"Sir?" "Sir?" "Good day." "Is there a gas station around here?" "Ah, thank you." "There he is!" "No, no... are you sure?" "No, it's not him." "It looks like him, but it isn't." "This is not the right street either, mom." "There they are!" "They are waving!" "Hello!" "Sorry we are late, but we got lost." "Yes?" "Yes." "We've been everywhere." "Hello, how are you?" "Palpitations or chest pain?" "A little." "A little." "OK." "Hello, how are you?" "Please come in." "Please sit down;" "here is a chair." "I will sit next to Osvaldo." "OK." "What happened after you found out that you had Chagas?" "Did you go to see a doctor?" "And what did he tell you?" "I went to see a doctor." "And he told me that there was no medicine for Chagas." "Not to get well, because they told me up front... there is no cure." "Did you have any discomfort as a result of Chagas?" "Sometimes I feel like..." "it gives me... in the heart." "I have to sleep with the windows open, always." "But here I had the test done again, and I still have the Chagas disease." "Did he eat well today?" "No." "Did he take his milk?" "Yes." "Well, put him here." "Hey, look at your mom." "He has conjunctivitis." "Is his eyelid stuck?" "Yes." "He wakes up with his eye closed?" "Yes." "Do we have colirium?" "Take a look." "Do you hear him coughing at night?" "Yes." "Does he cough a lot at night?" "Yes." "We don't have colirium." "There is no colirium?" "No." "The Chagas disease here is mainly a vector problem." "The "vinchuca" insect which has in its intestine... the Trypanosoma cruzi... bites people... and then defecates." "The Trypanosoma parasite is in the feces." "The bite causes itchiness." "People begin to scratch themselves." "And through the lesion the Trypanosoma enters the body... through the feces of... the vinchuca." "Sometimes during sleep children and adults scratch their eyes... and carry in their fingers the feces with the Trypanosoma... and so introduce the parasite through the mucus into the blood." "Once the Trypanosoma cruzi is in the blood two things can happen... the parasitic infection can prevail over the body's defenses... and you have acute Chagas... with fever, with different symptoms... depending on where the parasite is in the body... which can cause death." "which can cause death." "Or you can have..." "a situation... where the parasitic infection is not so serious... the body begins a process of... fighting... against the parasite;" "and that is the chronic phase." "Here in Argentina, finally the parasite finally... lodges itself in the heart... and slowly, over 30 or 40 , years, it destroys the heart... which eventually results... in altered... heart rhythms... in problems of cardiac... insufficiencies... and, well, death." "It has been six months... since we tested... the baby." "If it comes out negative we have to do it again in a year." "Her older daughter came out positive." "All right, little one." "What happened to her face?" "She was bitten by mosquitoes." "All right, little one." "OK, that is all, we'll call you with the results." "Bye!" "Bye!" "When did you first realize that you had Chagas?" "When I was tested for her, I was 19." "That was when I tested positive, but I was never bitten by the vinchuca." "I just tested positive for Chagas." "Then when I became pregnant with him, he tested positive... and then she did." "And how did you feel when you were 19 and learned that you had Chagas?" "How did I react?" "I don't know." "I never tried to find out... what the disease is all about." "But Chagas is inherited, no?" "It can be inherited..." "or through the vinchuca bite..." "Because I have Chagas." "When my dad died 20 years ago they took blood from me... and it came out that I have Chagas." "The doctor did a test on me and told me that I had it." "He gave me some pills... that I had to take for 60 days... after 60 days I was supposed to go back to get tested again to see if I still had it." "I explained to the doctor what my symptoms were." "If I bent over or was out of breath I had heart palpitations." "I had to straighten myself out slowly because of the heart pain... and the doctor told me that was Chagas." "After I took the pills I never returned... to get... tested again." "And how are you now?" "Well, it is just that a lady told me..." ""why don't you make a promise to the Holy Virgin of the Impossible?"" "So I made the promise, which I haven't fulfilled yet... and I know that I have to... but since I made that promise I have been much better." "The salary I am making is barely enough to get food." "If I have... enough money... to buy the medicine, I do, if not, I don't." "And time passes... and the kids don't get better." "It is impossible." "My base pay is US$70 per month." "With social assistance I