Combining ethnomedicine with biomedicine, Carrasco refined the herbal remedy for Chagas’ disease and reworked the ingredients of Sangre de Drago until he had concocted a “secret” recipe, which he called “Regenerator.” He tested it on his patients, injecting it into their muscles and observing its effects on arthritis, cancer, and Chagas’ disease.
Bolivian herbalists develop their skills by learning from other herbalists and through practice. When they treat a disease with an experimental herb, they give the patient small doses to observe its effects over several weeks. If a patient dies in treatment, they are held responsible. Bolivians practice retributive justice, and an herbalist may be killed by relatives of the deceased. Herbalists generally refuse to treat anyone they are unsure of curing; and this apparently works to the disadvantage of terminally ill patients. In instances of those chronically ill with Chagas’ disease, however, herbalists and victims are concerned less with its potential fatality than they are with the victim being unable to work. Illness for Andeans is basically a condition when they cannot work, and Western biomedicine’s definition of illness does not apply with Bolivian peasants who have tuberculosis and Chagas’ disease.
At first, Carrasco claimed that Regenerator cured several illnesses, as suggested by the following remark from a doctor: “If Carrasco was a serious scientist, he would only investigate cancer, but he indiscriminately injects Regenerator into patients of all diseases” (Zalles 1996). Oblivious to biomedical ethics, they blamed him not for experimenting on humans but for not focusing on cancer, a disease of upper-class Bolivians. They begrudgingly admitted that Carrasco was a “scientist of sorts” and that Regenerator had therapeutic potential.[8]
In spite of the medical doctors’ criticism, Carrasco continued to experiment on patients. Bolivians frequented his clinic in large numbers, forming lines into the streets to receive Regenerator. Carrasco published his results in 1984: “Regenerator serves as a muscle regenerator and a proven parasiticide for Plasmodium vivax (malaria) and T. cruzi.”
The success of Regenerator became internationally known, and at least one Japanese scientist visited Carrasco to learn about it. For years, Carrasco had kept the formula secret, but with the possibility of fame and fortune, he gave the formula to this person. The Japanese man patented it, produced it, and profited. He didn’t pay Carrasco.[9] Carrasco took his claim to the Bolivian court. After three years of litigation, however, he died and the case was discontinued.
The validity of Carrasco’s claims for Regenerator is found in case studies. Carrasco records thirty-eight patients cured of Chagas’ disease with Regenerator (Carrasco Capriles 1984). He lists the patients’ names and the results of laboratory tests for T. cruzi at the first and final analyses, with dates and name of the testing laboratory.[10] He daily injected one-half cubic centimeter of a synthesized form of Regenerator mixed with Vitamin K (10 mg) and a liver extract into the patient’s muscles (Carrasco 1984:72). Treatments were conducted daily from one month to under three years, or until the patient was cured, although it is doubtful whether Bolivian patients followed this strict regime.
Analyzing thirty-three records (five were incomplete), I found that fourteen (42 percent) of the patients were cured over a short period of from one to six months; fifteen (45 percent) of the patients were cured over a longer period of from seven to thirteen months; and four patients (12 percent) were cured over a long period of from fourteen to thirty-four months. The average cure was nine months (somewhat similar to a treatment plan of nifurtimox and benznidazole. An equal number of men and women were treated, indicating some equality in regard to infection and to treatment. Generally speaking, adult males in Bolivia have a higher incidence of Chagas’ disease and prefer doctors, whereas women prefer herbalists and diviners.
Carrasco claimed that patients with heart blockage were cured with Regenerator, being able to work even at strenuous jobs without cardiac fatigue. “Various of my patients had cardiac lesions, alterations of the nervous system and disturbances of digestive tubes, which had been determined by medical specialists, who deemed organ damage irreversible,” Carrasco (1984:49) wrote, “but fortunately I managed to cure many of these, or at least to avoid greater deterioration with my therapy.” Carrasco concluded that Chagas’ disease can be cured with Regenerator, which lyses, or gradually destroys, T. cruzi, and that it is more effective and has fewer side effects than do nifurtimox and benznidazole.
