5. To Treat or Not to Treat: Informing People Well at Their First Appointment
Juan Simeón Melo, 77, lived most of his life in a rural community. Now he lives in Garagoa, one of the most populated cities in Tenza. He was diagnosed with Chagas at the age of 65, and he regularly visits the internal medicine doctor here at the Tenza hospital.
This doctor, Miller Niño, receives about 30 patients a month with chronic Chagas disease, as well as 2-3 acute cases. An appointment often runs longer than expected, because any detail or other information is potentially important in assessing the health status of patients beyond what the tests can say. As elsewhere, time is valuable, as it is one of the keys to comprehensive care.
Juan Simeon’s brother also has Chagas. However, it was not detected until the heart showed signs of serious damage. He now has a pacemaker. Juan Simeon’s wife and children were also tested and turned out to be negative. After checking Juan’s condition, the internal medicine doctor only recommended that he loses a little weight to help his heart.
As Dr. Niño explains, “during the weeks that the patients are under treatment, they attend three times to a follow-up consultation to check if any side effect appears".
The doctor mentions that, in order to evaluate potential complications, “The patient is not given all the tablets for treatment at the beginning.” This way, we try to get the person to come back for follow-ups. “The problem is that many people who live in rural areas, when they are asymptomatic and otherwise feeling well, do not perceive the need to go back for a follow-up consultation, which sometimes entails a long journey.” In any case, Niño explains, that the side effects from treatment that they have seen thus far have been mild and easy to manage. “A key factor is how you inform the patient at the first consultation”, says Dr. Niño. “That’s when the patient begins to understand not only the importance of treatment, but also how time and potential side effects play into this”.
Pedro José Gutiérrez, 61, comes from a village in Almeida. There, the ‘pito’ is a persistent guest in many homes. He now lives in Garagoa, where he found a job paving the city streets. He earns about 35,000 pesos (7 euros) for a day’s work. He is afraid of having to go to medical appointments for treatment, worrying that it will result in him getting fired from this job that he needs so much. His diagnosis of Chagas was confirmed in September 2022. He has 4 children and tells us that not everyone has been tested for Chagas. He is now about to start treatment. Regarding the ‘pitos’, he says that “Over there in the villages, they believed it was an insect infestation, without any greater consequences”.
While Now it is mid-October and Pedro has come early for treatment, after being diagnosed in September. Others, the doctor tells us, do not show up for their appointment, or they come back only up to one year later, at which point the medical condition has to be re-assessed again.
Both Dr. Niño and Dr. Miguel Mauricio Alba, the doctor with the most years of experience treating Chagas in this municipality, agree that care has improved quite a bit in recent years.
“There is a greater level of interest from healthcare staff now,” Dr. Alba confirms. “Before, the coverage was very poor. Some patients did not show up due to fear and false rumors, or due to lack of interest. The system has improved a great deal now. We should no longer have these kinds of access problems because information is now much more widespread.”
A Comprehensive Health Care Route for Chagas (RIAS) has been implemented for several years now in the departments with the highest incidence of the disease in Colombia. Thanks to this pilot project, developed in collaboration with DNDi, the number of persons diagnosed and treated has increased until 13-fold and 5-fold respectively. This shows that it is possible and crucial to diagnose and provide early treatment at the first tier of healthcare.
Report compiled during field visits by Javier Sancho and Ulrich-Dietmar Madeja. Images from Jorge Martinez.
To arrive on time to interrupt Chagas disease: