The Kiss of Death

hundreds of them, tiny white beads inside walls, mattresses, and clothing. The earth and straw of their houses were filled with vinchucas. Inside their straw roofs we showed them nests of sleeping vinchucas.

We showed them the damage vinchucas do. We made them afraid. If you don’t scare the campesino, he won’t do any work. We also showed them the parasites with microscopes and pictures of people with intestines stretched out. We made them hear the irregular heart beats of chagasic patients, 1231234121234, with a stethoscope. We showed them radiographs of a normal heart and some of a chagasic heart. We had a video made and showed them that. We told them that they have a responsibility to take care of their children and that it is their responsibility if children suffer from Chagas’ disease. Fathers and mothers cannot permit that their children die from vinchucas, it is just as necessary to get rid of vinchucas as it is to have their children learn to read and write. After educating and motivating them, they agreed to fix their houses (Sensano interview 6/17/91).

Concientizacion was used by Sensano to frighten people and instill in them a hate of vinchucas. Peasants now had another object to fear; a bug they once thought was a sign of fertility was now seen as a harbinger of death. Bolivians realized the connection between vinchucas and some people with chronic heart disease, but life expectancy is not a major concern for peasants subsisting from day to day. Making peasants aware of disease-causing agents often is not enough to motivate them to do something. Disease and death are accepted facts of peasants’ lives; they have become long accustomed to the unhealthy environments of mines and factories and being subjected to revolutions, reprisals, and military repressions.

^{Figure 23.}

^{Education of children about housing hygiene is important to prevent Chagas’ disease. Traditionally children regard vinchucas as “toys” to play with.}

Preventative health measures modify behavior to the degree that these measures produce some immediate and desirable effects. With Chagas’ disease, once community members realized how nice their houses would be if they did not suffer from insect bites there and that they thus would have increased prestige, they were motivated to improve their houses. When I brought up the objection that peasants might revert to unhygienic conditions after the house was built, Sensano replied that this was not the case, because the women take pride in their new homes. They sweep them and put things away every day. Prestige is more motivational than is either injustice or economics.

Children and Women

The education of schoolchildren about disease is important because children and adolescents constitute half of Bolivia’s increasing population, with a growth rate of 2.7 percent a year. Children share knowledge with their parents. Sometimes parents resist children advising them, but studies by Fryer (1991) show that even though many parents showed initial resistance, they eventually began asking children about their lessons and learned with them. When fathers migrate to work and mothers tend the fields, older children often are left to take care of the smaller children and the households.

An important factor for Chagas’ disease lessons for children is making them applicable to household tasks (housing hygiene) and assisting children in educating their parents, such as assigning shared tasks for children and parents while calming parents’ fears about their own inferiority in the face of their children’s knowledge.

In Chuquisaca and elsewhere in Bolivia, inequality of women is increasing. Because of its social and cultural complexity, the division of labor among women, men, and children needs to be studied by anthropologists and sociologists so that education about housing improvement and maintenance and vector control can be carried out more effectively.

Andean women have always worked alongside men; but, because men have migrated to find work, women have had to assume men’s traditional roles. Women often have become the sole agriculturalists, child raisers, and housekeepers of families. Some mothers work the fields carrying their babies; urban mothers take babies to their market stalls, where they are kept in cardboard boxes, being called “cardboard box babies.” Vinchucas can take advantage of these babies. Toddlers remain at home, being cared for by slightly older siblings, usually girls. Thus, girls especially can spend less time at school. Peasant girls average four to six years of education, boys six to eight years.

Gender inequality also influences Chagas’ disease, in that there is greater malnourishment among girls than among boys, because Aymara girls often receive less food than boys. This makes girls more susceptible to acute attacks of the disease than boys. Also disadvantaged with less schooling and less Spanish instruction, girls learn less about Chagas’ disease.

One lesson observed from PBCM’s educational approach is that more efforts need to be made to educate women about Chagas’ disease and to address their increased responsibilities. This matter also needs to be discussed in group sessions with all community members.

House Improvement Committees

House Improvement Committees (HICs) were the functional units where plans and priorities for housing improvements were decided and where all participatory activities were coordinated. HICs consisted of a president and secretary who were responsible for organizing work groups of five to six villagers. HICs coordinated tasks with members of the community. These groups were assigned different tasks and were supervised by a master craftsman who taught members basic carpentry, about laying building foundations, tile making, and plastering. Local materials and personnel were used whenever possible. HICs and craftsmen supervised and coordinated the repair and/or construction of houses. They worked between the months of May and September, when agricultural work is least demanding and community members are most available. However, fiestas, popular during this time, delayed work for weeks at a time. Because of their success in Chuquisaca, HICs were adopted and modified as functional village units for other pilot projects in the departments of Cochabamba and Tarija (Ault et al. 1992:42, SOH/CCH 1994).[52]

Villagers worked to compensate for roughly half the cost of a house improvement ($75.00 per house) and provided supplies worth $18.75; and PBCM contributed supplies, fumigation, education, and supervision to the amount of $114.00. Each improved house cost $208.00, with villagers providing 45 percent and the project the remaining 55 percent.[53] Not counting free labor, the project improved a house for $114.00 and its total budget was $45,614 for 400 houses.[54]

As an evaluation, HIC failed to adapt to Andean labor and economic practices. Earlier, certain economic exchange principles of Andeans were discussed, such as ayni (labor debt), mita (community debt), and turqasina (resource debt) that can be used to facilitate housing improvement. Ayni and turqasina constitute a complicated system of exchange relationships that are socially embedded within familial and community relationships. Aynis are inherited and are considered more valuable than money, especially during harvest times and periods of hyperinflation. Thus, for example, if a roofer’s family was deeply indebted to other commoners who had taken care of his or her harvest, then the roofer got a chance to return the work obligation by doing roofing for the project. Although ayni implies exchanging like-work, HIC has been able to negotiate with both parties alternative work assignments. The president and secretary of the committee literally keep the books concerning ayni and employ it to accomplish necessary work.

Pilot project models need to fit the projects into the political and economic systems of the community in order to become replicated models. It is perhaps a misnomer to refer to them as pilot projects; a more