La migración de Chagas: la construcción bio-médica y socio-política de las enfermedades infecciosas tropicales

Questo studio propone un'esplorazione dei nessi tra processi migratori ed esperienze di salute e malattia a partire da un'indagine sulle migrazioni provenienti dall'America latina in Emilia-Romagna. Contemporaneamente indaga i termini del dibattito sulla diffusione della Malattia di Chagas, “infezione tropicale dimenticata” endemica in America centro-meridionale che, grazie all'incremento dei flussi migratori transnazionali, viene oggi riconfigurata come 'emergente' in alcuni contesti di immigrazione. Attraverso i paradigmi teorico-metodologici disciplinari dell'antropologia medica, della salute globale e degli studi sulle migrazioni, si è inteso indagare la natura della relazione tra “dimenticanza” ed “emergenza” nelle politiche che caratterizzano il contesto migratorio europeo e italiano nello specifico. Si sono analizzate questioni vincolate alla legittimità degli attori coinvolti nella ridefinizione del fenomeno in ambito pubblico; alle visioni che informano le strategie sanitarie di presa in carico dell'infezione; alle possibili ricadute di tali visioni nelle pratiche di cura. Parte della ricerca si è realizzata all'interno del reparto ospedaliero ove è stato implementato il primo servizio di diagnosi e trattamento per l'infezione in Emilia-Romagna. È stata pertanto realizzata una etnografia fuori/dentro al servizio, coinvolgendo i principali soggetti del campo di indagine -immigrati latinoamericani e operatori sanitari-, con lo scopo di cogliere visioni, logiche e pratiche a partire da un'analisi della legislazione che regola l'accesso al servizio sanitario pubblico in Italia. Attraverso la raccolta di narrazioni biografiche, lo studio ha contribuito a far luce su peculiari percorsi migratori e di vita nel contesto locale; ha permesso di riflettere sulla validità di categorie come quella di “latinoamericano” utilizzata dalla comunità scientifica in stretta correlazione con il Chagas; ha riconfigurato il senso di un approccio attento alle connotazioni culturali all'interno di un più ampio ripensamento delle forme di inclusione e di partecipazione finalizzate a dare asilo ai bisogni sanitari maggiormente percepiti e alle esperienze soggettive di malattia.This study explores the connections between migration processes and experiences of health and illness, investigating migration flows from Latin America to Emilia-Romagna. At the same time, the study examines the debate around the spread of Chagas disease, a 'neglected tropical infection' endemic in Central and South America that, given the increase in transnational migration flows, is currently being reconfigured as 'emerging' in the countries of destination. Adopting the theoretical and methodological paradigms of medical anthropology, public health and migration studies, the nature of the relationship between 'neglected' and 'emerging' is analyzed within the policies that shape European migration flows, with specific reference to the Italian case. The issues addressed relate to the legitimacy of the social actors involved in publicly framing the phenomenon, to the visions that inform the health policies for Chagas disease, and to the impact of these visions on the health care practices. Part of the research has been conducted within the hospital ward where the first service for Chagas disease diagnosis and treatment in Emilia-Romagna was established. An ethnography within and outside the service has been developed, involving the main actors in the research field - Latin American migrants and health professionals - with the aim of collecting visions, logics and practices starting from investigating the legislation that regulates access to the public health system in Italy. Through the collection of biographical narratives, the study sheds light onto particular migratory pathways and life trajectories in the local context; reflects upon the validity of categories such as 'Latin American', used in the scientific community in tight connection with Chagas disease; redefines the meaning of a culturally sensitive approach, within a broader re-thinking of the forms of inclusion and participation aimed at addressing health care needs and subjective ill health experiences

Storie di vita, racconti di malattia e migrazione. I simboli, le ragioni, i sintomi del Mal de Chagas nella periferia di Buenos Aires.

“A Buenos Aires essere chagasico significa chi sei e da dove vieni”. Queste le parole con cui Fernanda comincia a raccontare la sua storia. Una storia in cui l’esperienza della Malattia di Chagas, infezione cronica e silenziosa, appare indissolubilmente vincolata al suo vissuto di migrazione dalla periferia boliviana di Cochabamb

Storie di vita, racconti di malattia e migrazione. I simboli, le ragioni, i sintomi del Mal de Chagas nella periferia di Buenos Aires

L'esperienza della migrazione dall'America latina all'Italia, nella sua complessità storica, rappresenta il terreno in cui il vissuto biografico della Malattia di Chagas si carica di profonde e peculiari elaborazioni culturali

Mal de Chagas e povert\ue0: i Wich\uec di Mision Nueva Pompeya (Chaco, Argentina)

Popolazione indigena winch\uec e popolazione criolla sono vincolate da connesse relazioni storico-economiche e socio-culturali nel Chaco argentino. In tale contesto l'esperienza della malattia di Chagas si carica di peculiari vissuti biografici e interpretazioni culturali

Corpo, società, politica: la malattia di Chagas a Buenos Aires. Un'indagine congiunta tra antropologia medica e salute pubblica.

