Zoonoses, public health and the advancement of the agricultural frontier

Zoonoses, public health and the advancement of the agricultural frontier

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By Dra. Lilian Joensen

The interview of Dra. Oscar Daniel Salomón, researcher of zoonotic diseases; that we transcribe below, in addition to confirming the multiple impacts of monocultures and the advance of the agricultural frontier, it adds a new aspect: the Agro-export Model is much worse when viewed from the perspective of public health and the cost that this implies for the state.

Lilian Joensen: Can you introduce yourself?

Daniel Salomón: My name is Oscar Daniel Salomón. I am Director of the National Center for Endemo-Epidemics, of the National Administration of Health Laboratories, of the Ministry of Health and Environment of the Nation. I am an epidemiologist and entomologist. I work in eco-epidemiology, on the impact that environmental modifications have on vector-borne diseases, especially Leishmaniasis and Chagas, which are the ones that interest us most at this time.

L.J .: You can tell again, what you told the other day after I showed the movie "Soy Hunger" at Fatala, with which you greatly surpassed me and left me stunned.

D.S .: In the last four or five years the change of landscape in Argentina was clear and emblematic. For work, for twenty-five years we have walked twelve provinces in northern Argentina, and in that period we saw several changes in the landscape. We saw the de-industrialization of the countryside and we saw the pauperization of the countryside. Now we see an abrupt resurgence of modes of production that, in the best traditional style, only produce and reproduce a system of communal poverty. And from the point of view of our work, public health, disease also ends up being the cause and consequence of that poverty. This change is due explicitly and in the most visible way to the installation of the soybean monoculture, or if conditions allow it, an annual cycle of wheat and soybeans. Soybeans thus occupy most of the primitive agricultural-livestock territory, and advances on virgin land, causing intensive deforestation and pauperization of the land. In this way, there is a rapid accumulation and concentration of capital, where surpluses never reach the rural worker who is currently unemployed, absolutely impoverished, and with the most evident face of impoverishment, hunger in places where there is still enormous wealth of the land. . At the same time, the systems that usually worked in agricultural information and extension, since they begin to live on what generates export retentions, stimulate these crops and stop promoting cooperative plans or subsistence economies. Fundamentally, everything that generates commercial surplus is promoted, everything that generates wealth from short-term financial reserves and that, using ECLAC terminology, does not return in any useful way due to the deterioration of the terms of trade. Policies are not seen, I am not saying that they do not exist, but that long-term policies are not seen or are not implemented. You cannot ask a large company, an industrial producer, or a large landowner not to pursue profits. What has to be a legal framework that limits or redistributes them.

In that sense, what one is most afraid of about the model is that just as in the 90's in Argentina a whole system of apparent resurgence was created that was based on the sale of national companies, now a system based on the in export withholdings, in commodities, which do not create any kind of internal sustainable projection. Economic structures and strategies, such as those built from the fuels of southern Argentina, based on commodities, now replicated in the soybean model. But since the surplus only returns in the form of distributive paternalism, the moment that state contribution is withdrawn, the whole system falls because it was not invested in any source of legitimate resources.

On the other hand, very recently I saw in Iguazú, for the first time with certainty, orchards as sufficient sources of subsistence, always considering the good quality of the land involved and the appropriate area occupied by each family. But the important thing is that under these conditions they are capable of producing food self-sufficiency with a small surplus of products, for exchange or purchases in the market. I do not propose a subsistence country, but in the nutritional emergency, if a system of animal and vegetable exploitation were created in small farms with cooperative means of production, distribution or marketing, adapted to each area, we would not have to be creating magic soups with multi-nutrients when that variety of nutrients comes naturally from the soil. But if you opt for a system where an entire country is dedicated to a monoculture, and the entire economic structure is supported only by withholdings on the export of that crop, well, a very fragile vicious circle is being created, with the appearance of growth. short term.

But one thing is very evident, for everyone who has traveled the interior, that in all these areas where you see this economic revival through soybeans or some other eventual monoculture that appears, there is no trickle down to the poor. But there is a very intensive technification and an absolute dependence on inputs, as occurred during the alleged miracle of the green revolution. The green revolution, like this one, is not increasing the nutrients available in the world, but is fostering dependence on inputs and increasing profits via commodities for companies and landowners.

L.J .: Now, related to your specialty, that is to say, biology and Leishmaniasis in particular, you told a lot of stories the other day that I don't know if you could ever retell again.

DS: Leishmaniasis is a disease closely associated with the original vegetation, or when it has already been deforested and there are edges and islands of forest or jungle still intact, or in the so-called secondary vegetation where the vegetation grew back in the wild after the human intervention. With a very important trend in all of Latin America towards the urbanization of the disease. That is to say that those diseases that were from the jungle, are now settling around the cities or around the towns. Especially since this process is accompanied by a very intense migration to urban centers, not only to the most important urban centers but also to the closest urban centers, with a completely disorderly population growth. And thus, ecologically and culturally, an urbanization of rural life is produced, but also a ruralization of the peri-urban.

