The Kiss of Death

by affinal ties (masi ayllu), and by work (mitmaj ayllu). Kallawayas understand ayllu as the vertical triangular land masses divided into high, center, and low ecological zones where communities live. They also perform healing rituals to the earth shrines of the ayllu.

Aymaras — A civilization and ethnic group of Andean peoples who speak the Aymara language and live in the highlands of Chile, Bolivia, and Peru.

aynisina (ayni) — A basic Andean institution wherein peasants set up a system of compensation regarding work tasks. An ayni would be an amount of work, such as thatching a roof, that someone owes another because he or she has done the same or an equivalent task for that person.

B

barbeiro — A popular Brazilian name for vinchucas, or triatomine vectors of Chagas’ disease.

baseline study (survey) — A collection of initial epidemiological, entomological, and social data concerning incidence of disease, infestation of insects, and condition of housing that is used as a basis to determine the effectiveness of Chagas’ control projects.

Benznidazole (synonyms are R07-1051, Radanil, and Rochagan) — A drug used to treat Chagas’ disease. It is a 2-nitroimidazole derivative with antiprotozoal activity.

Bolivian agrarian reform — It marks the end of feudalism in Bolivia and began after the April 1952 revolution. It divided the haciendas, distributed land to the peasants, and abolished the tribute system. It restored to indigenous communities the lands which had been usurped from them, and it cooperated in the modernization of agriculture. After the Agrarian Reform law was signed, 90 percent of the landlords abandoned their estates and the countryside essentially belonged to the Indians.

C

campesinos (peasants) — A word used to refer to traditional Andeans and the vast majority of Aymara and Quechua farmers and herders throughout the Andes. They speak native languages and generally dress in traditional clothes.

capitalization — Influx of investment funds for capital development.

cargo system — A deeply embedded Andean political institution in which leadership is seen as a burden (cargo) to be carried voluntarily without material gain but which accrues toward becoming a complete adult (una persona muy completa) in the community. It entails a number of leadership responsibilities for each person: leading the village, taking care of fiestas, being a secretary, and, lately, being involved in community health work.

carrier (also carrier host) — One who harbors disease organisms in his body without manifesting symptoms-thus acting as a carrier or distributor of infection. Many Bolivians do not suffer from Chagas’ disease but are infected with Chagas’ disease and thus are carriers from which uninfected bugs can contract the parasite.

chagoma — A carbuncle sore or painful node covered by tight reddened skin that often, but not always, appears at the site where T. cruzi enters the skin. The most characteristic of these is Romana’s sign, which appears around the eye.

chapaco — A popular name given to people of the Department of Tarija, Bolivia.

cholos — Aymara and Quechua people who have adopted some Western ways but who continue to hold on to many Andean traditions. Many speak Spanish, and the men wear Western clothing, whereas many women continue to wear stove-pipe and derby hats and pullera (traditional skirts). In a hierarchical, class-stratified society, cholos are higher than campesinos (peasants) and lower than mestizos. The cholo class has become a dominant merchant class in Bolivia, excelling as truckers, traders, market vendors, merchants, and politicians. See campesinos and mestizos.

chronic phase (also called Tertiary Chagas’ disease, classic chronic) — A result of gradual tissue destruction, usually of the colon, esophagus, and heart. Some patients remain relatively asymptomatic until this phase when organ damage appears. Other patients who have suffered severe acute infections pass immediately into the chronic phase because of initial organ damage. The chronic phase is considered incurable, with only its symptoms being treated.

chuyma usu (“sick heart”) — A phrase used by Andeans to express heart disease, which often indicates T. cruzi infection.

colico miserere (“miserable colic”) — Refers to enlarged colon, often caused by obstruction or entangled intestines (volvulus) or denervation of intestinal tissue from T. cruzi infection.

colostomy — The opening of some portion of the colon onto the surface of the abdomen to release feces. This is performed when it is impossible for the feces to pass through the colon and out the anus due to damage caused by T. cruzi or other pathological conditions.

Community Health Workers (CHWs, promotores) — Members of an outreach program in which community members become involved in their own health delivery and elect some resident to be trained in providing primary health care. Many rural communities in Bolivia have CHWs, who play an integral part in the prevention of Chagas’ disease.

community participation — Involvement of community members in decision making involving acceptance of and compliance with certain social and behavioral changes in regard to Chagas’ disease.

concientizacion — (consciousness-raising education, CRE)A pedagogy of development that helps community members recognize the relationship of material conditions to behavioral, economic, social, and cultural factors by means of phenomenological investigation and analysis of concerns.

congenital transmission — Vertical transmission of T. cruzi from an infected mother to her infant, through the birth canal, blood, or maternal milk.

contamination — The deposit of T. cruzi in the fecal matter of triatomine bugs on the skin where the parasite enters through an abrasion or by scratching. This mode of infection is distinct from that of malaria parasites directly injected into the skin by mosquitos. Hygiene thus is an important factor when contamination is the primary route for infection.

cross-cultural communication — The ability of people from different cultures to be able to effectively express their concepts with terms that each side will understand and be able to fit into their culture.

cross-cultural community participation (CCCP) — Active involvement of technicians and community members from different cultures (such as Western biomedicine and Andean ethnomedicine) to discuss differences and be able to arrive at acceptable solutions to both.

cultural epidemiology — The study of cultural factors affecting the transmission, distribution, prevalence, and incidence of disease, which attempts to explain values, behaviors, and ethnomedical practices as they relate to the spread and curtailment of a disease. (Cultural epidemiology is a study initiated by the author, and it is the methodology employed in this book.)

culture — The sum total of artifacts, behaviors, beliefs, practices, technology, material objects, and values that societies hold and pass from one generation to the next. Cultures can be compared to “owner’s manuals” that one receives at birth from other members of the society, although cultures are dynamic and continually changing.

culture context — Configurations, patterns, or structural relationships characteristic of any culture that provide members with themes, values, and functional arrangements perceived as very important to them.

culture context model — A development model that considers culture context as the primary basis for adopting change, such as Chagas’ prevention.

culture context triangle — A model of development based on equal participation of 1) ethnomedical practitioners and community health workers, 2) community members, and 3) technical personnel within the cultural context of a community.

curandero — A generalized term used throughout Latin America to refer to traditional healers.