title: Controlled but not cured: Structural processes and explanatory models of Chagas disease in tropical Bolivia.
abstract: Dressler (2001:456) characterizes medical anthropology as divided between two poles: the constructivist, which focuses on the "meaning and significance that events have for people," and the structuralist, which emphasizes socioeconomic processes and relationships. This study synthesizes structuralist and constructivist perspectives by investigating how structural processes impact explanatory models of Chagas disease in a highly endemic area. The research took place from March-June 2013 through the Centro Medico Humberto Parra, a non-profit clinic servicing low income populations in Palacios, Bolivia and surrounding communities. Semistructured interviews (n = 68) and consensus analysis questionnaires (n = 48) were administered to people dealing with Chagas disease. In the interview narratives, respondents link Chagas disease with experiences of marginalization and rural poverty, and describe multilayered impediments to accessing treatment. They often view the disease as incurable, but this reflects inconsistent messages from the biomedical system. The consensus analysis results show strong agreement on knowledge of the vector, ethnomedical treatment, and structural factors related to Chagas disease. In interpreting Chagas disease, respondents account for the structural factors which place them at risk and impede access to care.
authors.affiliation: Department of Anthropology, University of South Florida, 4202 E. Fowler Avenue, SOC 107, Tampa, FL 33620-8100, USA. Electronic address: cforsyth1@tampabay.rr.com.
authors.forename: Colin
authors.initials: C
authors.lastname: Forsyth
mesh_terms: D000884:Anthropology, Cultural; D001294:Attitude to Health; D001838:Bolivia / Q000453:epidemiology; D014355:Chagas Disease / Q000453:epidemiology / Q000209:etiology; D019353:Endemic Diseases; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D011204:Poverty Areas; D012424:Rural Population; D011795:Surveys and Questionnaires
keywords: Bolivia; Chagas disease; Consensus analysis; Explanatory models; Structural barriers