This situation greatly increases exposure to Leishmaniasis now in a previously dispersed human population and now concentrated in small high-risk areas. But at the same time, the poverty and sanitary deficiencies of these disordered peri urban areas are related to nutritional deficiencies, with immunological deficiencies, which leads to more serious clinical expressions of Leishmaniasis. To such an extent that in many places, not in Argentina, but in the world with other forms of Leishmaniasis, the cost-effectiveness of giving the same therapeutic cure and a food supplement to the family with a sick child is being evaluated.

On the other hand, uncontrolled deforestation generates outbreaks of Leishmaniasis by increasing human exposure to the insects that transmit it, in areas where wild animals are found that act as reservoirs for the parasite. However, in this situation, the usual thing is that the worker, the axman or opening tracks, does not have legal protection since the work is done by contractors who in turn subcontract, who in turn subcontract, and so on until the responsibility. These workers live in the deforestation fronts, in very precarious conditions, completely exposed. And with this latest flood of soybeans, what we have had is a final and abrupt blow to deforestation, not in total hectares because it has been deforested for a century, but in the remaining hectares of native forests. Only the lands that are not economically profitable to deforest are really running out of deforestation, everything else is being deforested. And it is land that during the first cultivation after deforestation is very rich, but as good land of deforested forest is very loose soil, so it is very likely that in one or two years it will be completely washed away, and although deforestation occurs at the limit between Argentina and Bolivia or on the border between Argentina and Paraguay, that land will end up as sediment in the Río de la Plata after a couple of rainy seasons.

At the same time, emblematic and non-emblematic animals of conservationists are concentrating on islands of residual forest, in areas that, as I said before, are not profitable, such as places with slopes. And this forces many of these animals to migrate annually in height, towards colder or hotter places according to the time of year, further up or down the slope to escape human pressure. Associated with the new food source that is monoculture, but taking refuge in the remaining forest to avoid exposure. And that suddenly makes human-wildlife interactions much more intense than they were before. At certain times of the year, those that feed on crops may appear en masse, in "rats" for example, and carnivores descend behind. Today it is very easy to see in the morning on the edge of the crop in what used to be jungle, for example in the province of Salta, a huge amount of tracks of agoutis, tapirs, even, from time to time, of jaguars, anteaters with flags, species in danger of extinction that are also more exposed to human activity. A contact that was sporadic now becomes an intensive contact and many wild zoonoses begin to be important in the people who work in those crops or live around the crops. And the scenario even worsens when urbanized areas grow towards the cultivated area, through disorderly growth, without planning, offering densely populated areas in conditions of extreme poverty, malnutrition and poor sanitary conditions.

In Leishmaniasis this process has been very clear, because Leishmaniasis in Argentina had 40 cases per year until the 1950s, from the 80s in the inter-epidemic years it registers 400 cases per year, and in the epidemic years it has reached 1,400 cases and increasing. A re-emergence phenomenon due to two processes, intensive deforestation that alters wild populations, and peridomestic transmission of the previously wild disease. Where deforestation itself may not be the immediate cause of the Leishmaniasis outbreak, but the alteration that deforestation produced in the wild populations of reservoir animals and in that of the mosquitoes that can transmit or cause Leishmaniasis. And as we said, in turn with an increasingly deficient nutritional status of people. For example, in Formosa in 2001, an outbreak occurred at the time of the country's economic crisis, when many people who used to hunt or fish for recreation and secondarily for subsistence, began to do so as the most important source of subsistence. So many wild zoonotic diseases appear, because there are no longer 5 or 10 people who go hunting but people who regularly stay overnight in the mountains to hunt.

L.J .: In addition to Leishmaniasis, which other zoonoses find as a result of deforestation.

D.S .: There are zoonoses that appear when one deforests and leaves a curtain without deforesting, or ecological strips as they are called in some provinces, where, as we said, many animals accumulate. One of the animals that accumulates in the curtains is the human being, because he also likes that shade. There people settle to live, or rest during their daily tasks. Hantavirus is a disease that can increase in rodents concentrated in these curtains, and if a rodent with virus in the urine passed through a path and someone crosses that same path, a frequent risk situation is created. Above all, if, in turn, we have crops, even those of direct sowing, that have a vegetable blanket and suddenly it quickly disappears, that generates "rats". It was common to hear from the villagers who live around or within the sugar cane crops, for example, that when they burn the cane there are times when they have to leave the house to the rats for a few days, there is no merchandise that they can accumulate, nor noodles, no rice, because rats destroy everything. This traditionally happened with sugarcane, and continues to happen with direct seeding and soybeans, generating a huge health risk.