make US$150 a month." "But I need to feed 10 people here." "The kids are getting big, they eat like adults" "And there is no Government assistance for the medicine?" "No, the town has an assistance fund... but they give out their quota... and when they run out... there is no more." "Why did you leave El Salvador for the US?" "Poverty." "Poverty and violence." "If you are a good worker... the bad guys come... and they point a gun at you and say, "Give me what you have."" "So I came here looking for a better life... and have lived here almost 10 years." "I brought over my two other kids who were born there in El Salvador, my wife... and here we are, fighting." "In case they ship us off on a plane." "Hey, I can talk, right?" "Yes, yes." "There is a problem with Chagas;" "the resources are not well managed." "We spend lots of money on testing... on reagents and all that... but the investment... does not mean results." "The government programs are very concerned... that we check all pregnant women." "Pregnant women are in fact checked." "We test for Chagas in many pregnant women... but there is no follow up on the children of those mothers." "We should not study things for the sake of studying them." "Studies are not going to change the reality of Chagas." "Which is why our program... has looked retroactively at mothers... and has treated all of their children who tested positive." "Although the most common way to get Chagas... is through the... vector... the Triatoma infestans insect... commonly known as vinchuca... there are also other ways to become infected... through the mother's placenta... through transfusion, through organ donations... and also sometimes... through improper handling of infected blood... in a laboratory." "In Argentina we test and look for markers of various diseases... transmitted by transfusion." "Like HIV..." "Hepatitis C and B... syphilis... and also we look for markers... that indicate the presence of the Chagas disease." "This is done since many years ago... and we test 100%... of all donated blood... to detect antibodies for T. cruzi... the agent... that causes Chagas." "The law requires... that we do two tests... because of the high incidence... among donors." "This increases our ability... to detect the infection." "Before we used to think that Chagas... was only found in the northwest part the country." "But Buenos Aires has many infected patients... because many people come here to work from other places... and this migration has caused about 1 million people in Buenos Aires... to be sick..." "I mean, infected." "How many people have Chagas in Argentina?" "About 2,300,000 are infected with the Trypanosoma cruzi." "It does not mean that they are sick." "There can be people who are infected but who die of old age... and never have... any symptoms having to do with Chagas." "In the Americas... there are about 50,000 deaths... per year... due to Chagas." "Are you working on a cure to treat those who already have Chagas?" "We have a series of research projects... thinking that there are about 18,000,000... people that are infected in America... and those infected people... we have to give them an answer." "At this moment there are only two medicines approved." "One of the medicines has been pulled from the market... by the manufacturing lab." "It was not a good business for... for the lab to make a Chagas medicine." "And the only other medicine that we currently have... while being very effective in children... who are under 14 , and in acute cases... we don't use it in adults or in chronic cases... and it has severe side effects." "Why are the laboratories not developing new drugs to treat Chagas?" "The simple answer... is that it is a disease of poor people... that... is the reason." "Radanil is a drug that we have been using since 1970... there have been no new drugs from 1970 until today for Chagas... a disease that has been around for more than 100 years." "Yet we have drugs for skin care... for hypertension... dozens of drugs made every year." "Yet we are still with a drug... that is over 30 years old and that also has severe side effects." "It is like a forgotten disease." "A disease that is very current, but at the same time very forgotten." "If it is a forgotten disease in our country... where it is endemic, I can only imagine what it is like... in the countries where the labs are located." "There used to be another drug on the market, Nifurtimox... that was produced by Bayer." "But Bayer decided to pull it out of the market." "And if you could say something to the Bayer executives..." "what would you tell them?" "I would ask them..." ""What are you going to do with a baby that is born with Chagas?" "What treatment will you give that child?"" "How many babies