Consider Yourself a Citizen Scientist

Even before starting med school, Lourdes Delgado had an interest in tropical medicine. Then, as a medical student, she devised a program —in association with the Venezuelan Science Incubator— to train “citizen scientists”, who report to her on the places where they find chipos, the vector that spreads Chagas disease. She feeds a database with that information. It is not a small contribution, considering that there are no epidemiological data available in the country.

PHOTOS: ARNOLDO PORTA (Science Magazine) / INCUBADORA VENEZOLANA DE LA CIENCIA / FAMILY ALBUM

One day in March of 2018, Lourdes Delgado was at home in Barquisimeto, state of Lara, watching TV. A group of young people in white coats were being interviewed. They were medical students who had the microbiologist and epidemiologist Alberto Paniz Mondolfi as a professor. They said that Venezuela was a country prone to infections spread by animal bites or through contact with animals. They claimed that dengue fever and Chagas disease are two of the most common diseases in the country, and two of the more neglected because it is hard to document cases.

And if there is no information on record —they insisted—, people are at an increased risk of infection.

Lourdes was 17 at the time. She was just fresh from high school and had already enrolled in the College of Medicine of the Lisandro Alvarado Central Western University in Barquisimeto. She had the idea that physicians worked in doctors’ offices or operating rooms taking care of people. And that was basically it.

In that interview, the students mentioned something that caught Lourdes’ attention: 2016 was the last year where information was made available on precisely where and when outbreaks of those diseases were occurring in the country. Faced with such circumstances, they urged university students to join a field research program in Lara aimed at monitoring cases of Chagas disease and tracking the insect that spreads it: the triatomine bug, known in Venezuela as chipo.

About two months later, she applied to the Dr. Paniz program called Venezuelan Science Incubator (VSI).

She hadn’t stepped into a med-school classroom, but she had already learned at the VSI that the branch of medicine that studies some of the neglected diseases in question is tropical medicine and that the animals and other organisms that transmit them are known as vectors.

According to the medical literature she read, tropical medicine was usually practiced in rural areas and rarely in urban centers. Some of the textbooks were from the 1900s.  But it just so happens that temperatures have risen over the years and mosquitoes and chipos have migrated to the cities.  Lourdes remembered that, when she was in high-school, her friends in Barquisimeto got sick with dengue fever and experienced other acute fever symptoms.

She would turn on the TV to listen to the news on the subject:

—“As per the epidemiological bulletin issued by the Ministry of Health for the last week of December, dengue, Chikungunya and Zika fever cases are on the rise in Venezuela. The Tropical Medicine Institute of the Central University of Venezuela has reported Chagas disease cases in Caracas. The hotter temperatures and reduced rainfall in the country resulting from the El Niño climate phenomenon might be behind said cases,” she heard a journalist say.

And that was the year when the VSI began to document dengue cases in Lara.

Lourdes knew that dengue was a mosquito-borne virus, but she did not know much about Chagas disease. So, she decided to study chipos meticulously.

She read scientific articles and peer-reviewed journals according to which the disease only affected rural areas and farmers, and chipo was just the disease vector responsible for the transmission of a parasite known as Trypanosoma cruzi, the real cause of Chagas disease. She searched in the library and on the Internet for epidemiological bulletins with information on the cities and rural areas where the disease had been recently reported. She got nothing. The VSI had been advising people in Lara for a while on how to prevent and treat Chagas disease. But it was 2018 and it had been two years since the Ministry of Health last published epidemiological documentation.

There were no recent data other than the academic work published by physicians in various universities, mainly from Caracas, Mérida and Lara.

And almost every article referred to a possible increase in cases.

Some of the patients that visited the offices of her VSI professors were born and raised in a city, while others came from rural communities. Lourdes talked to patients who reported symptoms suggestive of Chagas disease, namely swelling of eyelids, nausea, enlarged lymph nodes and fatigue; they told her about the medication they were taking to cope with it.

It was during her lab practices at the VSI —not in college or at a doctor’s office— that she got to see chipos for the first time: they were bigger than a bedbug and larger than what she had imagined; they also had some kind of neck, which is seldom seen in other bugs.