At this time we do not have some traditional diseases that are associated with rodents, for example the bubonic plague, but it must be remembered that in the Andes of Peru and some areas of Bolivia the bubonic plague bacteria (Yersinia pestis) reappears, and that the Deforestation is occurring in our remnant of the Andean cloud forest, the Yungas. So, I am not saying that we are going to have plague, but that many zoonoses that have remained wild for many years and that in Argentina, for example, were not registered, can reappear due to this intensive contact with wild rats. Today we have many emerging diseases that we do not know what their size will be when they come into contact with human populations. We have fevers due to Rickettsiae such as spotted fevers, spotted fevers, which can have fatal outcomes, and are associated with ticks that are in turn associated with rodents. We have had cases in Jujuy. There have been cases in Brazil, Bolivia, and Paraguay.

L.J .: You were just commenting that when you went to the cultivation areas the ticks attacked you.

D.S .: Well, it has been very evident with the appearance of monocultures, where conditions of explosion of plague populations exist. By definition, man-made pests appear when an organism that is in balance is given the opportunity for unbalanced growth, and one of the typical opportunities for this unlimited growth is monoculture. To the extent that they eliminate predators and at the same time generate a uniform and very extensive landscape such as never existed in nature. It caught my attention, precisely in a recently deforested area of ​​Salta, that I was attacked by such a large number of ticks as had never occurred to me, a soy-wheat area, at the time of the ripe wheat fields. It is not even a livestock area, so they must be attacking wild animals that are going to eat the soybeans, such as agoutis. And so there may be explosions of tick nymphs in an area close to the one that already has a history of children killed by a fever of the type of the rocky mountains, of spotted fevers, in Jujuy

L.J .: When was this?

D.S .: It has been happening in the last ten years. Six cases of children living in close proximity with "spotted fever" due to Rickettsia transmitted by ticks.

L.J .: And was it close to that area?

D.S .: It was in Jujuy, in Palma Sola and surroundings, department of Santa Bárbara, in a partially forested area. But all the alterations that modify both the soil and the crops can generate plague explosions. At this time, in other areas, there are Pique explosions, which is a flea that gets into the skin of the feet or under the toenails, and if it is not treated the associated infections are so serious it can generate mutilations. The abundance of the flea depends, among other things, on the type of soil and climatic conditions, strongly associated with the strategies of exploitation and land cover, and in turn on the populations of rodents and domestic animals that maintain the cycle when they humans are treated. Of many of these diseases, unfortunately, not having a good historical record, we cannot say that they have increased because we do not know how much there really was before. But if we begin to take the comment of the locals as an indication, even if there is no record, we know that people "see" it much more than before. And this is something that occurs from Brazil, Paraguay and the entire Argentine Paraná area with an increase in periodic chop pulses in relation to years of drought. In many communities this can become a specific public health problem.

So there are problems, as we said, that are not intrinsic and specific to this process of soybeans as soybeans themselves, but are more related to the superstructure and economic strategy, or with monocultures, which pass but leave behind. highly vulnerable populations. For example, from a public health point of view, suddenly all the water in a community is withdrawn for commercial irrigation. I have seen entire rivers diverted, and communities that run out of water because the river was diverted for large-scale cultivation, even though the papers say that it is only an irrigation canal that guarantees drinking water for the population. This has been the case forever, but now it becomes more serious with crops that require permanent irrigation. And not only in desert areas transformed into cultivation areas, as traditionally in San Juan, Mendoza or Santiago del Estero, but also in areas that generally did not have water problems, taking years of drought, such as in Salta. And one suddenly sees that an entire river has been diverted with all the laws, dynamiting, doing whatever it takes to force it to change course. Creating in turn new problems in the headland that is eroding, it runs backwards due to the change in height of the course. And a focal problem becomes the problem of a remote group, from the aboriginal populations that move with the fishing and suddenly find groups that fish indiscriminately with dynamite, to the bulk of the population that was of rural extraction and that today are living in places without work, without water and without the possibility of making gardens, not even subsistence. Without physical, economic or cultural alternatives to make them. They are not promoted, and in places where there is no cultural tradition of vegetable gardens then magic formulas appear where a supernutrient is sought, as if what was needed was to replace traditional foods with soy. Inventing a soup with supernutrients or a magical yogurt, and not exploiting the diversity of products that already exist in the area, because we are talking about areas that normally produced a huge variety of fruits and vegetables, which made mini-exploitation of goats, pigs and chickens .

(Daniel stops and shows the map behind him).