are born with Chagas every year?" "It is a difficult question." "The health statistics... in Argentina... are incomplete... and in some cases, this disease is hidden by the Government." "So, that is a bit... the situation." "Our work is nice, yet hard, family preventive health." "We treat the families, before the disease gets to them." "That is why over the last 15 years..." "That is why over the last 15 years..." "I have fought, but I don't have the means to solve the problems." "We are fumigating... constantly, looking for the vinchuca." "Here we are going to prepare our equipment... we are going to work... we are going to fumigate... and continue the campaign against... the Chagas... disease." "Here at Mr. Castillo's house... we are going to continue working with our equipment." "How are you?" "We are coming to fumigate..." "against the vinchuca." "Good, good." "We are going to start the equipment." "We would be better off burning this!" "This is an ideal, dark place." "The vinchuca descends from the walls... feeds on the blood of the chickens... then returns to the cracks in the wall." "And it lives there." "That box has only bed covers?" "There we have... blood." "The vinchuca... bit people while they were sleeping." "People felt the bite and managed to kill it there." "Here... we see... the feces... of the vinchuca... which fall... to the floor... the Trypanosoma cruzi... is... in the feces." "Here in this cemetery... is my mother's grave." "I was... nine years old... when she died." "You were nine when your mom died?" "Yes." "My mother had..." "Chagas." "She was on her way to the medical post for a check up... and when she was returning home, on the road... she had a heart attack... because of Chagas." "She was forty five... and had a nine month old baby, that is my brother." "On the road down there where we came... she fell there... face down and the baby, who was on her back... rolled over her head and sat next to her." "Lets see..." "There..." "I never went back, afterwards." "You never went back?" "No." "It is the first time..." "Yes." "After 30 some years." "I think it is around here." "Over there she fell with the baby." "Yes, because this neighbor, she saw the baby." "Your brother?" "Right." "Crying?" "Right." "She came to see what was happening and saw my mom's body." "Which was lying there." "This is a sad story..." "My profession is based on this." "When I was studying I used to say, "How did I not know this before?"" "I could have saved her, given her a treatment." "You have seen that I am always on the go on the job." "Some will call me crazy." "But I am worried about... the health of people... so that children... are not... left alone... because of... carelessness... in the search... for the... vinchuca that is so malignant." "People don't give it importance, since it cannot be seen... there are no... evident symptoms." "People don't see Chagas?" "People don't see Chagas." "I think that your mother would be very proud of you if she were here." "Or maybe me..." "If my mom... could be here... she would be queen of the home." "She would have everything she would need." "But it is useless... because she is not here." "Perhaps she is happy, she is not here." "The ones who suffer are the children." "They are left without a mother." "Like it happened to me I am almost 40... and I am still thinking why isn't she here?" "With sudden death people are just fine... they have no warning and suddenly they fall, unconscious and they are dead." "It is not clear why... but it is often due to..." "Chagas that was not diagnosed..." "It often happens during... physical effort... like playing sports." "I know... of two kids here... who had that happen... and it was related to Chagas." "About... two years ago I began to feel, while at work... strong palpitations that would even change the color of my face... and my co-workers would ask me:" "Why do you look so pale?" "And I would tell them about the chest pains... and they would say:" ""Go sit down."" "I kept working and working for about a year... until it was so bad... that as soon as I began to work or walk I felt the pain." "So I came to see the doctor and he gave me medicine." "The medicine helps me, but it does not cure me... because if I don't take it for 1 , or 2 days and I make an effort... the pain starts again strongly." "Before I could work normally, but not now when it hurts." "Why did you decide to become a doctor?" "It's a mystery." "I really don't know why I became a doctor... but I am happy to be a doctor." "When I was a child I wanted to be a musician." "But I had a strong father who told me that I would starve as a musician... and he somewhat forced me to choose another profession... so I studied medicine, and after many years