Infrastructure for Chagas’ Control

PBCM’s infrastructure for a primary health care program served as an effective base for Chagas’ control. Its infrastructure included three zones, each with a central hospital with three doctors (a director and two others to lead traveling teams), two health workers, and two social workers. These zones contained twenty‑six puestos sanitarios (health posts) in the larger communities, each staffed with an auxiliary nurse and equipped with primary health care items (vaccines, antibiotics, bandages, and measuring instruments). Under Ruth Sensano’s leadership, auxiliary nurses within the three zones were provided with training, technical support, and monetary incentives. Peasants at the village level were responsible for their health and were invited to support a community health worker (CHW), already discussed. CHWs assisted auxiliary nurses and health teams and later became principal links between the village housing‑improvement committees and project technicians. CHWs usually serve for two or three years without pay; and they consider this part of their community service, un cargo (a load).

The cargo system is deeply embedded in Andean and Latin American culture; it predicates that leadership is a burden (cargo ) to be carried voluntarily without material gain, but this service accrues towards one becoming a complete adult (una persona muy completa ) in the community (see Bastien 1978, Metraux 1967, Wolf 1955). Adolescents grow into adulthood in part by serving the community. Adulthood is achieved by assuming tasks for the community.

The maturity of the individual relates to the community; the health of the community brings health to the individual. Throughout Bolivia, the cargo system has been used effectively to elicit community support, with some individuals accepting the load of overseeing the community’s health as a community health worker (CHW).

Sensano had also trained traveling teams of technicians. Traveling teams from the hospitals educated and coordinated activities of the auxiliary nurses and CHWs and provided them with educational materials such as videos, slides, and posters. The traveling team consisted of a medical doctor, social worker, and health educator. Each hospital had two traveling health teams, so that one team was able to visit every village once a month while the other team worked at the hospital. Traveling teams initiated Chagas’ control measures, completed base studies and evaluation studies, and provided technical assistance for housing improvement projects.