D.S .: Here we have a satellite image of Salta, on the border with Bolivia, both the Department of San Martín and the Department of Oran. An area that was typically farms, which were the ones that produced the first fruits and vegetables for the rest of the country. Firstfruits, because we are talking about the subtropics and it was where the first crops of the year appeared. Many of the citrus fruits and vegetables such as peppers, aubergines, ancos, came from that area, for example from Santa Rosa, in addition to the traditional sugar cane area. An area that was already dedicated to export, beans and peppers for export. Today, removing some areas of sugar cane, almost everything else is dedicated to soybean-wheat, even those that were remnants of original vegetation were deforested. This photo is from 2002. Today these same images are going to find many deforested areas. All that is clearer is the cultivation area today dedicated to soy. Deforestation advances until it reaches the unprofitable zone because the topography of the land does not allow it. In an area where only the oil exploitation areas are being forgiven, which in turn are also deforested and with common agricultural-livestock and oil projects.

Legislation has changed, theoretically business projects are generated to deforest conserving ecological corridors, but perhaps the most important are areas with communities without a tradition of subsistence through vegetable gardens, and that do not have access to a job that offers them human dignity. So without resources, they end up living on subsidies around the cities, transforming themselves into municipal employees with no concrete work but plans subsidized by the state, concentrating on peri-urban neighborhoods, also subsidized by the state. There are northern provinces where today 80% of the population must be living on federal co-participation, where those who do not work in the service sector are working for the national or provincial state. And where it is still very rare to see, as in Las Lomitas, Formosa, some aborigines with the old pro-huerta plans of INTA, but they were the fewest. But it was not a generalized cultural guideline, not everyone has a garden or has enough land to do it.

I believe that if there is a model, we must be aware of its scope and risks, it must be verbalized. And we are facing a large-scale model. It is shocking to return to Tucumán or Salta and see how the color of the crops, corn, pumpkin or the sugar cane of Tucumán has changed to find that as far as the eye can see by air and land it is all soy or soy yellow- wheat. One becomes aware of the term monoculture when one sees hectares, hectares and hectares not only equal, but with regular borders, without leaving any of the original vegetation pattern. From the air it is a geometry that transforms the landscape into a cubist vision, that violates the landscape, that has forced it to that structure and patterns. Perhaps neither the dispersed dwelling nor the rural ranch are optimal, nor that they are worth conserving. But if a country model was chosen, one hopes that the advantages and disadvantages for all will be made clear, that they will be democratically discussed and the model democratically chosen.

There is something that they express it several times in their documentaries, and it worries me too, how far people from the city are from seeing all this modification. One can say the landscape changed, and people do not realize it, it would seem a difficult conceptualization to visualize because one continues to see the same products on the supermarket shelves. But when one begins to travel, that change of landscape in a few years, that infinity of monoculture is shocking.

L.J .: When you hear about the Sustainable 100 Million Forum, which is planning to expand the agricultural frontier from 5 to 12 million hectares, what can be said?

D.S .: One, without being an economist, having listened to the economists, knows perfectly well that the problem of Argentina and the world is a problem of distribution, not of the agricultural frontier. When I counted that in Argentina in the 80 'we went from 40 cases to 400 cases of Leishmaniasis, that jump in the 80' occurred throughout the southern cone and I would say that in all of South America. This has to do with a first expansion of the agricultural frontier, after the oil crisis of the 70s, after the easy credits of the 80s and that many countries took advantage of it to do public works, the trans-Amazon highway for example , or hydroelectric projects, all projects that advanced on the wild border, the borders of primary vegetation. And they were not exclusively agricultural projects, but also industrialization projects. Today we are talking about a gas pipeline that connects Venezuela with Argentina. All of these projects generated the Leishmaniasis outbreaks that we know of. And I don't recall any expansion of the agricultural frontier that has meant more food for the people. It did mean a new redistribution of the land, usually in large estates. We have thus historically had expansion to the south in Argentina in the Desert Campaign, we have had an expansion to the north in the Chaco Campaign. Expansions of the agricultural frontier and in none of them has it been seen that this has resulted in a more equitable distribution of food. Likewise, the Slavic colonization in Misiones, today there is little left of those smallholdings or of the cooperative strategy, there are few left and less and less will remain while the traditional crops with which they are associated disappear.

If any sustainable strategy is proposed, it would be important that all strategies, both hydroelectric and agricultural expansion, specifically consider risks to public health in the impact assessment. That precisely in this impact evaluation sustainability is not only a financial return, but also a sustainability for the population that is living in the area or that may live in the area.

As a citizen, I can oppose deforestation from an axiological criterion, I consider it good or bad, but as a public health researcher, if it is deforesting, I have to find mitigation tools. As a health worker, I can't say that if they don't stop deforesting I won't do anything, because in the meantime they are deforesting and people are getting sick, then I have to act. Now, a priori, I cannot assure you without knowing where or what, where or how, to say that the expansion of an agricultural frontier is good or bad in itself. But if there are no mechanisms that guarantee a redistribution for me it is more of the same. Especially when comparable experiences in history, as in the "green revolution", generated more dependence on imported inputs. Then it generates a very dependent system, of creation and recreation of external debt, of dependence on inputs to produce, and of dependence on few powerful buyers. And in this I don't see any kind of sustainability.

