HBHS Novice - hbhsmun

Transcription

WHO
United Nations World Health Organization
topics:
 Chagas Disease
 Food Safety
Chaired by the Honorable
Sarah Heesacker, Cody Meicht, & Ciarra Nean-Marzella
S i n c e
HBHS
April 25th, 2015
1 9 7 8
Novice
hbhsmun.webs.com
Huntington Beach High School Model United Nations
World Health Organization
April 25th, 2015
Welcome to the World Health Organization!
Hi my name is Sarah Heesacker. I am a junior here at HBHS and I have
been in the MUN program for 3 years. In addition to my time consuming classes,
I also do a lot of volunteering with multiple organizations, both within and outside
of school. I am interested in studying science in the future, so I am looking
forward to watching you all debate these health related topics and come up with
well-researched creative solutions!
Salutations Novice delegates! I am Cody Meicht. I have been in MUN for
two years and it is by far my favorite class. I also play football at HBHS so I am
still assimilating to having such a busy schedule, but there is no way I would
consider quitting either of them. World Health Organization is one of my favorite
committees so I am looking forward to see what innovative solutions all of you
will come up with!
Hello delegates! My name is Ciarra Nean-Marzella. I am a sophomore
here at HBHS and this is my second year in our MUN program. Outside of
school, I play club volleyball and I am also involved in APA, or our HBHS’s
Academy of Performing Arts. I am so excited to be chairing WHO for this
conference and I can’t wait to see what great solutions you have prepared! Be as
creative as you can be in your solutions. I believe you will all do amazing. Good
luck and have fun researching.
Position Papers must be submitted to your Dais’s central email no later than 11:59 PM on
April 19th, 2015 to be considered for a Research Award. Research Awards will be presented
during committee; please be sure to follow the HBHSMUN Position Paper format available on
our website. Your Dais’s central email is: who.novice37@gmail.com
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1905 Main Street Huntington Beach, CA 92648 I hbhsmun.webs.com I who.novice37@gmail.com
April 25th, 2015
I. Chagas Disease
Topic Background
on the open bite wound and the parasite is
deposited through its feces.v This does not
immediately
contaminate
the
victim;
however, the natural human response is to
agitate the wound which in turn causes it to
open allowing for contamination.vi While the
primary acquisition of chagas disease is
through the triatomine insect, it can also be
contracted via blood transfusions and organ
transplants. vii In regions with medical
standards that are not strict or where proper
medical
tests
and
conditions
are
unavailable, blood infected with the Chagas
parasite as well as contaminated organs
can end up in use in regional medical
facilities, furthering the spread of Chagas.
Also, while not the primary concern when
addressing Chagas, there is the potential for
pregnant women to pass it on to their
children in the womb.
Nonetheless, people in South and
Central America are not defenseless
against the spread of this pathogen and
countries
have
undertaken
simple
objectives in an effort to prevent its spread.
The most prominent means of protecting
people in an area at risk is the use of
chemical insecticides to eradicate the
vectors, the two most widely used being
Deltamethrin
and
Lambda-cyhalothrin.
Despite there being no widely accessible
treatment for chronic phase Chagas, there
is an available treatment for its acute phase.
The two medications, both of which are
systemic antiprotozoals, are benznidazole
and
nifurtimox. viii Each
medication
effectively treats one hundred percent of
early acute phase infections; it acts by
moving through the bloodstream, targeting
parasites, and killing them, but it is only
effective to a point. As the infection persists
and the parasite undergoes more cycles of
amastigotes, producing trypomastigotes,
metacyclic trypomastigotes have a higher
potential of penetrating newer cells
Infecting approximately sixteen to
eighteen million people a year and killing
upwards of fifty thousand people, the
parasite Trypanosoma cruzi is responsible
for the emerging Chagas endemic in over
twenty one South American countries.i Poor
South Americans of all ages living at or
below the poverty line where their shelters
may harbor vectors in them tend to be the
largest demographic affected by Chagas.
The protozoan parasite T. cruzi is a vector
borne pathogen spread by the triatomine
bug, which, up until recently, had been
exclusively contained to South America.
