[32] Sufferers regurgitate food and water into the bronchial tubes and lungs, either choking or becoming further infected with respiratory diseases. Again, this is particularly deadly in high-altitude regions, which have markedly lower oxygen levels and a higher prevalence of respiratory pathogens.
Many Bolivians adapt to chagasic esophageal problems by consuming liquids whenever they are able to do so. Herbalists recommend teas from coca leaves to relax the throat and relieve the soreness. Peasants frequently chew coca leaves to achieve the same effects. Coca leaves have fourteen alkaloids, some of which are activated only through hydrolysisthat is, released by saliva or water (Bastien 1987a:57; Martin 1970:422; Duke, Aulik, and Plowman 1975). Bolivian doctors generally recommend bland semi-solid foods, especially cooked Andean cereals of quinua and caniwa, warmed to body temperature so that the esophagus will drain by force of gravity; but this is often ineffective. The solution has been to surgically cut the esophageal muscle. Doctors in Sucre performed about twenty such operations in eleven years; but this figure doesn’t indicate the actual number of achalasia patients who are unable to afford an operation, fear such procedures, or remain unaware of the option. Doctors at the Gastro-Intestinal Hospital in Sucre use the Heller technique modified by Pinotti. Originally, Heller cut the restricted area, but this did not produce effective results. Pinotti modified the procedure by only removing a narrow strip of muscle lengthwise along the constricted region. The resulting outcome of these operations has been satisfactory (Mendez Acufia, interview 6/24/91).
Bolivians rarely attribute difficulty swallowing to infection of T. cruzi. They explain choking and regurgitating as emotional states caused by disproportion of the certain humors or to the fact that they have not balanced their meals with wet and dry substances. This results in inadequate proportions of phlegm to aid in swallowing. They also relate certain emotions to these humors; so that, for example, someone with excessive bile is said to be angry and consequently has insufficient phlegm to swallow. As another explanation, they see the accumulation of fluids as a malfunctioning of the tubes relating to distillation processes of the body that work in centripetal and centrifugal motions.
Juana’s history demonstrates both the hubris and humility that can be associated with Chagas’ disease and other diseases that at first appear so clinically self-evident to scientists. When serious scholars begin to examine disease pathogens, they often discover that the world of microbiology can be immersed in environmental, social, and cultural systems. For years Andeans have suffered from colico miserere and volvulo, which they have understood according to their ethnophysiology. When modern science explains this away in terms of bugs and parasites, there often persists continued adherence to what they have believed. A crucial insight can be gained when colico miserere is seen not only as an entity with a cause but as a sign or symbol of some disequilibrium, imbalance, social infraction, or spiritual chaos. This sign is written upon the human body in painful and contorted ways. To remove part of a bodily tube or insert another orifice while detaching another can be seen to sacrilegiously deform a body that is imaged after the land, with fluids entering, concentrating, and dispersing. The hubris of the scientists who imagine that their uncovering of clinical facts will save people from disease is often turned to humility. And Juana, recognizing that she, her sister, and her mother had been bitten by infected vinchucas, still reverted to folk beliefs surrounding colico miserere. She recognizes, as do most other Andean peasants, that biomedical science is only as valuable as its capacity to eradicate disease and heal the sick; within her family, it is not a social and economic reality.
On the side of doctors and biomedical science, there is no clear agreement either-certain doctors are hesitant to accept that the high incidence of gastrointestinal problems in some communities is related to chagasic colonopathy; other doctors contend that T. cruzi is the exclusive cause of volvulus in other communities. Scientists are slow to believe that Chagas’ disease exists in higher altitudes, such as the Altiplano, where it is too cold for vinchucas, so they attribute gastrointestinal symptoms to other factors. Yet, evidence shows that Chagas’ disease is found in higher regions, and its present spread includes many new regions. The rule should be that when some of the above symptoms appear in Bolivia, a largely endemic zone of the disease, patients should be tested for Chagas’ disease.
CHAPTER SIX
Bertha: Mal de Corazon
Bertha (a pseudonym) is a resident of La Paz, Bolivia, who suffers chronic heart ailments from Chagas’ disease. Bertha’s medical history provides insights into the natural history of Chagas’ disease. As a child in the 1930s, Bertha was bitten by vinchuca bugs and infected with Trypanosoma cruzi in Tupiza, a small rural village in Bolivia. Later, as a mother with four daughters, she moved to La Paz after being abandoned by her husband. She made a meager living sewing for wealthy people. Late in 1974 she suffered heart disease and was diagnosed with Chagas’ disease. Presently, at age sixty-one, Bertha still sews dresses but also receives additional income from her married daughters.
Bertha is a small slender lady with sparkling dark brown eyes. She speaks Spanish, dresses in western- style clothes, and is of the mestizo class, in contrast to the cholo class, those who maintain Aymara and Quechua identity. Bertha narrated the following account to Dr. Pedro Jauregui, her personal physician, on July 22, 1991, illustrating the effects of chronic Chagas’ disease.
I was raised in a community of Tupiza, a valley of Potosi. We always traveled to the country. In the village the vinchucas entered the houses. I didn’t know anything about them when I was a child. Vinchucas were an inch long with wings, some were brown, brown-black, and they usually bit us. They laid their eggs, and we played with their eggs. At night without electricity we could feel them, we would pull off their heads. This was the way to kill them.
At other times I awoke with eyes swollen, then I put a little tea water and some leaves over the swelling. It was not a large swelling.
We didn’t have fear of them. As a child, I played with them, putting their eggs in a basket as if they were chicken eggs. I didn’t know that this bug was dangerous. We had sheep, chickens, and corrals where vinchucas would dig their nests. Another insect was chinchina. There were both types of insects because we lived in the valley. My father was an administrator in a mine so he traveled frequently. I think that vinchucas (barbeiros) inhabited most of the houses.
I left Tupisa when I was twenty years old and moved to La Paz. And until the age of forty-four I was a healthy person, going up and down the hills. I had no idea that I was sick with Chagas’ disease until 1974 when I felt fatigue, although before [that time] I had some allergies when I ate lentils. I began to get a swollen throat and spit blood. I didn’t know what it was. I didn’t feel anything for forty years. I didn’t have any idea that this was caused by vinchucas. I would get tired, fatigued, and experienced dizziness and many fainting [spells] around 1974. I was without a husband and when I knit alone, I experienced fainting. My daughter who slept at my feet felt that I was trying to kick her. This fainting continued for a year, and the next year I had more severe fainting, and the next year I was found laying in my room with another stroke after I had arose to get a drink of water.
After my children found me, they insisted that I see a doctor. Dr. Jauregui hospitalized me. He felt my pulse which was very low. He suspected Chagas’ disease and had me undergo a test [xenodiagnosis] where they determined it was Chagas’ disease with the same bites of [uninfected] vinchucas. I could feel the bites, and after they itched and burned a bit.
Only then did I learn about Chagas’ disease that was caused by vinchucas. I
