h e a l t hy l i v i n g i n i t i a t i veBui ld ing Hea l th Toge th e r

The Healthy Living Initiative is combining scientific research and local knowledge to build living environments that deter Chagas, a preventable yet neglected infectious disease that has infected more than 7 million people worldwide.(1) Our initiative is the outcome of collaborative research between Ohio University and Catholic University of Ecuador than began in 2001.

The World Health Organization labels Chagas Disease as ‘neglected’ because it disproportionately affects people struggling to make ends meet in under-served and marginalized communities that have limited or no access to health services. Neglected

BUILDING HEALTH TOGETHER

diseases create health, social and economic burdens that often place those they afflict in a cycle of poverty and disease.

The Healthy Living Initiative is working with communities in southern Ecuador to construct a Chagas disease prevention model which addresses the interrelated social, economic and political factors driving the disease. If proven successful, the model will serve as a transferable approach for effectively preventing Chagas, improving health and expanding opportunities for people whose potential is now restricted by this disease.

BUILDING HEALTH TOGETHER

In the pages that follow, learn more about our mission to prevent Chagas disease and build health, one healthy home at a time.

h e a l t hy l i v i n g i n i t i a t i ve – building health

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h e a l t hy l i v i n g i n i t i a t i ve – our approach

The Escaleras’ new home and the way live they in it are part of Ohio University and Catholic University of Ecuador’s ongoing efforts to build a uniquely comprehensive model for addressing the web of interrelated factors that drive Chagas disease in communities challenged by persistent poverty.

Despite the fact that millions of people are infected with Chagas disease there is no vaccination or consistently effective treatment for the illness which is largely incurable when not caught at onset. Investment in treatment and prevention methods for Chagas disease has been limited; traditional control

strategies are non-comprehensive and have not achieved long-term success. Preventing the spread of Chagas is especially important in communities where a lack of health, housing and water infrastructure contribute to an increased vulnerability to infectious disease.

Transmitted through a parasite, the disease disproportionately affects people living in under-served and under-resourced communities, largely in the Americas. Sustainable solutions to Chagas disease are needed now to allow at-risk families to avoid the burdens of this long neglected disease.

In June, 2013, Ecuadorian farmers, Jose and Hilda Escaleras entered a partnership with Ohio University and Catholic University of Ecuador to build a prototype home for preventing Chagas disease.

A N E W A P P ROAC Hto tackling Chagas disease

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CREATINGHEALTH LIVINGENVIRONMENTS one healthy home at a t ime

Our strategy for preventing Chagas disease and building health recognizes local capacities for identifying and solving problems and is dependent upon achieving a shared sense of ownership in all of the Healthy Living Initiative’s community-based efforts.

We are facilitating lines of action that generate the knowledge, skills and sense of self- and collective-efficacy required at the community level to create and sustain living environments that deter Chagas disease and support well-being. Through ongoing partnerships, we are working to

• improve infrastructure, • promote healthy living

practices and • increase income generation.

These key elements of a healthy

living environment are at the core of the Healthy Living Initiative model for sustainable Chagas disease prevention and control.

The three health determining areas of focus were identified through more than 13 years of research conducted in partnership with a diverse group of stakeholders, including community members, infectious disease researchers, and governmental and non-governmental organizations. Initiatiang and sustaining partnerships, capacity strengthening and building effective communication between actors are the processes we are using to achieve the Healthy Living Initiative’s overarching goals of Chagas disease prevention, healthy communities and healthy people.

Three key elements of a healthy living environment are at the core of the Healthy Living Initiative model for sustainable Chagas disease prevention and control

capacity strengthening

community organization

V

healthy living initiativeBuilding Health Together

partnershipcapacity

strengthening

infrastructure

incomegeneration

health

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h e a l t hy l i v i n g i n i t i a t i ve – our approach

STRENGTHENINFRASTRUCTUREthe conditions required for good health are built (they don’t just happen)

what we are doing Our primary function is to

facilitate community-based efforts that lead to the improvment of living environments found to be susceptibility to infestation by the “kissing bugs” that transmit Chagas disease, increased access to medical care and the construction of safe drinking water systems.

Adobe walls, dirt floors, and tile roofs are often quite porous providing the kissing bugs with many options for entry. Ease of entry and small windows that create dark environments make homes particularly inviting; a situation we are working with families in partner communities to change.

why it mattersLong-term solutions to the spread

of Chagas disease require addressing these unmet infrastructure needs -- a challenge not currently taken up by existing Chagas prevention and control strategies. Until now.

