El regreso de las epidemias: Salud y sociedad en el Peru del siglo XX
Abstract
Investigaciones sobre distintas epidemias ocurridas en el Perú durante el siglo veinte; eventos dramáticos de una extraordinaria riqueza informativa que proporcionaban diversas perspectivas sobre la salud pública, la política y la sociedad.
... They were unlikely to drain wetlands considered irrigation reservoirs or reconstruct housing. In the Amazon, a philanthropic landowner society managed a hospital from 1908 to 1918, with state support thereafter [2]. Compliance was inconsistent. ...
... Adequate treatment was limited by the belief that water spirits caused malaria. Patients were sometimes under dosed or overdosed with quinine and prescriptions sometimes disguised using unfamiliar names due to side effects [2]. A major Amazonian epidemic (likely P. falciparum) occurred during 1932 in Cuzco department, which was larger than local epidemics going back to at least 1898. ...
... Out of a population of 25,000, there were 6,000-10,000 deaths and 15,000 sick. This led to the development of the Cuzco Health Directorate Anti-malarial Service [2]. Peru centralized its public health response in 1933 by creating the Health Directorate Hygiene and Prophylaxis Service, which purchased wholesale quinine from the National Agrarian Society. ...
Malaria has been part of Peruvian life since at least the 1500s. While Peru gave the world quinine, one of the first treatments for malaria, its history is pockmarked with endemic malaria and occasional epidemics. In this review, major increases in Peruvian malaria incidence over the past hundred years are described, as well as the human factors that have facilitated these events, and concerted private and governmental efforts to control malaria. Political support for malaria control has varied and unexpected events like vector and parasite resistance have adversely impacted morbidity and mortality. Though the ready availability of novel insecticides like DDT and efficacious medications reduced malaria to very low levels for a decade after the post eradication era, malaria reemerged as an important modern day challenge to Peruvian public health. Its reemergence sparked collaboration between domestic and international partners towards the elimination of malaria in Peru.
... The economic development of Pucallpa, with its exponential population growth and increase in river traffic, had severe impacts on Shipibo livelihoods. A deteriorating sanitation situation altered the quality of the Ucayali River, as exemplified by the 1991-1992 cholera epidemic that I will discuss in more detail in chapter 6 (see also Cueto, 2000;Hern, 1991). ...
... (Hern, 1991, p. 31 -my translation) As painfully recalled by my informants, ancient customs such as the collection of water straight from the river became suddenly harmful. Nonetheless, despite the 322,000 registered infections and 2,909 deaths in Peru during the first year of the cholera epidemic (Cueto, 2000), there was little concern with prevention of waterborne diseases in territories where people relied directly on river water for survival. In 2000, nearly a decade after the cholera outbreak, only 5% of households in native communities had access to improved water sources (UNICEF, 2017, p.3). Mai Joshin only received a cistern with a functioning water pump in 2015, as part of efforts from international organisations to mitigate inequalities in Amazonia (see chapter 2). ...
The social and economic inclusion of Indigenous children in Amazonia, who are
overrepresented in poverty indexes, is key for the achievement of Peru’s development goals. However, the notion of child well-being that guides social protection may conflict with Indigenous values. This thesis is a case study of children enrolled in social protection programmes in a Shipibo village in Peruvian Amazonia. It aims to understand how children experience State intervention in a village that has been enduring scarcity caused by river contamination and changes in flood patterns. The research was carried out in two stages: firstly, through participant observation and interviews over a period of 7 months. Secondly, through
remote and collaborative fieldwork during the COVID-19 pandemic, using various qualitative methods including draw-and-tell, collective mapping, semi-structured interviews, and focus groups with a mixed-gender sample of 48 children (mostly aged 9 to 13) and 11 parents. I complemented this data with document analysis of guidelines for programmes Juntos (a conditional cash-transfer), Vaso de Leche and Qali Warma (which provide school meals), along with Indigenous organisations’ alternative propositions of well-being. Findings indicate that children have conflicting aspirations due to their combined experience of social protection
mechanisms and socio-environmental changes. While children’s definitions of a good life share commonalities with those of adults, such as an appreciation for the territory and its socioecological networks, children tend to individualise experiences of ill-being. Consequently, children propose simplistic solutions to problems such as harsher floods, land invasions and labour migration. I argue that the individualisation of ill-being is a consequence of a depoliticised formal education and the separation of children from decision-making spaces. The thesis supports claims that definitions of well-being vary with age and emphasises the importance of considering political and ecological changes when analysing children’s aspirations.
... Esto ilustra la histórica marginación y mala salud de nuestras mayorías como herencia colonial y de las subsiguientes repúblicas fallidas, al menos en cuanto a bienestar y salud equitativa. Las trágicas epidemias de viruela al inicio de la conquista (siglo XVI), de fiebre amarilla (siglo XIX), del cólera (1991), como el Covid-19, en sus resultados inequitativos, demuestran las profundas fallas de la sociedad peruana para asegurar un mínimo y equitativo bienestar (DSS) incluyendo un sistema de salud minimamente funcionante para todos [7] .¿Qué otros DSS estructurales estarían actuando en el presente?, tendríamos que aludir inevitablemente a DSS políticos como ¿qué tipo de democracia permite estas fallas y negligencias en sistemas de salud, protección social, pobreza, entre otros? ...