I went back a bit to music" "but we can talk about it later." "The ideal to treat an infectious disease would be to develop a vaccine." "The Trypanosoma cruzi is a very complex and intelligent parasite" "There are vaccines for bacteria, and for viruses, but not for parasites." "Because parasites are biologically complex... so one possibility would be the vaccine... this does not seem possible in the short term." "So we should address the preventable issues... an adequate control of the vector in the endemic areas... an adequate control in the blood banks... to avoid transmission through transfusion." "But even if we were to cut the vector cycle... and we would not have new Chagas cases... there will be many mothers, or girls who are already infected... who in 15 or 20 years will give birth to babies... who may have congenital Chagas." "Even in that ideal situation..." "I think that we will have Chagas for another 20-30 years... and then we would just have to deal... with congenital Chagas." "People who come to the Institute get tested serologically." "But in the case of babies of infected mothers... we need to see if the parasite is in the blood." "A serological test in a baby would be incorrect... because the baby already has the antibodies from the mother... what we need to find is the presence of the parasite." "It is a little box with 10 juvenile vinchucas that are hungry." "During half an hour they will suck blood..." "These nymphs, which are in the 3rd or 4th stage... have been fasting for 10 or 12 days." "These little vinchucas are placed on the baby's leg... and they are hungry." "You can tell if they have eaten because when you shake the box... they feel like little balls..." "they are full." "This is the process we use to know if her baby is infected... and should be treated... with a drug... and not have symptoms such... as heart disease... in 20 or 30 years." "So, the inconvenience... of this procedure... is in some way balanced... by the opportunity... to be treated with drugs... and cured." "We obtain a drop of their fecal matter." "We put them back in the box because in a month we will check them again." "She looks over the entire slide... to see if she can find the parasite that the baby could have." "If we find even only one parasite... we can already make the diagnosis." "Argentina still has... an area with Chagas... but in the last few years we have achieved the certification... in some provinces, of the interruption of the vector." "We are "cleaning"... very progressively, some provinces... and interrupting the transmission by the vinchuca." "Our goal, in the near future... is the definitive eradication of the disease." "But the Chagas situation in Argentina, compared to the past..." "But the Chagas situation in Argentina, compared to the past... has been diminishing progressively." "They are older people... who became infected... 30 or 40 years ago." "For example, in Santiago del Estero... if you take a sample of 60 year olds... you will find a high percentage of Chagas patients." "The last 30 years of the national Chagas program... have successfully lowered the infestation in houses... and shown a drastic drop in the number of new cases of Chagas." "At the beginning of the 90s... in Santiago del Estero we had 60 cases of acute Chagas." "Today they are reporting only 9 or 10 cases." "How often?" "Each year." "We were told that the Chagas situation was under control." "Lies, lies." "Lies." "The vinchuca is a factor." "I invite you, within an important city... like this one in Santiago del Estero to go out 20 or 30 blocks... and tell me if there aren't huts with vinchucas." "You tried to report a couple of acute cases and they didn't let you." "Yes, I have the clinical histories, I would have to look for them." "When I detected the cases of acute Chagas... in kids that had been brought from the countryside... they were tested." "Overnight, people showed up from the capital city..." "They took over the cases, and they took the clinical files from me..." "I'd made copies of the files, because I knew how we lived in this Province." "And in those days it was reported that there had been no acute cases... of Chagas in Santiago del Estero." "In our city hospital we have more than 1,500 births per year." "How many kids are born with Chagas every year?" "Nobody knows." "Those kids could be treated, and I tried to have them treated..." "and they blocked me." "They blocked you?" "Absolutely." "Why?" "Because nobody is interested in having that be known." "It is a hidden affliction." "It is a genocide." "It is a genocide." "We are out of the... chemicals... we need to test patients." "We can only test donated blood." "So if today someone comes in to be tested for Chagas you cannot do