The Kiss of Death

revenues through the municipalities for improving roads, schools, and houses. Proyecto Cardenal Maurer in Sucre is using municipal monies to improve houses to help control Chagas’ disease. Peasants also participate in a national health plan that favors women and children and maternal health care, which indirectly helps restrict Chagas’ disease. One of Bolivia’s leading anthropologists, Xavier Albo, sees this as giving the peasantry more political involvement. Because global integration into world markets is a necessary economic trend in Bolivia, traditional Andeans are becoming involved in the political process of the nation.

On the negative side, however, another leading Bolivian anthropologist, Pablo Regalsky, represents Indian federations that violently oppose this new legislation as leading to the demise of autonomous Andean leadership centered in the community (Andean village) as opposed to the municipality (Bolivian village). Municipalities have replaced communities as political nuclei, and vecinos (mestizos) assume leadership roles over the peasants. Even if peasants get elected to power in the municipalities, critics believe it will only be after they are corrupted by the political parties.

These changes have had a less than positive effect on Chagas’ disease. Peasants have lost large tracts of land to private corporations, for which they often work as migrant workers. In Misqui, Bolivia, for example, a large industrial dairy farm owned by investors has displaced fifty Quechua families who had previously held the land in common and through privatization laws were able to sell it to capital investors. Western property rights emphasize the rights of individuals, whereas Andean property rights emphasize ideas of commonality, exchange, and ecology. Whereas peasants traditionally held land in common and the community had a sense of social solidarity, emphasis now is placed on the individual, with few or no ties to the community. Individuals tend to think less of their commitment to the community than they did under Andean traditional patterns of work exchange, reciprocity, and shared land.

For example, if someone leaves the community to migrate elsewhere and leaves his house in disrepair, it will remain unattended and become a source of infestation for others in the community who have repaired their houses. It becomes more difficult to get community involvement in projects. Another concern is that peasants are rapidly becoming jornaleros (wage workers) for landowners after they sell or lose their land. This drastically changes the cultural constructs of how they perceive their homes and land, as discussed above. Finally, because of increased poverty, considerable numbers of peasants now work as migrant workers in Argentina, Chile, and Brazil. These and many other factors moved the Bolivian people to elect a new group of political leaders in 1997.

Suggestions

Endemic Chagas’ disease in Bolivia is a symptom of its unpaid “social debt.” Since 1985, Bolivians have paid more than $3 billion in debt repayment to institutions and international banks; but money must be reinvested in the environment and people of Bolivia. This must be done, if not for social justice, at least for economic survival, environmental protection, and disease prevention in Bolivia. Bolivia also must have equality of educational opportunity for all its people in order to compete in a global economy. A free market requires a radical educational reform which includes indigenous people and women in both rural and urban districts. Teachers to train other teachers are needed. The economic systems of Andeans need to be incorporated into free-market strategies. Andean communities can utilize their communal structure and economic exchange patterns to form strongly competitive cooperatives, which should be broad based to include credit and housing plans, consumer goods, and production goods.

There also is a need to change certain attitudes. The free market has brought new wealth to certain Bolivians, but this emerging middle class is driven by a consumerism that models itself after the few who are much richer and have no sense of nation building. They dissipate their wealth on such things as luxury homes and cars, investing the surplus in the United States. Bolivia’s wealthy never have believed in themselves or in their own country. The poor of Bolivia have a “solidarity of suspicion” about world economic integration, both in theory and practice. Finally, a national policy is needed to combat Chagas’ disease, because it debilitates members of the work force when they are most productive, leaves children without parental upbringing, and is costly to treat.

However, the political economy alone cannot be blamed for all unhealthy aspects of Bolivian housing. Chagasic control projects need to include the cultural economy of housing with the political economy, which will be the subject of subsequent chapters.

CHAPTER EIGHT Pachamama Snatched Her: Getting Involved

Chagas’ disease became a major concern for Ruth Sensano in 1989. She is director of Proyecto Britanico Cardenal Maurer (PBCM),[44] which sponsors Chagas’ control projects in the Department of Chuquisaca. PBCM improved 452 houses between 1987 and 1991, another 400 in 1992, and by 1997 it had improved 2,600 houses. [45] PBCM improved the first 452 houses with a budget of U.S. $83,256, out of which the community contributed almost half, or $37,642. By the year 2005, Sensano predicts, she will have improved another 2,500 houses, counting on assistance from tax revenues given to the municipalities for regional improvement, as discussed in the previous chapter.

A native of Sucre and a mestiza, Ruth Sensano learned to be a project director. She controls the accounting process carefully so that there isn’t any graft. Bolivians have a phrase in Aymara that translates roughly, “Sucking from above and sucking from below”; it refers to the mid-level Bolivian project personnel who steal from those above (foreign bosses) and from those below (peasants). Because of the great amount of graft in Bolivia, project directors need to scrutinize expenditures at every level.

Sensano is as shrewd as any native chola market woman and as accurate as an accountant: both skills enable her to deal with the bureaucratic economic systems of project supporters and the informal, dynamic economic systems of peasants. She was lured from a profitable accounting job in 1976 by Cardinal Maurer, a German immigrant and Bolivia’s first Roman Catholic cardinal, to extend health care to peasants within the Department of Chuquisaca. Since then, Sensano has established a medical program that serves 54,500 people in 168 communities in three zones of Yotala, Yamparaez, and Tarabuco. She accomplished in fifteen years what the Bolivian Secretary of Health with triple the personnel and budget was unable to do in thirty years.

When I met Sensano one June morning in 1991 in Sucre, Bolivia, she told me why she became involved: “About twenty months ago, we started the Chagas’ disease program. We found that campesinos came in with bulbulos, hardened and impacted intestines, and they couldn’t go to the bathroom. They say that they eat cold food, their intestines fill, harden, and they can’t defecate. This was caused by Chagas’ disease.” She also showed me a picture of a peasant with bulbulos who hadn’t defecated for months (see Figure 9).

^{Figure 21.}

^{Ruth Sensano is director of Chagas control in the Department of Chuquisaca, Bolivia. She has been a leader in the eradication of this disease, and her program is a model for other projects throughout Bolivia. (Photograph by Joseph W. Bastien)}

“We realized,” Sensano continued, “that in many communities people were sick with Chagas’ disease. The people are accustomed to vinchucasin their beds, thirty to forty in their beds. They are used to the bites. They say, ’All night we are taking off their heads and destroying them. We have to sleep outside the huts to escape them. Sometimes we don’t sleep all night because we have to kill vinchucas.’ When vinchucas bite, they scratch it.