Chagas and a Better Country: Sharing Knowledge and Experience Across Borders to Support the Fight Against the Disease

[This text is written by Javier F. Sancho, coordinator of the Global Chagas Disease Coalition, with the collaboration of Karina Egüez, departmental head of the Chagas diagnosis programme in Chuquisaca (Bolivia); Juan Domingo Irala, biochemist at the at Central Military Hospital (Paraguay); and Lilian Cristina Méndez, gynecologist at the San Pablo Maternity and Children’s Hospital in Paraguay, (Paraguay).]

“It was the best way to confirm that all the experience I had gained over the course of my professional life had been good for something.” This was the clear and emphatic verdict expressed by Dr. Karina Egüez, departmental head of the Chagas diagnosis programme in Chuquisaca (Bolivia), after participating as a trainer in the most recent seminar on the comprehensive management of Chagas disease in urban areas, held in Asunción (Paraguay) in January.

Under the umbrella of the European Union’s ADELANTE 2 Window, which promotes triangular cooperation in Latin America and Caribbean, this training programme provides a venue for Bolivian and Paraguayan professionals to share their knowledge and experiences with the aim of improving Chagas care in Paraguay. The effort is being coordinated by ISGlobal and Juan Misael Saracho Autonomous University (Tarija, Bolivia), together with Paraguay’s National Malaria Eradication Service (SENEPA), which oversees the national Chagas programme.

Under the umbrella of the European Union’s ADELANTE 2 Window, this training programme provides a venue for Bolivian and Paraguayan professionals to share their knowledge and experiences with the aim of improving Chagas care in Paraguay

The attendees, who represented 27 different health institutions and structures, appreciated that the seminar specifically addressed the importance of the urban context in the management of Chagas disease, given the great impact it can have at the global level. Karina Egüez was pleased that her experience could be applied to Paraguay, “a fellow country engaged in the global fight against this disease”. At present, 30% of people living in endemic areas of Paraguay are exposed to Chagas infection and more than 165,000 are currently infected.

From Living With the Chicha Guasú to Working Against It

In addition to theoretical training, participants received practical training in the laboratories of the Research Institute for Health Sciences. Juan Domingo Irala, a biochemist at Paraguay’s Central Military Hospital, described his experience. “I was somewhat reluctant to participate because I work mainly in clinical microbiology and have barely any experience with the serological diagnosis of Chagas disease,” he confessed. However, he had heard of many “cases of fellow citizens with positive serology”. In fact, “last year we even had a newborn who died of congenital Chagas disease,” he added. Irala recalled that, during visits to his grandparents’ house as a child, “we would sleep on beds of woven cowhide that were infested with the vector of this disease: the chicha guasú, as we call it in Paraguay.” For someone more accustomed to laboratory work, Irala found this practical training in the diagnosis of Chagas disease to be extremely useful.

Photo: María Soledad Silva Guerín

In fact, “many of the participants had no experience with the laboratory techniques we taught,” explained Karina Egüez. “After this seminar, we will therefore be able to initiate and coordinate Chagas diagnosis activities in the units that have received training. This is the start of a new stage in the clinical surveillance of Chagas disease.”

The attendees, who represented 27 different health institutions and structures, appreciated that the seminar specifically addressed the importance of the urban context in the management of Chagas disease, given the great impact it can have at the global level

The participation of specialists from a diverse range of research and health-care fields proved especially enriching. Lilian Cristina Méndez, a gynaecologist at the San Pablo Maternity and Children’s Hospital in Paraguay, commented: “As a doctor who works with a very vulnerable population, this new knowledge will help me adopt better practices and provide better guidance to patients.” Juan Domingo Irala, the biochemist, noted that he will now be able to offer more information to people in his community, both professionally and socially.

Participants were impressed by the analysis of the current situation of Chagas disease in Paraguay by Dr. Vidalia Lesmo, head of the national Chagas programme at SENEPA, who grounded her presentation in recent data. The attendees also appreciated the capacity and support provided by the staff of Paraguay’s Research Institute for Health Sciences, whose laboratories hosted the practical training activities.

Dr. Egüez, from Bolivia, was pleasantly surprised by Paraguay’s local reagent production capacity: “Having diagnostic tools made with locally circulating strains greatly increases the sensitivity of the tests used on the Paraguayan population,” she explained. “Likewise, using two versions of the ELISA serological test—one for basic labs and the other for more complex labs—is a strength that should be fully exploited by the laboratory network and the national Chagas programme.”

Training to Make the Country a Little Better

“This seminar was a reality check for the everyday practice of our profession,” commented Lilian Cristina Méndez, the Paraguayan gynaecologist, who noted that Chagas is still a very neglected disease, even within the medical profession. But, she said, this in-depth training on diagnosis, treatment and management of complications has reinforced the participants’ interest and commitment to breaking down barriers and improving patient care. In short, “this will make our country a little better,” concluded Méndez.

At present, 30% of people living in endemic areas of Paraguay are exposed to Chagas infection and more than 165,000 are currently infected

The conclusions and results of the training activities held as a part of this ADELANTE 2 initiative will be presented at the 17^th Workshop on Chagas Disease, to be held simultaneously in Barcelona and Tarija on 14 and 15 March.

Photo: María Soledad Silva Guerín

A post-seminar feedback survey found that all participants were willing to act as liaisons in their workplaces to expand Chagas training and improve care for patients with this disease. Upon returning to Bolivia, Dr. Egüez sent us the following message:

“I carry in my heart and mind all the people I met during this marvellous experience. Thank you so much for including me in this training activity, and for the flawless organisation of each and every one of the activities. I hope my professional contribution fully met your expectations, and I would be thrilled to repeat the experience again someday.”

More information

Cooperation initiative of ADELANTE Window: Comprehensive care for Chagas disease

ISGlobal Participates in Two Triangular Cooperation Projects of the European Programme ADELANTE 2