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Health, Migration, and NTDs: An Anthropological View

Also called American trypanosomiasis, Chagas disease was first discovered by the clinician and scientist Carlos Justiniano Ribeiro Chagas in 1909 in Brazil, who identified a new species of flagellated microorganism that was to be found in the intestines of hematophagous insects, in the blood of various domestic animals, and in the blood of people. The parasite was called Trypanosoma cruzi, in honor of Professor Oswaldo Cruz (Araujo-Jorge et al. 2017). One hundred and eleven years later, on April 14, 2020, World Chagas Day was officially recognized and celebrated for the first time. The objective was to give visibility in the global health agenda to the challenges faced by people affected by Chagas disease. In the midst of the COVID-19 pandemic, the celebration of a neglected tropical disease was obviously obscured by more imminent concerns. This is the nature of neglected tropical diseases (NTDs); also referred to as silenced diseases. “When we say that Chagas disease is a silent disease we are simply stating a fact: in most cases it is a disease that presents no suspicious signs or symptoms for several years [. . .] until a heart or digestive dysfunction develops in its chronic stage. However, when we say that Chagas disease is a silenced disease we want to stress that there are those who wish to silence it” (Medecins Sans Frontier 2005, my emphasis). Chagas disease is silenced because it is (or was once) a disease of poverty, and affects people who are not the main target of pharmaceutical research. It is also a disease prevalent in rural areas and often among indigenous communities, where silence is tied to a legacy of colonial domination, expropriation, and exclusion of indigenous people from national projects across Latin America. As Parker and Allen argue (2014:224) “it is mostly neglected people who are infected with neglected diseases.” The silence that engulfs Chagas as a neglected disease extends beyond its endemic context and affects people in non-endemic countries through migration. In non-endemic countries, the lack of knowledge of the disease by the medical profession, the precarious status of migrants, and the complexities of vertically transmitted Chagas shroud the disease with additional complications. The World Health Organization recognizes that infectious diseases of poverty (another way to refer to NTDs) are intrinsically connected to structural violence (Farmer 2004). The terminology “Neglected Tropical Disease” is a legacy of colonialism, as these were associated with tropical colonies, exotic, remote, and not concerning Europeans. Renaming the infectious diseases of poverty aims to focus on the fact that these diseases are often a result of poverty and are not necessarily connected to a specific geographic location. However, the term “neglected tropical disease” is the more prevalent one, and its abbreviation NTD is widely used among researchers and public and private organizations dedicated to “end the neglect.” The fact that the terminology “infectious diseases of poverty” did not gain traction within the various disciplines and organizations that deal with these diseases is a question worth pondering. It is a weighty (and still very much unresolved) colonial legacy that permeates all disciplines dealing with NTDs. The hierarchy of knowledge (with biomedicine at the apex and social sciences at the base), the structure and geographic location of donor and beneficiary organizations, the interactions