... Eli de Gortari's book, La ciencia en la historia de México [Science in Mexican History] (1963), is one of the few early general investigations into Mexican science, as is its counterpart into Argentine science by José Babini (1954). By the 1990s, a historiography of professional science had taken shape, with works by the likes of Marcos Cueto (1989, 1997), Stuart McCook (2002, and Obregón Torres (2002). More recently, many other works have fed into this school, including studies by Henrique Cukierman (2007) Interestingly, unlike in Europe and the United States, the functionalist oriented sociology of science in Latin America was rare in sociology departments, although it did have more of a presence among groups conducting bibliometric studies in an attempt to produce indicators (Schwartzman 1985;Velho 1994). ...
The paper deals with the emergence and development the STS field in Latin America, from the sixties on. After an introductory section containing some considerations on the maturation of and approaches
to STS in the region, the paper delves into cognitive, institutional, political and social dimensions of the development of this field. It gives then some background, mentioning policies as drivers of knowledge generation, the institutionalization of social studies of science and technology, and STS training. An individual section deals with journals and congresses as spaces for interaction. A chronology of the STS field’s development in Latin America is followed by a brief examination of the role of the STS field in contemporary Latin America. It is argued that researchers belonging to this community are in a good position to critically analyze the current relations between science and society, to assist decision-makers and help the public understand the implications of present-day technoscientific change, as well as to support the development of fairer, more equitable solutions to combat the challenges of today’s changing world. It goes
without saying that, far from having reached maturity, this is a space in a permanent state of construction.
... Entre otros aportes, se destacan las indagaciones de Armus (2005de Armus ( , 2007 en tono al eje ciudad y salud, el estudio de Babini (2000) sobre la historia de la medicina, las indagaciones de Belmartino (2005) y de Souza y Hurtado (2010) en torno a las prácticas médicas en el siglo XX y XIX, respectivamente, y el estudio de las controversias científicas ligadas al tratamiento del Chagas (Zabala, 2009(Zabala, , 2010Kreimer y Zabala, 2007;Kreimer, Romero y Bilder, 2010). 3 Asimismo, enfocando prácticas médicas desde el Perú y Latinoamérica, los trabajos de Cueto (2000Cueto ( , 2004 han implicado un aporte relevante tanto para la historia social, como para los estudios del campo ciencia-tecnología-sociedad (CTS). En este sentido, cabe también mencionar los estudios de Martins y Maia (2003), y Moulín (2003). ...
La fiebre hemorrágica argentina (FHA) es una enfermedad viral aguda grave, detectada en 1955, que está radicada en una zona de intensiva actividad agrícola. Este artículo indaga algunas de las líneas de investigación recientes, con el objetivo de analizar continuidades y rupturas en las prácticas médicas y en los grupos sociales identificados como principales grupos de riesgo de la FHA. Para ello, se realiza un somero recorrido por la historia de la enfermedad, y se explora la trayectoria del centro de salud que concentra las investigaciones, la producción y la distribución de la vacuna, el Instituto Nacional de Enfermedades Virales Humanas “Dr. Julio I. Maiztegui” (INEVH). A partir de literatura secundaria especializada, fuentes primarias y entrevistas a investigadores y personal del INEVH, se estudia esta trayectoria institucional y los conflictos presentes en su desarrollo, asociados a problemáticas sociales y económicas del medio rural en el que viven y trabajan tanto los médicos y científicos involucrados como la población afectada.
... Ubicar a Sevlever, y su trayectoria, en el contexto de la salud internacional es el objetivo que atraviesa todo nuestro trabajo, por lo que sostenemos un primer diálogo con los aportes de Marcos Cueto (1996Cueto ( , 1997Cueto ( , 2004Cueto ( , 2013 y Anne-Emanuelle Birn (2006). A partir de sus estudios, pudimos reconstruir un escenario, el de la salud internacional, que comenzó a configurarse a principios del siglo XX y acabó por convertirse en un espacio fundamental tanto para la constitución de agencias sanitarias en América Latina como para la profesionalización de recursos humanos en Salud Pública. ...
