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For my final week of rotations, I was in the Chagas clinic, one of the most important healthcare clinics in Tarija.
About 60% of Tarija's population is infected with Chagas, an epidemic that much like AIDS and tuberculosis, is highly stigmatized, largely affects underprivileged communities, and takes many lives every year. However, unlike AIDS and TB, Chagas has been neglected by the 1st world as a major health concern, and although a cure was discovered 100 years ago, no new research or support has been given to fight this epidemic, and the same medication, unimproved, has been around since.
Chagas is transmitted by a beetle that comes out only at night and lives in homes that are not properly sealed (not insulation or sheetrock - much of Latin America and Africa's poor). The bug bites the person while he or she is sleeping, and defecates near the bite. If the bug carries the Chagas parasite, this parasite enters when the person subconsciously scratches and allows the feces into the bloodstream.
The first 4-6 weeks of being infected, there are very few and subtle symptoms that very rarely get diagnosed. Unfortunately, this is the main time where treatment can really help. After this "acute" period the disease goes into a dormant phase for a few years, which is asymptomatic. After that, the parasite (which lives in the body's cells) starts to cause damage to the heart and to the digestive system. The heart often gets enlarged, and many people with Chagas suddenly die of heart failure. Also, the esophagus, colon, and intestines may develop lesions, become enlarged, and deteriorate over time. This is often fatal. There is treatment at this point, but not to reverse the damage, only to stop progression of the disease.
During my rotation in the Chagas clinic, I spent some time in the lab, where all of the blood work is done. The biochemists were really welcoming, and explained to me what they were doing. Patients came in for blood work, some of which were new Chagas diagnoses, while others were check ups to see how they were responding to treatment. Also, each patient's liver function was checked before and during treatment, because the medication (much like chemotherapy) is aggressive, and very harsh on the liver. Someone with liver disease cannot receive Chagas treatment because it is too dangerous. I also spent sometime with the doctors in their consultation rooms, where they received new as well as long-term patients with Chagas. I got to listen to the long-term impacts that Chagas has on the heart - very irregular and slow beats. I also saw a man who was recently bitten by the Chagas vector (vinchuca).
The doctors in this clinic are in the trial process of developing a new Chagas drug which will hopefully be more successful and have less side effects. Because of this, some of the patients were on the original medication, and others on the new drug.
It was extremely interesting to learn about this new disease, and will hopefully hear about its continued diminish over the next few years.
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