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Source: corresponsalesclave.org

2015 Data show a rise in the rate of tuberculosis in Chile and an expert estimates that there is a gap linked to the lack of community, indigenous and migrant agents, in the actions of the health centers to identify cases and treat the disease.  

By: Francisco Olivares Antezana

Low community participation, especially from indigenous people and migrants, could be one of the main problems in the response to tuberculosis (TBC) in Chile, which, according to the last official report available in this link  -, is a disease that raised its rate by almost one percentage point , from  13,4 in 2014, to 14,2 per  100 thousand inhabitants in 2015.

Olivia Horna, from the Tuberculosis Parliamentary Front of the Americas (left) and  Silvana Gutiérrez, Aymara woman (right).

Dr.  Olivia Horna, focal point in Chile of the Tuberculosis Parliamentary Front of the Americas and professor at the University of Chile, estimated that this upturn is due, on one hand, to an aging population with high prevalence of diabetes and smoking to HIV co-infection, and on the other hand, to a gap in studies of contacts and community work that would allow health teams to timely identify infected people.

In this scenario,  Horna told Corresponsales Clave that Chile clearly has three populations with greater vulnerability: the elderly, the migrants and the indigenous people.  She thinks that 20% of TBC patients are seniors, whereas data from the Ministry of Health (MINSAL) state that more than 2 thousand 500 people live with TBC, out of which 10.1% are migrants and 3.2% are indigenous people.

According to the last report of MINSAL, there are two regions in the upper north of the country that double the national rate:  Arica and Parinacota (31,4); and Tarapaca (32,1). It is worth noting that these areas have a notorious percentage of these key populations (indigenous people and migrants). In Arica and Parinacota, 36% of cases are indigenous people, and in Tarapaca 27% are foreigners.

Community Agents

In the interview with Corresponsales Clave, Horna draws attention to a worrying situation: health centers and hospitals practically do not go out to their communities to look for people with symptoms of the disease, but they wait for them to get there asking for care, which, many times, may happen at very advanced stages   of the infection.

Therefore, she believes that the government should return to the strategy of community agents, training them and integrating them to TBC control teams to timely detect cases and accompany people during treatment, as it is done in some areas in Spain, in order to ensure adherence to the drugs.

TBC prevention activity in  Arica, Chile, on the world day of the pandemic in 2017.

Regarding migrants and indigenous people, the doctor emphasized that these community agents should belong to those communities, to become facilitators of the health teams that many times do not take into account cultural differences and different ways for diagnosis and treatment, especially among the First Nations.

Although these cultural barriers explain their vulnerability to TBC, Horna said that migrants are young and healthy people that, after being exposed to the Koch bacillus in their home countries, they develop the disease in Chile due to their precarious living conditions.

Corresponsales Clave: In addition to the lack of community agents, don´t you think that the almost police-like control of people with TBC is an issue, as they must go to their health center and take the medication in front of an official? Wouldn´t it be time to rethink the relationship with people?

Olivia Horna: Unfortunately, health care personnel think they have the power. The provision of care is always vertical. Not horizontal.  It is not an obligation, it is the right of the patient to take the treatment or not. That police-like control is historical and at some point, it might have worked but not at present.    What needs to be done is to accompany that person, in a horizontal way. It is time to change, to think differently. We have to look from the other side.

To Live Well

Silvana Gutiérrez, is an Aymara woman from the city of Arica, who since 2007 has worked at the indigenous Aymara association  Suma Qamañataki/ To Live Well, in the community response to tuberculosis among their urban communities.

TBC MORTALITY AMONG AYMARA AND NON-INDIGENOUS PEOPLE IN UPPER NORTH OF CHILE

If the size of Aymara and non-Aymara population were  the same, then , between 2004-2006, for every 10 non-Aymara people that died due to this cause, 77 people would have died, and 64 between 2007-2009

Graph of a report prepared by anthropologist  Malva Pedrero for  SEREMI of Health in Arica and Parinacota, Chile.

She emphasized to Corresponsales Clave that it is necessary that the Ministry of Health returns to the support that it provided them, as an organization, until 2009, paying for the mobilization and food expenses of its group of volunteers when they went to the field to report their peers on how to prevent the disease, detect it on time and accompany people during treatment.

She said that two years ago they carried out their last activity, delivery of non-perishable food to people with TBC, but that it is urgent to retake the work  “because as Aymara people our situation remains the same, we even have moved backwards, according to statistics.  When you ask people on the street about TBC, some know about it,  but most of them do not¨, she said.

Silvana refers to statistics worked  by anthropologist Malva-Marina Pedrero, on the official database, which have warned that indigenous people of Chile are in higher risk to die and get TBC than non-indigenous people.

Government Actions

Another area in Chile where the indigenous population is highly vulnerable to TBC is the Araucania Region, Mapuche territory that represents 24,65 of all cases. Bernardo Melipil, a cultural advisor of the Health Service of Northern Araucania of the Ministry of Health, told Corresponsales Clave that one strategy to face the situation has been to train intercultural facilitators that work in the welfare network, to timely detect people with symptoms of the disease.

Although he stated that the last socio-cultural, epidemiological study in his territory (the Malleco province) in 2011, showed records of concern on TBC, he said that there is no Mapuche organization working on this topic as a priority.

In the Arica and Parinacota region, the Regional Secretariat of the Ministry of Health (SEREMI), told Corresponsales Clave, through a statement, that they hope that the health consultation to indigenous peoples carried out in 2016, will produce a regulation on the right to health with cultural relevance, allowing public health centers to create participation spaces in the response to tuberculosis.

Meanwhile, the authority stated that they have made progress in training indigenous monitors on TBC, and in training higher education students as TBC and HIV monitors since 2015, to whom they invite to activities to educate in the prevention of the disease and to make investigations in areas of high concentration of Aymara people and migrants. The association  Suma Qamañataki has also been invited to these activities.

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