This study explores the role played by international organizations such as the Rockefeller Foundation and the Pan American Health Organization in the professional career of the Argentine Public Health expert David Sevlever, who used international contacts and training courses in other countries to build a career in the nascent field of Public Health in Argentina
This article uses non-literary essays that appeared in the Peruvian press during the Oncenio period in Peru (1919–30) to nuance our understanding of Latin American Orientalism. Critical study of the extant material shows that there were at least three strands of Orientalism circulating among Peruvian readers, with the presence or absence of Asian communities in Peru and the larger history of Spanish imperialism and Spanish-language Orientalism acting as their conditions of possibility. While the large Chinese community in Peru triggered an Orientalist backlash akin to modern Anglo-French Orientalism, the absence of Southeast Asians in the country allowed for a more medieval-colonial Orientalism to persist, one that focused more on wonder for and exoticisation of Asian cultures. The exception would be the Philippines, which due to its previous history as a Spanish colony, was presented as a ‘modern’ country comparable to any in Latin America. Given that representations of Southeast Asia are often overlooked in the study of Latin American Orientalism—which in turn tends to focus on literary representations by writers from countries like Argentina or Mexico—this article fills these gaps and contributes to the global histories of Latin America and of Orientalism.
Until the 1980s, studies on the history of science, engineering, architecture, and health in Peru were developed mainly by professionals in these areas. However, from this decade onwards, historians became more interested in these lines of research. This paper offers a historiographic balance of the research in these branches of history in the last 40 years through their characters and contributions, the institutions to which they belonged, and the activities they developed relevant to Peru’s progress.
By studying the Third Plague Pandemic in Iquique, Chile, this article aims to contribute to the recent trends of scholarship that emphasize the global scope and impact of historical pandemics in local contexts. It examines how the local population and especially saltpeter workers understood, contested, and even neglected the epidemic due to local tensions. Methodologically, this paper relies on an ample array of sources, with an emphasis on sociocultural artifacts produced by local residents, such as poetry, newspapers of the working class, and cartoons. We conclude that in Chile the epidemic that affected Iquique in May 1903 revealed the government’s inability to respond to epidemic outbreaks manifesting in areas far from Santiago, the capital city. In Iquique, the workers and lower classes responded massively, denying the epidemic. The popular sources reveal an anti-central government and anti-big capital sentiment that ultimately led Iquiqueños to perceive the plague as a hoax.
Este artículo examina los vínculos entre Argentina y la Organización Panamericana de la Salud (OPS) a través del caso de la Escuela de Salud Pública de la Universidad de Buenos Aires desde su creación en 1958 y hasta mediados de los años 1970. En diálogo con trabajos contemporáneos que indagaron el surgimiento de actores internacionales de salud pública en diferentes regiones del mundo, nos preguntamos por el papel jugado por la OPS en la Argentina en los años sesenta y setenta. A partir de un corpus de materiales de archivo (como legajos administrativos, publicaciones periódicas, etc.) y fuentes secundarias, presentamos los antecedentes históricos de la relación entre algunos médicos argentinos y el organismo panamericano, así como los inicios de la colaboración entre instancias locales e internacionales para la formación de especialistas en salud pública. Luego de esto intentamos reconstruir las acciones llevadas adelante por el organismo panamericano en territorio argentino con especial énfasis en el caso del desarrollo de la Escuela de Salud Pública.
Esta introducción aborda el proceso de urbanización en el Perú de 1940 en adelante desde dos niveles distintos pero interrelacionados. En primer lugar, se señalan algunos de los principales efectos de la urbanización en la sociedad peruana contemporánea y se interpretan episodios importantes de la historia política desde las ciudades. En este sentido, se llama la atención sobre el potencial renovador de la historia urbana para reinterpretar la historia peruana desde la segunda mitad del siglo veinte. La comprensión de más de un proceso fundacional de dicho periodo puede cambiar radicalmente si se tiene en cuenta que el crecimiento urbano y la migración rural-urbana fueron elementos determinantes. En segundo lugar, se repasa la producción académica acerca de diversas facetas de la vida urbana en el Perú durante este período, desde los inicios de la explosión urbana hasta el presente. Señalamos algunas de las principales tendencias dentro de esta literatura interdisciplinaria y, en particular, discutimos la emergencia de una historiografía urbana sobre América Latina y sobre el Perú. Sugerimos que los temas conectados con procesos políticos mayores a nivel nacional y global, los estudios acerca de ciudades fuera de Lima, las condiciones ambientales, y el estudio de la movilidad urbana son a la vez algunos delos vacíos de esta historiografía emergente y de los campos más promisorios para su crecimiento. Para terminar, presentamos tres artículos que contribuyen a estos nuevos horizontes temáticos.
The coronavirus pandemic has exposed a global tendency throughout history to blame immigrants for propagating epidemics. Chinese individuals were thus targeted during past public health crises in Peru, but during the current coronavirus pandemic racist notions painting people of Chinese descent as “agents of contagion” diminished significantly. Here we examine three major epidemics (yellow fever, the bubonic plague, and covid-19) to demonstrate the current and somewhat surprising shift in negative attitudes toward the Chinese community. Peruvians’ refusal to embrace derogatory terms (the “Chinese virus”) or target individuals of Asian descent constitutes an intriguing case at a moment when xenophobic discourse is rampant in the Western hemisphere.
