Raghavan, Maya

School of Public Health - International Health



Bolivia-Chagas Disease Surveillance in an Endemic Community in Rural Bolivia

American trypanosomiasis, also called Chagas Disease is a vector-borne disease caused by an infection of the protozoan parasite Trypanosoma cruzi. There are two stages of Chagas disease; the acute phase which is usually asymptomatic, but symptoms are mild and characterized by fever, malaise.  Many cases of chronic infection are asymptomatic, but about 20% to 30% of cases chronic infection can lead to major complications: Chagas cardiomyopathy or gastrointestinal Chagas disease.

Chagas disease is a neglected tropical disease that disproportionately affect the poorest persons, usually living in rural areas.  Chagas is most important parasitic disease in the Western Hemisphere, with an extremely high morbidity rate.  It is estimated that the disease burden, measured in disability-adjusted life-years, is 7.5 times as much as malaria. Chagas is endemic to Latin America which had an estimated prevalence of 5.7 million in 2010.

Bolivia, in particular, has the highest prevalence of Chagas disease in the world - an estimated 6% of the population is infected with the parasite, and about 99% of infected persons are unaware of the infection. 

What we aim to do in an endemic, rural community are to 1) detect the prevalence of Chagas disease in an endemic community, 2) gain an understanding of the knowledge and attitudes of Chagas in the community and 3) carry out surveillance and elimination of the vector in the village.

PI Mentor: Robert Gilman

I stepped off of the plane into Bolivia and first saw sun and palm trees. The Santa Cruz airport was small, and I was through immigration and security quickly – after they had opened and gone through all of my luggage and questioned me about why I was traveling with a centrifuge. My Spanish right off the plane was not up to the task of describing what a centrifuge is used for, so I think they waved me through out of frustration more than acceptance. This was when I realized that I would not speak in English for the next six months, except to fellow American researchers, of which there were few. 

My first thought while making the three hour journey to the field site was how empty Bolivia felt. The road was flanked by large fields, and I learned later that this was the agricultural center of the country. I was not expecting the infrastructure to be as undeveloped as it was, even though I had read that Bolivia was the poorest country in South America by GDP. However, I loved Bolivia immediately. There were few tourists and even fewer Americans, so I had to interact and build relationships with local Bolivians to do my work and socialize. Sometimes I felt frustrated and just wanted to speak English to someone, to feel like I could express myself completely in my own native language. This could be challenging also because I did not have Wi-Fi or consistent cell service at the field site. Being disconnected allowed me to settle in and get to know people quickly, but I also feel isolated at times. I learned when I needed to reconnect and when being offline allowed me to fully experience and stay present in my time there. 

I was the project manager of my study, so I was in charge of planning nearly every logistical part of the process. This was more responsibility than I had taken on in previous studies that I had been a part of. I learned so much about organizing a team, building connections in a foreign country, working with a diverse team, data management, and most importantly, problem solving. I learned that working in public health can be 90% troubleshooting and thinking on your feet. We had a research protocol, but at every step some unforeseen issue would arise. I learned how efficiently I could work in the face of these stressful moments, and I learned how much I enjoyed the thrill of making everything come together successfully.

I remember being at the field site in the jungle with blood samples in 90 degree heat and no air-conditioning when the centrifuge stopped working. If we were not able to spin the samples before storing them, they would be unusable in that heat. We were hot and uncomfortable and growing more nervous by the minute. I had to run up the road to get cell service so that I could look up potential solutions online. I ended up putting a small fan in the centrifuge to cool it down between spins, after realizing that it was stopping because it was overheating. By the end of my project, I had three centrifuges under my bed, one of which worked properly. I had lugged these three hours from the city in a shared taxi and then on foot on a jungle trail and over a bridge to my house at the field site. 

I was often out of my comfort zone during this project, but I had a lot of fun experiencing and learning new things every day. The story about the centrifuges sums up one of the most unique tasks I had and how problem-solving with limited resources often occurred. I went in arrived in Bolivia with an open mind, so I think I was able to adapt quickly to the unexpected. I adopted a cat, and I also built a support system of friends and colleagues that kept me on my feet. To anyone with similar goals who wants to work in a developing country, I would emphasize how important finding a support system is and how important it is to keep an open mind and expect some difficulties. I loved my time in Bolivia, and I am grateful for all of the interesting and kind people that I met while living in such an incredibly beautiful country. I am looking forward to my next opportunity to work in international health.


May 2021



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