The Case of a Tropical Disease and Its Treatment: Science, Society, and Economics

by
Cathy Santanello, Department of Pharmaceutical Sciences, Southern Illinois University at Edwardsville
Jennifer Rehg, Department of Anthropology, Southern Illinois University at Edwardsville

Part I—A Mysterious Ailment

Although he was afraid to take off from work and risk losing his job at the banana plantation, Adrian Mora decided he was much too weak to continue his ten hour shift. He had already spent most of the morning applying pesticides and covering clusters of bananas on the trees with plastic bags in order to protect them from wind, birds, and insects. He informed his boss, Don Jose, he must go home and rest, but he would work extra hours later in the week to make up the lost time.

He walked through the farm, set against the edge of remnant fragments of lowland tropical rainforest. This part of southwestern Costa Rica used to be continuous forests and mangrove swamps, but as the land was developed for fruit plantations, cattle ranches, and other types of agriculture, the forests were cleared. Small wooden houses set on low stilts now lined cleared strips of land between the bananas and the forest edge. Palm trees were left standing to provide some scant shade and so that the workers could make use of the palm fronds for roof thatch. Tangled scrubby, secondary growth vegetation stretched out to the houses from the forest edge, years after the clear-cutting. Many workers lived here to be near the plantation rather than commute from the town of Quepos 65 km away (see map).

Adrian was an illegal immigrant from Nicaragua. He had fled south with his brother, Alejandro, to Costa Rica in search of a better economic future about seven years ago. He and his brother did not want to risk the chance that they might be deported, so they had never applied for official permission to live in Costa Rica. Another Nicaraguan immigrant had helped him and Alejandro get jobs at the banana plantation as temporary workers. The brothers worked whenever the plantation needed some extra help, especially during harvest time. They moved around from one farm or plantation to the next as unskilled laborers. At the plantation Adrian made 110,000 colones (about US$200) per month. This was less than Costa Rican minimum wage, but since he and his brother were not legal workers, they were not listed on official employee records. As an indocumentado, Adrian had to take whatever work was available, and often for less than what a Tico would be paid and without other benefits.* The brothers continued to send money to their mother and younger siblings back in Nicaragua. At least the plantation owner allowed him and his brother to live in one of the plantation houses for free.

Adrian arrived back at the three-room house that he and Alejandro shared. They had trouble keeping the house clean because they rarely took a day off while working at the plantation. Since their jobs were not secure, they worked as much as possible when the plantation needed them. Cracks between the slats of the wooden walls and floor allowed dirt and insects to enter the house. Adrian looked up at a few, small open spaces in the thatched roof, and realized they needed to collect more palm fronds to patch it.

As he lay in his hammock into the evening hours, he wondered why he was not feeling well. “Maybe I’ve just been in the sun too long. Or maybe I am sick from the chemicals sprayed on the fruit trees,” he thought. “I have heard of Ticos who have gotten cancers from their prolonged exposure to the pesticides. Could the pesticide that we use on the bananas cause me to feel so poorly?” Adrian rubbed absent-mindedly at his eyelid, which was becoming swollen. “I am so tired, and should eat something to keep my strength. But I am not hungry at all.”

Adrian was worried enough he considered visiting a doctor at a local clinic. “Despite my low wages, I could probably still afford to visit a doctor.” Costa Rica had a national health care system with affordable services and treatments, and healthcare was extended to illegal immigrants as well as citizens and legal refugees. “But I do not want to take the chance that if I go to a doctor, someone might find out that I am here illegally and report me.”

His heart seemed to beat oddly and he felt flushed. Adrian hoped that this was simply a result of his anxiety. He blankly stared at the insects swarming around the electric lamp on the porch, lit each night to keep away nocturnal animals. Adrian swatted at a bug alighting on his forehead as he drifted off to a restless sleep.

* Indocumentado literally means “undocumented” or without identity papers; the term is commonly applied to illegal immigrants. Tico is a nickname for Costa Ricans; the formal spanish name for a person from Costa Rica is Costarricense.