Entre los años de 1880 y 1891, en Cajatambo, –provincia de Lima- fue afectada por epidemias de viruela (1880 y 1886) y sarampión (1889). Las autoridades civiles aplicaron una serie de medidas sanitarias para contener y neutralizar su contagio y propagación. La presente investigación analiza estas epidemias tomando como fuentes documentales los registros de defunciones de las parroquias Santa María Magdalena de Cajatambo, San Agustín de Cajacay, San Francisco de Asís de Chiquián y Nuestra Señora de la Purísima de Gorgor.
This chapter examines the work done in Latin American history of science during the past few decades. A social turn that could be traced to the 1970s sought to understand how science and modern scientific disciplines emerged. Studies assumed their origins to be mainly European or North American and concentrated on how science took roots in Latin America’s culture, society, and politics. The focus was on Latin American nations as self-sufficient entities and a criticism of Eurocentric approaches, and the key concepts of reception, adaptation, and negotiation were used. This turn was challenged toward the turn of the twenty-first century in a global turn, when novel investigations emphasized transnational connections and circulation of knowledge. The global turn questioned studies limited to what occurred in Latin American countries and examined intermediaries who established links not only with the Global North but also with Asia and Africa.
En julio 2010 se presentaron por primera vez en el Perú cuatro casos de la peste neumónica, en la costa del departamento de La Libertad. Ello es un hecho grave de la salud pública en el Perú, lo que revela que en nuestro país existen males infecciosos ancestrales que requieren inversión y apoyo. Por ello, haremos una breve revisión de esta dolencia histórica de la medicina peruana.
La enfermedad constituye uno de los temas que ha sido objeto de estudio desde épocas pasada pero que ha emergido como foco de investigación y disertación en las dos últimas décadas (1991-2011), ganándose un papel protagónico dentro de la historiografía latinoamericana.
Dos preguntas, entre otras, consideran el comienzo del trabajo: ¿Por qué estudiar las enfermedades como problema en las dimensiones socioeconómica y cultural?, ¿Existe una historiografía de las enfermedades en ese ámbito de estudio en donde los aspectos sociales cuentenen la comprensión de las realidades colectivas a diferentes escalas territoriales? Los diversos asuntos tratados referidos a la enfermedad lo han hecho en el
marco de debates que varían entre las cuestiones epistemológicas; las cifras que muestran la evolución de la mortalidad infantil, por ejemplo; los controles y políticas
sanitarias; las políticas de Estado frente a la enfermedad, la medicalización y las profesiones relacionadas con la salud; las enfermedades como la tuberculosis, la sífilis, la gripe, entre otras. Un intento de realizar una historiografía de la enfermedad dentro del subcampo de estudio de la historia social y cultural de la misma, revela los debates y
circunstancias descritas alrededor de los mismos. Los trabajos que se consideran refieren a países como Argentina, México, Perú, España y Colombia y considera
especialmente los períodos del siglo XIX y XX.
A forma como políticos, médicos, farmacêuticos e a população da Bahia se posicionaram diante da desconhecida doença que vitimou cerca de 30 milhões de pessoas nos anos de 1918/19, estrutura o livro. Nele são analisados os diversos aspectos relacionados à gripe que matou o presidente Rodrigues Alves, em janeiro de 1919, antes mesmo de tomar posse. A autora produziu “um belo e inédito mosaico”, tomando por base fontes documentais as mais diversas para fundamentar a pesquisa sobre o enfrentamento do vírus influenza. Gilberto Hochman, pesquisador da COC/Fiocruz e autor do prefácio do livro, exalta “o delicado artesanato” na produção da narrativa que provoca o interesse, a surpresa e até mesmo a compaixão pelos que sofrem nos tempos de epidemia. A obra permite compreender especificidades locais da chamada República Velha na Bahia, além de possibilitar estabelecer comparações da epidemia em perspectiva global, tornando-se importante fonte de pesquisa, ainda mais neste atual momento em que a pandemia pelo vírus da influenza A (H1N1) começa a perder força no hemisfério sul, mas persiste a possibilidade de futura ocorrência de novo repique.
Il s’agit d’abord, d’étudier la capacité des chinois du Pérou d’être ou non dans l’Histoire, de pouvoir la faire, pour ensuite voir comment sont-ils devenus une race sans histoire au Pérou ? Nous analyserons comment les sino-péruviens ont été revêtus par le discours savant d’une deuxième nature expliquant leur infériorité et les cantonnant, au mieux, au statut de travailleurs efficaces et soumis. Nous étudierons, également, la relation chinoise et la construction de l’identité nationale péruvienne ; pouvaient-ils revigorer l’âme nationale péruvienne ? Comment sont-ils devenus invisibles dans le récit identitaire péruvien ?, Pour ce faire, nous utilisons un large éventail de sources (thèses universitaires, textes diverses sur l’immigration au Pérou, journaux satiriques, récits de voyages, mémoires, etc.).
