Duámaco Escribano

PatientStory-Chagas

Chagas Disease
Colombia

Duámaco Escribano doesn’t know how old he is. His identity card says he is 29 years old, but those who know him say he must be 25 or 26. In the indigenous community to which he belongs, the Koguis – one of the four ethnic groups living in the Sierra Nevada, on the north coast of Colombia – life isn’t measured in years: it starts with birth and ends with death, however long it may be.

Duámaco lives in Palomino, a small town in the province of La Guajira, in the northern part of Colombia at a remote site, inhabited by the community for hundreds if not thousands of years. He says that access to the area is difficult by motor vehicle, so they must travel there on foot. From the place where he lives to the nearest urban area, the journey may take two hours. The area is isolated from what he calls ‘the Western system’, or what ‘white people’ call ‘civilization’.

He says it is hard to find a hospital or a school as the Westerners know them and, anyway, traditional medicine prevails: the Mamo is the highest authority, the healer and the one who authorizes a patient to go to a ‘white’ hospital, if he sees that the illness goes beyond his ability to provide a solution.

The area where Duámaco lives is infested by ‘kissing bugs’, the insects that transmit Chagas disease. There are many infected among the indigenous population. He knows because since 2003 he works as a community leader in public health. He studied medicine at the University of Magdalena but changed the course to environmental sciences. Now he educates children in his community about Chagas disease and how to avoid the kissing bugs.

Despite the large number of cases of Chagas, which surprised the researchers who visited the area, from the perspective of the Kogui worldview, there is no cause for alarm: ‘Diseases are part of life, born with us because they are a form of natural control’, says Duámaco. ‘What happens is that human beings want to alter the normal cycle of life and, therefore, persist to cure diseases’, he says.

According to his community’s beliefs, the insect that transmits the disease is not bad. It lives among people and drinks their blood, because humans have invaded its territory, leaving it with no options for survival. ‘The kissing bug is a guardian of Mother Earth and by transmitting Chagas disease, it charges us for all the evil that we are doing to the environment. He is charging a spiritual debt’, he says.

Ironically, Duámaco was diagnosed with the disease between 2008 and 2009, he does not remember exactly when. He has the symptoms, but cannot receive the treatment, because it is only for children under 18 years old. ‘That’s the protocol’ said the indigenous health service provider in his area.

‘I dedicate myself to inform my community about Chagas disease, especially the children and youth. But what can I say to the adults, if they cannot receive the treatment?’, he says with some indignation. ‘The EPS [Health Promotion Agency] say they don’t know Chagas because they don’t want to assume the cost to treat it.’ He is aware that there are many people in his community with heart diseases, which, very likely, have their origin in Chagas disease; but it is difficult to ascertain, for those who die in the Sierra Nevada do not have an autopsy and the news of the deaths fail to reach nearby urban centres.

Duámaco doesn’t know what he has done wrong or why Chagas is charging him, but he lives with dignity, serenity, and resignation to his illness. He doesn’t say it, but it seems that his effort to guide his community in health issues is a way to drive them out of neglect, of that deep and dark oblivion into which many people like him are plunged, people who no one knows about, not even when and how they die, there, deep in the Sierra Nevada.

 

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