La malattia di Chagas colpisce oltre 10 milioni di persone in America Latina. Un tempo caratterizzante le zone rurali, rappresenta oggi, a causa dei flussi migratori, un problema di salute pubblica anche in aree urbane. Attraverso gli strumenti disciplinari della salute pubblica e dell\u2019antropologia medica, si presenter\ue0 in forma dialogica una ricerca realizzata nel contesto di Buenos Aires. Si analizzeranno le relazioni tra le esperienze individuali di malattia e le strategie politiche e sanitarie, evidenziando come determinanti socio-economici giochino un ruolo fondamentale nella costruzione locale dei significati e delle simbologie inerenti salute e malattia, rendendo necessaria un\u2019analisi dell\u2019universo locale e soggettivo al fine di ripensare criticamente le politiche sanitarie globali

Addressing healthcare for migrants and ethnic minorities in Europe: A review of training programmes

Background: The global phenomenon of migration has dramatically changed the social context in which healthcare professionals operate. European states are facing a growing need to effectively train healthcare professionals to understand and respond appropriately to the diverse needs of migrants and ethnic minorities. While many European Union (EU) countries have adopted specific initiatives, there is considerable variation in these activities and few examples of evaluation of the quality of these training courses. Aims: This article describes findings from a review conducted as a part of the ‘Training packages for health professionals to improve access and quality of health services for migrants and ethnic minorities, including the Roma (MEM-TP)’ project, which sought to identify and assess training programmes for health professionals delivered in Europe between 2004 and 2013. Methods: The review and analysis of training materials comprised three components: (1) a review of the published and unpublished literature, (2) a survey addressing national contact persons, and representatives of international organisations and non-governmental organisations and (3) an assessment of the quality of the training programmes identified. Results: The review showed that training programmes tend to be characterised by low levels of participant involvement in training development, delivery and evaluation. Training programmes often lacked an explicit pedagogical approach, did not systematically focus on outcomes in training design, implementation and evaluation, and were poorly linked to key organisational and policy support. Finally, while cultural competence continues to be the broad conceptual approach used in training programmes, alternate approaches such as intersectionality, equity and person-centred care are emergent. Conclusion: Training programmes in Europe can be further improved in order to ensure an effective response to the diverse needs of patients, carers, health professionals and the community

Chagas disease at the crossroad of international migration and public health policies: why a national protocol is not enough

Since the year 2000, Chagas disease, traditionally known as a rural Latin American affliction, has been rising in the ranking of international health priorities due to the growing migration flows from endemic areas to non-endemic ones. Using the example of Italy and reporting preliminary results of a study carried out in the district of Bologna, the paper will argue that a disease-centred public health approach might be inadequate when dealing with complex and uncertain situations, in which complete statistical data are not available or not reliable, and in which the involved actors, health professionals on the one side, migrants on the other, appear to be unaware of the issue, or might even be denying it. In such a context, an effective public health approach should be capable of crossing disciplinary boundaries and bridging the gap between health services and communities, as well as between health and social issues

Flussi migratori e nuove patologie di importazione: la cardiomiopatia chagasica cronica

Chagas disease, caused by the parasite Trypanosoma cruzi, is transmitted by triatomine bugs in endemic regions of the American continent and less frequently by blood transfusion and congenital transmission. Immigration rates explain why the disease can be found worldwide. Non-endemic countries that receive a significant amount of Latin American immigrants should be familiarized with the disease to allow prevention, diagnosis and early treatment. In Italy, where no serologic screening is routinely performed to detect Trypanosoma cruzi in blood donations, a special consideration must be held. Accordingly, attention to congenital transmissions of the disease should be drawn considering the lack of newborn screening. Though commonly unrecognized, chronic chagasic cardiomyopathy is the most common type of chronic myocarditis in the world

Mal di Chagas: un problema emergente di salute pubblica in Italia?

La malattia di Chagas \ue8 una infezione parassitariaendemica nel continente americano che interessacirca 16-18 milioni di persone.Considerando una percentuale pari al 9.5% di im-migrati latino-americani in Italia, e le vie di tra-smissione non vettoriale, per via congenita, trasfusione di sangue e trapianto di organi, si concludeche la malattia di Chagas rappresenti oggi un pro- blema emergente di salute pubblica anche in Italia. Linee guida e protocolli specifici sembrano necessari per una adeguata prevenzione, diagnosi e trattamento

La malattia di Chagas in un paese non endemico: il conte-sto bolognese. Analisi multidisciplinare della malattia e del fenomeno migratorio.

Chagas disease is a parasitic illness endemic in 21 countries of Central and South America, affecting over 10 million people. Due to the increase of migration fows to Europe, Chagas disease is an emerging public health issuein non endemic countries. In Italy, where no specific policy has yet been developed, the Centre for International Health of the University of Bologna is carrying out the project \u201cChagas disease in a non endemic country: a study in the district of Bologna\u201d. A multidisciplinary and multi-method approach was adopted to estimate the problemand its impact in our territory. A retrospective analysis was performed searching several databases in order to collect information concerning the demographic and epidemiological profile of Latin American migrants coming from endemic countries. At the same time, a preliminary ethnographic research was conducted to start unveilingthe main socio-anthropological characteristics of this population, thanks to the involvement of key informants and community associations. According to preliminary findings, Chagas disease is a present and possibly increasing reality in our territory. Due to the particular features of the affected population, socio-cultural variables have to be considered for their impact on the visibility of the condition and on health seeking behaviors