Background
Understanding the dynamics of malaria transmission in diverse endemic settings is key for designing and implementing locally adapted and sustainable control and elimination strategies. A parasitological and epidemiological survey was conducted in September–October 2012, as a baseline underlying a 3-year population-based longitudinal cohort study. The aim was to characterize malaria transmission patterns in two contrasting ecological rural sites in the Peruvian Amazon, Lupuna (LUP), a riverine environment, and Cahuide (CAH), associated with road-linked deforestation. Methods
After a full population census, 1941 individuals 3 years and older (829 in LUP, 1112 in CAH) were interviewed, clinically examined and had a blood sample taken for the detection of malaria parasites by microscopy and PCR. Species-specific parasite prevalence was estimated overall and by site. Multivariate logistic regression models assessed risk factors for parasite infection by PCR, while SaTScan detected spatial clusters of PCR-positive individuals within each site. In addition, data from routine malaria surveillance in the period 2009–2012 were obtained. ResultsParasite prevalence by PCR was higher in CAH than in LUP for Plasmodium vivax (6.2% vs. 3.9%) and for Plasmodium falciparum (2.6% vs. 1.2%). Among PCR-confirmed infections, asymptomatic (Asy) parasite carriers were always more common than symptomatic (Sy) infections for P. vivax (Asy/Sy ratio: 2/1 in LUP and 3.7/1 in CAH) and for P. falciparum (Asy/Sy ratio: 1.3/1 in LUP and 4/1 in CAH). Sub-patent (Spat) infections also predominated over patent (Pat) infections for both species: P. vivax (Spat/Pat ratio: 2.8/1 in LUP and 3.7/1 in CAH) and P. falciparum malaria (Spat/Pat ratio: 1.9/1 in LUP and 26/0 in CAH). For CAH, age, gender and living in a household without electricity were significantly associated with P. vivax infection, while only age and living in a household with electricity was associated with P. falciparum infection. For LUP, only household overcrowding was associated with P. falciparum infection. The spatial analysis only identified well-defined clusters of P. vivax and P. falciparum infected individuals in CAH. Reported malaria incidence indicated that malaria transmission has long occurred in LUP with primarily seasonal patterns, and confirmed a malaria outbreak in CAH since May 2012. Conclusions
This parasitological and epidemiological baseline assessment demonstrates that malaria transmission and parasite prevalence is heterogeneous in the Peruvian Amazon, and influenced by local socio-demographics and ecological contexts. Riverine and road construction/deforestation contexts must be taken into account in order to carry out effective anti-malaria control and elimination efforts.
Se indagó sobre los desórdenes de la salud mental de los inmigrantes chinos (culíes) que llegaron al Perú en el siglo XIX, entre 1849 y 1874, para suplir la carencia de mano de obra después de la abolición de la esclavitud. Se revisó las publicaciones históricas sobre las condiciones de vida de esa población; los datos se sustentan en registros provenientes de sus centros de trabajo. Los informes, que abarcan el período entre 1865 y 1900, permitieron delinear alteraciones emocionales y de conducta relacionadas con estrés prolongado (reclutamiento traumático, larga e insalubre travesía marítima, sin familia, con trabajo en condiciones de semiesclavitud y encierro en galpones). Se colige la presencia de estados asteniformes somatógenos, depresivos, hipocondríacos o de simulación en los trabajadores calificados como ‘mañosos’. La literatura refiere prácticas homosexuales en el encierro obligado de varones solteros y enfermedades de transmisión sexual que incluye a la sífilis; un elevado consumo de opio que trató de ser reemplazado por alcohol y coca; actitudes de desesperanza, resistencia y rebeldía que condujeron a suicidios y homicidios así como a rebeliones grupales y a colaboracionismo durante la Guerra del Pacífico. Estos hallazgos históricos, confrontados con las estadísticas hospitalarias del Manicomio del Cercado (primera parte), coinciden en señalar el alto consumo de opio, por los cuadros diagnosticados en el hospital psiquiátrico como ‘locura tóxica’ asociada a ese estupefaciente. Hay una discrepancia entre los informes históricos de frecuentes enfermedades de transmisión sexual, incluyendo sífilis, y la escasa prevalencia hospitalaria de parálisis general progresiva (PGP), la forma psiquiátrica de la neurosífilis revelada en la primera parte de este estudio. En la discusión de esta incongruencia se plantea la posibilidad de una malarioterapia ecológica como factor influyente en la baja prevalencia hospitalaria de PGP.
Objective: To understand the macro institutional conditions of "Families in Action
Program" of the municipality of Manizales, between the years 2005-2010, and
the concepts of development and poverty that underlie the program. Methodology:
Two sources of information were used as a way to obtain this knowledge: firstly via the
stories of social and institutional actors obtained through semi-structured interviews,
focus groups and participant observation, and secondly through reviewing secondary
information. The development, poverty and the macro and micro realities were the
analyzed categories. They emerged from the theoretical discussion and grounded the
design of instruments for collecting information
Runa soncco, a Quechua term for "Indian heart", is the title of a magazine published between 1935 and 1948, which articles reveal the intention to integrate the Andean culture with Western public health on-site. It also turned into a key tool for the dissemination of the sanitation and education message and the indigenous movement led by Dr. Manuel Núñez Butrón, one of the first experiences in promotional preventive care in Peru and in the world - a pioneer of what four decades later would be called "primary health care".