If you talk to me about the sustainability of the macroeconomy, about a country that decides to live off export retention, it may be. But then a redistribution system is demonstrated where legitimate resources are generated so that the strategy is sustainable, for when the international grain market changes and that monoculture to which they were dedicated is suddenly interrupted and prices fall. The world has known this story from the dramas of coffee or rubber, or in Argentina the entire area that produced flax, that produced flaxseed as oil. If it does not demonstrate a form of redistribution that generates a sustainable way of life, the most visible product of the proposal is hunger. And perhaps less visible but more deteriorating in sustainability as a society is the issue of dignity. Many people, on the one hand, without being an original discovery what I am going to say, if they are worried about what they are going to eat tomorrow they cannot think of anything else, of another larger project. And if, in turn, one has a system that produces less and less food and is already seeing it today: entire generations with significant comprehension and learning problems due to child malnutrition; generations that do not have all the potentiality they should have to think; generations that create and recreate dependency, losing even their dignity because they get used to it, because they cannot think from another perspective, they have no alternative to think from another perspective. And I believe that it is in this place where the responsibility of the sectors that were relatively more favored by society really begins, and of the leaders who are theoretically the representatives of society, to assume sustainability as a sustainability of human dignity. That is, to generate a system that if a sustainable structure is proposed, people do not depend on less stable variables of the strategy but on a form of decent subsistence independent of the grain market, independent of the interest on a debt that goes up or down.

Many of the provinces that boast about the level of employment achieved or the amount of export withholdings they have had will fall if those random benefits are withdrawn. The system cannot be self-sustaining. They have generated absolutely nothing permanent in 10 or 20 years of net profit. So I do not see, if the rules of the game do not change, how history will change in the next 5 years because there is twice as much land dedicated to agricultural exploitation. Because ultimately the leaders are the same, the economic structure on which they live, grow and sustain themselves is the same. And the power structures in each of the sectors are the same, especially in the agricultural sectors, although they have changed from large estates to foreign companies, they all respond to the short-term profit of the companies. And the old landowners and other sectors that today work for companies when large profits appear, spend them on luxury goods. It is like being in one of those eastern countries where all the oil profits are in the hands of 2 or 3 families, who spend it on luxury goods, in the financial market that they theoretically hate, but do not reinvest it to improve the quality of life of its population.

Entonces tenemos que una comunidad que ha perdido dignidad, que no puede pensar en otra cosa salvo la subsistencia inmediata y menos va a pensar en un sistema económico o discutir seriamente un sistema político. Un sector mayoritario que está hambreado, que no se va a poder educar porque no accede a la educación. Y eso no es sólo sustentabilidad, es embargar el futuro, es construir un sistema dependiente para que se reproduzca la dependencia.

L.J.: Tenés idea de cuánto le cuesta al estado, por ejemplo en salud, las consecuencias de esta expansión de la frontera agrícola.

D.S.: Estamos iniciando algunos proyectos, muy incipientes, de evaluación de costos al menos de Leishmaniasis, para tener esos datos. Es difícil hablar de costos porque hay muchos costos indirectos y muchos costos ocultos, se tiene que trabajar muy seriamente para llegar a conclusiones con rigor metodológico. Lo que sí es evidente es que las ganancias que van al sector privado y los costos los está pagando el estado. Hoy no puedo decir en números cuánto le cuesta, pero el sector privado no lo paga.

L.J.: Un tratamiento de Leishmaniasis, tenés una cifra de cuánto sale?

