"Improving the health status of underserved populations through sustainable and comprehensive research, service and educational initiatives related to infectious diseases."

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As our group tours a hospital in Shell near Puyo, Ecuador that has been set up by evangelic missionaries, we hear Spanish spoken with a United States accent. This is a hospital where many doctors and nurses from the United States and other countries can come to work, some specifically with tropical diseases. As we enter the lab, we are told of a 9-month-old boy, brought in recently with symptoms of high fever, general malaise, and vomiting. A blood smear had helped confirm the diagnosis of Chagas disease.  The child was given medication and eventually recovered; however, the lab retained the blood smear and we were able to view the slides showing Trypanosoma cruzi trypomastigotes, the parasites responsible for this tropical disease.

Within the workshop, my impression was that Chagas disease is the tropical disease least understood by the people of Ecuador. Chagas is spread through the feces of Triatominae insects (Kissing Bug) that become an infectious vector after feeding on the blood of an infected host.  The first stages of Chagas can create mild symptoms that may go unnoticed or may require more serious attention, as in the case we encountered. The disease may lie dormant for up to 20 years only to later develop cardiac, esophageal, or bowel problems and ultimately death.  Because Chagas is currently incurable, except if detected early in infection, it is important to detect risk factors and work in a preventative manner in endemic areas to control the disease. Chagas is thought to be concentrated in specific areas in Ecuador.  During our visit we heard of few cases, of which many are sent to the capital, Quito, for confirmatory diagnostic and treatment. This case near Puyo is new to the area and provided the need for a deeper look into the new community with Chagas.

We study the kissing bugs collected from a house with a case of Chagas disease

Many of the houses in the community are poorly built with cracks in the walls, ceiling, and floors

Our group was able to visit the community were the Chagas case came from, which consisted of only 10 houses. Since the initial search of the house and the peridomicile, the family had collected multiple kissing bugs, of which one is confirmed to be Rhodnius robustus, a known vector of Chagas disease in the Ecuadorian Amazon. Many of the houses in the community are poorly built with cracks in the walls, ceiling, and floors.  At night, kissing bugs are attracted to the light from the houses and are able to find a human host through the cracks of the house, creating a risk for the transmission of Chagas.  We were honored that the families allowed us to meet them and look at their houses and peridomicile. We visited several houses in the community and met many of the dwellers.  This experience provided a deeper look into the true problems that lead to the spread of the Tropical diseases with which we are concerned and the issues that face this country.  Other communities we visited show many of the same problems with an emphasis in the lack of economic security.  This contributes to the spread of Chagas and other Tropical Diseases.  While visiting the hospitals and health centers during this workshop shows one side of the story, the communities themselves demonstrate the spectrum of the issues we study.  It is important to understand Tropical diseases from beginning to end, from transmission to treatment and beyond. This workshop has gone beyond even this to help us see first hand the range of factors contributing to the ongoing presence of tropical diseases.