Chagas Disease and Brazil’s Unified Health System (SUS): The Challenge of Confronting Historical Gaps

It is estimated that more than two million people are living with Chagas disease in Brazil. Although many affected people live in large cities and state capitals, a vast contingent remains dispersed across rural and sparsely populated zones, in extensive inland areas, much of it within a corridor stretching from the Northeastern semiarid region to the Southern pampas, passing through the Cerrado of Central Brazil, a region severely affected by the endemic. Outside this wide belt where vectorial transmission has been virtually interrupted, new cases continuously emerge from the sylvatic circulation of T. cruzi in the Amazon region. Many of affected persons, often unaware of their condition, face major difficulties in accessing adequate medical care. They move through poorly defined therapeutic itineraries, where even basic procedures such as serological testing, electrocardiograms, or echocardiograms are difficult to obtain. It is necessary to map the most vulnerable and priority areas, to incorporate CD into primary health care programs through health information systems, to expand access to electrocardiographic evaluation with telemedicine support, to ensure referral and counter-referral systems to cardiology and gastroenterology outpatient clinics, to facilitate access to echocardiography, and to identify facilities that provide high-complexity procedures. In conclusion, it is crucial to build care pathways based on the organizational principles of the SUS: universality, decentralization, equity, comprehensiveness, and hierarchization, as well as popular participation through patient associations and health councils. Upholding these principles for people affected by CD—and other cardiomyopathies—is essential not only for survival but also for ensuring dignity and hope, especially in inland communities, where more vulnerable populations depend on primary health care as the only gateway to treatment. In this article, we seek to highlight the main barriers to healthcare faced by people affected by CD, proposing a general framework for their medical care, with the aim of contributing to healthcare policies.