The integration of traditional Indigenous knowledge with medical expertise is a defining feature of an innovative project to tackle Chagas disease, developed by the Drugs for Neglected Diseases initiative (DNDi) and partners in Colombia. The pilot project is being implemented in the Sierra Nevada de Santa Marta mountains of northern Colombia, home to the Indigenous Wiwa people, where one in three people live with the disease
The approach is already bearing fruit. Treatment adherence among women, children, and adults has been high: fewer than 10% of patients diagnosed discontinued treatment before completing their full treatment course. According to medical literature, the average dropout rate is 20%.
Carried out in partnership with local leaders, the Organización Wiwa (Organización Wiwa Yugumaiun Bunkuanarrua Tayrona), the health organization Dusakawi IPSI, and the municipal government, the project brings diagnosis and treatment to the community and incorporates traditional knowledge into strategies to eliminate the disease.
‘All health actions developed with Indigenous peoples must be intercultural. This interaction between ancestral Indigenous knowledge, traditional Indigenous medicine, and Western medicine—as some call it, referring to the medicine of the big cities—is essential. They must go hand in hand to expand access and treatment for these populations who have long been affected by Chagas,’ says Dr Rafael Herazo, DNDi medical focal point and specialist in Chagas disease.
In 2024, a total of 1,577 tests were carried out in the Wiwa community at the Dusakawi IPSI laboratory—an unprecedented achievement. Of these, 82% were for women and 12% for children. T. cruzi—the parasite that causes the disease—was detected in 14% of those tested, around 90% of whom began treatment shortly after diagnosis.
The Wiwa who tested positive are among the estimated 450,000 people living with Chagas disease in Colombia, according to the World Health Organization (WHO). There are 12 million people living in the nearly 600 municipalities of the country considered at risk for Chagas transmission by the national Chagas subprogramme.
As symptoms can take years, sometimes decades to develop, most people with Chagas do not know that they are living with the infection.
Chagas, among other forms, is transmitted by triatomine insects, or ‘kissing bugs’. They are known locally as pitos. The Wiwa did not associate the bite of the pito with illness. For them, these insects are enchanted beings—considered sacred guardians that appear in homes to collect spiritual debts caused by the destruction of nature.
‘I didn’t know they could strike us so hard, causing us so many problems—even death,’ says José Maria Martinez, director of the Indigenous organization Dusakawi IPSI.
To truly eliminate Chagas disease, it’s essential to control these vectors. But how do you do that in a community where insects are considered part of the community?
The answer came from the leaders themselves. Before fumigation, a Mamo – a Wiwa spiritual leader—performs a ritual ceremony using seeds from native trees so that the pito do not suffer. Mamo Juan Pastor Simón explains that the ceremony calms the insects so that they stay in the forest and do not reinfest the houses.
Spreading information about the disease also involves the whole community. Víctor José Loperena Mindiola, a well-known 67-year-old local leader, is a major ally in this effort. Mindiola is also a musician who travels between communities, bringing entertainment along with potentially life-saving information. He makes a point of telling people about his own treatment: ‘The medicine is strong, but I managed to complete the treatment,’ he says proudly.
Prioritizing the needs of women and children
The work with the Wiwa also addresses congenital transmission, or transition from mother to child during pregnancy. ‘Interrupting the disease in future generations necessarily depends on diagnosing and treating women of childbearing age so they don’t transmit the disease to their children during pregnancy,’ says Dr Rafael Herazo.
Wiwa women have been included in an evaluation to assess the performance of simple rapid diagnostic tests for Chagas, led by the Colombian National Institute of Health and DNDi. This activity contributes to achieving one of the goals of the Pan American Health Organization (PAHO) EMTCT-Plus initiative in the Americas: to test and treat 90% of women and newborns.
When a pregnant woman tests positive, her baby should be tested as soon as it is born. If her baby has Chagas, treatment must begin immediately. And treatments need to be specially adapted for young children’s needs.
Together with partners such as ELEA and FMS laboratories, DNDi has developed a water-soluble, oral formulation of the medicine benznidazole for children weighing up to 20 kilograms, making it much easier to administer the drug. A paediatric formulation of another medicine, nifurtimox, is also available. It is estimated that almost 100% of newborns can eliminate the parasite if treated in the first year of life.
Most children with Chagas show no signs or symptoms of the disease, but Chagas can also result in severe clinical manifestations if children are not treated, including heart failure and neurological problems.
To halt congenital transmission, it is essential to prioritize the prevention, control, and treatment of Chagas disease by ensuring that young women of childbearing age, especially those from endemic areas, are tested and treated appropriately. Interrupting the chain of infection from mother to child can protect the health and security of families and communities for generations to come.
This World Chagas Disease Day, we are happy to celebrate the health of the Wiwa people!
Photo credit: Neil Brandvold-DNDi