D.S.: De un tratamiento de Leishmaniasis puedo dar solamente el costo de la droga, en un adulto son unos 100 dólares. Pero tenemos que pensar que una enfermera le tiene que poner la inyección con una jeringa descartable dos veces por día a una persona por unos 20 días. Que tiene que haber un sistema de diagnóstico atrás. Un sistema clínico para hacer el seguimiento del paciente. Y hablando de costos hay que considerar que la droga genera efectos secundarios, el más típico es el dolor de las articulaciones, artralgia, que a medida que va pasando el tratamiento a mucha gente le impide moverse. Si bien es un efecto pasajero, cuando se termina el tratamiento la persona se recupera, en un jornalero eso significa quizás 20 días perdidos de trabajo, significa quizás que una familia se queda 20 días sin ingresos. O en áreas de algunas culturas aborígenes la persona se interna para hacerse el tratamiento y viene toda la familia a internarse con el consiguiente costo para el sistema de salud. O el enfermo es un niño y tiene que acercarse con algún mayor hasta la ciudad, porque no hay una enfermera local, y en ese caso hay costo de pasaje o costo de ausencia de la jefa de familia, la madre, que desatiende a los otros hijos. Por eso hay que tener muy en consideración los costos indirectos y ocultos que existen en estas enfermedades, porque es muy común estar hablando solamente de costos directos, cuando el mayor impacto de las enfermedades en áreas rurales hay que medirlo como días perdidos de trabajo, de viaje, de vivir en la casa de un pariente en el pueblo, amén de la droga en sí. A su vez, uno puede tener un costo adicional para el sistema porque en los países limítrofes el sistema asistencial es privado, entonces para acceder a este tipo de tratamiento en forma gratuita deben cruzar la frontera sobrecargando los costos nacionales. Otra vez aclaro que este comentario no es un juicio axiológico, el hecho en sí no es malo ni bueno. No me parece que a la gente que vive en el área de frontera se le tenga que negar tratamiento, ni me toca a mí opinar que en el otro país es incorrecto privatizar la salud. Pero es un hecho concreto que pasa y que sobrecarga el sistema. Pero si de pronto una empresa decide que va a deforestar un puchito como dicen ellos, un puchito de 500 hectáreas que le quedaba sin deforestar porque les conviene tener 500 hectáreas más de soja, y eso produce 15 o 50 o 100 enfermos de Leishmaniasis, de quién es la responsabilidad social, ya que todos indican al Estado como el único responsable de garantizar la cura de esos enfermos

L.J.: Cuando hablás de Leishmaniasis, hablas tanto de la cutánea, la mucocutánea como de la visceral?

D.S.: En la Argentina estoy hablando principalmente de Leishmaniasis cutánea y mucocutánea. Es decir la Leishmaniasis tegumentaria, que aparece en la piel, que si se cura sin tratamiento espontáneamente, o si se cura en forma incorrecta, tiene probabilidad de desarrollar en muchos años una forma mutilante del rostro y eventualmente fatal, que es la Leishmaniasis mucocutánea.

La transmisión de Leishmaniasis visceral en la Argentina hoy no esta comprobada, pero la tenemos en la frontera con Paraguay y probablemente ya haya pasado la frontera. Estamos instaurando un sistema de vigilancia. La Leishmaniasis visceral tiene el riesgo de una letalidad más alta y su potencial urbanización. En otros países latinoamericanos se está viendo incluso asociada a algunas rutas de transporte. Por ejemplo la ruta del sur de Brasil que va a Bolivia, donde varias localidades, progresivamente a lo largo de la ruta fueron teniendo brotes epidémicos.

L.J.: ¿Cuáles pueden ser los motivos de esto?

D.S.: Uno de los motivos es probablemente que en el caso de la Leishmaniasis visceral, que no pasa con la tegumentaria, el perro es uno de los reservorios. Y hay migraciones con los animales domésticos y con ciertos patrones culturales de cría de cerdos y gallinas, permitiendo sitios donde se reproducen los insectos que la transmiten. Y es probable que una vez que se establece en un lugar, por migración, va pasando a los otros. No es un fenómeno que esté del todo entendido. Está estudiándose en la zona de frontera, para saber si puede entrar por Formosa o eventualmente por Misiones, pero fundamentalmente por Formosa, y desde Formosa extenderse por toda la ruta hacia el sur.

De la misma forma la Leishmaniasis tegumentaria, hace algunos años decíamos que el límite sur de la transmisión epidémica era más o menos en los 28º de latitud sur un limite que en la Argentina cruzaba las provincias de Santiago del Estero, Corrientes, Catamarca. Pero el año pasado ya encontramos no la enfermedad, pero poblaciones de vectores, de insectos que pueden transmitir la enfermedad, en las provincias más al sur, de Entre Ríos, Santa Fe y Norte de Córdoba. Inclusive en Entre Ríos y Santa Fe cerca de la ciudades capitales. Si a eso sumamos, según comentarios de la población y por lo que uno ve, que también ha habido tropicalización de la zona en toda la fauna y la flora de la galería del Río Paraná, donde cada vez el trópico se va más al sur, estamos aproximándonos a una situación de riesgo nueva en la Argentina. Insectos transmisores de Leishmaniasis tegumentaria muy cerca de los grandes centros urbanos, donde hay periurbanos enormes y desordenados, donde la población susceptible pasa a ser geométricamente más grande. Un riesgo donde aunque el sur tenga tasas más bajas de transmisión, el número absoluto de enfermos será más importante, y también el costo social y el costo para el sistema de salud. Por eso en el 2005 incorporamos a Córdoba, Santa Fe y Entre Ríos al Programa Nacional de Leishmaniasis para que estén preparados no sólo para atender a migrantes desde las zonas tradicionalmente endémicas, pero que estén preparados también para un posible brote autóctono de Leishmaniasis.

L.J.: Volviendo a la Leishmaniasis visceral, cuáles son la causas de las migraciones.