This essay is a first approximation to the study of Hipolito Unanue's thinking influence on the Peruvian epidemiology discourse construction. After describing general aspects of Unanue's thought on the processes of disease propagation, we discuss how at the beginning of the XX century, in middle of the debate on the community problems and the various possibilities of the nation's development, different authors retake Unanue's ideas, who had already been raised up as a cultural hero of the medical community. We analyze his influence in the work of intellectuals like Paz Soldan, Olaechea and Lastres analyzing the diverse particularities of their thinking decodifying process and how this allowed the development of an identity process linked to the making of a 'Peruvian conscience', that is, of a particular way of seeing and transforming the world. This systemic way of approaching Peru's complexity is one of the characteristics of the initial development of Peruvian epidemiology, where History, Geography, Sociology, Anthropology, and Eugenics converge to outline explanations proper to the diseases propagation processes in Peru.
When some five hundred people in eastern Venezuela died from cholera in 1992–93, officials responded by racializing the dead as “indigenous people” and suggesting that “their culture” was to blame. Stories that circulated in affected communities talked back to official accounts, alleging that the state, global capitalism, and international politics were complicit in a genocidal plot. It is easy to attribute such conspiracy theories to differences of culture and epistemology. I argue, rather, that how political economies position different players in the processes through which public discourses circulate, excluding some communities from access to authoritative sources of information and denying them means of transforming their narratives into public discourse, provides a more fruitful line of analysis. In this article I use—and talk back to—research on science studies, globalization, and public discourse to think about how conspiracy theories can open up new ways for anthropologists to critically engage the contemporary politics of exclusion and help us all find strategies for survival.
This is a qualitative study of the politics of public health surrounding a resurgent tuberculosis epidemic in Lima, Peru during the 1990s. The paper traces the role of debt and neoliberal economics in creating conditions for the epidemic, and the reforms that turned Peru's TB program into a model for treating drug-susceptible disease by 1996. Despite this success, public health officials were blind-sided by the appearance of drug-resistant TB in the late 1990s when their "good" program turned out to be not good enough. The study follows the conflict, and eventual collaboration, that ensued between the Ministry of Health and a local NGO affiliated with Boston-based Partners in Health, which undertook a radical program of community-based directly-observed therapy (DOTS-Plus) to treat drug-resistant patients who otherwise would have died. Lessons from this case are relevant to many international settings where "hot-spots" of drug-resistant TB currently exist and go untreated, posing a threat to the success of national TB control programs.
The cholera epidemic in Peru brought to light the miserable state of local water and sanitation conditions. The author discusses the relationship between waterbone diseases and water and sewerage conditions in Peruvian peri-urban areas, or pueblos jovenes. These diseases are associated with poor living conditions. In 1989, only 52 percent of the population had access to piped water, and only 39 percent to sewerage. About 52 percent of schools lack light, water, and sewerage. In Lima, 2 million people daily eat meals from street vendors who lack access to fresh water or toilet facilities - 90 percent of a sample of their food was fecally contaminated. The author estimates the per capita costs of providing in-house water and sewerage facilities in urban areas to be 180 in rural areas. The cost of constructing easy-access water facilities (a standpipe less than 1,000 meters from each house) and latrines in urban and rural areas is an estimated 40. In short, the total cost borne by the urban poor over four years is equivalent to the cost of providing them with permanent water and sewerage facilities. Providing those facilities would relieve the urban poor devoting an average of 23 percent of their income to meeting their water needs.
Entre diciembre, 1957, y mayo, 1958, se han efectuado pruebas de susceptibilidad del Anopheles pseudopunctipennis al DDT y el Dieldrín en 11 localidades de varios valles de la región occidental del Perú, localidades en las que con anterioridad se había rociado insecticidas clorados en campañas de salud pública. En la determinación de la susceptibilidad se ha empleado la técnica recomendada por la Organización Mundial de Salud. Las dosis medias letales (CL50) que se ha determinado oscilan entre 0.38 y 0.92 por ciento para el DDT; y 0. 13 y 0.26 por ciento para el Dieldrín, valores que se encuentran dentro de los límites de susceptibilidad natural o normal de los anofelinos no resistentes.
Due to the limited supply in Peru of polyelectrolitic solutions recommended for the initial treatment of cholera diarrhea, a massive amount of isotonic sodium chloride solution was used during the recent cholera epidemic. This treatment proved adequate based on the low mortality rate, which compared favorably with international mortality rate reports. A preliminary observation of six adult Peruvian patients hospitalized with hypovolemic shock and metabolic acidosis secondary to cholera diarrhea showed remission of hypovolemic manifestations and significant improvement of serum bicarbonate, pCO2, and base excess after rapid intravenous infusion of a solution of isotonic sodium chloride. This intravenous solution seems adequate as the initial intravenous fluid for patients with severe cholera, as a logical alternative to currently recommended polyelectrolitic solutions containing bicarbonate or lactate.
