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The Kiss of Death: Chagas' Disease in the Americas

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Social and Cultural Issues

Culture Context Model
Social Costs
Political Economy

Cultural and social factors influence Chagas' disease. Chagas' disease is often considered from only a biomedical perspective, "Pachacutej" ("reversed time") and "500 years" 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 with vinchuchas. 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. (See Ethnomedicine)

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