The Kiss of Death

based upon an epistemology of exchange: knowledge is mutually arrived at between interested parties. This is essential for Chagas’ disease, principally because of its social and cultural complexity that affords no unilineal or vertical approach.

Conclusion

The PBCM Chagas’ control project was built upon an existing health program and consequently it attacked Chagas’ prevention by focusing on the sickness.[60] Concientizacion, as practiced by PBCM, was exclusively about insect infestation and the sickness. The problem was not dealt with economically and socially: How are the people to take care of their cattle, pigs, and sheep? What can be done if someone abandons a house? What needs to be done to curtail migration? How can productivity be increased so as to lessen poverty?

When I last visited Ruth Sensano on June 13, 1997, I repeated the above criticism. She agreed with many of the points but added: “You have to begin somewhere and do something.” More than anything, development projects have to be within the reach of the people.

She looked tired and weary. I took her picture and asked her if she had any parting words. She replied: “Ama Kella (don’t be lazy), Ama Sua (don’t be a thief), Ama Lluya (don’t lie).” These are the words Mama Oqllo taught in ancient times to the women of the Incario.

CHAPTER NINE Sharing Ideas

Jose Beltran teaches children and adults about Chagas’ disease. He is a model teacher for Chagas’ prevention in the Department of Tarija and is the major educator for a number of communities that have improved over 1,350 houses by 1997. He succeeds because he communicates in culturally meaningful ways. Jose provided me with some examples:

I have good relations with the peasants because I am Tarijeno and speak their language, a dialect close to that of northern Argentina, chapaco style. Tarijenos share more and are much more open than Qollas (highland Andeans). Yesterday, for example, when I arrived late, they wanted to know why. It bothered them that they wasted time waiting for me. I always use simple language, “Poque se han hui?” “Why did you flee?” Or “Le wa sumba hu un piedrada,” “I am going to throw a stone.” Other Bolivians can’t understand Tarijenos because they speak a folk Spanish.[61]

I always use images. If I speak of parasites as something very small that you can’t see, they are not going to understand this. The microscope is putting many lenses to the eyes of your abuelita [grandmother] so as to increase the size so that she can see. Teachers are too scientific. You have to have the mentality of the peasant, which is related to earth and all organisms in it. This is the foundation upon which we must build, otherwise we will get nowhere.

The chagas parasite is like us. It looks for different places. We want places that please us, and we remain in places that we like, that give us food and where the harvest is good. So too the parasite inhabits our organs to get food, develop, and multiply. It colonizes our body (Beltran, interview 5/16/97).

Jose Beltran has been a health educator for Tarija Chagas’ projects for six years. Previously, he worked in health education for the Bolivian Ministry of Health for fifteen years. Tarija projects are noteworthy for their education about Chagas’ disease and serve as examples for other programs.[62] The Department of Tarija has the same percentage—78 percent—of houses infested with vinchucas as does Chuquisaca. Percentages of vinchucas with T. cruzi are lower in Tarija with 20 percent, compared to 23 percent in Chuquisaca (SOH/CCH 1994). Tarija has 61 percent of its people infected with Chagas’ disease, compared to 78 percent in Chuquisaca and 46 percent in Cochabamba. Tarija projects constructed 750 houses in five communities between 1992 and 1994, and 600 more in six other communities between 1994 and 1997. Chagas’ control projects were placed in the Department of Tarija for both health and political reasons. Tarija has produced two presidents in recent years, Victor Paz Estenssoro (1985-1989) and Jaime Paz Zamora (1989-1993), both of whom made great efforts to address social concerns of their people.

^{Figure 27.}

^{Chagas’ control project worker checking a guinea pig house for vinchucas. (Photograph by Joseph W. Bastien)}

Tarija’s warm and temperate climate helps explain its high incidence of Chagas’ disease. The Department of Tarija borders on Argentina to the south, Paraguay to the east, the Department of Chuquisaca to the north, and the Department of Potosi to the west. Its geography consists of lower valleys, plains, and a dry boreal forest (Gran Chaco), the scene of a disastrous war between Bolivians and Paraguayans from 1932 to 1935. The region is noted for its wheat, cattle, and grapes, which are pressed, fermented, and distilled to make wine, singani, and pisco. The climate is moderate, with altitudes of 1,000 to 3,000 feet, making it a vacation spot for tourists from within Bolivia and from neighboring countries.

Factors in the increase of Chagas’ disease in the Department of Tarija have included the increase of population within urban areas. According to the 1976 census, the total population was 187,204 inhabitants, with 72,740 people (39 percent) living in urban areas and 114,464 people (61 percent) living in rural areas. The surface area of the department is 15,052 square miles, with a population density of 12.4 people per square mile (Munoz 1977). According to the 1992 census, the total population was 290,851, with 159,841 inhabitants (55 percent) living in urban areas and 131,010 inhabitants (45 percent) living in rural areas (Censo Nacional 1992). This reflects a national trend in Boliviaa marked decrease in the percentage of inhabitants living in rural areas. Between the years of 1976 and 1992, Tarija had a population growth rate of 2.81 percent, above the Bolivian national average of 2.03 percent. This movement of population from rural to urban areas and subsequent crowding in communities has spread vinchuca bugs to the cities, causing a marked increase in Chagas’ disease.

Another factor in the spread of Chagas’ disease has been the regular migration of Tarijefios to Argentina and Chile for farm work. Decreased agricultural production and loss of land has forced many Tarijefios to look for seasonal work elsewhere. They travel in large numbers to harvest sugar cane in the Department of Santa Cruz, Bolivia. Of ethnic concern, nomadic Guarani peoples have been displaced by dams and flooding of their land. Some of them now have infection rates of 100 percent, seriously endangering the survival of the last of these hunters and gatherers.

The Department of Tarija is culturally and ethnically rich. Colonial Spanish culture similar to that of Argentina predominates in Tarija. It is referred to as chapaco and has a wealth of proverbial sayings, songs, couplets, and a distinct Spanish dialect. Cowboys and Guarani Indians roam throughout the plains and forests. Local natives consider themselves descendants of Chiriguanos, a long-extinct ethnic group associated with lowland tribes of the Department of Santa Cruz. Aymaras and Quechuas consider themselves superior to lowland peoples. Aymaras and Quechuas further distinguish Tarijenos from Cambas, although both groups are lowlanders. People from La Paz and Cochabamba find Tarijenos amusing, slow-mannered, and not terribly listo