Interdisciplinary Approach

An interdisciplinary approach is necessary to deal with socioeconomic and environmental factors in the spread of Chagas’ disease. A major problem of the pilot projects was that Chagas’ disease was narrowly considered from a biomedical perspective, with little if any consideration of the cultural, economic, environmental, and social factors involved in this epidemic.[76]These pilot projects thus pointed to the importance of including the social and economic sciences in the effort to prevent Chagas’ disease. Narrowly focused approaches of particular disciplines are insufficient to deal with its complexity. If this book has shown anything, it is that Chagas’ disease is complicated by issues of biology, chemistry, parasitology, pathology, entomology, economics, ecology, sociology, and ethnology. Each of these studies is necessary to deal with Chagas’ control and disease. Detailed and varied perspectives need to be brought together within the culture context. The CCT model converges toward an apex of prevention and treatment of Chagas’ disease.

Anthropologists look at Chagas’ disease from a cultural perspective. Culture is seen as the major influence upon people’s behavior. Anthropologists examine the relationship of people’s values and behaviors with environmental factors related to vinchucas and T. cruzi. They study the etiology of Chagas’ disease and how people deal with its symptoms. They are able to explain the cultural dynamics of shamans, midwives, and curanderos. Anthropologists can be seen as the translators and negotiators between the technical‑scientific world views of project personnel and the cultural practices of peasants.

The following anthropologists have contributed to the prevention of Chagas’ disease. Oscar Velasco integrates ethnomedicine and biomedicine in the treatment of Chagas’ disease. Alan Kolata and Charles Ortloff (1989) have shown that the raised‑field technique in about A.D. 500 at Tiahuanaco, an archaeological site on the Altiplano, was a more productive farming technique than that used now by the Aymara, which was introduced by the Spaniards. Raised‑field techniques also provided better nutrition. Applying this archaeological knowledge, Kolata is reintroducing raised‑field techniques to Altiplano Aymaras.

Social anthropologist Xavier Albo has studied Aymara and Quechua political and economic systems to assist his public policy advocacy of their interests, and his studies greatly assist project personnel in these matters. Cultural anthropologist Pablo Regalsky leads an institute that promotes the ethnoscientific knowledge and traditional agricultural systems of peasants in the valleys of Cochabamba and Misqui. He has helped Quechua peasants of Ragaypampa restore traditional methods of crop rotation to enhance production and to maintain adaptive varieties of potatoes within the Misqui region. This has offset the trend for single‑crop production of russet potatoes, caused by the demand for larger potatoes to make french fries in Cochabamba.

Sociologists deal with social stratification and ways to deal with divisions between peasants, city dwellers, cholos, and mestizos. Bolivian sociologists have been very helpful in the understanding of gender and age roles. There is a body of statistical information available that provides quantitative information about demographics, migration, income, and social stratification. Project sociologists are needed to assist in group dynamics, enlisting community participation, and providing leadership. Social psychologists are helpful in assessing motivational factors and social behavior.

Juan José Alva, for example, works in rural sectors of the city of Cochabamba on housing concerns and Chagas’ control. He is also a professor of sociology at the University of San Simon in Cochabamba. He teaches rural teachers and has been influential in getting them to use educational material that is adaptable to the people in these areas.

Roberto Bricefio‑León and Silverio González analyze economic and social conditions leading to infestation of triatomines in villages of Venezuela. They introduced locus of control theory into the SOH/CCH pilot projects in Bolivia. Locus of control implies that an individual’s general expectations about his or her ability to control the future greatly influence that individual’s response to house improvement programs (González Tellez, interview 10/15/91). People’s notion of whether the future is controlled by themselves, the state, fate, or luck greatly influences their desire to act to prevent anything or improve houses. González helped project personnel deal with the fatalistic attitude of peasants. He also found that, after they improved their houses, many people gained a sense of empowerment.

