University of California, Irvine, tested these alkaloids and found them to reduce population growth of T. cruzi epimastigote forms (Cavin, Krassner, and Rodriguez 1987). Native herbalists can be of help in identifying potentially effective drugs from natural sources. Using native lore can reduce the number of empirical tests often conducted on natural plant products. Plant products provide an alternative to toxic synthetic drugs and indicate potentially active structures for chemists interested in synthetic molecular modifications. This research, along with that of Carrasco, strongly points to the possibilities of dealing with Chagas’ disease by the use of medicinal plants.
The connection is interesting between herbalists’ treatment of Chagas’ disease through the use of castor oil as a purgative for empacho and susto and Carrasco’s concoction of the shrub’s agents into an injectable solution, Regenerator. Native herbalists have an entirely different ethnophysiology of how the symptoms of Chagas’ disease are cured by purgatives, yet it was their use of this substance for that disease that led Carrasco to further refine it for biomedical purposes. As another example, peasants chew coca leaves after eating potatoes, which they say is necessary to balance the hot with the cold. Chewing coca leaves regulates carbohydrate metabolism. It frequently happens that folk beliefs, rituals, and home remedies reveal effective treatments for Chagas’ disease. Andeans follow these native systems of medicine because at least to some degree they work. Doctors and scientists exclusively advocate biomedicine. A wiser path would appear to be to integrate ethnomedicine with biomedicine for the prevention and treatment of Chagas’ disease.
Parasiticides: Nifurtimox and Benznidazole
Andean traditional medicine provides treatments for Chagas’ disease as well as insecticides that may even be better than the present products produced by pharmaceutical and chemical companies. Western biomedicine does not have an effective cure for chronic Chagas’ disease. Presently, the two prescription drugs used for treating Chagas’ disease are nifurtimox (produced by Bayer, recently discontinued) and benznidazole (Roche), used for acute and chronic phases (see Appendix 13). Bolivians find both costly, unsatisfactory, and painful, and many prefer to go to native herbalists for cures. Neither drug is available in the United States, except through special permission from the Centers for Disease Control in Atlanta. No drug is registered for use to help prevent Chagas’ disease.
Nifurtimox and benznidazole are used in short-term cases, but their efficacy varies in different geographical areas, probably as a consequence of variation of parasitic strains. Many patients object to taking large doses of these drugs over a long period of time (as long as one year).[13] Patients can also suffer serious side effects, including anorexia, vomiting, skin allergies, and various neurological disorders, which may be a consequence of damage to their tissues (Urbina et al. 1996). Bolivians also realize that the pharmaceutical cure is only temporary if they live in chagasic areas, as it is likely they will be reinfected with T. cruzi. One advantage of actually harboring T. cruzi is that it provides partial immunity from suffering another acute attack.
The complexity of Chagas’ disease has been addressed by Andean culture in a number of ways. Andeans deal with the symptoms of Chagas’ disease through rituals, community concern, and herbal medicines. Yachajs and yatiris have combined forces with doctors to combat or adapt to T. cruzi. They appear to have dealt with Chagas’ disease as adequately as has biomedicine. Even if this is not so, its possibility necessitates much closer examination of ethnomedical systems for solutions to endemic diseases throughout the world. Andean rituals also provide a great service to medical science by indicating the interrelatedness of Chagas’ disease to the environment, showing how the human body is related to the earth and its organisms in reciprocal ways.
CHAPTER FOUR
The Crawling Epidemic: Epidemiology
One of my first encounters with kissing bugs, vinchucas, was in the airport in Cochabamba, Bolivia, where I went to meet Benjamin Menesis, who had arrived from Sucre and was carrying a suitcase with over 1,000 specimens of the insect. Menesis was a technician for the Proyecto Britanico Cardenal Maurer (PBCM), which was conducting a vinchuca-eradication program in the Department of Chuquisaca, Bolivia. An important part of this program at the University in Cochabamba was to determine the rate that vinchuca bugs became infected.
Staff had collected vinchucas from houses in Chuquisaca with flypaper and by means of a contest among schoolchildren to see who could bring the most vinchucas to school. Pupils thus realized how infested their homes were and received a lesson on Chagas’ disease. The director of PBCM, Ruth Sensano, stored the vinchucas in an ice chest. They became active in the dark box, being nocturnal creatures, and began a scratching sound clearly audible to anyone within twenty feet. When the box was opened and a lit flashlight placed inside, the vinchucas quieted down due to their photosensitive nature.
Menesis hand-carried the freezer box onto the airplane in Sucre, refusing to put it in the hold where the cold might kill the vinchucas. He carried a radio to drown out chirping in flight with some loud music. Airport surveillance questioned Menesis about the chest, and he told them that he was carrying medical samples. Ruth Sensano convinced the inspector that Menesis needed to get the contents of the box to Cochabamba as quickly as possible for medical reasons. Menesis arrived without mishap in Cochabamba an hour later, and we joked about what could have happened if the box had come open inside the airplane and 1,000 vinchucaswere released, with over half of them carrying T. cruzi.
The vinchuca species most largely responsible for chagasic transmission in Bolivia is Triatoma infestans, which is relatively non-aggressive and whose bite is more annoying than it is painful. Consequently, Bolivians do not refer to the insects as “assassin bugs,” as they are called in the U.S., but as “vinchucas,” from the Quechua word huinchicuy, which means something that falls rapidly, because they glide down from the rafters, and as “kissing bugs,” because they prefer to suck blood from the faceoften from the lips and from near the eyes. Although Triatoma infestans has thus avoided the name “assassin bug” for the more benign name “kissing bug,” there is the subtle irony that the “kiss” of the bug can lead to death.
Epidemiology of Chagas’ Disease in Bolivia
In Bolivia, estimates are that one in five (1.5 million people) of the total population (7.3 million) have Chagas’ disease, and that half the population live in endemic areas of the disease (SOH/CCH 1994; see Figure 13). An earlier epidemiological survey of Chagas’ disease was carried out in 1978 in Pongo, a village situated eleven miles from Santa Cruz, capital of the tropical oriental plains (De Muynck et al. 1978). Researchers examined the infection rate of houses by triatomines; the infection rate of the triatomines by T. cruzi; the infection rate of human, canine, and feline populations; cardiac and digestive morbidity; and the construction of houses. Some 26 percent of the houses were infested with T. infestans, 53 percent of the humans were found infected with T. cruzi; and 23 percent of the dogs and 7 percent of the cats were also infected. Some 7 percent of those older than five years showed electrocardiogram signs compatible with chagasic myocardiopathy, and 2 percent had an elevated risk for
