The subject of this conference reflects the scientific
community's interest in seeking to understand the complex
causal web whose various social, economic, and biological
components interact in the production and reproduction of
schistosomiasis and its control in relation to community
participation.
From the onset, the author stresses the impossibility of
dealing separately with community participation, as if social
components were just one more "weapon" in the arsenal for
schistosomiasis control.
This study begins with a brief historical review of the 71
years of control activities with this endemic disease,
stressing the enormous efforts and huge expenditures in this
field vis-a-vis the limited results, despite the extraordinary
technological development of specific, classical control
inputs such as new treatment drugs and molluscicides.
The article then discusses the various strategies used in
control programs, emphasizing ideological consistencies and
contradictions. Interactions at the macro and micro levels are
discussed, as are the determinants and risk factors involved
in producing the disease's endemicity.
Unequal occupation of space leaves the segregated portion of
the population exposed to extremely favorable conditions for
transmission of the discase. This raises the issue of how to
control an endemic disease which is so closely linked to the
way of life imposed on the population. The study challenges
the classical control model and suggests an alternative model
now undergoing medium-term investigation in the States of
Espirito Santo, and Pernambuco, Brazil.
The author concludes that we do not need new strategies, but a
new control model, contrary to the prevailing classical model
in both concept and practice. From the conceptual point of
view, the new model mentioned above is different from others
in that schistosomiasis control is seen from a social
perspective stressing the population's accumulated knowledge
in addition to the building of shared knowledge. The model's
praxis has the following characteristics: (1) it is integrated
with and financed by research agencies and health services;
(2) it operates at the local health services level; (3) use of
molluscicides has been eliminated; (4) emphasis is given to
individual medical treatment and improvement of sanitary
conditions.