Economists devise ways that projects can be financed by community members. They also help to increase productivity in rural areas. Many factors in vector infestation are related to economic problems. Migration and inadequate housing are caused in part by low productivity, unemployment, debt peonage, and impoverishment. Chagas’ disease has increased because poverty in Bolivia and other countries of Latin America has increased, especially in cities.

Innovative economists are forming microcredit institutions and cooperatives to assist community members to develop free trade. As an example, Marco Antonio Prieto analyzes problems within the rural communities of Chuquisaca and devises economic measures such as microcredit and cooperatives to deal with these problems. Ronald Gutiérrez, an economist for Plan International, studies how the political economy affects migration and housing development in the Department of Tarija. Plan International and Pro‑Habitat provide credit for housing improvement in the barrios of Tarija. Ruth Sensano has introduced the production of tile roofing to certain communities. It serves not only to prevent vinchucas but also as an additional source of income to the community. The parish in San Lorenzo, Territory of Lomerío, has a housing cooperative that provides credit to Chiquitano Indians to build houses and a tile‑and‑brick cooperative to provide them with building materials.

Agriculturalists study land to increase productivity, decrease depletion, and improve farming and herding. They have introduced rotational planting. Livestock suffer similar symptoms of Chagas’ disease, and its toll on sheep, cattle, goats, horses, alpacas, llamas, and guinea pigs is very great. Percentages of livestock infection are proportional to percentages of human infection wherever animals are kept near dormitories, which is almost always the case among peasants. Chagas’ disease’s toll on animal productivity is a concern that Bolivians generally haven’t even begun to consider. At the present, the major concern is that domiciliary animals attract vinchucas and are carriers of T. cruzi, adding yet another infected blood source for uninfected vinchucas. Agriculturalists deal with ways that livestock can be kept so that they do not serve as reservoir hosts for parasites. Bolivian agriculturalists also practice veterinary medicine and are necessary to treat infected and ill livestock.

Linda Gregg, an expert in animal husbandry, studies goat and cattle herding among the Quechuas of Misqui, Bolivia, an area where Chagas’ disease is 70 percent endemic. She provides medical care for sick animals and has found that imported cattle brought hoof‑and‑mouth disease to cattle in the region. She is introducing ways to increase herds, produce healthier animals, and improve herding techniques to minimize erosion caused by goats. She also is assessing the loss of productivity in livestock as caused by T. cruzi.

Community health workers have been trained in agriculture and animal husbandry in the Department of Oruro. They have introduced carpas solares (solar gardens) to hundreds of communities of the Altiplano, where previously because of the cold nights and altitude of 12,500 feet the growing of tomatoes, cabbages, onions, and carrots was not feasible. Now these communities have vegetables to help balance their diet of potatoes. Workers also have introduced new types of seeds and rabbits.

Naturalist Jaime Zalles studies the economical uses of wild plants throughout Bolivia. He and ethnologist Manuel de Luca have published popular books on the medicinal and nutritional uses of plants. Written in the Aymara, Quechua, and Guarani languages, these books are well‑illustrated and helpful guides to members of the community, CHWs, and ethnomedical practitioners. Zalles gives presentations to peasants about Chagas’ disease and informs them about native plants that can be used to treat its symptoms or as insecticides. He cultivates medicinal plants for export and is involved with scientists trying to find herbal cures for Chagas’ disease, AIDS, and cancer.

These specialists, many of whom are Bolivians, may provide innovative and unique solutions to Chagas’ disease, and many could be employed for less than the cost of one consultant from the United States. They constitute an interdisciplinary team for dealing with Chagas’ disease. Bolivians should be able to provide a more integrated interdisciplinary and culturally sensitive approach to the prevention of Chagas’ disease than could international agencies or nongovernmental organizations. However, they too must avoid Bolivia’s inherent class and race stratification. They too need to be trained in the culture context triangle. Their endeavors do bear out the premise of the culture context model: that people within a community know best how to solve their own problems once they are educated about them. The role of project workers is to meaningfully educate them.