The Burden of a Weakened Heart in the Andes

Very few Bolivians with chagasic heart disease (.01 percent) are as fortunate as Bertha in being able to have pacemakers installed and to be treated by an expert doctor. Acquired in her infancy, Chagas’ disease has left Bertha with irreversible heart damage: arrhythmia (irregular heartbeats) and bradycardia (slow heartbeats), which could lead to heart failure or sudden death without the help of a pacemaker. Many Bolivians have no medical insurance. Pacemaker implantation costs about U.S. $3,000 per person in Bolivia, prohibitively expensive where the average income is U.S. $580 per person per year. No drug exists to reverse these patients’ chronic condition, because of the immunological consequences of the original infection. Many victims are farm or mine workers who are unqualified to find lighter jobs. They have little alternative but to continue work and face the daily prospect of their hearts failing to pump enough blood through their bodies to keep them alive. Chagas’ disease can seem especially cruel to these workers: when they are supposed to be at the strongest phase of their lives and most able to support young children, they are debilitated and unable to work as hard.

The socioeconomic impact of the disease during the chronic stage is high, as data from Bolivia show: about 25 percent of the infected population (1,500,000 people) will develop severe cardiac and digestive lesions such as cardiac arrhythmia (215,000) and megaesophagus and megacolon (150,000; see Valencia, Jemio, and Aguilar 1989).[34]In 1992, the indirect costs of lost production in Bolivia due to Chagas’ disease morbidity and mortality amounted to $100 million, and the direct cost for Chagas’ disease treatment reached $20 million (SOH/CCH 1994). The collective biomedical cost for pacemakers and corrective surgery at $3,000 per person would run about $1 billionastronomically unfeasible in Bolivia as well as in other Andean countries. Put another way, this is enough for the improvement or construction of a million rural dwellings at a minimum estimated cost for each of U.S. $1,000. Data from Brazil are equally grim, with 45,000 cases of cardiac arrhythmia and 30,000 cases of megaesophagus and megacolon estimated annually, with the collective cost at about U.S. $225 million per year (Special Programmes 1991 Report).

In the Andes, chronic Chagas’ disease debilitates Andeans who have evolved with strong hearts adapted to the low oxygen of higher altitudes. Highland Andeans have an extra pint of blood in their bodies and larger lungs to accommodate the 20 to 30 percent less oxygen at levels between 9,000 and 16,000 feet. Climbing up and down hills and mountains, Andeans have enjoyed the aerobic effect that daily exercise provides runners. Chagas’ disease has not been particularly prevalent at higher altitudes because vinchucas prefer warmer and more humid climates. However, this has drastically changed with the massive migration of infected Bolivians and vinchucas to practically every site in the Andes. Because of layoffs in the mines, droughts, floods, and increased cocaine production, peasants seasonally travel to endemic areas, where some become infected with T. cruzi and bring it and vinchucas to other regions. Lowland peoples have also spread this disease to highland Andeans through blood transfusions.