An Afterthought

Juana’s history demonstrates both the hubris and humility that can be associated with Chagas’ disease and other diseases that at first appear so clinically self‑evident to scientists. When serious scholars begin to examine disease pathogens, they often discover that the world of microbiology can be immersed in environmental, social, and cultural systems. For years Andeans have suffered from cólico miserere and vólvulo, which they have understood according to their ethnophysiology. When modern science explains this away in terms of bugs and parasites, there often persists continued adherence to what they have believed. A crucial insight can be gained when cólico miserere is seen not only as an entity with a cause but as a sign or symbol of some disequilibrium, imbalance, social infraction, or spiritual chaos. This sign is written upon the human body in painful and contorted ways. To remove part of a bodily tube or insert another orifice while detaching another can be seen to sacrilegiously deform a body that is imaged after the land, with fluids entering, concentrating, and dispersing. The hubris of the scientists who imagine that their uncovering of clinical facts will save people from disease is often turned to humility. And Juana, recognizing that she, her sister, and her mother had been bitten by infected vinchucas, still reverted to folk beliefs surrounding cólico miserere. She recognizes, as do most other Andean peasants, that biomedical science is only as valuable as its capacity to eradicate disease and heal the sick; within her family, it is not a social and economic reality.

On the side of doctors and biomedical science, there is no clear agreement either‑certain doctors are hesitant to accept that the high incidence of gastrointestinal problems in some communities is related to chagasic colonopathy; other doctors contend that T. cruzi is the exclusive cause of volvulus in other communities. Scientists are slow to believe that Chagas’ disease exists in higher altitudes, such as the Altiplano, where it is too cold for vinchucas, so they attribute gastrointestinal symptoms to other factors. Yet, evidence shows that Chagas’ disease is found in higher regions, and its present spread includes many new regions. The rule should be that when some of the above symptoms appear in Bolivia, a largely endemic zone of the disease, patients should be tested for Chagas’ disease.