The Impact of Professional Internships on Chagas Disease Management

The training and exchange programme for health professionals from Paraguay, Spain and Bolivia—financed by the European programme Adelante 2—was enriched by on-site internships at a centre of excellence for Chagas disease care in Tarija (Bolivia).

This training format proved highly popular. A survey conducted at the most recent Chagas workshop, held in Barcelona on 14 and 15 March, found that internships were the option that received the most votes. Among the surveyed participants were several people who gave or received training in Tarija.

The training and exchange programme for health professionals from Paraguay, Spain and Bolivia—financed by the European programme Adelante 2—was enriched by on-site internships at a centre of excellence for Chagas disease care in Tarija (Bolivia)

The experience included two theoretical and practical seminars in rural and urban areas of Paraguay. Eighteen Paraguayan professionals subsequently travelled to the centre of the Platform for the Comprehensive Care of Patients With Chagas Disease in Tarija to hone their knowledge of the disease. At the centre, which is affiliated with a local institution—Juan Misael Saracho Autonomous University—that has extensive experience in Chagas disease management due to its location in a highly endemic area, the participants received hands-on training from Tarija-based professionals.

Vidalia Lesmo, head of the Chagas programme at the Paraguayan Ministry of Health. Aleix Cabrera / ISGlobal.

The theoretical and practical seminars held in Paraguay with Bolivian and Spanish colleagues had already produced spectacular results, according to Dr. Vidalia Lesmo, head of the Chagas programme at the Paraguayan Ministry of Health. At the Chagas workshop, Dr. Lesmo reported a 400% increase in treatments initiated in the urban area of Asunción (Paraguay) compared to the same period the previous year. “Personal involvement and the growing number of reference professionals in the different specialities at the various centres” were among the reasons for this increase, she explained.

The seminars held in Paraguay with Bolivian and Spanish colleagues had already produced spectacular results, according to Dr. Vidalia Lesmo, head of the Chagas programme at the Paraguayan Ministry of Health, who reported a 400% increase in treatments initiated in the urban area of Asunción (Paraguay)

However, participants were even more appreciative of the practical training they received during their internships in the endemic region of Tarija. They were able to enhance their knowledge of clinical aspects, as well as electrocardiography, entomology, laboratory work, and information, education and communication activities. It was a participant-centred educational process based on acquiring competencies through clinical sessions and real-life case studies. As part of the continuous assessment process, verification instruments were applied, activities were recorded and reports were submitted to the professionals responsible for the training.

Lourdes Ortiz, director of the Platform for the Comprehensive Care of Patients With Chagas Disease in Tarija (Bolivia). Aleix Cabrera / ISGlobal.

The Platform for the Comprehensive Care of Patients With Chagas Disease in Tarija, which began as a collaborative project between ISGlobal and the CEADES Foundation, has been integrated into Bolivia’s health system. Lourdes Ortiz, director of the Tarija Platform, commented: “This experience originated at Juan Misael Saracho Autonomous University, and it includes not only a care structure but also research and training.” In fact, the centre has been welcoming interns for 10 years. “The instruments and care guidelines that we have defined here must be adapted to the settings where these professionals work—the places that they will be returning to,” noted Dr. Ortiz, before adding: “Training is never a one-way street. The content shared by our professionals with our Paraguayan colleagues has allowed us to gain a better understanding and share experiences in both directions.”

For participants such as Cynthia Gómez, a doctor at the Puerto Casado Health Centre in Alto Paraguay, the internship was a chance to observe first-hand “the empowerment of each and every one of the members of the Bolivian team in Tarija”, while also gaining knowledge that “will have a direct impact on improving care for patients with Chagas disease in Paraguay”.

For participants such as Cynthia Gómez, a doctor at the Puerto Casado Health Centre in Alto Paraguay, the internship was a chance to observe first-hand “the empowerment of each and every one of the members of the Bolivian team in Tarija”

It was the first international internship experience for Noelia Leiva, a nurse who works at the same centre in Alto Paraguay. In her feedback, Noelia made some suggestions about how to improve pre-internship preparation for people who, like her, are doing this for the first time. Above all, she appreciated “the interdisciplinary human and technical team” of the Tarija Platform. She took note of the comprehensive care processes, the records kept of people affected by Chagas disease and the spirit of the members of the professional team, who clearly “love their work”.

It was the first international internship experience for the nurse Noelia Leiva. She took note of the comprehensive care processes, the records kept of people affected by Chagas disease and the spirit of the members of the professional team, who clearly “love their work”.

Joel Santander, a senior laboratory technician at the Irala Fernández Health Centre in the Paraguayan Chaco, acquired “new skills for the care, diagnosis and follow-up of patients with Chagas disease”. He appreciated the value placed on communication between health staff and patients, noting that “the information provided must be clear and direct”. As for more technical aspects, Joel underscored the importance of laboratory work in diagnosing Chagas disease so that patients can begin treatment and follow-up. “Follow-up is vital as it allows you to catch any alterations, which can sometimes be less than obvious—for example, an adverse reaction to a drug,” added Joel.

Iván Allende, a paediatrician and infectious disease specialist who took part in the workshops in Paraguay. Aleix Cabrera / ISGlobal.

Iván Allende, a paediatrician and infectious disease specialist, was another professional who took part in the workshops in Paraguay. Iván has experience in management and coordination in the health system and currently works in public hospitals. At the Chagas disease workshop, he described the Adelante 2 experience as a tool that has managed to “raise awareness among a sizable group of public providers”. Iván is aware that the system still has a long way to go in terms of investing in the care programme for people with Trypanosoma cruzi infection. “These efforts need to begin with the community, so that, in the medium term, we can stop considering Chagas a neglected disease,” he commented. Iván also highlighted the training capacity and experience of colleagues—including the ISGlobal team—from both endemic and non-endemic areas.

According to Vidalia Lesmo, head of Paraguay’s Chagas programme, the partnership between the three organisations and the three countries made the whole process very easy. The development of guidelines for the management of Chagas disease and theoretical and practical activities carried out with personnel from different parts of the Chaco and the capital city have ensured that “there is a wider network of trained people and centres with more tools and problem-solving capabilities,” explained Dr. Lesmo. “The programme can therefore rely on these nodes without having to centralise all of its activities.” According to Dr. Lesmo, the whole experience was highly productive. “I hope we can do it again someday,” she declared.

The Paraguay-Bolivia-Spain knowledge-exchange programme to optimise the management of Chagas disease during the COVID-19 pandemic forms part of a triangular cooperation initiative supported by the Adelante Triangular Cooperation Window for the European Union, Latin America and the Caribbean (https://www.adelante2.eu/en). A partnership was formed for this purpose between the Barcelona Institute for Global Health (ISGlobal), Juan Misael Saracho Autonomous University of Bolivia and the National Chagas Programme of Paraguay.

This text contains contributions from Irene Losada (assistant coordinator of ISGlobal’s Chagas Initiative), Vidalia Lesmo (director of the National Chagas Programme of Paraguay), Lourdes Ortiz (director of the Platform for the Comprehensive Care of Patients With Chagas Disease in Tarija), Iván Allende (paediatrician and infectious disease specialist from Paraguay), Javier Sancho (coordinator of the Global Coalition for Chagas Disease) and Paraguayan participants in internships organised in Tarija.