Ohio University and Catholic University of Ecuador are investigating the potential to use

applied scientific research to motivate health-promoting social change -- a pursuit that has game-changing potential.

recent activities• Conducted baseline studies to

determine triatomine infestation rates, homes decay status, and knowledge, attitudes and practices in relation to homes and health

• Architectural team members consulted with community members to develop designs for an ‘anti-bug’ prototype building structure

• Collaborated with community members to construct two prototype ‘anti-bug’ building structures that employ replicable, affordable, simple and culturally-sensitive building technology

• Facilitated social organization to fund, build, and improve water systems in Guara, Chaquizhca, and Bellamaria

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INCREASE INCOME GENERATION OPPORTUNITIES

what we are doingOur work in the communities we

serve has provided insights into lives rendered challenging by poverty and social marginalization. It has also revealed the presence of beauty, compassion, resilience and a desire among community members to improve the quality of their lives.

Lines of action that contribute to economic development are central to our Chagas disease prevention strategy. Together with our partner communities, we are exploring a range of avenues for expanding income generating opportunities; each driven by the belief that people burdened by poverty deserve support as they activate their own agency to improve the condition of their lives.

why it mattersPeople challenged by poverty

in communities in southern Ecuador, and around the world, face a shortage of opportunities to generate income. Barriers to financial stability work in conjunction with

a lack of housing, health, water and affordable and accessible education infrastructure to increase vulnerability to infectious and chronic disease.

recent activities• Facilitated construction training

certificate program attended by 22 community members

• Provided organizational development support for Los Ceibos Artisan group through marketing and planning workshops, as well as an exploration of new markets

• Ongoing collaborations with community members to explore agricultural techniques that help sustain food sovereignty and safety

• Conducted agricultural production training focusing on increasing income derived from farming activities

• Investigated ecotourism potential• Launched assets-based

community development

we are collaborating with partner communities to reduce financial barriers to good health

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h e a l t hy l i v i n g i n i t i a t i ve – our approach

BUILD HEALTH

what we are doingHealth is deeply personal and

inextricably tied to a host of biological, social, cultural, economic and political factors. For these reasons, our strategy for building health depends upon developing a critical understanding of local contexts through direct engagement with the communities we serve. We work together with local health workers, community leaders and those responsible for promoting health in their own families to integrate local and external knowledge to achieve the best possible individual and community health.

Our collective efforts range from medical screenings for acute health challenges to the development of educational programs designed to affirm cultural and social norms that support good health and transform cultural and social norms that undermine it.

why it matters When we fail to generate

opportunities for everyone to pursue good health, we are contributing to a cycle of disease and poverty that undermines the struggle of people

living in poverty to improve the conditions of their lives.

For the Healthy Living Initiative, success means Chagas transmission is prevented, community members grow healthier and we increase the chances that members of our partner communities avoid perpetual cycles of poverty and disease.

recent activities• Promotion of education,

information and knowledge sharing efforts that help to establish the relationship between health and living environments in this specific context.

• Facilitation of mobile clinics and launch of community pharmacy

• Dialogues with local populations to establish alternative health-promoting practices for raising animals, crop storage and home maintenance

• Conducted research into pre-existing, community-based living practices for warding off Chagas disease transmission

• Collaborated with Ecuadorian Ministry of Health to fumigate houses in partner communities

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we are working to understand the relationship between health and home (houses and how people live in them) to determine health promoting behaviors that are sustainable over time

NEVER HEARD OF CHAGAS DISEASE?

It is estimated that 75 to 90 million are at risk of being infected with Chagas worldwide yet this infectious disease remains relatively unrecognized by mass media and receives less funding than HIV/AIDS, malaria or tuberculosis. 2 All too frequently, Chagas disease is also unknown by people living in areas where the illness is endemic, including regions in Mexico, Central and South America.

Once thought to be limited to Latin America, Chagas is now being diagnosed in the southwestern part of the United States and it is estimated by the U.S. Center of Disease Control that there are more than 300,000 persons living the disease within the United States.3 In the majority of these cases, the T. cruzi infection was transmitted by disease vectors in the endemic countries.

