Sydney Worrall Reflection – Health policies in Bolivia: Vector-borne diseases

Sydney Worrall, a College of Medicine student, was awarded a Center for Global Health Student & Trainee Travel Grant in early 2024 to pursue a project with Child Family Health International in Tarija, Bolivia. View more photos of her time in Bolivia in this Flickr photo gallery.

Traveling alone to another country can be a nervous, but exciting experience. It has been several years since I have been able to travel and be fully immersed in another culture and health care system. I was very grateful for a smooth 24-hour journey to Tarija, Bolivia from Charleston and that my bags made it through 3 layover transfers. Arriving in Tarija was almost like landing home in Charleston with the first feeling of heat and humidity. 

I was greeted at the airport by the amazing Fabricio who runs the Child Family International Health program in Bolivia and his wife the medical director Dr. Karina Gamarra. They immediately took me to the Ferreyra family who would be hosting me for the next month and I promptly passed out for most of the day from travel exhaustion. The next day I met Karina and Fabricio for dinner to go over my project and what each week in Tarija would entail.

My project focused on the Bolivian Health system and vector borne illnesses of Dengue Fever and Chagas Disease both of which are endemic to Bolivia. Chagas is one of the most prominent public health focuses in Bolivia since almost the entire country is susceptible. The first week I was in the Centro de Salud Nestor Paz, which is similar to a neighborhood primary care doctors office. The second week I was at the Plataforma de Chagas which focuses solely on Chagas diagnosis, treatment, and follow-up. They also have a government funded chagas project on medication treatment with varying dosing and times (30, 45, and 60 days). The current treatment is 60 days of benznidazole or nifurtimox. Both medications have some unpleasant side effects and compliance is a concern in treatment due to the length of time. My third week I was in the government Entomology Laboratory testing Triatoma Infestans insects for Trypanosoma cruzi infestation, as well as examining Dengue containing mosquitos. My last week was focused on finishing my research and presentation with Dr. Gamarra and sometime in the main hospital.

The most impactful part of my experience was going out in the community with the Centro de Salud nurses and physicians and going out with the Entomology Lab to find the Triatoma infestans bugs in people’s homes. Both experiences showed the life outside of the city center and this is where I was able to see the door-to-door vaccinations and health checks. This was so important for the families who didn’t have time to take their children to the health center during the day due to work, school, or transportation issues. These neighborhoods were about a 20-minute drive from the health center, and it could be a difficult walk for young children or the elderly. With the entomology lab it was impressive to see how searching for the bugs goes and where they commonly hide in the outdoor areas and inside the house. If any bugs were found, they were caught, brought back to the lab and tested, and if positive for T. cruzi, then technicians are sent out to spray for the bug and the family is recommended to go to the Chagas platform for testing.

Throughout my time in Bolivia, I was able to regain my fluency in Spanish and see a new healthcare system. What struck me the most was the amount of outreach to the community that is built into the practice here. The health center went out one a month or more often during vaccination season for school. Each community has a health board with leadership from the community to tell the needs of the community. Having this direct input makes such a difference in care and I would love to incorporate this more into my future practice.