However, currently there are over eleven
species that have been reported throughout
the southern United States. ii Perhaps the
most
beneficial
and
dangerous
characteristic of T. cruzi is that its stages of
infectivity, the acute phase and the chronic
phase, allow an ample amount of time, two
to twelve months, for treatment if it can be
identified, yet it makes it extremely difficult
to locate those who are carrying the
parasite. iii Symptoms of Chagas disease
during its acute phase are mild and range
only from swelling around infected sites, to
slight fever, fatigue, and nausea; this closely
mimics common ailments. However,
symptoms become more critical entering the
chronic phase; in most cases thirty percent
suffer from cardiac disorders as a result of
the parasite breaking down cardiac tissue
and ten percent suffer from neurological or
digestive irregularities. In both situations,
the infection is ultimately fatal. iv Another
beneficial characteristic of the Chagas
parasite is that it is exclusively spread by
the triatomine bug through its feeding
process. Unlike other pathogens, T. cruzi is
not directly injected into the bloodstream by
the triatomine insect. Instead, after feeding
on a person the triatomine insect defecates
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efficiency when treating cases. xii PAHO is
also working with the WHO and the
governments of a few countries in Central
America on the Chagas Disease Vector
Control Initiative. The objective of the
initiative is to reduce the transmission of the
disease in Central America. xiii Chagas
disease is one of the ten diseases targeted
for elimination by PAHO and WHO between
2015 and 2020. In addition, the WHO
issued a report titled “Investing to Overcome
the Impact of Neglected Tropical Diseases,”
which is an outline of their plan to combat
many diseases, including Chagas. xiv The
WHO, United Nations Childrens’ Fund
(UNICEF), United Nations Development
Programme (UNDP), and World Bank all
sponsor the Special Programme for
Research and Training in Tropical Diseases
(TDR). TDR uses research and training in
order to fight diseases of poverty, which
includes Chagas. One of their reports
details research priorities for three vectorborne disease, including Chagas, and
presents certain focuses such as vector
control and improved health systems.xv
furthering the infection beyond the
capabilities
of
known
systemic
antiprotozoals. ix Of course, most effort
should be directed toward halting the
disease early on. There is an emerging way
to slow the onset of chronic Chagas, sadly it
is often disregarded as a means of large
scale use by South American countries
because it is significantly more expensive. It
does not function as a complete treatment
as the disease remains in the patient, but it
can prevent the onset of fatal symptoms.
The method consists of the use of an
antifungal azole compound and sulfoximine
antiprotozoal molecule to destroy pathogens
in the blood stream.x
United Nations Involvement
The United Nations (UN) has recognized
the extent of Chagas disease and is
committed to the goal of complete
eradication of the disease. The World
Health Organization (WHO) has been
successful in reducing the transmissions by
vectors as well as blood transfusions in
Latin America. The WHO plans to reach
their goal of elimination by focusing on
global informational systems, preventing
transplants
or
transfusions
between
countries with the disease and those
without, supporting diagnostic tests, and
promoting case management of all
cases. xi Another organization that is very
involved in preventing and controlling
Chagas disease is the Pan American Health
Organization (PAHO). They work closely
with the WHO with the formation of
strategies and plans. In 2010, PAHO
passed the “Strategy and Plan of Action for
Chagas Disease Prevention, Control and
Care.” The first goal detailed in the
document is to interrupt transmission of T.
Cruzi by vectors and transfusions, which
they plan to execute by broadening the
prevention and control measures. The next
goal is to decrease morbidity and mortality
by increasing access to health care,
including improving diagnosis, quality, and
Case Study: Bolivia
Bolivia is the country where Chagas
disease is the most common. In small
Bolivian communities, such as Palmarito,
between 30 and 40 percent of children
under the age of 15 have the disease and
the numbers are only higher in adults. The
triatomine bug that causes Chagas disease
is called “el timbucu” by the locals, but it is
difficult to detect much like the disease
itself, which may not show symptoms. The
disease threatens the simplistic lifestyle in
these small villages that live in mud huts
and carry water by hand. In Palmarito and
three other Bolivian villages, a research
program has been implemented in order to
prevent and control the disease. One of the
main techniques they are utilizing is
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April 25th, 2015
destroying the nesting sites of the
bugs. The doctor there shows the locals
certain habits they can maintain in order to
control the nesting areas. These practices
include checking their mattresses where the
bugs reside as well as moving their farm
animals further away from their houses
since the bugs hide in the animals’ fur. The
bugs can even stay in cracks in the mud
walls, so residents need to ensure they
cover all cracks in a timely manner. The
village elder in Palmarito is in charge of
organizing meetings and informing the rest
of the community.
