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4 - 2005 Fall - The Kiss of Death

The Kiss of Death

By Milana McLead

Mayra Gomez, 12 (center), and her brother, Roney, 10 (left), both have Chagas disease. "What scares me the most is that any time my kids could drop dead," says their father, Marino. World Vision photo by Jon Warren.
For or families in Central and South America, THERE IS A FATE WORSE THAN POVERTY– sudden death due to a killer disease they may know nothing about. A “SILENT KILLER” LURKS among them.

It is so silent they live entire lives not knowing it is there. Stalking them at night, the killer sucks their lifeblood, slowly destroying families and endangering every child’s future.

The predator numbers in the thousands— a legion of doom that hides within thatch roofs and mud walls, waiting for its victims to fall asleep before attacking. And yet, for all its stealth and cruelty, the predator is something quite ordinary: a beetle. A simple blood-sucking beetle that carries a murderous parasite—Trypanosoma cruzi—that transmits a life-threatening disease named Chagas.

“People had been dying for many years in this zone because of Chagas, but they never associated it with the ‘kissing bug,’” says José Antonio Velasquez, municipal assessor in San Francisco de Opalaca, in western Honduras. “They associated [the deaths] with myths, witchcraft, and other diseases, but never Chagas.”

Drawn by the warmth of mammals and the carbon dioxide they exhale, the beetles—known in Honduras as chinches (pronounced “cheen-chayz”)—prefer to feed near the face, thus earning the “kissing bug” alias.

“Before, people had no idea about Chagas disease, until they got help from World Vision [and others],” says José. “Only then did the population begin to be educated and understood that Chagas meant death.”

In the poverty-stricken foothills of Honduras, the bugs find an ideal environment within the stick or mud-block houses of the indigenous Lenca people. Deep in those lush hills, the Lenca live off the land in isolated communities that are at least a day’s walk from the nearest city and often hours by foot from the nearest public health clinic.

One in three people bitten by the chinches will die of Chagas disease. Once in the bloodstream, Chagas parasites— found nearly exclusively in Central and South America—invade and destroy some of the body’s organs. Over the course of 10 to 20 years, the parasites damage the heart, intestines, and esophagus beyond repair. For up to 30 percent of those infected, the damage will be fatal. With some 18 million Latin Americans infected, Chagas disease (named for its discoverer, Dr. Carlos Chagas, in 1909) kills an estimated 50,000 people annually.

But even with widespread infection rates, many communities remain unaware of how Chagas disease is killing them.

‘We didn’t know’

Two types of beetles host the life-threatening parasite for Chagas disease. Triatoma dimidiata (pictured here) is native to Honduras. World Vision photo by Jon Warren.
Expectación Rodriguez, 37, is a subsistence farmer in the Monteverde community of San Francisco. A cowboy hat shades his face from the sun, but deep concern is still evident in his dark eyes. Expectación explains that his community spent years unaware of how Chagas disease was silently destroying them.

“We found out about it through World Vision,” he says. “We didn’t know anything about the bug before. When we found out, we began to worry. Our fear, as parents, is that the bug will bite our children.”

Children and women are highly susceptible to the beetle’s bite. In poor households without enough beds, children are likely to sleep on the dirt floors, while women slumber next to the stick or mud walls of the house—giving the bugs easy access to their next meal.

“I learned about Chagas about 10 years ago, when [government] testing was first done,” says José Carmen Vasquez, 55. “Before that, we lived with the chinche, we saw them in the house, but we didn’t know anything about Chagas. [Once I learned] about it, I felt in danger, and felt that my kids or I could die at any time.”

José’s son, Herman, is slightly smaller than his 13-year-old buddies. His school uniform—white pleated shirt, dark trousers— hangs from his bony frame; he tires quickly. The youngest of José’s four children, Herman was tested for the disease in recent months. “I was afraid, because people would tell me that when you turn 20 you will die,” Herman says. The boy tested positive for the disease.

His sister, 20-year-old Perfecta, has watched Herman’s health struggle from birth. “He’s the sickling,” she says. “Ever since he was a baby, he’s always been sick. His lungs hurt, his heart hurts, he is achy. He cannot go to the fields to work much because he gets tired really quickly. He can’t work or play too much. If he runs, he gets too tired.”

A disease of poverty

“Where you will find Chagas disease, you will find the worst poverty imaginable,” says Dr. Gilles de Margerie, coordinator of the health subprogram for CIDA (Canadian International Development Agency) in Honduras. “You have to live in an awful shack to get Chagas. It’s as simple, and unfortunately, as complicated, as that.”

The disease affects the poorest of the poor—those unable to seek medical help, those whose deaths often go unrecorded— making absolute statistics hard to come by. Even so, it is estimated that some 300,000 Hondurans are infected, nearly 6 percent of the population.

The pressing need to control Chagas disease has climbed onto most Latin American countries’ national agendas. The government of Honduras recently implemented a strategy to combat Chagas with a goal of eradicating the disease-carrying bugs by 2010. World Vision has been working in Honduras since 1974 and notes among its most recent successes the reduction of Chagas disease in the northern region of Yoro. As a result, the organization was a natural fit as a key partner in the Honduran national strategy along with others such as CIDA, the Pan-American Health Organization, JICA (Japanese International Cooperation Agency), government housing agencies, and the Secretary of Health.

Together, the agencies are working to implement a comprehensive battle plan to fight Chagas disease—an approach most experts agree is the only hope for success.

“Ask anyone who knows anything about Chagas,” says Gilles. “The intervention is quite simple. You find the bug. You spray the house. You find the infected children. You treat them if they’re under the age of 15. Then, you make sure the houses stay bug-free. Ideally, if you want to keep the bug away, you have to improve the housing.”

