Castro, Irma

Universidad Nacional de Lanús: Portal de revistas científicas de la UNLa "Arturo Peña Lillo"

debate / debate 31SaLUd COLeCtIVa, buenos aires, 8(Suppl 1):S23-S38, November, 2012Universidad Nacional de Lanús | Salud Colectiva | english edition ISSN 2250-5334 | e-ISSN 1851-8265| ISSN-L 1669-2381or two full meals per day), poor housing (precari-ously constructed) and/or poor education (illiterate or with incomplete primary education). thus, in the study population, 3,572 patients (74%) (p<0,001) were considered to be at poverty level. the conclu-sions of the study were compelling:1. In a population with Chagas, healthy according to cardiological studies by the Chagas Network of the GCBA, a significant unemployment rate due to discrimination was observed, which in turn favors the presence of poverty and low levels of education. 2. those employed were paid “under the table” (without an employment contract). therefore, high unemployment added to the prevalence of under-the-table work determines the lack of access to a health insurance plan, in order to receive better medical care and discounts on drugs when necessary.3. the rights to work, education and decent housing are seriously compromised in a population “stig-matized” for having Chagas disease although they are healthy enough to perform all types of activities.4. “Poverty” may be the cause or the consequence of Chagas disease. Whichever the case, those af-fected are placed in a serious position of inferi-ority before the population without Chagas. Social ethics does not seem to cover people stigmatized simply because they have a reactive blood test.all of this serves to demonstrate that it will be very difficult to change this characteristic of the disease in a few years’ time, as accurately described by the author (1) using the criterion of “visibility and invisibility of the disease,” still relevant today.bIbLIOGRaPHIC ReFeReNCeS 1. Zabala JP. La enfermedad en su laberinto: avances, de-safíos y paradojas de cien años del Chagas en argentina. Salud Colectiva. 2012; 8(Suppl 1):S9-S21.2. auger SR, Storino R, de Rosa M, Caravello O, Gon-zalez MI, botaro e, bonelli L, Rossini O. Chagas y sida, la importancia del diagnóstico precoz. Revista argentina de Cardiología. 2005; 73(6):439-445.3. Storino R, auger S, Jorg M. ¿Porqué la enfermedad de Chagas es un problema tan difícil de resolver? In: Manual práctico: atención médica del paciente cha-gásico: un enfoque biológico, antropológico y social. buenos aires: ediprof; 2003. p. 129-150.]4. auger S, Gorocito M. Vías de Contagio. In: enfer-medad de Chagas: nuevo tratamiento de la cardiopatía incipiente. Sarrebruck: editorial academia española; 2012. p. 7-14.5. auger S, Mitelman J, Giménez L, abuin JC, Pérez Prado G, Vallaza M, Garro N, Caviglia S, et al. Red y Programa de Chagas del GCba: Chagas y derechos hu-manos, aspectos médicos, psicosociales y éticos. buenos aires: 12º Jornadas de enfermedad de Chagas-Mazza: Chagas y derechos humanos, aspectos médicos, psico-sociales y éticos. (Forthcoming 2012).CItatIONauger S. Commentary on the criterion of visibility and invisibility in Chagas-Mazza disease. [debate]. Salud Co-lectiva. 2012;8(Suppl 1):S29-S31.the translation of this article is part of an interdepartmen-tal collaboration between the Undergraduate Program in Sworn translation Studies (english <> Spanish) and the Institute of Collective Health at the Universidad Nacional de Lanús. this article was translated by Victoria Vallejos and Patricia Velázquez, reviewed by Mariela Santoro and modified for publication by Vanessa Di Cecco.Chagas disease: a complex problem enfermedad de Chagas: un problema complejoCastro, Irma11Cardiologist. Former Head of Diagnosis and Treatment, National Chagas Service. Professor, Universidad Nacional de Córdoba, Argentina. irmacas@arnet.com.ar Commentary on: Zabala JP. the disease in its labyrinth: ad-vances, challenges and paradoxes over 100 years of Chagas in argentina. Salud Colectiva. 