Also, the local
government has periodic screenings of the
walls for bugs. Insecticides are sprayed
which has had some success, but
unfortunately the bugs re-colonize quickly
and therefore have been difficult to
control. The health supervisor of the region
hopes to expand this program to other
communities due to the benefits the
research has provided in improving the lives
of the locals.xvi
Médecins Sans Frontières (MSF) is
a private international program for
humanitarian aid that has worked with the
UN in the past. They are working in Narciso
Campero in Bolivia to provide treatment for
people infected with Chagas disease. In
addition to treating the disease, MSF also
works to prevent, such as with vector
control in the form of fumigation, and
diagnose it. Since the disease can be hard
to detect, they also hold informational
meetings for the people who live in the rural
areas, which is where most of their projects
for Chagas disease in Bolivia occur.xvii
In 2013, doctors, specialists, and
researchers met in Cochabamba, Bolivia to
talk about Chagas disease. More than one
million people have Chagas disease in
Bolivia and the Minister of Health of Bolivia,
Dr. Juan Carlos Calvimontes, spoke about
the
disease
often
goes
undetected. Fortunately, he also stated that
the infestation rate of the bugs has gone
from 70 percent to 3 percent due to their
efforts. However, the prevalence rate is still
20.4 percent, with most of the infections
occurring in rural areas. xviii Nevertheless,
Chagas disease in Bolivia is not limited to
rural areas as it is also prevalent in urban
areas. More than half of Cochabamba’s
population lives in peripheral urban districts,
also known as popular zones. The rates of
infection were especially high in children
between the ages of five and thirteen. This
is due to a high vector infection rate, which
led to heart problems in children of the
same ages.xix Overall, the issue of Chagas
disease in Bolivia is a very serious one and
while measures have been taken to combat
it, it remains prevalent throughout the
country.
II. Food Security
Topic Background
actions of growers or producers from
virtually anywhere can have a detrimental
affect to consumers around the world. There
is no exact statistic due to a wide range
data that is unavailable, however the WHO
Foodborne illnesses are a serious
threat to a globalized world where the
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and CDC estimate that millions potentially
billions suffer from some form of an illness
related to food each year. With diarrheal
diseases alone killing over two million, the
death toll from improper food safety
awareness is staggering, not even
accounting for the hundreds of thousands
hospitalized every year. xx Also, it is critical
to examine the economic toll that improper
food safety regulations can have. Outbreaks
of foodborne diseases such as E. coli can
devastate the entire crop population in a
region costing farmers or industrial
plantations millions of dollars in lost
produce. This principle especially applies to
internationally traded crops that have
become a major industry; for example, the
WHO reported that the 2011 E. coli
outbreak in Germany cost the US one point
three billion dollars in farmer’s losses and
two hundred and thirty six million in
emergency aid payments made to other
European countries.xxi
There is a vast spectrum of diseases
contractible from food safety misconduct,
some of which are the fault of growers and
producers, others the consumers, because
they each play a critical role in ensuring the
prevention of foodborne illness. The most
common
microbial
pathogens
that
contaminate food are bacteria. xxii Bacteria
such as E. coli and Salmonella typically
enter food supplies via undercooked poultry
or other animal related products and poor
quality drinking water.xxiii They usually cause
symptoms such as headache, abdominal
pains, vomiting, and profuse diarrhea, all of
which in many cases are fatal. The growing
concern on an international level is
antimicrobial resistant bacterial strains that
are becoming increasingly common due to
the improper usage of veterinary or human
antimicrobials used to combat the bacteria.
The second most common cause of
foodborne illnesses are viruses, particularly
noroviruses that are characterized by
nausea, fever, abdominal pain, and
explosive vomiting. xxiv The most common
cause of noroviruses entering the food
supply are infected handlers, most of which
undergo no medical evaluation before
handling food. Parasites are the third most
common biological contaminant of food and
are found in two forms: protozoa, which are
unicellular organisms, and helminths, which
are larger multicellular worms that can be
seen without a microscope. xxv They are
spread primarily by the improper storage of
meats making it vital to store meats at
temperatures at or below forty degrees
Fahrenheit in order to ensure that parasitic
contaminants are neutralized. xxvi While less
likely parasites can also be spread to fresh
produce via contaminated water or soil.
