With the start of a new week came the start of a new rotation. Week 7 of my rotations focused on public health and the diagnostics of chagas. I worked with Dr. Edith, who works for S.E.D.E.S, which is an acronym for the public health department here.
On the first day of rotations, Dr. Edith, a couple other CFHI interns, and I went to a local elementary school to teach the parents about chagas. Surprisingly, the room was filled with parents to the point that there were no empty seats and parents were standing in the back. We gave a powerpoint presentation and handed out brochures that contained information about chagas infection, treatment, and prevention. I noticed that most of the parents were very interested in the presentation and learning about chagas. They even asked some very good questions. However, one aspect that I found to be slightly ineffective was the brochures that we handed out to the parents because some of them couldn’t read. However, thankfully, the brochures had pictures on them to help explain some of the concepts that we were trying to get across. At the end of the presentation, Dr. Edith explained to the parents that in the next following weeks we would be returning and giving free rapid chagas test. Of course, several of the parents were very concerned about the process since we would need to obtain a small blood sample. One parent even stressed concerned that he didn’t want any medical students, interns, or unqualified people performing the test on his child. Dr. Edith handled the situation gracefully and went through the process of rapid chagas testing. The test is really simple and is a qualitative test for the detection of antibodies to Trypanosoma cruzi, which is the causing parasite. First, the doctor uses a small “pincher” to poke the child’s finger in order to cause bleeding. The doctor then uses a plastic pipette to suck up some of the patient’s blood and places the blood in a sample well. A diluent is then added to the well. The results of the test are read within 15 minutes after the diluent is added. If one pink line appears in the “control” area and no line in the test area then that is a negative result. However, if there is a line in the “control” area and also one in the “test” area then the person is “suspected” of having chagas. We use the term “suspected of having chagas” because it isn’t 100% sure that the kid has chagas. In order to confirm 100% that the kid has chagas, a sample of the child’s blood is taken to the chagas lab at Hospital San Juan de Dios and is analyzed. After Dr. Edith’s explanation, many of the parents seemed more at ease.
For the other days in the week, my internship consisted of traveling to different schools and giving the rapid chagas test. One of the schools we visited was Escuela Seccional, which is in Chaupicancha. Chaupicancha is located very far in the countryside, and it took us about 1.5 hours just to get there. Not only at Escuela Seccional did we test the kids for chagas but there was also a doctor on our team that held consults and people from the community visited him. For the remainder of the week, we tested kids at a kinder called PanAmericano.
At the schools, my job basically consisted of prepping/setting up the stuff for the test, running the rapid tests after the doctor had obtained the blood sample, and filling out a portion of the paperwork.
Overall, I really enjoyed this rotation because it is an area of public health that I am interested in pursuing one day. Out of the 167 kids that we tested, only 16 were “suspects” of chagas. In Bolivia, the prevalence rate of chagas in those less than 15 yrs old is 5.5%. Overall prevalence (including adults) is about 70%. What I really liked about this rotation was the fact that this diagnostic program actually went to the people instead of having the people come to them. For example, I know for a fact that if we had not gone to Chaupicancha there would have been no way to test the kids because Chaupicancha is really far away from the center of Tarija and most families that live in the countryside do not own vehicles. In addition, although Bolivia is the poorest country in South America, the Bolivian government seems to be investing what little money they have in trying to keep Bolivian children healthy. In my opinion, I believe that when it comes to an infectious disease such as chagas, prevention and early detection in children is key because if we can prevent and treat a problem now then in the long run there is the possibility of a healthier country with the potential of increasing the country’s productivity and development and also lowering long-term healthcare costs.
In addition to the rotation this week, I was also able to spend some time in the vinchuca lab. Vinchuca’s are the insects that act as vectors and transmit the parasite. At first, I was a little freaked out by the lab because I don’t like bugs (even if they are in glass containers), and in this lab I was surrounded by them. Julio, who is the man that runs the lab, gave me a tour of the lab. He also showed me the bugs that resemble vinchucas and how to differentiate the look-alikes from the real thing. In addition, he showed me how to test a vinchuca for epimastigotes (the Trypanosoma cruzi morphological stage found in the vinchuca)
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