Carrasco made his case from clinical records and laboratory results. One concern with the results of the final analysis for each patient is that the majority of tests (thirty-five) were direct examinations of the blood, and T. cruzi is not easily found in the blood, being predominantly intracellular. Three tests were indirect (detection of antibodies to T. cruzi) immunofluorescent tests, similar to the ELISA test used for AIDS. Not used by Carrasco, xenodiagnosis is where uninfected vinchucas are allowed to bite the patient for thirty minutes under the armpit, and their fecal matter is observed thirty days later to see if it contains T. cruzi. All these tests are commonly used in Bolivia for Chagas’ disease. It is possible that some patients with positive results from the Carrasco study still harbor T. cruzi but in lesser numbers than previously found. Even this would indicate some effectiveness of Regenerator. However, recent studies indicate that Chagas’ disease can manifest itself clinically even though parasites have been eliminated, because of misdirection of the human immune system (see Appendix II: Immune Response).
Therapy for Chagas’ disease comes in varying degreesfrom controlling the parasite population in the body to completely eliminating it. Jaime Zalles, in an interview on 11 May 1997, said that Sangre de Drago (Croton roborensis HBK) is an effective treatment for Chagas’ disease, not in the refined form of Regenerator, but in a pattern of administering four drops daily for four days, then rest for four days, then the resumption of the drops for another four daysall for the length of six months. It should not be used for anemic patients, however, because it decreases red blood cells in the body.
Sangre de Drago is sold in small bottles by herbal vendors throughout Bolivia for ten pesos in Bolivian money (U.S. two dollars), and it is purchased by Bolivians for Chagas’ disease. Patients claim that it cures them, altough it more probably relieves the disease’s symptoms; but its properties as a parasiticide have yet to be verified by laboratory tests.
Jaime Zalles treats chagasic heart disease with three flowers of retama (Spartumjunceum) in maté (steeped in hot water), with two leaves of cedrón (Lippia triphylla Kunth). Ingredients serve as a tranquilizer for heart attacks. Toronjil (Melissa officinalis L.) is also used for heart problems.
Zalles treats chagasic constipation by placing clay on the stomach, then providing a drink of papaya juice (including the fruit’s skin) and flax seeds (Linum usitatissimum). Zalles’ wife, Negrita, recommends castor oil. Herbalists often have patients with sore throats from Chagas’ disease gargle with warm coca water. These remedies can relieve the symptoms of Chagas’ disease, allowing patients to return to work. Restoration to complete health is an impossible dream for many peasants who lack the resources to pay for cures. They adapt through the use of household remedies, herbs, and rituals, which provide some level of relief and renewal. Until the problem is addressed by wealthier nations, the simple products of Mother Earth (Pachamama) remain their primary resource.
Figure 12.
Jaime Zalles talking to a herbal vendor in Tarija, Bolivia, about the use of Sangre de Drago for curing Chagas’ disease. Zalles is Bolivia’s foremost expert in the use of medicinal plants for medicines and has written herbal manuals for Bolivians in Spanish, Aymara, Quechua, and Guarani languages. (Photograph by Joseph W. Bastien)
More successfully, native plants provide insecticides for eliminating vinchucas: compounds including ruda (rue, Ruta chalapensis), ajenjo (absinthe, Artemisia absinthum), andres waylla (Cestrum mathewsi), and jaya pichana (Schurria octoarustica) are experimentally proven insecticides. Bolivians have learned this and
use large quantities of these plants. They cut them into small pieces, smash them, and boil them in water. This is then mixed with dirt and used to fill holes in the adobe. Another method used is to pound small rocks into the holes of the adobe. Plaster is mixed with coca, an excellent insecticide, and fleshy parts of prickly pear cactus (Penca de Tuna or Opuntiaficus indica) to form a glue that helps the plaster stick to the adobe. A compound called el paraiso, made from muña (Satureja boliviana), is used to kill potato worms and has been suggested for vinchucas. Peasants also use spiders and carpinteros (small household lizards) to rid their houses of vinchucas. The plant floripondio (Datura sanguinea) gives off a nightly fragrance that discourages vinchucas from entering the houses around which it is planted.[11] Eucalyptus leaves burned inside the house at evening have a similar effect. These native remedies and insecticides are all relatively safe and environmentally sound, something that cannot be said for pharmaceutical drugs and commercial insecticides.