2012;8(Suppl 1):S9-S21.I share Zabala’s view (1) that Chagas is a complex entity, with biological, environmental, economic, labor, political, educational, and so-ciocultural factors whose convergence creates a vicious circle in which the subjects and their en-vironment are immersed and from which it is dif-ficult for them to escape.32 CaStRO I.SaLUd COLeCtIVa, buenos aires, 8(Suppl 1):S23-S38, November, 2012Work licensed under the Creative Commons attribution-NonCommercial 4.0 International Licensethis complexity makes it necessary for multi-disciplinary teams to intervene in order to manage the problem in its entirety (2). It is also true that health care professionals show a lack of interest in this issue as well as cognitive deficiencies, as stated by Zabala (1), possibly due to deficits in their training.We must acknowledge that public health policies have confronted the problem, allocating substantial financial resources to disease control, housing, promotion and education. Nevertheless, the problem remains endemic in areas that have not been reached by the available resources, areas with a high risk of transmission where determining factors have not been modified; high-cost activ-ities have been carried out without ensuring the continuity necessary for results to be sustainable. In terms of research, there has been signif-icant development in the disciplines that study this issue, greatly impacting the knowledge regarding trypanosoma cruzi, the vector, transmission mechanisms, and the immunology and pathology of the disease, among other aspects. a decrease in transmission has thus been achieved, although it is not a generalized decrease, as marked differences exist in some provinces.the subjects, victims of the problem, are in-visibilized due to many factors: one the one hand, due to the lack of knowledge about the disease, the little social demand existing, the decrease in expectations, the isolation and abandonment due to lack of information; and on the other hand, em-ployment discrimination, related to their low levels of education and their supposed inability to work. as the hiring process is terminated with a positive serological result without ever reaching a definition of their clinical state, these subjects are led to frus-tration. a process is therefore enabled by which subjects are submerged into the informal labor market, with low wages and a very poor quality of life, and are thus enclosed within a vicious circle that prevents them from moving forward (3,4).The efficiency of public health policies varies in the provinces with the highest risks, which show a state of inertia regarding primary and secondary prevention. this attitude of inaction worsens the problem and becomes more noticeable with the horizontalization of the disease control programs.It is evident that Chagas disease is a complex problem which requires:  multidisciplinary teams highly trained and pre-pared for decision-making, with effective and efficient financial and human resources;  national policies articulated with provinces and local governments in all regions, giving priority to high-risk areas (5);   political and administrative continuity for im-plementing programs;  training in diagnosis and treatment, so that health care professionals become protagonists instead of passive spectators.the urbanization of Chagas increases the complexity of medical care due to its association with other pathologies and states of immunode-pression, with a high social and economic cost to the public health system, which requires a critical mass of professionals to diagnose and treat reactivations. to conclude, Law 26281 (6) stipulates the protection of subjects from prevention to free treatment, involving all workplace, social and political actors, in professional, technical or administrative roles, with their corresponding responsibilities.bIbLIOGRaPHIC ReFeReNCeS 1. Zabala JP. La enfermedad en su laberinto: avances, de-safíos y paradojas de cien años del Chagas en argentina. Salud Colectiva. 2012;8(Suppl 1):S9-S21.2. Pinto dias JC. evolución del conocimiento epidemio-lógico y situación epidemiológica actual. 1° Congreso Virtual de Cardiología. [Internet]. 2000 [cited 20 Sep 2012]. available from: http://www.fac.org.ar/cvirtual/cvirtesp/cientesp/ecesp/ecc4500c/cpinto/cpinto.htm.3. briceño-León R. enfermedad de Chagas: de la enfer-medad rural a las epidemias urbanas. Segundas Jornadas de Fortalecimiento de la enseñanza de Chagas en las Ciencias de la Salud. Córdoba, Universidad Nacional de Córdoba, octubre de 2010.4. briceño-León R, Gabaldón a. La casa enferma: socio-logía de la enfermedad de Chagas. Caracas: Fondo edi-torial Acta Científica Venezolana; 1990.5. Pinto dias JC. La comunidad y el control de la en-fermedad de Chagas: integración, rol, supervisión y evaluación de su participación. [Internet]. Montevideo: Grupo de trabajo OPS en enfermedad de Chagas; 2001 [cited 20 Sep 2012]. available from: http://www.amro.who.int/spanish/ad/dpc/cd/consulta-7.pdf.6. Congreso de la Nación argentina. Ley 26.281. [In-ternet] InfoLeG, Información Legislativa: 2007 [cited 20 debate / debate 33SaLUd COLeCtIVa, buenos aires, 8(Suppl 1):S23-S38, November, 2012Universidad Nacional de Lanús | Salud Colectiva | english edition ISSN 2250-5334 | e-ISSN 1851-8265| ISSN-L 1669-2381Sep 2012]. available from: http://infoleg.mecon.gov.ar/infolegInternet/anexos/130000-134999/131904/norma.htm.  