After infecting a person, parasites have a
vast array of symptoms and while they
usually include diarrhea, abdominal pains,
and vomiting there are certain cases in
which the infections can lead to severe
damage of major internal organs, which if
untreated leads to organ failure. xxvii Finally,
the last major biological contaminants are
prions, which are microscopic organisms
viral in nature but composed entirely of
proteins which allows for their rapid
manifestation in the brain matter of
organisms. xxviii Though prions are rare and
affect only about one out of every million
people in a population it is important that
they be controlled since there is no medical
treatment of any kind.xxix Once a prion has
manifested inside a brain, it will ultimately
lead
to
the
degeneration
and
dysfunctionality of neurons, resulting in a
fatality. There are many ways people can
come to be infected by prions, however the
most common means through food is the
infection of cattle with bovine spongiform
encephalopathy (BSE) which can then be
acquired
by
people
through
the
consumption of the contaminated tissues
from the cow. xxx The resulting effect is the
development of Creutzfeldt-Jakob disease
in the consumer, and while in developed
nations regulations are put in place to
ensure the safety of the meat being sold to
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April 25th, 2015
consumers, in less developed nations
where food is scarce there is a higher
potential disease factors, such as BSE, go
ignored.
Aside from harmful biological agents
that can affect the safety of food there is
also a growing concern in the international
community about certain chemical agents. A
major concern is naturally occurring
toxicants such as cyanogenic glycosides,
ciguatera, and histamines. xxxi Cyanogenic
glycosides are found primarily in bamboo
chutes, yuca, and certain pits and seeds of
fruits. The particular foods that harbour this
toxicant are in most cases selective to Asian
culture where they are used in a wide
variety
of
dishes;
however,
the
concentrations of cyanogenic glycosides
only pose a real threat when the foods are
not prepared accordingly and the proper
temperature is not reached. Since it does
not pose a significant threat to adults, steps
are often neglected, though it can result in
hydrogen cyanide poisoning in infants
leading to underdeveloped muscle groups
and lessened cognitive abilities. xxxii
Ciguatera and histamines are both
transmitted via fish. Ciguatera is a toxic
compound that causes severe abdominal
pains, vomiting, and diarrhea and is
acquired through the consumption of
predatory reef fish typically weighing greater
than six pounds.xxxiii Fish such as barracuda,
hogfish, and yellowfish grouper naturally
have a higher concentration of ciguatera as
a result of their diet which consists of
smaller fish that feed on Gambierdiscus
toxicus, the marine algae responsible for the
production of the ciguatoxin. xxxiv The best
way to prevent ciguatera poisoning is either
to educate people to avoid consuming large
amounts of these fish species or to refrain
from certain organs where the compound
builds up from being processed into food.
No cure exists for ciguatera poisoning
however one gram of twenty percent
intravenous mannitol solution can greatly
reduce symptoms. xxxv Another example of
naturally occurring toxicants are histamines
which build up in marine organisms, causing
scombroid poisoning which is identified by
burning sensations, palpitations, blurred
vision, and vomiting. In order to prevent
scombroid poisoning, fish must be kept at or
below four degrees Celsius from the time of
being caught to being cooked.xxxvi Treatment
is often only required in extreme cases, due
to most symptoms residing in a few days.
Another class of chemical contaminants are
persistent organic pollutants or POPs which
reside in food due to the continued
application of herbicides and pesticides
which build up and then are consumed by
humans. While there are hundreds of POPs
the prominent example are dioxins which
build up in meat and other animal products
as a result of their high concentration in the
environment due to unregulated industrial
processes such as burning waste and the
overuse of pesticides in the animals’ food
supply. Dioxins are responsible for a
number of cancers and have been known to
damage kidneys and reproductive organs
as well. Currently people’s consumption of
dioxins worldwide is rising and the majority
of people are unaware of a simple method
that drastically reduces dioxin levels in
meat: broiling. Broiling is a realistic short
term solution to high dioxin levels aside
from a vegan diet, but long term waste
management and pesticide control must be
used to regulate this chemical. xxxvii Lastly,
heavy metals such as lead and mercury
make up the third sphere of non-biological
contaminants that are detrimental to people
who consume the foods that contain them.
They are found in water and soil often as a
result of old or unregulated pipe usage
where eroded foundations may expose
water to dangerous heavy elements that
then contaminate the soil and ultimately the
food it is grown in. xxxviii Heavy metal
exposure can be deadly and in many cases
results in kidney damage, organ failure, and
reproductive harm.xxxix The most crucial step
in preventing heavy metals from entering a
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April 25th, 2015
region’s food supply is implementing
regulations that test water and soil and hold
growers accountable for keeping the
pollutants
out
of
their
produce.
protocol and has analyzed cases in which
liability with harmful LMOs has been seen
as an issue.
