanliness, keeping chicken coops away, and raising the alarm when they find a vinchuca in the house or its surroundings. They know that Chagas disease can be cured, and now they are the ones who pass this knowledge on to their families, bringing hope to end the disease in their homes. 

The vinchuca, the vector insect that transmits the Chagas parasite, lives in the warmth of the homes of the families it sickens. This is the cruel irony of this disease: hosting in one’s own home the culprit of so many deaths and suffering, living with the enemy under the same roof. A roof usually dilapidated, with gaps and cavities that shelter the vinchuca. And if not, in the walls, those adobe walls where time and the dry environment create small cracks that serve as comfortable living spaces for the insect. 

“When I was young, I remember friends who suddenly died... many! But before, we didn’t know, and now we do. It’s the vinchuca, the Chagas. That’s why I became a volunteer, so that everyone knows.” The elderly man becomes emotional as he speaks and welcomes us with a brief speech in Pozuelos. Under the typical leather hat of the Chaco, his dark and wrinkled skin reveals that he works under the sun. He, like many others in all communities, is a volunteer at his community’s vector information post. They are responsible for health education about Chagas among their neighbours and for tasks such as monitoring the appearance of vinchucas in chicken coops and homes. 

Sanitized and Suitable Homes 

Any basic manual on Chagas prevention explains the importance of having a sanitized and suitable home to prevent infestation by vinchucas. However, vulnerability and lack of economic resources make it unfeasible for many families to improve or change their homes. The state has barely any funds for this activity, and when it does, it builds completely new houses instead of remodelling existing ones. This would be fine if there were many resources, but with a limited budget, new homes reach very few families. 

For this reason, at Probitas, we support our local partner, Nor Sud’s solution: improving families' quality of life with the effort of the families themselves. In short, involving communities in their own development, improving their homes, and thus their health. We have conducted basic training in wall, floor, and roof rehabilitation and have distributed the necessary materials for these repairs. 

Javier Zulueta, International Program Manager, explains how “in the communities, people have become aware of Chagas, and a solidarity bond has been created through the rehabilitations. Older neighbours, single mothers, and people with functional disabilities have received support from other neighbours, strengthening the ties between families.” 

In the community of Pozuelos, the newly rehabilitated houses shine under the midday sun. The whitewash stands out against the green of the vegetation, and the brightness hurts the eyes. We speak with a single mother of three children who tells us how the vinchucas nested in her old adobe house. Now, she proudly shows us her new home while one of her children tends the livestock in front of the house. 

In parallel with the rehabilitation of homes, we have conducted awareness and information sessions and workshops about the disease in all communities. 

Now, these communities, previously vulnerable and neglected, are informed and empowered to fight against Chagas.