CItatIONCastro I. Chagas disease: a complex problem [debate]. Salud Colectiva. 2012;8(Suppl 1):S31-S33.the translation of this article is part of an interdepartmen-tal collaboration between the Undergraduate Program in Sworn translation Studies (english <> Spanish) and the Institute of Collective Health at the Universidad Nacional de Lanús. this article was translated by Victoria Vallejos and Patricia Velázquez, reviewed by Mariela Santoro and modified for publication by Vanessa Di Cecco.Chagas disease: a brief analysis of some of the factors influencing the disease’s persistenceenfermedad de Chagas: breve análisis de algunos factores que influyen en su persistenciaMoretti, Edgardo11PhD in Biochemistry. Specialist in Immunology. Laboratory Head, National Chagas Service. Professor, Faculty of Medical Sciences, Universidad Nacional de Córdoba, Argentina. eram112@live.com.arCommentary on: Zabala JP. the disease in its labyrinth: ad-vances, challenges and paradoxes over 100 years of Chagas in argentina. Salud Colectiva. 2012;8(Suppl 1):S9-S21.as dr. Juan Pablo Zabala’s excellent article (1) demonstrates, Chagas disease offers a clear ex-ample of the need to find points of connection be-tween the biomedical and social sciences, which often travel in separate lanes. the complexity of this endemic disease requires the perspectives of different disciplines as well as the making of po-litical decisions to which these different disciplines should contribute. In this way, social, bioethical, psychological, anthropological and philosophical aspects must be present in any discussion aimed at making the problem “visible” and contributing to its solution, considering the human being as the main objective. Foucalt’s (2) concepts of bio-politics and biopower and badiou’s (3) notion of spectacle bodies, enslaved bodies and bodies with ideas serve as examples of this.    I will discuss some aspects that I consider significant (although strictly speaking, Zabala’s whole article is significant) from a biomedical perspective based in my professional training and from a social perspective based in my personal inclinations. I agree with Zabala’s lucid way of addressing the problem using the tension of visibility-invis-ibility. I also consider central his questioning of the persistence of the disease for more than 100 years and his critique of the simplistic approaches adopted in an attempt to explain that persistence.the multiple paradoxes accompanying Chagas disease start with the discovery of Trypanosoma cruzi, the etiological agent, and the disease caused by this parasite. due to several cir-cumstances – among them the famous “mistake of Carlos Chagas” in attempting to establish a cause-and-effect relationship between trypanosomiasis and goiter, two entities associated in time and space – this disease has always been the subject of discussion. Unfortunately, these discussions, rather than contributing to the solution of the problem, have pushed it into the background and subordinated it to irreconcilable personal posi-tions, political ups and downs, excessive “medical-ization,” among other situations that have favored such descriptions as “forgotten disease,” “silent and silenced endemic disease” or “hidden harm.” even the World Health Organization (WHO) in-cludes it among the sadly labeled “neglected dis-eases,” an adjective undoubtedly well applied to describe men and women whose “invisibility” marginalizes them (1), as stated by Zabala. Or, in the words of dr. Ramón Carrillo: “Faced with the diseases caused by misery, faced with the people’s sorrow, anguish and social misfortune, microbes, as causes of disease, are poor causes.” In the article under discussion, there is a quote from a WHO publication (4) according to which “official data” reveal that 8 million people are infected. If in Latin america just a few years ago the number of infected was estimated at 18 million people, it is difficult to understand how this last official data, “decreasing” year by year, 

Enfermedad de Chagas: un problema complejo

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Enfermedad de Chagas: un problema complejo

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Universidad Nacional de Lanús: Portal de revistas científicas de la UNLa "Arturo Peña Lillo"