Friday 05 December 2008, San José, Costa
Rica
HEALTH-LATIN AMERICA:
Women Crusaders Against
Epidemics
By Diego Cevallos
MÉRIDA, Mexico (IPS)
- With cutting-edge
science, social
organisation and a
strategy that puts an
emphasis on prevention
and environmental
controls, Cristina Díaz
and her team checked the
spread of dengue in
Cuba, while María Monroy
did the same with Chagas’
disease in Guatemala.
Díaz has a doctorate in
biochemistry and won
Cuba’s National Science
Award in January, and
Monroy has a PhD in
medical entomology and
won the National Science
Award from Guatemala in
2004.
The Cuban researcher is
fighting a disease that
affected 866,000 people
in Latin America and the
Caribbean between
January and October
alone, while the
Guatemalan scientist is
working to curb a
disease that has
infected more than 10
million in the region.
The achievements of Díaz
and Monroy, and of
several other women
involved in the field of
"ecohealth," were
celebrated during the
Dec. 1-5 International
Ecohealth Forum 2008,
which drew some 600
academics, scientists,
government experts and
activists from dozens of
countries around the
world to Mérida, on
Mexico’s southeastern
Yucatan peninsula, to
discuss the relationship
between health and the
environment.
In separate interviews
with IPS, Díaz and
Monroy both pointed out
that climate change,
which is modifying
temperatures and
seasonal cycles, and the
destruction of
ecosystems, are
increasing the spread of
the two diseases, which
are transmitted by
insect bites.
DENGUE DROPS TO ZERO
"This year, we have not
had any cases of dengue
in Cuba, we have it
under control. If there
are cases, they are all
imported (by carriers of
the disease visiting
from other countries),"
the Cuban researcher
said with obvious pride.
Díaz attributed that
success to the
"multidisciplinary
approach" that she said
was followed in her
country, where cases of
dengue fever were
counted in the thousands
in the not-so-distant
past.
In fact, it was in Cuba
that the first epidemic
of the potentially
deadly dengue
hemorrhagic fever
occurred in the
Americas, in 1981, with
more than 10,000 cases.
The health sector pays
the costs of dengue
fever, but the causes of
the problem are found in
the environment, said
the expert.
Díaz and her team at the
Pedro Kouri Institute of
Tropical Medicine in
Havana convinced the
authorities that it was
necessary to incorporate
environmental controls
and wide social
participation in the
fight against dengue.
As a result, starting in
2002, areas that served
as mosquito breeding
grounds were identified,
and the authorities,
along with local
residents, got to work.
The dengue virus is
carried by the Aedes
aegypti mosquito, which
transmits the disease by
biting an infected
person and then biting
someone else.
Although there is
neither a cure nor a
vaccine for the disease,
the symptoms generally
abate if the patient
follows a regime of
complete rest, continued
hydration -- intravenous
in severe cases -- and
treatment with
acetaminophen. But
complete recovery can
take up to a month.
Symptoms include a high
fever, rash, severe
headache, pain behind
the eyes, muscle and
joint pain, loss of
appetite, nausea and
vomiting. Most
infections result in
relatively mild illness,
but some cases progress
to dengue hemorrhagic
fever, which can be
fatal.
Prevention efforts
involve making sure that
water does not
accumulate in
containers, like
discarded tires, flower
pots or old oil drums in
shady areas close to
human dwellings in urban
areas, where the
mosquitoes thrive
because they prefer to
lay their eggs in clean
water.
According to the
Pan-American Health
Organisation (PAHO),
nearly 866,000 people in
the region were infected
by dengue fever this
year as of late October,
and 238 patients died.
The countries of South
America, with Brazil at
the head, were hit
hardest.
"If the vector appears,
it means we have an
environmental problem,
which has to be
attacked," said Díaz.
The multi-disciplinary
approach goes beyond the
spraying of affected
zones, which is not
effective on its own,
said the researcher.
FEWER FORESTS, MORE
CHAGAS’
"Three weeks ago,
Guatemala became the
first country in Central
America to be declared
free of Chagas’ disease
transmission by the WHO
(World Health
Organisation)," said
Monroy, the founder of
the laboratory of
entomology and
parasitology at the
University of San Carlos
School of Science and
Pharmacy in Guatemala.
The Swiss-educated
scientist said that a
decade ago, hundreds of
cases of Chagas’ disease
were reported annually
in her country. But this
year, after several
years of work with local
communities, "we have
controlled the problem,
using a holistic
approach," she said.
There is no cure or
vaccine for the often
deadly Chagas' disease,
and in most cases only
treatment of symptoms is
possible.
The disease is caused by
the bite of the reduviid
bug, which lives in
crevices and gaps in
poor rural housing --
like thatch, mud or
adobe huts -- in a
number of Latin American
countries.
The bug transmits a
protozoan parasite named
Trypanosoma cruzi
through its faeces,
which human victims
unwittingly rub into the
bite wound left by the
bug, or into their eyes,
mouth or nose. The
parasites thus enter the
victim's bloodstream and
gradually invade organs
of the body, often
causing severe damage to
the heart, digestive
tract or nervous system.
The disease has three
stages: acute infection,
in which symptoms occur
soon after infection; an
asymptomatic phase,
which can last months or
years; and chronic
infection.
In the first stage,
which only a small
minority of patients
suffer, symptoms include
swelling of the eye on
one side of the face,
exhaustion, fever,
enlarged liver or
spleen, swollen lymph
glands, a rash, loss of
appetite, diarrhea and
vomiting.
Symptoms in the chronic
stage can appear years
or even decades after
infection. Health
problems include
serious, irreversible
damage to the heart or
intestinal tract.
Monroy said that most
reduviid bugs live in
the forests, and that
"when we cut down the
forests, the bugs have
to go somewhere, and we
provide them with ideal
conditions. What
temperature does the bug
like?...23 degrees
Celsius, the same
temperature I prefer, so
they come to our homes
where it is warm,
slightly damp, and
dark," she said.
"We provide the
conditions that make
Chagas’ disease a public
health problem," said
the scientific
researcher.
Monroy works with health
authorities in Guatemala
to combat the spread of
the disease, with the
direct participation of
affected communities.
Local communities are
taught about the disease
and its characteristics,
and with that
information, they adapt
their homes to keep the
reduviid bug out and to
live in harmony with the
environment, she said.
Only an "integrated
approach that leaves
aside spraying as the
sole method for fighting
the disease" is
effective, said the
scientist.
PAHO reports that the
socioeconomic impact of
Chagas’ disease in Latin
America is extremely
high, ranking it behind
respiratory infections,
diarrhea and HIV/AIDS.
"In Guatemala we have
curbed the disease; we
no longer have a
significant number of
cases, thanks to the
integral approach. If
this strategy is applied
in the rest of the
countries, the battle
will be won," said
Monroy.
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