D.S.: Las causas de las migraciones son las mismas que se están dando en otras enfermedades, razones fundamentalmente económicas. Son las migraciones rural-villas, villas-ciudades, ciudades-ciudades sobre todo en frontera, ciudades-megaciudades, con viajes periódicos a sus lugares de origen, lo que genera una doble circulación de patógenos. La ciudad de Asunción, en Paraguay, registra cada vez más casos de Leishmaniasis visceral, tanto en perros como en humanos, han instaurado un programa. Nosotros, te comenté antes, en Clorinda, en la provincia de Formosa, frente a la ciudad de Asunción, en el 2002 no encontramos el insecto vector. Teníamos otros insectos parecidos, pero no el que transmite la Leishmaniasis visceral, que en esta zona del sur es uno solo. Pero en noviembre del 2004 ya apareció en Clorinda, de este lado de la frontera.

L.J.: ¿El vector es?

D.S.: Lutzomia longipalpis. Apareció en noviembre de 2004 en plena ciudad de Clorinda. Y como hay pobladores, que si los favorece el cambio de la moneda, compran perros de raza en Asunción, de pronto traen un cachorro con Leishmaniasis visceral a Clorinda, en un lugar donde ya está instalado el insecto que transmite la enfermedad. Y también pasan animales sin dueño a través de la frontera seca. Que quede claro que no estoy diciendo que la Leishmaniasis visceral en Argentina aparecerá por culpa de Paraguay, sino por una situación socio-ecológica compartida. Esto no es un tema de autoridad nacional ni de soberanía, es un tema común de la región. A los efectos socio-demográficos, como en todas las fronteras de vecinos con buenas relaciones, algunas ciudades argentinas son ciudades periféricas satélites de Asunción, la gente cruza y viene a comprar aquí y de aquí cruzan y van a comprar allí. En una encuesta en Clorinda observamos que casi el 30% de las personas habían dormido en la ciudad de Asunción la semana anterior en casa de amigos o parientes. Y es lógico en una frontera casi seca, cruzada por un río donde hay puentes peatonales. Es una situación hasta legítima de esa comunidad. Es una comunidad binacional. Eso no quiere decir que haya que aceptar que de los dos lados haya perros vagabundos que crucen la frontera en forma constante esto genera un riesgo para los dos lugares. Sobre todo que esa frontera es una puerta de entrada a las rutas comerciales que comunican Asunción con Corrientes o Resistencia, lugares con los que hay intercambio comercial pero también numerosos lazos familiares.

En todo proyecto de expansión o desarrollo, por lo que decía antes, hay que evaluar los impactos. Hay una fuerte tradición, que no está mal, en la evaluación de impacto sanitario y ecológico que viene de la ingeniería ambiental y donde, de pronto, algunos aspectos de salud pública son descuidados, o tomados en cuenta sólo en las obras hídricas. Pero en la construcción de las evaluaciones de impacto se ha ido creciendo por tópicos, es un área que ha ido creciendo por agregados y sumatorias. Entonces, se puede abogar con fuerza para que se incorpore la sustentabilidad económica de las comunidades afectadas por los proyectos, algo que ya se incorporó cuando las represas inundaron terrenos y se mudaron a los habitantes del área, aunque no siempre se garantizó una fuente de subsistencia sustentable y digna para los mismos en la nueva localidad. Y lo mismo cuenta para incorporar a la evaluación de riesgos el aspecto sanitario de insectos vectores y mamíferos reservorios antes de realizar los proyectos en zonas de riesgo.

L.J.: Para ir terminando, vos contabas el otro día que cada vez que preparabas un protocolo para captura de insectos para investigación epidemiológica, cuando llegabas al lugar indicado, te habían dejado ya sin monte primario para trabajar y te corrían el lugar por la deforestación.

D.S.: Si, es por la aceleración de los tiempos de la deforestación, gracias nuevamente a la soja. Esto nos ocurre justamente con un proyecto para evaluar el impacto de la deforestación sobre las poblaciones de insectos. Tenemos que hacer muestreos de insectos sobre las áreas de vegetación primaria, así que armamos un protocolo de investigación y cada vez que vamos a instalarlo, se corrió la frontera de deforestación y la vegetación primaria es campo de cultivo. Hablamos de kilómetros y kilómetros y kilómetros donde la vegetación primaria está cuando nos vamos, y cuando volvemos ya es soja. Así que nos corremos hasta la nueva área donde queda vegetación nativa remanente, instalamos nuestras primeras trampas, y cuando volvemos a los 2 o 3 meses, de nuevo nos han corrido la frontera hasta que, como decía, en muchos de estos lugares como en las sierras de Orán prácticamente llegaron a la ceja del monte. Más de ahí, no se puede ir, porque ya no hay más. Ya no hay más monte tampoco. Es todo vegetación secundaria.

