Chagas, leprosy, malnutrition: a nurse’s work in Argentina’s Indigenous communities

ENASHU founder José Antonio Boggiano has been leading medical brigades to northern Argentina for a decade and says ‘people don’t know’ how serious the health crisis there is

Mision KM 2 Wichí community Health center. Image: Amy Booth, July 2022

The first time José Antonio Boggiano visited an Indigenous community in northern Argentina, he remembers feeling overwhelmed by the inequality he saw. “It made me feel helpless,” he said. 

The trip left such a profound impact on him that he and his wife Marisa decided to found an NGO to lead health missions in the area. Since September 2013, Nursing for Humanitarian Assistance (Enfermería para la Asistencia Humanitaria, ENASHU) has brought medical care to remote communities in Chaco, Salta, and Formosa provinces that would not otherwise have access to treatment. Most, although not all, are of the Wichí Indigenous people.

Since its foundation a decade ago, ENASHU has treated over 15,000 patients. But with Argentina languishing in a drawn-out economic crisis, it’s getting harder to get aid to the communities that most need it: they have had to postpone their next two operations due to an overall decrease in donations.

Boggiano spoke to the Herald about the health problems Indigenous communities face, the challenges they experience when seeking treatment, and why the government hasn’t invested more resources in supporting them. It has been lightly edited for length and clarity.

Why did you found ENASHU? And why did you choose to base your projects in northern Argentina?

The first thing I tried to do was primary health care. I knew there was a lack in northern Argentina and that it would be useful. But after we made our first trip to Formosa, we saw the terrible reality there and realized that nurses alone would not be able to carry out the work that needed to be done. We could be a group of multidisciplinary health teams, not just traveling nurses.

What’s it like in the communities were you work? 

The conditions are really bad. They have no running water or sewage systems, and sometimes they don’t even have septic tanks. In general, we go to isolated Indigenous communities a long way from even small cities.

What type of health problems do you see?

In these communities there are illnesses like Chagas, leprosy, tuberculosis and child malnutrition. Chronic illnesses are not always diagnosed, and at other times aren’t treated. Children have lots of intestinal parasites due to the lack of drinking water and hygiene. 

To organize the missions, we ask for help through social media. After the first few years we developed a network of caciques [Indigenous leaders] that we’d talk to. We try to carry out two health operations a year. We find a place to use as a base, and from there we visit a circuit of communities of between 50 and 1,000 people. 

Pharmacies in the trunks of vans

There, we establish a space with a place for nurses, a place for the doctors like pediatricians, and a zone that’s used as a hospital. Then there are pharmacies, which are literally set up in the trunks of the vans. That’s where prescriptions are received and medicine is dispensed. 

What sort of challenges do your professionals and the Indigenous communities themselves face?

The Indigenous population suffers discrimination by health professionals, albeit not everywhere and not by all medics. They also experience discrimination by some criollos [non-Indigenous people]. 

The roads to these communities are dirt tracks that are not maintained, and there is a lot of rain for much of the year. It is very difficult to travel to these places.

Every community has a kind of health center, but there are no permanent doctors or nurses. That means people’s illnesses get worse, but getting patients to a hospital is complicated. The nearby hospitals are really bad. Once they arrive at one hospital they have to be referred to a better one, which may be up to 500 kilometers away. It can take 15 hours to get there. A 270km journey can take 12 hours due to the road quality, because vehicles can’t get through.

Have you seen a difference in the last 10 years?

Look, many years ago we had a meeting with some politicians and when we asked why there had been no change in healthcare, they replied: “Healthcare does not give us votes.” The interest in improving quality of life and public health for people isn’t a priority. If an election’s coming up, they might give them an ambulance, but then the government doesn’t cover fuel costs. The ambulances break down and they don’t provide them with spare parts. 

Unfortunately there is a lot of corruption on all levels. You have mayors or governors who have a lot of money and the people are poor. Investing in health equipment, keeping hospitals up to date, and investing in trained health professionals is not a priority for them. Without changing this, it’s difficult to change anything else. People don’t know about the situation in the north. 

What are the consequences of postponing your next two health operations?

These people are waiting for our help, which we haven’t been able to give them because we haven’t been able to get the money. When you’ve calculated the fuel cost for the vehicles, the medical equipment and so on, it’s too much, given the current economic situation. 

“Profound crisis”

On Wednesday, Boggiano sent a letter to Argentina’s Health Minister Carla Vizzotti, warning that hospitals in the impoverished province of Chaco were experiencing a “profound socio-sanitary crisis” that “could result in the avoidable loss of lives.” He warned that one hospital was resorting to a donation campaign to secure basic medical supplies, while another had so little money for fuel that it could not afford to transfer patients. 

As president of ENASHU, he called on the national Health Ministry to intervene. “The situation described is not only concerning,” he wrote. “It is unacceptable in a country that seeks to guarantee the fundamental right of health to all its citizens.”

To learn more about ENASHU and support their work, visit their website here.

Cover image: The health center in the Wichí community of Misión Km 2, Salta province, July 2022. Image: Amy Booth


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