Onchocerciasis: The Last Challenge

Diseases that make the world invisible

Imagine not being able to see the sun’s light, the blue sky, or the road home. That is the reality for people with onchocerciasis, a neglected disease that causes skin and eye lesions that, if not treated in time, can cause blindness.

Latin America is a world example in the fight against this disease. Colombia, Ecuador, Guatemala, and Mexico have already eliminated onchocerciasis, also known as river blindness. The yanomami territory in Brazil and Venezuela is the last stronghold for eliminating this disease in the region.

The Last Challenge

Onchocerciasis is transmitted through the bite of a fly found in river basins. Treatment with a tablet can prevent this disease.

In order to eliminate the last foci of river blindness in the Americas, an antiparasitic treatment is administered to nearly 20,000 yanomamis twice a year. Brazil has been giving this treatment for eight years, to accelerate the elimination of this disease. The physicians who travel to their territory also treat all patients, look among the yanomamis for those with signs of ocular or skin disease, conduct awareness campaigns and collect flies in sentinel areas to confirm whether the parasite that transmits the disease is present.

Distance is not a barrier to delivering health

A medical team travels to the farthest reaches of Brazil’s Amazon jungle, where the yanonamis live. Physicians, nurses, laboratory technicians and other professionals fly there once a month, to treat and prevent different diseases among this indigenous population.

Using and fueling the airplane has a very high cost. Brazil’s Ministry of Health devotes R$26 million (about US$ 6 760 000) every year just to pay for flying time, as this exceedingly remote area of the Amazon can only be reached by air.

Those most affected by onchocerciasis

The nomadic yanomami indigenous populations that move freely in the border area between Brazil and Venezuela are the hardest hit by onchocerciasis or river blindness. Their access to health care has a high operational cost given the distance and the large area they cover across the two countries.

In Brazil, the yanomami Indigenous Special Health District spans 97,000 square km (almost twice the size of Honduras, for example) in the Amazon jungle in the state of Roraima. There are 319 villages there, with a population of nearly 16,000 from the Yanomami and Ye’Kuana ethnic groups. In Venezuela, some 16,300 yanonamis live in 8,200 square km in the Upper Orinoco, in the Casiquiare Biosphere Reserve.

Together, these two areas form the largest forested indigenous territory in the world. But for the yanomamis, this is a single land, and we must go to them to treat for onchocerciasis.

Health in their language

Indigenous advisors are part of the health team that visits the yanomami communities in Brazil and Venezuela. Their job is to speak with each member of the yanomami community and explain how the drugs work and what medicines they should take to prevent onchocerciasis.

Part of their job is to inform the population about the symptoms of this disease, how it can be contracted, and how to prevent it.

The curse of Xawara

The yanomamis call infectious diseases “xawara.” The “xapirí” or shaman cannot cure these diseases, because they were brought in by agents from outside their habitat. This population lives in areas where there is illegal mining, fires have destroyed their homes, and they face diseases previously unknown to them.

To treat onchocerciasis there, it is very important to understand the yanonamis’ cultural and ethnic cosmovision. This is where Brazilian comprehensive health care, through the Special Secretariat of Indigenous Health (SESAI), comes into play, forging a link between ancestral health and the public health care system. The health team that travels to this corner of the Amazon jungle also includes an anthropologist who remains contact with the state medical health team and the xapirí.



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