Social and Cultural Issues

Cultural and social factors influence Chagas' disease. Chagas' disease is often considered from only a biomedical perspective, with little concern for cultural and social factors that influence behavior and values. Social behavior and cultural beliefs or values influence the way people respond to the parasitic cycle of T. cruzi. For example, Andean peasants view insects as an integral part of life and many object to insecticide campaigns as destructive to life. Their worldview reflects maintaining balance with nature. Peasants love their animals and protect them in their houses, so it is difficult to have them keep them in corrals. They believe that their ancestors are connected to abandoned buildings, so they resist removing unused buildings, even though they are infested withvinchuchas. Others believe that vinchucas are signs of fertility. Their children play with them, racing the adults and gathering their eggs.

Culture Context Model

Chagas' disease presents many culturally related concerns. Because symptoms of chagas may appear years after the initial infective bite, people rarely associate its symptoms of heart disease, volvulus, and constipation with vinchucas. Latin Americans posit the symptoms of illnesses with more immediate causes, such as improper diet or an imbalance of the hot, cold, wet, or dry. Parasitic cycles are difficult to understand for traditional people with distinct ethnomedical beliefs concerning disease and its treatment. Ethnomedicine also provides many sources for irradicating chagas. A Culture Context Model of Chagas' Control attempts to lessen the gaps in cross-cultural communication between health workers and community members. This model triangulates upward from three corners. Project personnel and technical assistance, community members and participation, and community health workers and ethnomedical practitioners form a pyramid whose apex is prevention and treatment of Chagas' disease. The parts converge toward common goals, maintaining distinct identities, and operate within a shared cultural context distinct to the community. (See Kiss of Death: Chagas Disease in the Americas, pages 143 through 145, for an explanation of this model.) The Social Costs Social costs of Chagas' disease are huge for peoples of Latin America. It is a debilitating disease that fatigues peasants, 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 cause malnourishment that leads to susceptibility to Chagas' disease. Even more costly, many adult victims die during their most productive years. (This is documented as Disease Adjusted Life Years, or DALYs.) 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 as measured by years of life lost adjusted for disability. Social stratification creates divisions in Latin America that are difficult to bridge. Chagas' disease is mistakenly considered a disease of peasants and Indians, as if T. cruzi respects class differences. Rich and middle classes do not recognize that vinchucas inhabit their houses, as easily as cockroaches invade ours. Argentineans call chagas "The Unrecognized Disease," being not only detected but considered something "others" suffer, especially poor people and peasants. Social stratification combines with racism in Latin America to influence the political economy that represents upper classes and whiter races and that neglects supporting chagas campaigns identified with lower classes (Indians and peasants). Because Latin America is targeted for investment and tourism, information about contagious diseases, such as chagas, might deter this. Other social issues Another social issue affecting chagas is the attitude of peasants that they are not in control of their destiny. Locus of control implies that an individual's general expectations about his or her ability of control the future greatly influence that individual's response to house improvement programs. 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. R. Briceño-León and S. González have dealt with the fatalistic attitudes of peasants. They found that, after they improved their houses, many people gained a sense of empowerment. Peasants need to rediscover a sense of empowerment through cousciousness-raising education. Chagas' prevention depends upon community participation. Too frequently, housing projects are purely vertically structured programs. Community participation refers to community members making decisions about, accepting, and complying with certain behavioral changes necessary to combatting chagas. Obstacles to this are superior attitudes of project supervisors and technicians towards peasants, not being able to speak the language of the community, and not including community members into planning phases. Taken from: http://www.uta.edu/chagas/html/sociSoci.html