it?" "We have no reagents." "Why?" "Probably because they don't have reagents in the ministry." "They don't send you any?" "No." "We have the same problem with fumigation." "The national service has set up a program." "We often look for... insecticides... or... equipment to fumigate with... and we often cannot get it... because the Government does not have it." "Although it may seem incredible in the 21st century... here in Icanio, only 6 miles from town... people have come together to say "Enough!"" "There are 150 vinchucas... that were found in this modest home that you can see behind me." "150 in this one, and a similar number in other homes in this area." "We were told that there are no more vinchucas." "You were lied to." "There are vinchucas." "And they will continue to exist until there is fumigation... until the government begins to keep the promises they make... with all these programs to fight Chagas." "And the reason we are giving this testimony... is that there are national... and provincial programs... to fight against Chagas... funds are supposedly sent... and yet the people here, you can see it in the images... have their houses completely full of vinchucas." "The problem is there, and this is only one example of it... but I think that in many parts of Santiago... the same situation is occurring." "I don't know how someone can think that we are fighting the vinchuca... with the poverty we have... with the degrading conditions in which people are living." "I don't know how someone can think... that people who don't have drinking water, who have no utilities... who live in huts, cannot have vinchucas." "There it is a rural area." "There is no public water... we get it from wells." "There is no electricity, no paved roads." "Do you remember this insect?" "Yes." "We lived in homes that were not like this." "They were made with palm branches, the roofs and walls, and there we lived." "And in between the palm leaves the insects also lived." "What are they called in El Salvador?" "Chinche." "I remember once when I was little... my father grabbed the chinches and burned them with a candle." "And once I took the candle... and put it on a chinche that was among the palm leaves... and the leaves caught on fire and we all had to run out..." "I almost burned the whole house." "How did you get Chagas?" "I think that while working in the fields... sometimes you sleep in the woods... sometimes you sleep in the woods... you don't sleep at home." "I think that is... where I got..." "Chagas." "She has Chagas." "And how did you get it?" "We don't know." "She was tested, and has Chagas." "And now..." "I sell milk, I clear woods." "Any job that comes up... even the roughest, I have done." "I know all the rough jobs." "There is none I haven't done." "Worst would be to have nothing..." "Hi guys." "How are you?" "How are you doing?" "Did you sell your corn?" "There is none left?" "Bye." "How is Karina?" "Where is your mom?" "Did you tell grandma?" "How are you, grandma?" "How have you been, well?" "I am deaf, I can't hear." "Have you been taking your medicine?" "Yes, doctor." "Is Karina giving you the medicine?" "No, Karina is." "Because Chagas is thought of as a disease of poor countries... there is not much funding for research." "From Mexico south is where... the vinchucas are and where Chagas was." "But we must be increasingly aware... of transmission... by transfusion." "For example, we have to think what happens with... the population migration... from poor countries... towards the US and Europe... with poor immigrants... that go... and are not the wealthiest people and who then in a strategy for survival... they sell their blood... which is not tested... and given... the prevalence... of the Trypanosoma that they carry from here... it is not unthinkable that this will be a problem... in the developed countries." "Excuse me sir, just a question, do you know Chagas?" "No." "Do you know Chagas?" "What?" "Chagas." "No, I don't know what it is." "Just a question, do you know Chagas?" "No, we don't know Chagas." "Do you know Chagas?" "No, not at all." "Do you know Chagas?" "No." "Do you know Chagas?" "Absolutely not." "Sorry." "It is just a little question..." "I was a completely normal person." "And when I arrived here..." "I... began... to be tired, tired, tired." "So I went to the doctor and he said immediately..." ""Your heart is completely destroyed."" "And that there was nothing to do." "It was a shock for me to be a healthy person and to be told... that my heart was going to stop." "So I began to experience... psychological problems." "It was so sudden to go from being well, to not being well." "The cardiologist never thought about Chagas?" "No, they don't know anything about the disease here." "The