– you are not alone

h e a l t hy l i v i n g i n i t i a t i ve – about Chagas

The World Health Organization (WHO) has labeled Chagas disease as a ‘neglected tropical disease’ because it disproportionately affects people living in poor and marginalized communities in tropical climates with limited or no access to health services, adequate housing infrastructure, clean water or disease prevention practices. Neglected diseases create health, social and economic burdens. It is estimated that Chagas disease results in an annual global economic cost exceeding 7 billion USD4 -- much of which is the result of individuals disabled by this chronic illness. People living with Chagas disease can become too sick to work, sliding further into the poverty that saddled them at a higher risk for contracting the disease in the first place.

In 2010, the World Health Assembly renewed the call to step up efforts to win the battle again Chagas disease.5 Ohio University and Catholic University of Ecuador are answering this call by capitalizing on their longstanding and highly productive partnership to implement the Health Living Initiative. The long-term research endeavor places Chagas disease prevention and control at the center of both universities’ infectious disease research agendas and elevates Chagas disease prevention’s status on the agendas of key governmental and non-governmental actors in the United States and Ecuador.

elevated risk: a burden of poverty

a newglobal priority

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Q & Achagas disease

99 percent

of people affected do not have access to treatment

7 million

people have Chagas disease

1/3 of people

affected by Chagas disease will develop heart or digestive disorders; many with fatal

consequences

75-90 million

are at risk of infection

7 billion

is the estimated global economic cost every year. Largely due to lost

productivity of people living with the disease

$

h e a l t hy l i v i n g i n i t i a t i ve – about Chagas

Why is the disease called Chagas?Chagas disease, also referred to as American trypanosomiasis, was discovered in 1909 by Brazilian physician Carlos Chagas.

Where is Chagas disease found?It is endemic in Mexico, Central and South America. Cases are also now present in southwestern United States, Europe, Western Pacific.

How does the disease spread?The disease is an infection caused by the parasite Trypanosoma cruzi (T. cruzi) which is primarily transmitted by various species of triatomine bugs, often called “kissing bugs.’ Transmission is also possible through pregnancy, blood transfusion, and far less frequently through organ transplantation or laboratory accidents. The “kissing bugs” are nocturnal and tend to bite humans around the

mouth (or sometimes eyes) at night. The T. cruzi infection is transmitted through the triatomine bugs’ feces. Human hosts introduce into their systems by scratching the bugs’ itchy bite.

What happens when a person is infected with the Chagas disease?The disease has two phases: an initial, acute phase which lasts for about two months, has flu-like symptoms and is treatable, and a chronic phase in which the parasites primarily reside in the heart and digestive muscle causing progressive destruction and potentially death.

What can be done to prevent the disease?Prevention efforts include spraying with insecticide to deter parasite carrying insets, house improvements that make structures less permeable and protective living practices. Insecticide-based control strategies

alone are not effective to control triatomines re-infestation in spread areas. Blood screening is vital to prevent infection through transfusion and organ transplantation.

Who is thinking about Chagas disease prevention and control? Chagas disease is considered one of five parasitic diseases that have been targeted by the U.S. Center for Disease Control for public health action.The World Health Organization prioritized 17 neglected disease, including Chagas, that collectively affect more than 1 billion people worldwide.

What is the treatment?There is no vaccine for Chagas disease and the two treatment drugs available are generally ineffective if not administered at the onset of the acute phase.

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HEALTH BUILDERS

meet some of the healthy living initiative’s

Community member and medical staff and students, Ohio University School of Heritage College of Osteopthic Medicine and Catholic University of Ecuador

Anita Villacis, principal investigatorCatholic University of Ecuador

Mario Grijalva, director Tropical Disease Institute

Gloria Cumbicus, Los Ceibos artisan group

Doris Correa, Bellamaria Casa Communal builder

We are establishing and sustaining relationships across

borders of all sorts -- geographic, cultural, social, disciplinary and political -- to create conditions

that prevent and control Chagas disease and promote health.

Sylvia Jimenez, Healthy Homes for Healthy Living sustainable architecture researcher

Nelson Patterson, Ohio University graduate research assistant

Sandra Caceres, Catholic University of Ecuador, architectural student

Carmen Capa and Dionisio Jimenez, Healthy Homes for Healthy Living partners

undergraduate & graduate service

learning

HIGHER EDUCATION: UNUSUAL AND UNPLUGGED

Since 2007, students with academics interests as diverse as microbiology and visual ethnography have come togeth-er to participate in the Healthy Living Initiative. Students from the United States and around the world travel to Ecuador where they contribute their knowledge and skills to Chagas disease prevention and control research.

