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Controlled but not cured: Structural processes and explanatory models of Chagas disease in tropical Bolivia

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  • Forsyth, Colin

Abstract

Dressler (2001:456) characterizes medical anthropology as divided between two poles: the constructivist, which focuses on the “meaning and significance that events have for people,” and the structuralist, which emphasizes socioeconomic processes and relationships. This study synthesizes structuralist and constructivist perspectives by investigating how structural processes impact explanatory models of Chagas disease in a highly endemic area. The research took place from March–June 2013 through the Centro Medico Humberto Parra, a non-profit clinic servicing low income populations in Palacios, Bolivia and surrounding communities. Semistructured interviews (n = 68) and consensus analysis questionnaires (n = 48) were administered to people dealing with Chagas disease. In the interview narratives, respondents link Chagas disease with experiences of marginalization and rural poverty, and describe multilayered impediments to accessing treatment. They often view the disease as incurable, but this reflects inconsistent messages from the biomedical system. The consensus analysis results show strong agreement on knowledge of the vector, ethnomedical treatment, and structural factors related to Chagas disease. In interpreting Chagas disease, respondents account for the structural factors which place them at risk and impede access to care.

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  • Forsyth, Colin, 2015. "Controlled but not cured: Structural processes and explanatory models of Chagas disease in tropical Bolivia," Social Science & Medicine, Elsevier, vol. 145(C), pages 7-16.
    • Handle: RePEc:eee:socmed:v:145:y:2015:i:c:p:7-16
    DOI: 10.1016/j.socscimed.2015.09.022
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    1. Weller, Susan C. & Baer, Roberta D. & Garcia de Alba Garcia, Javier & Salcedo Rocha, Ana L., 2012. "Explanatory models of diabetes in the U.S. and Mexico: The patient–provider gap and cultural competence," Social Science & Medicine, Elsevier, vol. 75(6), pages 1088-1096.
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    4. Jennifer M Manne & Callae S Snively & Janine M Ramsey & Marco Ocampo Salgado & Till Bärnighausen & Michael R Reich, 2013. "Barriers to Treatment Access for Chagas Disease in Mexico," PLOS Neglected Tropical Diseases, Public Library of Science, vol. 7(10), pages 1-10, October.
    5. Miller, Elizabeth M., 2011. "Maternal health and knowledge and infant health outcomes in the Ariaal people of northern Kenya," Social Science & Medicine, Elsevier, vol. 73(8), pages 1266-1274.
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    1. Cucunubá, Zulma M. & Manne-Goehler, Jennifer M. & Díaz, Diana & Nouvellet, Pierre & Bernal, Oscar & Marchiol, Andrea & Basáñez, María-Gloria & Conteh, Lesong, 2017. "How universal is coverage and access to diagnosis and treatment for Chagas disease in Colombia? A health systems analysis," Social Science & Medicine, Elsevier, vol. 175(C), pages 187-198.
    2. Martínez-Parra, Adriana Gisela & Pinilla-Alfonso, Maria Yaneth & Abadía-Barrero, César Ernesto, 2018. "Sociocultural dynamics that influence Chagas disease health care in Colombia," Social Science & Medicine, Elsevier, vol. 215(C), pages 142-150.

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