cardiologist only saw the heart problem... and told me that the only option was to get a pacemaker." "Then I met this Dr. Carlier... and... he told me... that with Radanil... perhaps I could be... treated." "But, unfortunately... my body completely rejected the medicine..." "I was going to die quicker... from the side effects..." "And society does not understand." ""She seems fine!" "What is wrong?"" "The symptoms are not very evident." "No." "She is in fact... a Bolivian woman... from Santa Cruz... who was working... here illegally... as a domestic." "She became pregnant, had her baby... and the gynecologist realized... that the placenta had a problem." "They sent a sample... to a pathologist... who made the diagnosis of Chagas... the baby was gaining weight, had no fever... but when we tested him he had the Trypanosoma." "So we treated the baby... and he took it well." "Quickly the levels became negative." "We followed up for several months and he never became positive again." "So he was cured." "Hi." "How are you?" "Chagas originated in Latin America." "It can be cured in children, but not in adults." "It is important that mothers from rural Latin America... that were bitten by the insect should be tested." "I have been here for 7 years... and I bring this disease from my country... the only thing I would feel was a pain underneath my heart... but I thought it was a muscle pull... or that I was winded." "I never took it seriously... until one day when the disease attacked me very strongly." "I went into shock, I had an arrhythmia." "I fell unconscious." "My coworkers picked me up;" "I had no idea what had happened." "I discovered that I had Chagas 20 years ago." "I had constant headaches... and my intestine..." "I always had constipation... but I carried on with my life without worrying too much." "I did not know that I had Chagas in my heart... but I knew it was all over my body." "Are you the only person in your family with Chagas?" "Who, me?" "Yes." "No." "My older brother... died 4 years ago... with intestinal Chagas." "My other brother, with heart Chagas." "And another, with Chagas in the intestines, even after an operation." "There is no home fumigation in El Salvador?" "No, not for the "chinches."" "After I brought her here..." "I thought it was a good opportunity to complete a treatment... that had been left unfinished in El Salvador." "She had been bitten by a "chinche" in 1999." "I took her to the local clinic here in Willamsburg... and they referred my daughter to a hospital in Norfolk..." ""The King's Daughter."" "The doctor knew almost nothing about Chagas." "I had to explain it to him; he began to research it on the Internet." "I told him the name of the test in El Salvador... and he did not understand me, because they don't know it by that name." "In El Salvador I wanted to study computers... but here I want to learn a second and a third language." "Three languages." "I was going to study languages in El Salvador." "But my parents wanted me... to come here... so..." "I came." "It is hard to leave your land and come here." "Do you remember seeing the chinches, and being bitten by them?" "Yes, I used to kill them;" "they used to bite me." "My cousins would say:" ""That is a chinche; kill it."" "And when you killed them, did they have blood inside?" "Yes, they spurted blood;" "it was ugly." "Why are you concerned?" "Because until I was 7, I grew up... where the insects were." "Two or three weeks ago, my heart was hurting a lot." "Hello!" "I am Rick, I have an appointment to donate blood." "OK." "Could you please sign in here." "OK." "Ah..." "Ricardo... is it Preve?" "Right." "I had a question because you also have the Chagas disease." "What is that exactly?" "It's a parasitic disease." "They usually find that over in Middle Eastern countries." "Oh, in the Middle East?" "Like Palestine, or Israel?" "Yes." "I have never been to Israel." "I guess maybe for the people going to Iraq, or something." "Yeah." "Also the Chagas disease and the Leishmaniasis, that is another one..." "That is from the Middle Eastern countries..." "Yeah." "OK." "Let me get you to sign for me here." "OK." "She is asking if they did an electrocardiogram before." "Did they do this heart analysis before?" "Yes." "You work as a chef, you said?" "Yes, in the kitchen." "You have heart problems?" "Yes, I cannot work fast." "I get tired." "My heart palpitates, I feel like I am choking." "Did they give you some medicine?" "I am taking medicine... but it is only when I take the medicine... that the fatigue goes away." "When you were little you remember the chinches?" "Yes." "In the homes?" "In the homes." "Many?" "Yes, many." "God be with you." "Thank you very much!" "Thank you Lorenzo, and good luck!" "Goodbye."