MSF and Chagas

• MSF experience in the field

In 1999, Médecins Sans Frontières (MSF) set up its first diagnosis and treatment project for sufferers of Chagas disease in Yoro, Honduras. Since then, the organization has developed several programmes in Nicaragua, Guatemala and Bolivia.

In 2002, MSF began its first Chagas disease project in Bolivia, the country with the highest incidence of the disease in the world. For four years, the organization worked in the rural area of Entre Ríos, in the province of O’Connor, in the Tarija region, treating patients up to the age of 15. Following this, MSF increased treatment up to the age of 18 in a new project, this time in suburban zones in two districts of Sucre, also in Bolivia.

Based on the experience acquired in their projects and the results of recent studies into the effectiveness of the treatment in adults, MSF is now working in three suburban districts in the city of Cochabamba. The activities are being carried out in collaboration with the Bolivian Ministry of Health in an integrated way in five primary care centres, where children and adults up to the age of 50 are treated and diagnosed. Using the same approach, the organization is currently setting up a new project in the rural zone of Cochabamba region, where it is working to involve the communities in all aspects of the strategy (prevention, diagnosis and treatment), in an area where the vector is much more prevalent.

• It is possible to treat Chagas in limited resources environments and remote areas.

At the end of 2008, MSF had carried tested over 60,000 people for Chagas disease and treated 3,100 patients, of whom around 2,800 successfully completed the treatment. This shows that, although current resources are not ideal, the diagnosis and treatment of Chagas disease is viable in environments with limited resources and remote areas if various coordinated activities are carried out:

Informing and educating the population about possible means of transmission, symptoms, treatment and the basic hygiene and prevention measures for the disease. This includes educating local authorities, health workers, community leaders and the families of sufferers.

Integrating vector control with diagnosis and treatment programmes to avoid new infections. Houses where sick people are living must to check if the vector is present and fumigated when necessary, but the importance of prevention should not mean that treatment is relegated to second place.

Actively detecting and diagnosing infection. The lack of symptoms and the problem of access to diagnosis for a large section of the at-risk population continue to be a serious problem. It is for this reason that MSF recommends the detection of Chagas in endemic areas; the availability of rapid tests makes this much easier.

Treating the sick. The treatment of Chagas disease has to be supervised weekly by qualified healthcare workers, as it can cause side effects. With good supervision, these effects are manageable and a high percentage of patients complete the treatment, with a low incidence of adverse effects requiring hospitalisation (0.07 per cent in MSF projects) and no deaths.

Training healthcare workers in the diagnosis, treatment and supervision of patients. There is a need for doctors for controlling serious side effects, nurses for early detection, monitoring and adherence to treatment, and laboratory technicians for the tests to confirm infection.

Ensuring supply and logistics to attend to rural communities (the most affected). For this, it is of the utmost importance to have a strong supply chain of medicines and laboratory reagents, as well as the capacity to store serological samples in optimal refrigeration conditions for future treatment tests.

In addition to these six components, the motivation and commitment of the healthcare workers and the patients themselves in tackling the disease, as well as government support, are essential if the programme is to be a success.