Traducción de: Changements a Puno. Etude de Sociologie Andine
Cholera was the classic epidemic disease of the nineteenth century, as the plague had been for the fourteenth. Its defeat was a reflection not only of progress in medical knowledge but of enduring changes in American social thought. Rosenberg has focused his study on New York City, the most highly developed center of this new society. Carefully documented, full of descriptive detail, yet written with an urgent sense of the drama of the epidemic years, this narrative is as absorbing for general audiences as it is for the medical historian. In a new Afterword, Rosenberg discusses changes in historical method and concerns since the original publication of The Cholera Years. "A major work of interpretation of medical and social thought . . . this volume is also to be commended for its skillful, absorbing presentation of the background and the effects of this dread disease."âI.B. Cohen, New York Times "The Cholera Years is a masterful analysis of the moral and social interest attached to epidemic disease, providing generally applicable insights into how the connections between social change, changes in knowledge and changes in technical practice may be conceived."âSteven Shapin, Times Literary Supplement "In a way that is all too rarely done, Rosenberg has skillfully interwoven medical, social, and intellectual history to show how medicine and society interacted and changed during the 19th century. The history of medicine here takes its rightful place in the tapestry of human history."âJohn B. Blake, Science
En este informe se presentan las diversas definiciones de casos de cólera usadas en los países de América Latina que se han visto afectados por la epidemia; se da el número de casos de cólera y de las defunciones por la enfermedad (según datos notificados a la OPS por los países latinoamericanos en 1993), y se describen algunas tendencias regionales de la incidencia de cólera. La información relacionada con la forma en que se definieron los casos de la enfermedad se obtuvo por medio de un cuestionario administrado por la OPS en octubre de 1993. En total, 948 429 casos de cólera fueron notificados a la OPS entre enero de 1991 y diciembre de 1993 por los países latinoamericanos afectados por la epidemia y las incidencias anuales más altas se registraron en el Perú (1991 y 1992) y Guatemala (1993). La tasa de letalidad para todo el trienio, y también para 1993, fue de 0,8%. La incidencia de cólera mostró una tendencia descendente general en la mayor parte de los países sudamericanos pero aumentó en casi todos los países de Centroamérica. Se observó gran variabilidad en las definiciones aplicadas para notificar casos de cólera, casos de cólera hospitalizados y defunciones atribuibles al cólera. Esta variabilidad dificulta cualquier comparación global entre países (y hasta estimar la carga de morbilidad y evaluar la calidad de la atención sobre la base de las tasas de letalidad), y aun las tendencias notificadas dentro de un mismo país deben evaluarse con cuidado. Es muy probable que en un futuro la situación se complique por la llegada de la cepa Vibrio cholerae 0139 a América Latina, situación que genera la necesidad de distinguir entre ella y la cepa 01, que es la predominante. Para efectos de simplificación y para lograr la amplia aceptación y extensa divulgación de la información sobre los casos, se recomiendan las siguientes definiciones: caso confirmado de cólera 01: infección por V. cholerae 01 toxígeno, confirmada por métodos de laboratorio, en cualquier persona con diarrea. Caso confirmado de cólera 0139: infección confirmada por V. cholerae 0139 toxígeno, confirmada por un laboratorio, en cualquier persona con diarrea. Caso clínico de cólera: diarrea acuosa de carácter agudo en una persona mayor de 5 años que busca tratamiento. Defunción atribuible al cólera: defunción durante la semana inmediatamente posterior al comienzo de la diarrea en una persona con cólera confirmado o diagnosticado según la definición clínica. Paciente hospitalizado con cólera: persona con cólera confirmado o diagnosticado según la definición clínica que pasa un mínimo de 12 horas en un centro de atención para el tratamiento de la enfermedad.
The epidemic of cholera that began in Peru in January, 1991, marked the first such epidemic in South America this century. Subsequently, over 533,000 cases and 4700 deaths have been reported from nineteen countries in that hemisphere. We investigated the epidemic in Trujillo, the second largest city in Peru. Trujillo's water supply was unchlorinated and water contamination was common. Suspect cholera cases were defined as persons presenting to a health facility with acute diarrhoea between Feb 1, and March 31, 1991. We studied a cohort of 150 patients who had been admitted to hospital and conducted a matched case-control study with 46 cases and 65 symptom-free and serologically uninfected controls; we also carried out a water quality study. By March 31, 1991, 16,400 cases of suspected cholera (attack rate 2.6%), 6673 hospital admissions, and 71 deaths (case-fatality rate 0.4%) had been reported in the province of Trujillo. 79% of stool cultures of patients with diarrhoea presenting to a single hospital yielded Vibrio cholerae O1. In the case-control study, drinking unboiled water (odds ratio [OR] 3.1, 95% confidence interval [CI] 1.3-7.3), drinking water from a household water storage container in which hands had been introduced into the water (4.2, 1.2-14.9), and going to a fiesta (social event) (3.6, 1.1-11.1) were associated with illness. The water quality study showed progressive contamination during distribution and storage in the home: faecal coliform counts were highest in water from household storage containers and lowest in city well water. V cholerae O1, biotype El Tor, serotype Inaba, was isolated from three city water samples. Cholera control measures in Trujillo should focus on treatment of water and prevention of contamination during distribution and in the home. Trujillo's water and sanitation problems are common in South America; similar control measures are needed throughout the continent to prevent spread of epidemic cholera.
