The Bolivian consulate in Barcelona has hosted a trial coordinated by the Asociación de Amigos de Enfermos de Chagas (ASAPECHA) and the Public and Community Health team of the Drassanes-Vall d'Hebron Centre for International Health and Infectious Diseases to improve the detection of Chagas disease among the population of the Andean country. The results published in BMC Infectious Diseases prove the effectiveness of involving a country's consulate in community health campaigns aimed at the population they represent. The initiative has focused on raising awareness of Chagas disease with the aim of increasing the number of diagnostic tests. Chagas disease is a little-known pathology in Catalonia, but of great concern in Bolivia.

Chagas disease is caused by infection with the Trypanosoma cruzi parasite found in some species of bedbugs in South America. The World Health Organisation estimates that six to seven million people are currently affected worldwide. It is considered a silent disease because patients may be asymptomatic for a long period of time. However, in the absence of early detection and treatment, one third of those infected will have life-threatening conditions, mainly cardiac, but also digestive or neural. In addition to the difficulty of detecting a silent disease, Chagas has a strong social stigma and is largely unknown outside the regions where it is endemic. As a result, the population of South American origin living overseas has a high rate of under-diagnosis.

The strategy proposed by the community health team of the Vall d'Hebron International Health Unit was to hire two Bolivian community agents who were trained in how to raise awareness and inform about Chagas disease. These agents are more effective because they speak the languages, dialects, and understand the culture of the target audience, which facilitates the establishment of a bond of trust. The action was carried out with the complicity and collaboration of the Bolivian consulate, a strategic place because it is visited by most of the community, as there are administrative processes that can only be done there. This action is part of a new concept of community health called 'Hospital Without Walls'. This initiative empowers civil society to identify the main psychosocial triggers that need to be addressed, encouraging them to participate in the design, development, and implementation of their own prevention and intervention strategies.

Two different campaigns were implemented. The first was informative and encouraged users to go to the Drassanes centre for a test. The second was more hands-on and offered on-site diagnostic tests. This proved to be more efficient (100% of people who were offered a test accepted it), as it is much easier for the user to take the test on the spot than to travel to another centre. A total of 309 tests were carried out, 17% of which were positive.

Useful for other health campaigns

The strategy also proved useful beyond Chagas disease; for example, 51 cases of other diseases and infections were detected and treated. For this reason, it has been proposed to incorporate the strongyloidiasis test into the screening carried out at the consulate, as this parasitic infection was found to have a high incidence among the population.

At the same time, the campaign served to remind users of pending vaccinations and to take steps to obtain a complete immunisation. These other benefits certify that consulates can be key allies when it comes to carrying out community health interventions among their users. These are sectors of the population that, due to culture, language or custom, can be very difficult to reach with traditional campaigns.