That last step is crucial. Improved housing will keep Chagas from coming back. In Yoro, World Vision constructed 421 new houses. They are simple, decent, 400-square-foot structures, and feature the key elements that prevent the beetles from moving in: zinc or clay-tile roofs, plastered adobe walls and concrete floors. With that simple intervention, families can live without fear of Chagas. “It’s not rocket science,” says Gilles. “You fix the house, you seal the fate for the disease. It will not come back into that house.”

Declaring war on the chinches

Once a house is fumigated, and the beetles eradicated, constant vigilance is required. Lombardo Ardon, Chagas project director for World Vision Honduras, searches Gregoria Gomez' house for chinches. It's a relief when he finds none the positive result of the project's fumigation phase. World Vision photo by Jon Warren.
World Vision’s Chagas Project focuses on the municipality of San Francisco de Opalaca. Home to the Lenca people, Opalaca ranks 297th out of 298 municipalities in terms of poverty. There is no potable water, no telephone, no electricity, and no transportation.

Opalaca’s population of 8,600 is scattered over 116 square miles, about the size of Las Vegas. Even if the people don’t thrive here, crops do—from coffee and corn to bananas and beans. Still, the people of Opalaca endure isolation and poverty, and are marginalized by a sheer lack of resources, opportunities, employment, education, and agricultural expertise. Despite the yielding land, some 87 percent of the population is malnourished, with 90 percent living in poverty. Perhaps it is no coincidence that the word Lenca means “man of rock”: It takes rock-solid grit to survive this hardscrabble existence.

But World Vision is there, bringing child sponsorship to 1,800 of the area’s nearly 9,000 children. As in other communities where child sponsorship helps shape a better future, Opalaca is benefiting— slowly, but surely—through World Vision assisted health care, educational support, microenterprise, agricultural techniques, and community development.

Community development is crucial in any Chagas intervention, say experts, because once houses are sprayed, children tested, treatment administered, volunteers educated, and houses improved—vigilance is necessary to prevent the beetle’s return.

Chagas project manager Lombardo Ardon says that the first step in World Vision’s battle plan was to fumigate the 7,950 houses in the area, then to test all 8,960 children under the age of 15. Why under 15? The sad reality of Chagas disease is that for anyone older than 15, the parasite’s unremitting destruction of human organs likely has gone too far for community-based treatment to be effective. “Chagas kills you in the prime of your economic productivity,” says Gilles. “These children are born in houses that are infested [with the beetles]. They don’t become infected at 10. They become infected at 10 days or 10 months.”

To fight back, the World Vision team created “vigilance committees” composed of adults and children in every village. Volunteers were trained to provide help for at-risk houses, demonstrating how to find and safely capture the chinche, and how to accurately report back to the committees about the insects.

“We knew that [involving] the community would be very important, and that was World Vision’s stronghold,” says Gilles.

One year into the project’s two-year timeframe, Lombardo can see how community involvement has improved the villages’ chances for survival. “A lot of merit has to go to the community members themselves,” he says. “Once they found out there were a lot of kids infected with Chagas, they were very interested in working together.”

For now, fumigation has eradicated most if not all the chinches from Opalaca. But housing improvement or replacement is the only long-term prevention. And that takes time. As a result, vigilance remains critical to preventing the return of the beetles.

Further steps include medical evaluations for the 349 Chagas-infected children.

Soon, the treatment acquired and administered by the government health ministry will be under way. But that treatment must be carefully administered according to a child’s weight and age— twice-daily tablets for up to 60 days—and many parents are illiterate, with more than one child infected. Successful treatment will depend greatly on community support and involvement.

“It works,” Gilles says. “We know there are fewer children getting the disease. And that means these kids are not going to die when they’re 30 or 40 years old.”

No longer afraid

Five-year-old Francis Orellana's parents recently partnered with World Vision to build a new house. Its zinc roof, plastered adobe-block walls, and concrete floor will provide a safe haven from the threat of Chagas disease. World Vision photo by Jon Warren.
As evening falls, Herman sits on a wooden bench in a darkening room of the community center with four of his friends. The group is part of their school’s vigilance committee. As they talk about Chagas disease, they explain why they joined the committee.

“We don’t want Chagas to be in our community anymore,” says Efrain Vasquez, 13. “It causes death!” His cousin, Elvin Vasquez, 12, agrees: “I was afraid to die. It was said that it caused death. We know now how to be OK.” The youthful vigilantes are perfect for the job—who better to look for bugs? “We look for chinches in the roofs of houses,” explains Elvin. “We look in piles of wood, cracks in the walls. So far, we haven’t found any.” Lombardo explains this positive development: “Because the entire community was sprayed, it’s hard to find the bug now.” Herman admits to being fearful about Chagas disease. But knowing he will receive treatment, he shows a child’s lighthearted spirit: “I am happy now, because I will be OK,” he says.

In many ways, this isolated community is winning the war against its once-silent killer. Partnering with World Vision, the parents of Opalaca are fighting back, through education and community vigilance. The silence has been broken.

And yet, for Herman’s father and other parents, the battle’s initial victory is bittersweet. They can save their children, but these same children may very well become orphans.

“As adults, we don’t know who has Chagas,” says Expectación. “We know we have no treatment, and that’s why we are conscious we are going to die. We know we are bitten, so there is no other remedy but to wait for what is coming to us. But we don’t want that to happen to our kids. Being able to do something for our kids, that’s what we’re trying to do. We want to protect our children.”

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