adaptive varieties of potatoes within the Misqui region. This has offset the trend for single-crop production of russet potatoes, caused by the demand for larger potatoes to make french fries in Cochabamba.
Sociologists deal with social stratification and ways to deal with divisions between peasants, city dwellers,
Juan Jose Alva, for example, works in rural sectors of the city of Cochabamba on housing concerns and Chagas’ control. He is also a professor of sociology at the University of San Simon in Cochabamba. He teaches rural teachers and has been influential in getting them to use educational material that is adaptable to the people in these areas.
Roberto Bricefio-Leon and Silverio Gonzalez analyze economic and social conditions leading to infestation of triatomines in villages of Venezuela. They introduced locus of control theory into the SOH/CCH pilot projects in Bolivia. Locus of control implies that an individual’s general expectations about his or her ability to control the future greatly influence that individual’s response to house improvement programs (Gonzalez Tellez, interview 10/15/91). People’s notion of whether the future is controlled by themselves, the state, fate, or luck greatly influences their desire to act to prevent anything or improve houses. Gonzalez helped project personnel deal with the fatalistic attitude of peasants. He also found that, after they improved their houses, many people gained a sense of empowerment.
Economists devise ways that projects can be financed by community members. They also help to increase productivity in rural areas. Many factors in vector infestation are related to economic problems. Migration and inadequate housing are caused in part by low productivity, unemployment, debt peonage, and impoverishment. Chagas’ disease has increased because poverty in Bolivia and other countries of Latin America has increased, especially in cities.
Innovative economists are forming microcredit institutions and cooperatives to assist community members to develop free trade. As an example, Marco Antonio Prieto analyzes problems within the rural communities of Chuquisaca and devises economic measures such as microcredit and cooperatives to deal with these problems. Ronald Gutierrez, an economist for Plan International, studies how the political economy affects migration and housing development in the Department of Tarija. Plan International and Pro-Habitat provide credit for housing improvement in the barrios of Tarija. Ruth Sensano has introduced the production of tile roofing to certain communities. It serves not only to prevent
Agriculturalists study land to increase productivity, decrease depletion, and improve farming and herding. They have introduced rotational planting. Livestock suffer similar symptoms of Chagas’ disease, and its toll on sheep, cattle, goats, horses, alpacas, llamas, and guinea pigs is very great. Percentages of livestock infection are proportional to percentages of human infection wherever animals are kept near dormitories, which is almost always the case among peasants. Chagas’ disease’s toll on animal productivity is a concern that Bolivians generally haven’t even begun to consider. At the present, the major concern is that domiciliary animals attract
Linda Gregg, an expert in animal husbandry, studies goat and cattle herding among the Quechuas of Misqui, Bolivia, an area where Chagas’ disease is 70 percent endemic. She provides medical care for sick animals and has found that imported cattle brought hoof-and-mouth disease to cattle in the region. She is introducing ways to increase herds, produce healthier animals, and improve herding techniques to minimize erosion caused by goats. She also is assessing the loss of productivity in livestock as caused by
Community health workers have been trained in agriculture and animal husbandry in the Department of Oruro. They have introduced
Naturalist Jaime Zalles studies the economical uses of wild plants throughout Bolivia. He and ethnologist Manuel de Luca have published popular books on the medicinal and nutritional uses of plants. Written in the Aymara, Quechua, and Guarani languages, these books are well-illustrated and helpful guides to members of the community, CHWs, and ethnomedical practitioners. Zalles gives presentations to peasants about Chagas’ disease and informs them about native plants that can be used to treat its symptoms or as insecticides. He cultivates medicinal plants for export and is involved with scientists trying to find herbal cures for Chagas’ disease, AIDS, and cancer.
These specialists, many of whom are Bolivians, may provide innovative and unique solutions to Chagas’ disease, and many could be employed for less than the cost of one consultant from the United States. They constitute an interdisciplinary team for dealing with Chagas’ disease. Bolivians should be able to provide a more integrated interdisciplinary and culturally sensitive approach to the prevention of Chagas’ disease than could international agencies or nongovernmental organizations. However, they too must avoid Bolivia’s inherent class and race stratification. They too need to be trained in the culture context triangle. Their endeavors do bear out the premise of the culture context model: that people within a community know best how to solve their own problems once they are educated about them. The role of project workers is to meaningfully educate them.
Decreased Productivity
Economic and social costs of Chagas’ disease are huge for Bolivians and other peoples of Latin America. Chagas’ disease helps creates a downward spiral of productivity; it is a debilitating disease at all stages. At its early stages parasites sap vital nutrients and dispel toxic waste products; at its later stages diseased organs totally disable workers. Most notably, peasants suffer fatigue, especially those working at higher altitudes, where they often must stop farming their plots or leave the work to relatives and children. The inability to work results in decreased crops, which causes malnourishment that leads to increased susceptibility to Chagas’ disease.
Even more costly, many adult victims die during their most productive years. Children are left without mentors and families without breadwinners. Remaining members of the community then must assume responsibility for the survivors. For this reason, Chagas’ disease is a major obstacle to development in Latin America. The World Bank considers it the fourth most serious health problem in Latin America (after respiratory and diarrheal illnesses and HIV infection), as measured by years of life lost adjusted for disability (see Figure 31). From a cost-benefit analysis, it is cheaper to build a house for every Bolivian family than to cover the cost of Chagas’ disease to the economy from loss of production (not including the loss of animals).
Agrarian productivity also has declined in the Altiplano because of environmental and economic factors. Vast deforestation of the Altiplano caused widespread loss of other vegetation and water shortages. Insect populations shifted from wooded areas to houses. Highland peasants moved to lower, more disease-infested regions of the Alto-Beni and Santa Cruz. Bolivian peasants are having problems competing against large-scale commercial farmers. Rural Bolivia lacks electricity, secondary-education facilities, and adequate health care. These factors also have discouraged children from taking over the family farm. As a result, rural-to-urban ratios have plummeted from 74-26 percent in 1950 to 42-58 percent in 1992.