Background

In order to become familiar with diseases endemic to Costa Rica, read the following webpages on health concerns in Mexico and Central America from the U.S. Centers for Disease Control and Prevention:

• http://wwwn.cdc.gov/travel/regionCentralAmerica.aspx
• http://wwwn.cdc.gov/travel/destinationCostaRica.aspx

Make sure to investigate the links to additional information on diseases listed for this region, or other internet sites which include information on these diseases and their symptoms.

Questions

1. What are some important infectious human diseases that are endemic to Costa Rica and Central America, based on information from the Centers for Disease Control?
2. What types of symptoms characterize these diseases?
3. What are some similarities in the symptoms of these diseases that might complicate diagnosis of a specific condition?
4. What are some peculiar or specific symptoms to each disease that might aid in diagnosis?
5. How might a patient’s environment (e.g., living conditions, socioeconomic situation) relate to accurate diagnosis?

References

The following references provide further background information.

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Centers for Disease Control and Prevention, Division of Parasitic Diseases. Reviewed September 23, 2004. Fact Sheet.

http://www.cdc.gov/chagas/factsheet.html. Accessed on Oct. 10, 2006.

Chiquita Brands International, Chiquita in Costa Rica.

http://www.chiquita.com/Discover/images/costaeng.pdf. Accessed on Oct. 10, 2006.

Emaús, F. 1998. The price of bananas: The banana industry in Costa Rica. Global Pesticide Campaigner 8(1).

http://www.panna.org/resources/pestis/PESTIS980522.4.html. Accessed on Oct. 10, 2006.

Food and Agricultural Organization of the United Nations (FAO); Committee on Commodity Problems; Intergovernmental Group on Bananas and on Tropical Fruits. First Session, Gold Coast, Australia, 4–8 May 1999; The Impact of banana supply and demand changes on income, employment and food security.

http://www.fao.org/docrep/meeting/X1390E.htm. Accessed on October 1, 2006.

Kollien, A.H. and G.A. Schaub. 2000. The development of Trypanosoma cruzi in Triatominae. Parasitology Today 16:381–387.

Mannon, S.E. 2005. Pathways to informal work in Costa Rica. American Sociological Association. Philadelphia, PA. August 2005.

Martin, C. 1999. Bananas—The facts. New Internationalist 317.

http://live.newint.org/issue317/facts.htm. Accessed on Oct. 2, 2006.

Romaña, C.A., D. Brunstein, A. Collin-Devalaud, O. Sousa, and E. Ortega-Barria. 2003. Public policies of development in Latin America and Chagas disease. The Lancet 262:579.

Rosero-Bixby, L. 2004. Spatial access to health care in Costa Rica and its equity: A GIS-based study. Social Science and Medicine 58:1271–1284.

Umezawa, E.S., A. M. Simonsen Stolf, C.E.P. Corbett, and M.A. Shikanai-Yasuda. 2001. Chagas disease. The Lancet 357:797–799.

United Nations Conference on Trade and Development (UNCTAD), INFO COMM: Market Information in the Commodities Area. Information on banana.

http://www.unctad.org/infocomm/anglais/banana/sitemap.htm. Accessed on Oct. 10, 2006.

U.S. Department of State. Costa Rica: Country reports on human rights practices—2004. Released by the Bureau of Democracy, Human Rights, and Labor, February 28, 2005.

http://www.state.gov/g/drl/rls/hrrpt/2004/41755.htm. Accessed on October 1, 2006.

U.S. Department of State. Costa Rica: Country reports on human rights practices—2005. Released by the Bureau of Democracy, Human Rights, and Labor March 8, 2006.

http://www.state.gov/g/drl/rls/hrrpt/2005/61722.htm. Accessed on October 1, 2006.

Wesseling, C., A. Ahlbom, D. Antich, A.C. Rodriguez, and R. Castro. 1996. Cancer in banana plantation workers in Costa Rica. International Journal of Epidemiology 23(6):1125–1131.

Wiley, J. 1995. Undocumented aliens and recognized refugees: The right to work in Costa Rica. International Migration Review 29(2):423–440.

World Health Organization. Chagas disease.

http://www.who.int/tdr/diseases/Chagas/. Accessed on Oct. 10, 2006.

Date Posted: 12/15/07.

 

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