CN: (quien filmó la entrevista) Me daban unos retorcijones en el estómago cuando escuchaba.

L.J.: Sí me superó totalmente. Creo que dejamos la película así. Lo pasamos así sin nada, porque para qué editar? Porque, en realidad, cuando una habla de todo esto, piensa: ¿puede ser tan malo todo, no?

D.S.: Y lamentablemente no es un sistema diferente a lo que uno viene viendo en forma histórica. El problema es el engaño.

L.J.: Y cada vez pero, porque es la negación también.

D.S.: Es como cuando en los ’90 uno le decía a los riojanos: ¿ustedes se cruzaron a Tucumán?, esta riqueza que viven es una ilusión. Ellos decían: no, no, de alguna forma se va a mantener. Una negación absoluta. Ya se estaba cayendo todo y lo negaban.

Vivimos una sociedad, en toda Latinoamérica y quizás en el mundo en una sociedad negadora, que vive negando, vive jugando a la desmemoria y donde este cortoplacismo hace que los pequeños momentos donde hay un aparente crecimiento, se consideren eternos. Entonces, es una pequeña fiesta para algunos. Gotea a la clase media, esa clase con capacidad de decisión, o que debería tener capacidad de decisión, y se conforman con dos mangos. Y vos le decís, esto no puede durar, porque esto no va a durar.

L.J.: Y ellos dicen, aguantemos estos 4 años y después echémosle la culpa al que viene.

D.S.: Y… un poco como comentábamos, para mi entender, sabiendo que la comunidad europea no va a poder mantener este sistema de compra de la soja, porque en algún momento va a tener que rever su sistema de subsidios, y donde nos va a quedar como único gran comprador China, es una ruleta rusa, es una ruleta china realmente, pero es una ruleta rusa. China tiene el poder para cambiar el precio.

La CEPAL con Prebisch y los economistas de los 60′ impusieron la idea del deterioro de los términos de intercambio, cuando los productores primarios venden barato y compran caro, y después vino la escuela liberal criticándola de bagatelas marxistas. Pero independiente de las ideologías el deterioro del intercambio está a la vista. Porque volvemos a elegir un sistema de país de producción primaria, sin ningún valor agregado. Estamos en tiempo de la revolución liberal y entramos en el segundo centenario exactamente igual que como en el primer centenario. La fiesta del segundo centenario, como la del primero, va a ser la fiesta del granero del mundo donde solamente van a festejar esas 5 familias que llevaban sus vacas a París, o el quebracho a Inglaterra. Pero en este momento es muy difícil decirle a la gente que vivimos en una sociedad económicamente vulnerable. Porque estamos con la misma vulnerabilidad que en los 90′. Si, ideológicamente es distinta, pero en la base… Es volver a Galeano, la pobreza de los pueblos como consecuencia de la riqueza de la tierra. Aquí y en los otros países de Latinoamérica es lo mismo.

Vos hablabas de Paraguay. Es interesante, de pronto ir a la zona del Chaco, a la zona menonita y ver ese híbrido económico que han hecho rodeados de aborígenes y criollos, una sociedad cooperativa casi Amish. Donde el excedente tampoco ha salido del ámbito menonita.

L.J.: Bueno, los Menonitas han cobrado tanto poder en Paraguay.

D.S.: Y hoy se están instalando en Santiago del Estero, de las mismas colonias Menonitas de Paraguay.


En los últimos días de 2005 la Dra. Lilian Joensen, bióloga molecular, investigadora de la enfermedad de Chagas y miembro del Grupo de Reflexión Rural, fue invitada a disertar en un Seminario en el Instituto Nacional de Parasitología "Dr. Mario Fatala Chabén" ( Participaron del mismo el Director del Instituto, investigadores, técnicos y estudiantes.

Finalizada la proyección de la película ‘Hambre de Soja’, que se utilizó a fin de promover la discusión y el debate, y luego de algunos comentarios, tomó la palabra el Dr. Oscar Daniel Salomón, investigador de enfermedades zoonóticas quien comenzó a relatar sus experiencias recogidas en los innumerables viajes de trabajo durante más de 25 años por las doce provincias del norte argentino.

Sus reveladores comentarios nos movieron a solicitarle una entrevista que fue filmada en video por Claudia Nose, del área de Docencia del Instituto Fatala Chabén.

La entrevista además de confirmar los múltiples impactos de los monocultivos y del avance de la frontera agropecuaria, que como GRR hemos venido denunciando en los últimos años, agrega un nuevo aspecto que no habíamos abordado en profundidad: el Modelo Agroexportador es mucho peor si se lo mira desde la perspectiva de la salud publica y del costo que ello implica para el Estado.

Dra. Lilian Joensen

Video: TIBI Presents Fireside Chat on Cellular Agriculture, Presenters: Dr. Liz Specht and Dr. Ali Kh.. (June 2022).