1. Access to Healthcare and Perceptions of Chagas Disease among Latin American migrants in Geneva, Switzerland
Marina Gold, Yves Jackson, Maria Teresa Cardenas, Oscar Montoro, Gaelle Martinez and Pedro Albajar Vinas
1. Introduction
Chagas Disease management entails complex problems in non-endemic countries:
Frequent lack of awareness of patients' socio-cultural contexts by health professionals
Irregular migratory status of communities at risk
Lack of access to screening/diagnosis and treatment
Lack of understanding of Swiss medical care by patients
Less than 10% of CD-affected migrants are diagnosed and treated.
Assess prevalence and perception of CD in Geneva.
3. Results
80 and 140 people were estimated to have attended the events in 2016 and 2017 respectively, 39 and 66 were screened. Most were women (76%) and from Bolivia (87.2%).
Overall, 12/105 were seroreactive and 99 responded to the questionnaire.
Questionnaire results revealed a poor understanding of Chagas disease transmission, notably regarding congenital and blood transfusion and organ transplant routes – all three relevant in non-endemic countries.
The questionnaire and interviews revealed a low priority given to personal health in the context of post-migration cumulative stress, irregular residency status and daily life challenges to harness income.
Top life priorities are given to: 1) taking care of family, 2) leisure time (given its scarcity in a migration oriented to work); 3) securing and maintaining employment.
Remittances sent to children and relatives in home country leave migrants in a very vulnerable economic situation.
Employment and family duties are placed above general health.
General health is rarely understood as the lack of disease and is instead composed of a complex aggregate of social and affective commitments: being able to fulfill family duties, a balanced social life, the importance of a good nutrition, and a safe working environment.
The general mistrust in the health care system creates a complex situation for migrants and health professionals to communicate about preventive health practices. This does not only emerge from migrants’ irregular migratory status, but of a previous mistrust against official institutions which can be traced back to migrants’ experiences in their home country.
WHO 2013
2. Methods
This is a collaboration between the patient’s association Aswisschagas, the Geneva University Hospital, Mundo Sano and the World Health Organization
During the 2016 and 2017 Chagas Day annual meeting we offered free serological testing using a rapid diagnostic test (Stat-Pak, ChemBio Inc.) and in 2017 a check of blood pressure and sugar levels, aiming to de-stigmatize the Chagas test.
We also conducted a qualitative survey on health perceptions and general knowledge on Chagas disease.
The surveys are part of an on-going anthropological analysis of health perceptions among Latin American migrants in Geneva. The questionnaire explored: 1) the degree of knowledge about CD; 2) the epidemiological exposure to the disease; and 3) the respondents’ general health perceptions.
Four in-depth interviews were conducted between the two events, providing in-depth anthropological understandings of health perceptions.
Concepts associated with good health
Members of HUG and Aswisschagas conducting the serological tests, 2016
4. Conclusions
 Even in communities where Chagas disease is part of the cultural lore, there are misconceptions regarding its transmission methods which need to be addressed.
 While health is an important element of migrants' daily concerns, it is constantly negotiated with other social and economic priorities, such as family commitments and employment.
These findings suggest avenues for improvement:
Capacitating the community on Chagas disease literacy
 Different health priorities as well as often incompatible notions of health and appropriate health-seeking behavior cause miscommunication between patients and doctors.
Allowing the healthcare system to respond in a more culturally sensitive way to migrants’ health needs
Working synergistically between community and health care professionals to address the issue more holistically
 Other migration studies1 reveal that in the face of economic austerity employment is a means to an end and helping family and access to food are key determinants of a ‘good' life.
Consider the issue of Chagas disease in a comparative way to learn from other non-endemic countries’ experiences2
1 Castañeda, H. (2010). “Im/migration and health: conceptual, methodological and theoretical propositions for applied anthropology” NAPA Bulletin, 34, doi: /j x
2 Soriano-Arandes, A., Angheben, A., Serre-Delcor, N., Treviño-Maruri, B., Gómez i Prat, J., & Jackson, Y. (2010). “Control and management of congenital Chagas disease in Europe and other non-endemic countries: current policies and practices.” Tropical Medicine and International Health, 21(5), doi: /tmi.12687
Supported by World Health Organization
Copyright Colin Purrington (