Two 01 Vibrio cholerae, E1 Tor strains, serogroup Ogawa were isolated from diarrheal stool material of two North American males residing or visiting in Peru. No other enteric pathogens were found. These strains did not produce cholera toxin as detected by enzyme-linked immunosorbent and Y1 adrenal cell assays, nor did they hybridize with an oligonucleotide probe for heat-labile (LT) toxin of Escherichia coli. These two cases are the first reports of 01 V. cholerae isolated from clinical specimens in South America.
At the Matlab Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh, the authors examined the blood groups of patients hospitalized between January and September 1979 for diarrheal disease due to a variety of bacterial and viral agents. A significant association was identified only for cholera, in which cholera patients were twice as likely to have blood group O and one-ninth as likely to have blood group AB as community controls. A follow-up study of family contacts of cholera patients, carried out between September 1980 and July 1982, indicated that blood group did not affect an individual's risk of having a culture-proven infection with V. cholerae 01 but was directly related to the severity of disease. Individuals with the most severe diarrhea compared with those with asymptomatic infection were more often of blood group O (68% versus 36%, p less than 0.01) and less often of AB (0% versus 7%, p less than 0.01). It was not possible to identify the molecular basis for this genetically related protection using biologic models of cholera that are currently available. The constant selective pressure of cholera against people of O blood group may account in part for the extremely low prevalence of O group genes and the high prevalence of B group genes found among the people living in the Gangetic Delta.
This review attempts to follow the trail of the development of epidemiological aspects and concepts of yellow fever and yellow fever transmission (vectors, vertebrate hosts, spacing of epidemic outbreaks) with less emphasis on well-documented early history and more emphasis on epidemiological problems still remaining, plus discussion of possible means of resolving certain of these problems.
A persisting reservoir of the Gulf Coast strain of toxigenic V. cholerae O1 in Louisiana and Texas marshes and the shipment of seafood from these areas throughout the United States means that sporadic cases and outbreaks of cholera may occur anywhere in the country for the foreseeable future. Such cases are most likely to occur during warm months, especially between July and October. Physicians should think of cholera when consulted for severe watery diarrhea, even when the patient has no history of travel, and alert the laboratory. Experience has shown that US food and water sanitation is good enough to make either secondary transmission or large outbreaks unlikely; however, as long as we have foodborne and waterborne outbreaks of bacterial enteric diseases, the Gulf Coast strain may appear in a situation in which it can multiply and be ingested in large numbers by many people. The Latin American cholera epidemic has caused more cases of cholera in the United States in 2 years than the total of Gulf Coast strain cases identified during the past 20 years. The epidemic's future is uncertain. Despite knowing a great deal about cholera epidemiology, we cannot fully explain the ebb and flow of cholera epidemics. We do not know why cholera was apparently eliminated from the Western Hemisphere by 1900, nor can we predict which areas will be affected next or whether cholera will remain in a given area transiently or become endemic. The fact that cholera disappeared from the Western Hemisphere in the last century does not necessarily mean that it will disappear again. The situation is different now in several ways. The current pandemic is caused by the El Tor biotype, which persists better in the environment than does the classical biotype. Travel is now more frequent and more rapid. Finally, the population of the Western Hemisphere is about 14 times larger now than it was in 1850 and produces about 80,000 metric tons of human feces each day, of which only a fraction is treated. Thus, cholera will probably become endemic in Latin America and persist indefinitely.
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Human malaria originated in tropical areas of the Old World but the Pleistocene glaciations delayed its spread in the Northern Hemisphere. The last glaciation produced temperatures 9 degrees C lower than those prevailing today in Southern Europe, making the transmission of malaria there virtually impossible. When temperatures approximately equal to those of today were reached 10,000 years ago, the disease and some of its most effective vectors, Anopheles labranchiae and A. sacharovi, spread to the North although the refractoriness of the European vectors to Pasmodium falciparum probably delayed the spread of the malignant tertian parasites. Malaria may have spread earlier in the Levant and parts of Asia, due to a less marked drop of temperature during the last glaciation but we have witnessed in contemporary times the spread of A. stephensi, one of the most effective vectors in the area. The first noticeable decline of malaria was seen in Europe during the nineteenth century due to new agricultural practices and changed social conditions. The final disappearance of the disease in Europe and North America was due more to those changed conditions than to the use of DDT and other residual insecticides which were going to fall in so-called eradication campaigns in the Third World.