Scientists in Cochabamba are investigating native plants for use in insecticides against vinchucas.[12] They are presently using an organic phosphorus, Deltametrina (Pirotroides), a French product from a piretro plant. It is biodegradable, inexpensive, and protects an area from six months to a year. Only 25 milligrams per square meter are used for vinchucas. It is toxic for larger animals only in greater quantities. Deltametrina costs ten dollars a liter, while Petramina costs $1,200 a liter. One problem, however, is the availability of Deltametrina.
Chilean scientists have been testing Kallawaya medicinal plants for the treatment of Chagas’ disease. Initial findings have been very encouraging in that several of the plants appear to work towards the cure of Chagas’ disease. Herbalists in Bolivia regularly use plant extracts with indole alkaloids, which suggests the possibility of medicinal effectiveness without excessive toxicity (Bastien 1987a; Cavin and Rodriguez 1982). Various tropical plant species used by tribal groups contain beta-Carboline alkaloids (Allen and Holmstedt 1980). Scientists at the University of California, Irvine, tested these alkaloids and found them to reduce population growth of T. cruzi epimastigote forms (Cavin, Krassner, and Rodriguez 1987). Native herbalists can be of help in identifying potentially effective drugs from natural sources. Using native lore can reduce the number of empirical tests often conducted on natural plant products. Plant products provide an alternative to toxic synthetic drugs and indicate potentially active structures for chemists interested in synthetic molecular modifications. This research, along with that of Carrasco, strongly points to the possibilities of dealing with Chagas’ disease by the use of medicinal plants.
The connection is interesting between herbalists’ treatment of Chagas’ disease through the use of castor oil as a purgative for empacho and susto and Carrasco’s concoction of the shrub’s agents into an injectable solution, Regenerator. Native herbalists have an entirely different ethnophysiology of how the symptoms of Chagas’ disease are cured by purgatives, yet it was their use of this substance for that disease that led Carrasco to further refine it for biomedical purposes. As another example, peasants chew coca leaves after eating potatoes, which they say is necessary to balance the hot with the cold. Chewing coca leaves regulates carbohydrate metabolism. It frequently happens that folk beliefs, rituals, and home remedies reveal effective treatments for Chagas’ disease. Andeans follow these native systems of medicine because at least to some degree they work. Doctors and scientists exclusively advocate biomedicine. A wiser path would appear to be to integrate ethnomedicine with biomedicine for the prevention and treatment of Chagas’ disease.
Parasiticides: Nifurtimox and Benznidazole
Andean traditional medicine provides treatments for Chagas’ disease as well as insecticides that may even be better than the present products produced by pharmaceutical and chemical companies. Western biomedicine does not have an effective cure for chronic Chagas’ disease. Presently, the two prescription drugs used for treating Chagas’ disease are nifurtimox (produced by Bayer, recently discontinued) and benznidazole (Roche), used for acute and chronic phases (see Appendix 13). Bolivians find both costly, unsatisfactory, and painful, and many prefer to go to native herbalists for cures. Neither drug is available in the United States, except through special permission from the Centers for Disease Control in Atlanta. No drug is registered for use to help prevent Chagas’ disease.
Nifurtimox and benznidazole are used in short-term cases, but their efficacy varies in different geographical areas, probably as a consequence of variation of parasitic strains. Many patients object to taking large doses of these drugs over a long period of time (as long as one year).[13] Patients can also suffer serious side effects, including anorexia, vomiting, skin allergies, and various neurological disorders, which may be a consequence of damage to their tissues (Urbina et al. 1996). Bolivians also realize that the pharmaceutical cure is only temporary if they live in chagasic areas, as it is likely they will be reinfected with T. cruzi. One advantage of actually harboring T. cruzi is that it provides partial immunity from suffering another acute attack.
The complexity of Chagas’ disease has been addressed by Andean culture in a number of ways. Andeans deal with the symptoms of Chagas’ disease through rituals, community concern, and herbal medicines. Yachajs and yatiris have combined forces with doctors to combat or adapt to T. cruzi. They appear to have dealt with Chagas’ disease as adequately as has biomedicine. Even if this is not so, its possibility necessitates much closer examination of ethnomedical systems for solutions to endemic diseases throughout the world. Andean rituals also provide a great service to medical science by indicating the interrelatedness of Chagas’ disease to the environment, showing how the human body is related to the earth and its organisms in reciprocal ways.