The Healthy Living Initiative provides faculty and students with a hands-on international service learning experience where they may participate in key aspects of an ongoing public health intervention. Many students integrate the program into their masters’ and doctoral programs by designing, implementing and evaluating

HIGHER EDUCATION: UNUSUAL AND UNPLUGGED

Healthy Living Initiative research projects over the course of their graduate careers.

The Healthy Living Initiative is jointly administered by Ohio University’s Tropical Disease Institute and the Center for Infectious Disease Research at Catholic University of Ecuador.

Implementing education abroad research programs together since 2001,

these two research institutions have developed the know-how to ensure academically fulfilling and safe experiences for students.

For more information about the Healthy Living Initiative travel abroad program, please visit http://www.oucom.ohiou.edu/tdi/InternationalResearch/In-ternationalResearch.htm.

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BUILD WITH US

The Healthy Living Initiative is bringing people together to build living environments that support health in communities where Chagas and other preventable illness too often deny people the opportunity to be healthy and pursue the things that matter most

to themselves and their families. Following are a few of the ways you can contribute to the Healthy Living Initiative and to our efforts to generate favorable conditions for health in underserved communities that are committed to partnering for positive change.

Join us today in fostering opportunities for better health

h e a l t hy l i v i n g i n i t i a t i ve – health builders

The Healthy Living Init iative is a multidiscipl inar y research effor t of the Ohio Univer sity’s Tropical Disease Institute

Learn more about Chagas disease and TDI’s research effor ts at oucom.ohiou.edu/tdi .

Help us r a i se awareness about Chagas d i sease and the Hea l thy L iv ing In i t i a t ive by shar ing our wor k wi th other s .

Connect wi th us on Twit ter and Facebook and become a Hea l thy L iv ing Hea l th Bu i lder.

Par tner sh ip i s fundamenta l to the Hea l thy L iv ing In i t i a t ive approach .

Please contact us i f you , or your or gan izat ion , would l i ke to know more about our wor k .

Become a health builder here’s how

ohio university tropical disease

tdiohiou

oucom.ohiou.edu/tdi

learn volunteer partneract

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Ohio University Healthy Living Initiative Graduate Research AssistantsCenter for International StudiesOhio University Office of Education AbroadOhio University Heritage College of Osteopthic Medicine1804 Grant: Healthy Living Initiative Graduate Research Experience

Pontificia Universidad Católica del EcuadorFacultad de Ciencias Exactas y NaturalesEscuela de Ciencias BiológicasFacultad de ArquitecturaDirección de Investigación

Chaquizchca, Bellamaria, and Guara community membersAthens local communityAyuda en Accion, EcuadorChildren’s HeartlinkGobierno Autonomo Descentralizado Canton CalvasMinisterio de Salud Publica - Area de Salud N. 5Plan InternationalRotary Club International, Athens, OhioRotary Club International, Loja, EcuadorTsiky Zanaka

We are grateful to work in collaboration with the following individuals, organizations and institutions as we continue to shape the Healthy Living Initiative model and examine its potential for preventing Chagas disease and improving health in the communities we serve.

OUR PARTNERS

1 World Health Organization, WHO. (2009). Neglected tropical diseases, hidden successes, emerging opportunities. Retrieved from http://apps.who.int/iris/han-dle/10665/44214.

2 ISGlobal Barcelona Institute for Global Health (2012, March). Chagas: A disease that can no longer be neglected. Retrieved here.

3 Centers for Disease Control and Prevention, CDC. (2014). Parasites - American Trypanosomiasis (also known as Chagas disease). Epidemiology and risk factors. Retrieved from http://apps.who.int/iris/handle/10665/44214.

4 Lee, B. Y., Bacon, K. M., Bottazzi, M. E., & Hotez, P. J. (2013). Global economic burden of Chagas disease: a computational simulation model. The Lancet Infectious Diseases, (4), 342. doi:10.1016/S1473-3099(13)70002-1.

5 World Health Organization. Department of Control of Neglected Tropical Diseases, Crompton, D. W. T., Daumerie, D., Peters, P., & Savioli, L. (2010). Working to overcome the global impact of neglected tropical diseases: First WHO report. Retrieved from http://whqlibdoc.who.int/publications/2010/9789241564090_eng.pdf.on neglected tropical

REFERENCES

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h e a l t hy l i v i n g i n i t i a t i ve – health builders

h e a l t hy l i v i n g i n i t i a t i ve – health builders

oucom.oh iou . edu/td i