viernes, marzo 13, 2009

Coutinho (2003) y Azogue (1993). Chagas. Brazil y Bolivia.

Comments on
Coutinho, Marilia. 2003. “Tropical Medicine in Brazil: The Case of Chagas Disease,” in Diego Armus (ed.), Disease in the History of Modern Latin America. Durham: Duke University Press.

Azogue, E. “Women and congenital Chagas; disease in Santa Cruz, Bolivia: epidemiological and sociocultural aspects” Social Science and Medicine. 37 (1993): 503-511.

Chagas, as a condition that affects humans “only when their living conditions become so degraded that they are similar to those of the natural reservoirs” (76) is the focus of this work. Here, Coutinho wants to understand the social determinants of transmission of this “disease of poverty”, which is carried by an estimated of 18 million people in Latin America, with 25% of the total population at “risk”. Perhaps the specific form in which Chagas is transmitted via an insect that defecate feces infected with a parasite which penetrate the human host through the wound and get into the bloodstream makes this disease more “repulsive”. By 1909 “neither parasite nor bug nor disease was known before Carlos Chagas” (77) discovered it. The beginning of the 20th century saw the emergence of a particular branch of medicine: “tropical medicine” not only in the colonies of the imperial powers but also in countries such as Brazil. (There was a distinction between the “insect vector theory” in the tropical diseases from the metropolitan infectious diseases.) The Tropicalista School in Brazil was involved with development and social justice, they “opposed slavery and openly rejected the tropical degeneration thesis that was popular in Europe in those days” (79). They have a political agenda of national development and self-reliance in relation to health care. Chagas had a lot of opposition within and outside Brazil. After his death the disease was forgotten and research stopped, although the disease was spreading throughout the continent. In Jujuy, Argentina with some overlap Salvador Mazza also conducted many research and found the etiology and with the help of Cecilio Romaña discovered the specific diagnostic marker of the acute phase, a conspicuous eye infection. They promoted a radical change in the conditions of living for people at risk and the fumigation (burning if was possible and feasible) of rural houses. In Brazil with the military coup the d’état in 1964 almost all the parasitological research was ruined and researchers dismissed and fired. The main reason of the disease, poverty and poor housing and life conditions, was never attacked by any government neither in Brazil nor in Argentina.

The main points of this article is how regions where Chagas disease is endemic (tropical and sub-tropical regions and in the valleys) develop into “risk areas” for women migrating from non-endemic regions, and the need to produce proper strategies for the control of this non-vectorial type of transmission of Chagas disease. This congenital transmission in the second generation is the focus of this article.

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