When the lab professors had her check a dissected chipo and a few samples of the insect’s stomach contents under a microscope, she noticed a number of thin, tiny spots that moved as if they were tadpoles. Those were the Trypanosoma cruzi.

—”Are chipos so elusive that people fail to see them? Where do they hide?” she wondered.

Less than two months later, she was invited by the VSI to a field activity. They would travel to villages in the state of Lara to talk to people and find out if there were chipos in the area.

It was December of 2018 and the sun was scorching in Humocaro Alto, a village some 66 miles south of Barquisimeto. The students visited the colonial houses, mostly made of mud, asking residents if they had found chipos home and if they knew where to go if they ever caught one.

—”I squash them like cockroaches,” many responded.

They were about to visit the tenth house when a 14-year-old boy approached Lourdes and her team.

He had a dead bug in his hands.

— “I find them every week at home, more than one if it’s hot.”

Lourdes noted that the insect was brown in color and had some black spots. It was about 1 inch long and looked like a fingerprint, narrow near the head and wide at mid belly. It had an elongated, needle-like head, with bulging black eyes. Its six legs were folded because it was dead, but they were long and thin. And its antennae protruded from its head, just past its eyes; they looked like poorly trimmed whiskers because one of them was broken.

Without a doubt, it was a Panstrongylus geniculatus, a type of chipo.

— “Do all the bugs you find look the same?” she asked. “Let’s go wash our hands right away.”

On their way to the boy’s house, in the hot sun, Lourdes explained to him that these bugs, the Tritatominae, feed on blood and can spread the Chagas disease. She went on to say that the chipo is the vector of the disease, but it does not infect people as mosquitoes do, through a bite: it bites people’s skin to feed from it and then defecates at the bite site. It is in its feces that the parasite thrives. When people scratch because of the itching caused by the bite, tiny tears are formed, which allow the parasite to enter the body.  If the parasite is detected early, people have a better chance of controlling the disease. But it can be asymptomatic, which means that it could take years, even decades, for some to find out that they have been infected, right when their hearts stop pumping blood properly and are severely damaged.

That’s why doctors always warn against touching a chipo with one’s bare hands.

— “But then, how do I pick them up and take them to the doctor?” asked the boy.

— “Next time I’ll take a picture of it and pass it on to you so you can see that I’m not lying when I say I find one every week.”

And the boy made good on his promise. Every week, Lourdes would receive a WhatsApp message from him with a photo: some were chipos; some were green bugs that feed on plants and do not carry the parasite that causes Chagas. He would make questions and she would answer. They went on like that for two years, until the boy was finally able to tell a chipo from other bugs and would send her photos only when it was actually one.

Every time that Lourdes, as part of the program, went on a field trip to remote areas in Lara or Portuguesa, she would come back with piles of handwritten reports she had to convert to digital. That, and the fact that the trips were quite an ordeal, made the experience exhausting for many of her colleagues.

— “Why is traveling out of town so expensive? It requires time, and mobile data, and gas… Why is it that the doctors are the ones to travel?” she heard a colleague complain.

At that precise moment, she got a message from the boy from Humocaro Alto with another photo of a bug.

As she watched the screen, an idea occurred to her.

— “What if we don’t travel that often, but ask people to report to us? Sure, there are tests we need to do ourselves, but we can ask them to call us so that we can teach them how to identify chipos and the symptoms of Chagas.”

— “But we travel to those places precisely because there is no phone signal or Internet there…,” said her partner.

— “We’ll find a way,” said Lourdes.

In a country where access to technology is not a given, where power outages are a frequent occurrence and where there are just a few medical doctors left, it was harder than it seemed. Lourdes had to arm herself with patience. Lourdes began exchanging ideas with her college professors and with those from the VSI to devise training programs for local community leaders, physicians and nurses to teach them to identify a chipo when they saw one. And she learned how to use geolocation tools and databases and had to do a great deal of additional field research work to teach locals to identify a chipo, making them into what she calls “citizen scientists.” She traveled to about ten villages and cities in more than five states across the country to lay the groundwork for her idea.