The harmful effects of food not only
come from manmade chemicals, but it can
also be affected by natural disasters due to
climate change. Climate change disasters
include droughts, flooding, excess amounts
of rain, or no rain at all. This is why the
World Food Programme (WFP) is aiding a
variety of countries in Asia and Africa adapt
to the hanging weather patterns due to CO2
emissions. WFP has aided developing
countries such as Bangladesh and Niger
work to increase the number of crops in
their country and given them the tools and
skills needed in order to allow it to be long
term. Resolution 1984/63 mentions the aid
to developing countries and briefly
discusses their needs as well as the
elaborations of set and strict guidelines for
product distribution and the protection of the
buyer. WFP has also create the Climate
Adaptation Management and Innovation
Initiative (C-ADAPT) in order to create
climate-induced food insecurity checks in
order to teach these countries how to adapt
to the unstable climate as well as well as
come up with backup plans in case a
devastating natural disaster occurs. This
programme has been created for more
developing countries to aid already povertystricken areas from losing any more of its
agriculture.C-ADAPT is currently being
funded by the Swedish Government and
has been successful with the help of other
UN organizations such as FAO and IFAD.xlv
United Nations Involvement
The
Cartagena
Protocol
on
Biosafety on Biological Diversity, adopted in
January 2000, is an international agreement
that ensures the safety of all foods, assures
the correct use of Living Modified
Organisms (LMOs) that could potentially
have harmful effects on biodiversity, and
scales the risks that could occur to humans
if there is an effect in the safety measures.xl
The Protocol’s goal is to stop any
biodiversity from harming any type of
natural organism and informs countries on
what is considered proper methods used in
order to keep food from becoming a risk.
A/RES/39/248 mentions similar issues
concerning education on hazardous,
products, protecting buyers from damaging
economic interest, and physical safety
regulations which should be implemented
by the government. xli This resolution
focuses on the safety guidelines which
should be strictly abided by. A/Res/38/147
also has similar economic and social policy
as well as the implementation of guidelines
for the safety of the consumer. xlii The
Cartagena Protocol has create risk
assessment which is then completed by
countries to ensure the safety of the LMO
as well as LMOs being imported and
exported mentioned in Article 15. Countries
will use scientific and factual evidence in
order to check for possible dangers in LMOs
in order to prevent it from risking the lives of
humans. xliii The Cartagena Protocol also
adopted
the
Nagoya
Kuala-Lumpur
Supplementary Protocol on Liability and
Redress that discusses the international
liability if LMOs create serious damage in
another country. xliv The Ad-Hoc Working
Group has contributed to the legality of this
Case Study: Food Pollution
Food pollution is the presence of
toxic chemicals within food or the
contamination of crops and livestock. Some
instances of food pollution can be soil
poisoning, water poisoning, and air
poisoning. The harmful effects to these
crops can lead to severe sickness to
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April 25th, 2015
humans who consume this product. This
could then lead to severe health issues
hormonally, mess with one's nervous
system, and affect the metabolism. The
pollution of crops through harmful pesticides
can also increase the risk of cancer. Some
of the pollution in the soil is due to the
effects of the environment, but it is
strengthened by the irresponsibility of
man. For example, the soil from the
Atacama Desert in Chile is considered
polluted due to the vast percentage of
perchlorate in the soil, but the reason the
levels of perchlorate are so high is because
of the chemicals put into the soil which then
raise the levels of the natural chemical. The
release of perchlorate would be fine if they
were released at a natural level, but due to
the rise, it can become dangerous. One
man-made chemical that contributes to soil
pollution is xenobiotics. These are
commonly found in water runoff from farms
using pesticides- and radioactive sludge.
Crops and agriculture are not the
only food consumed by humans that suffer
from the harmful effects of pollution. Marine
life such as eel, tilapia, clams, and shrimp
suffer from murky and toxicated waters in
local streams and farms. For example, in
Fuqing China located in the Fujian Province,
massive water shortages and sewage
infested waters harm the local fish in the
area. xlvi Due to the increase of marine life
farms, the water has been to spread out and
has become more infested with agricultural
run-off. This could lead to an increase in an
unhealthy liver and a higher risk of acquiring
cancer. Local workers claim that their
waters are brown and covered in a thick
layer of pollution.