CHAPTER FOUR
The Crawling Epidemic: Epidemiology
One of my first encounters with kissing bugs, vinchucas, was in the airport in Cochabamba, Bolivia, where I went to meet Benjamin Menesis, who had arrived from Sucre and was carrying a suitcase with over 1,000 specimens of the insect. Menesis was a technician for the Proyecto Británico Cardenal Maurer (PBCM), which was conducting a vinchuca-eradication program in the Department of Chuquisaca, Bolivia. An important part of this program at the University in Cochabamba was to determine the rate that vinchuca bugs became infected.
Staff had collected vinchucas from houses in Chuquisaca with flypaper and by means of a contest among schoolchildren to see who could bring the most vinchucas to school. Pupils thus realized how infested their homes were and received a lesson on Chagas’ disease. The director of PBCM, Ruth Sensano, stored the vinchucas in an ice chest. They became active in the dark box, being nocturnal creatures, and began a scratching sound clearly audible to anyone within twenty feet. When the box was opened and a lit flashlight placed inside, the vinchucas quieted down due to their photosensitive nature.
Menesis hand-carried the freezer box onto the airplane in Sucre, refusing to put it in the hold where the cold might kill the vinchucas. He carried a radio to drown out chirping in flight with some loud music. Airport surveillance questioned Menesis about the chest, and he told them that he was carrying medical samples. Ruth Sensano convinced the inspector that Menesis needed to get the contents of the box to Cochabamba as quickly as possible for medical reasons. Menesis arrived without mishap in Cochabamba an hour later, and we joked about what could have happened if the box had come open inside the airplane and 1,000 vinchucaswere released, with over half of them carrying T. cruzi.
The vinchuca species most largely responsible for chagasic transmission in Bolivia is Triatoma infestans, which is relatively non-aggressive and whose bite is more annoying than it is painful. Consequently, Bolivians do not refer to the insects as “assassin bugs,” as they are called in the U.S., but as “vinchucas,” from the Quechua word huinchicuy, which means something that falls rapidly, because they glide down from the rafters, and as “kissing bugs,” because they prefer to suck blood from the faceoften from the lips and from n
ear the eyes. Although Triatoma infestans has thus avoided the name “assassin bug” for the more benign name “kissing bug,” there is the subtle irony that the “kiss” of the bug can lead to death.
Epidemiology of Chagas’ Disease in Bolivia
In Bolivia, estimates are that one in five (1.5 million people) of the total population (7.3 million) have Chagas’ disease, and that half the population live in endemic areas of the disease (SOH/CCH 1994; see Figure 13). An earlier epidemiological survey of Chagas’ disease was carried out in 1978 in Pongo, a village situated eleven miles from Santa Cruz, capital of the tropical oriental plains (De Muynck et al. 1978). Researchers examined the infection rate of houses by triatomines; the infection rate of the triatomines by T. cruzi; the infection rate of human, canine, and feline populations; cardiac and digestive morbidity; and the construction of houses. Some 26 percent of the houses were infested with T. infestans, 53 percent of the humans were found infected with T. cruzi; and 23 percent of the dogs and 7 percent of the cats were also infected. Some 7 percent of those older than five years showed electrocardiogram signs compatible with chagasic myocardiopathy, and 2 percent had an elevated risk for sudden death as a consequence of their chagasic heart disease. More recent studies have found similar results throughout many rural areas in Bolivia (Valencia 1990a, 1990b; see Appendix 5).
The incidence of disease is highest in rural areas, where 42 percent of the people live and where poverty, lack of education, and poor housing facilitate infestation by vinchucas. The average rural income per year is $580, the illiteracy rate is 50 percent, and the fertility index is 6.1 per mother (1992 census). Forty to eighty percent of rural people are infected with T. cruzi, and 38-78 percent of the homes are infested with T. infestans. Over 30 percent of the insect vectors captured in and around rural houses are infected with T. cruzi. These areas are generally those lived in by the indigenous population (60 percent of the population) and to a lesser extent by the mestizo population (25 percent) and those of European descent (15 percent). Some ethnic communities are seriously debilitated by Chagas’ disease, and their survival and well-being can be seen as a race against T. cruzi.
The Kiss of Death Page 8