Her project consisted of receiving reports remotely and advising people through a phone screen. It was not a far-fetched proposition, for the Museum of the Institute of Agricultural Zoology of the Central University of Venezuela had been identifying for several years the insects that users of the X social network sent them in photos. And, although some Venezuelan entomologists had moved to other countries, they continued to work with people who came across specimens of the Caribbean fauna.

Lourdes did not hesitate to contact them for her project.

She learned in the process that such digitized care approach was known as “tele-entomology.” But, as chipos can carry parasites, the VSI coined the term “tele-parasitology” to name it.

As early as March of 2020, in the midst of the COVID-19 pandemic quarantine, Lourdes’ and the VSI’s project began to materialize in a campaign called #BringYourChipo.

After the first training sessions, a male nurse from Acarigua, Portuguesa, sent her a text message telling her that he had found what looked like a chipo. Lourdes sent him a form that he needed to complete. Every single answer he sent describing the insect and the place where he had found it was processed in a computer and the information transferred to a geo-referenced digital database.

If the insect’s characteristics matched those of a chipo, Lourdes would advise him on how to catch it and take it to the nearest scientific research center so that it could be tested and checked for the parasite that causes Chagas disease.

More and more locals were sending her messages and sharing with their friends their experience with her and the VSI on how to notify bug sightings.

Between 2020 and 2021, Lourdes and a team of 18 scientists, including physicians, parasitologists, engineers, entomologists, and ecologists, received at least 110 reports from local residents, medical doctors, and nurses from 18 Venezuelan states. And each report came from an individual trained by the VSI, that is, a “citizen scientist.”

Although not all reports were of chipos —only 79 were—, the objective had been fulfilled: in a short period of time, they were able to map the places where chipos and cases of Chagas disease were appearing, that in a country where information on Chagas disease has not been made public for seven years.

Thanks to this joint effort between science professionals and local residents, it was possible for them to confirm that the Pastrongylus geniculatus, the type of chipo found by the teen from Lara, was migrating from the forests into the cities faster than they expected.

It is August of 2023. Lourdes is still studying medicine at the Lisandro Alvarado Central Western University.

On her lab desk, Lourdes’ cell phone vibrates with each new WhatsApp message. Someone has sent her a photo of a bug.

—”Hello, I would like to know if the insect in the photo is a chipo. Someone gave me your contact. I am from El Cafetal, Baruta Municipality, Caracas.”

Lourdes inspects the image. It is evident from the brown color with spots and the elongated head with bulging eyes that it is indeed a chipo, specifically of the Pastrongylus geniculatus type.

—”Hi, nice to meet you. Yes, it’s a chipo. I am sending you the instructions on how to fill out your report. Just be careful: place the insect inside a container, but don’t touch it, and wash your hands; we’ll make arrangements for you to take it to the Institute of Tropical Zoology of the Central University of Venezuela, which is the closest place to have it examined,” replied Lourdes resolutely.

It is all familiar to Lourdes. So far this year, she has read various research papers from the Central University of Venezuela, the University of The Andes and the Lisandro Alvarado Central Western University —the most prominent research centers for Chagas disease in the country— that warn of an increase in chipo sightings in cities like Caracas, due, among other factors, to rising temperatures and climate change.

Not a week goes by that Lourdes doesn’t get to teach about medicine and entomology through a screen. Some of the messages she receives are of sightings of bugs that don’t spread Chagas disease, but she’d rather deal with a false alarm than with an alarm that fails to be raised.

—”I’ve already filled out the form. Thank you for taking my report. I will be contacting you in case I see another insect like that one,” the woman finally said.

—”My pleasure. Consider yourself a citizen scientist. Thank you for contacting us and contributing to the #BringYourChipo campaign,” adds Lourdes as she says goodbye. The insect arrived at the Institute of Tropical Zoology of the Central University of Venezuela and the parasitologists performed tests on it. It turned out that the chipo was infected with Trypanosoma cruzi.  The woman and Lourdes had to wait a couple of days for the results to come out.

It wouldn’t have been possible if they hadn’t thought outside the box of a doctor’s office.

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