Nutrient pollution has also seen to
be fatal to the fish we eat which not only
affects humans, but also other animals who
feed off these fish. Nutrient pollution causes
the creation of thick, green algae in the
water restricting oxygen from enter the
water, suffocating the fish, blocking out
sunlight and killing them. xlvii Many times
these algae release toxins that remain
inside the fish after it is already dead.
Animals such as seagull, sea lions, dolphins
and turtles that feed upon these animals are
soon affected after they consume them and
the effects can then be fatal. These
blossoms of algae have quickly spread
across U.S waterways and lake creating
dead zones. Dead zones are areas of water
that are so thick with algae that their a lack
of oxygen in the water. From the
Chesapeake Bay to the Gulf of Mexico,
there are over 166 dead zones.xlviii The dead
zones from the Gulf of Mexico then empty
into 31 different streams and lakes in the
US, threatening the fish and other marine
life in the area.
Food pollution to crops, livestock,
and marine life do have the potential to
harm human consumers. If someone
consumes a large amount of food filled with
harmful toxins without knowing they are
present, they are at a higher risk of liver
damage and a variety of cancers. The
raising of awareness for the pollution of
crops and fish has occurred for cases such
as the Fuqing polluted waters which
focusing on decreasing the pollutants in
water areas.
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April 25th, 2015
Questions to Consider
Chagas Disease:
1. What actions has your country taken towards eliminating Chagas disease in your
country and/or others?
2. What techniques have or have not been successful in treating Chagas disease
(including early and later stages of disease)?
3. What ways can Chagas disease be prevented?
4. If your country suffers from Chagas disease, what are some of the contributing factors to
the spread of the parasite?
5. Is your country aided by any organization (WHO, ECOSOC) that has been able to lower
the percentage of people affected by Chagas?
6. Can your country afford the vaccine for Chagas? If they can, have they been able to
distribute it to countries in need?
Food Safety:
1. What regulations does your country have on food safety, such as with food production
labeling?
2. What actions have been successful in preventing and dealing with outbreaks of
foodborne diseases?
3. Has there been an issue in your country regarding food violations that did or could have
harmed your people?
4. Has your country signed any documents or treaties regarding food safety?
5. Has your county had any damage due to LMOs?
6. How many resources (financial, samples, and/or researchers) has your country allocated
toward finding solutions to biological or non biological agents that contaminate food?
7. To what degree is your country affected by improper food safety regulations? Is it
primarily biological or chemical? What steps, if any, have been taken to combat it?
i
http://www.who.int/mediacentre/factsheets/fs340/en/
http://www.cdc.gov/parasites/chagas/gen_info/vectors/
iii
http://www.efpia.eu/diseases/27/59/Chagas-Disease
iv
http://whqlibdoc.who.int/hq/1999/WHO_CDS_WHOPES_GCDPP_99.1.pdf
v
http://www.cdc.gov/parasites/chagas/gen_info/vectors/
vi
http://www.cdc.gov/parasites/chagas/biology.html
vii
viii
http://whqlibdoc.who.int/hq/1999/WHO_CDS_WHOPES_GCDPP_99.1.pdf
ix
http://www.cdc.gov/parasites/chagas/biology.html
x
xi
xii
http://www.paho.org/hq/dmdocuments/2011/CD50-16-e.pdf
xiii
https://sustainabledevelopment.un.org/index.php?page=view&type=1006&menu=1348&nr=1496
ii
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xiv
http://www.paho.org/hq/index.php?option=com_content&view=article&id=10440%3A100-millonespadecen-alguna-enfermedad-infecciosa-desatendida-en-las-americas&Itemid=1926&lang=en
xv
http://www.who.int/tdr/about/en/
xvi
http://www.who.int/tdr/research/vectors/community_based_interventions/ecohealth/chagas-bolivia/en/
xvii
http://www.msfaccess.org/content/treating-chagas-rural-bolivia-photo-story
xviii
http://www.dndi.org/media-centre/press-releases/1582-chagas-week.html
xix
http://www.ncbi.nlm.nih.gov/pubmed/18797753
xx
http://www.scidev.net/global/health/opinion/time-to-count-the-burden-of-foodborne-disease.html
xxi
xxii
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HBHS Novice - hbhsmun

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