Abstract

Introduction

Intestinal parasites from soil-transmitted helminths are a public health problem. Such infections are a significant cause of morbidity and mortality among disadvantaged populations in developing countries (Socias et al., 2014SOCÍAS, M. E. et al. Geohelmintiasis en la Argentina: una revision sistemática. Medicina, Buenos Aires, v. 74, n. 1, p. 29-36, 2014.). As the name implies, geo (earth)-helminths (worms) - among which Ascaris lumbricoides, Trichuris trichiura, Strongyloides stercoralis and members of the Ancylostomidae family are included - are parasites whose lifecycle requires them to pass through the ground and whose mode of transmission means infecting humans with eggs and larvae that survive there thanks to certain conditions of humidity, temperature and clay content (Pierangeli et al., 2003PIERANGELI, N. B. et al. Estacionalidad de parásitos intestinales en suelos periurbanos de la ciudad de Neuquén, Patagonia, Argentina. Tropical Medical & International Health, Oxford, n. 8, p. 259-263, 2003.). It is estimated that between 10 and 20% of the population of Latin America suffer from such parasites, which can produce serious gastrointestinal disease and can affect child growth and development (Matzkin et al., 2001MATZKIN, R. J. et al. Parasitosis entéricas en una población escolar periurbana de Resistencia, Chaco, Argentina. Revista Científica, Resistencia, v. 1, n. 1, p. 25-37, 2001.; Taranto et al., 2003TARANTO, N. J. et al. Clinical status and parasitic infection in a Wichi Aboriginal community in Salta, Argentina. Transactions of the Royal Society of Tropical Medicine and Hygiene, Oxford, n. 97, p. 554-558, Oct. 2003.). Despite their importance on an educational and economic level, besides that of public health, such infections are widely ignored and find themselves in the Neglected Tropical Diseases (Bethoni; Brooker; Albonico, 2006BETHONY, J.; BROOKER, S.; ALBONICO, M. Soil-transmitted helminth infections: ascariasis, trichuriasis, and hookworm. Lancet, London, v. 10, n. 367, p. 1521-1532, 2006.).

The soil-transmitted helminth infestation process poses a challenge for scientific activity, although the negative effects on health, are well-known, morbi-mortality is very difficult to measure (Pezzani et al., 1996PEZZANI, B. C. et al. Estudio de las infecciones por enteroparasitosis en una comunidad periurbana de la provincia de Buenos Aires, Argentina. Boletín Chileno de Parasitologia, Santiago de Chile, n. 51, p. 42-45, 1996.). A coincidence of climatic factors-high temperatures and humidity - together with deficient sanitation and waste management systems, as well as inadequate hygiene are needed in order for an infestation to occur (Costamagna et al., 2002COSTAMAGNA, S. R. et al. Epidemiología de las parasitosis en Bahía Blanca (Provincia de Buenos Aires) Argentina - 1994/1999. Parasitología Latinoamericana, Santiago de Chile, v. 57, n. 3/4, p. 103-110, 2002.; Menghi et al., 2007MENGHI, C. I. et al. Investigación de parásitos intestinales en una comunidad aborigen de la provincia de Salta. Medicina, Buenos Aires, v. 67, n. 6, p. 705-708, 2007.; Milano; Oscherov, 2002MILANO, A. M. F.; OSCHEROV, E. B. Contaminación por parásitos caninos de importancia zoonótica en playas de la ciudad de Corrientes, Argentina. Parasitologia Latinoamericana, Buenos Aires, v. 57, n. 3/4, p. 119-123, 2002. Disponível em: <http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-77122002000300006&lng=es&nrm=iso>. Acesso em: 24 dez. 2013.
http://www.scielo.cl/scielo.php?script=s... ). Although there are studies that have approached the problem comprehensively, considering the complexity of the relationship between the parasite, the host and the environment, (Navone et al., 2006NAVONE, G. T. et al. Parasitosis intestinales en poblaciones Mbya-Guarani de la provincia de Misiones: aspectos epidemiológicos y nutricionales. Cadernos de Saúde Pública, Rio de Janeiro, n. 22, p. 109-118, 2006.) no studies were found that approached the relationship of these elements with the multiple factors operating on the populations over time (Sy, 2009SY, A. Una revision de los estudios en torno a enfermedades gastrointestinales: en busca de nuevas alternativas para el análisis de los procesos de salud-enfermedad. Salud Colectiva, Buenos Aires, v. 5, n. 1, p. 49-62, 2009.).

Based on the premise that parasitic infestation processes have no one single cause, that they have multiple determinants at different levels of organization (Redpaith; Allotey; Pokherl, 2011REDPAITH, D.; ALLOTEY, P.; POKHERL, S. Social sciences research in neglected tropical diseases 2: a bibliographic analysis. Health Research Policy and Systems, London, n. 9, p. 22-45, 2011.) we conducted an anthropological study in Orán, located in the Argentinian province of Salta. This rural area is an economic enclave (Rodriguez, 2009RODRIGUEZ, M. G. Barreras naturales: la conjunción de lo urbano y periurbano en San Ramón de la Nueva Orán: ciudad encajonada y dispersa. In: NEMIROVSKY, A. S. Globalización y agricultura periurbana en Argentina. Buenos Aires: Facultad Latinoamericana de Ciencias Sociales, 2009. Disponivel em: <http://www.flacso.org.ar/uploaded_files/Noticias/agriculturaperiurbana.pdf>. Acesso em: 29 jul. 2013.
http://www.flacso.org.ar/uploaded_files/... ) in which the population present elevated levels of prevalence for a variety of geo-helminths (Taranto, 1993TARANTO, N. J. Prevalence of Strongyloides Stercoralis infection in childhood: Oran, Salta, Argentina. Boletin Chileno de Parasitología, Santiago de Chile, v. 48, n. 3/4, p. 49-51, 1993.; Taranto et al., 2003TARANTO, N. J. et al. Clinical status and parasitic infection in a Wichi Aboriginal community in Salta, Argentina. Transactions of the Royal Society of Tropical Medicine and Hygiene, Oxford, n. 97, p. 554-558, Oct. 2003.; Kroliewiecki et al., 2009KROLEWIECKI, A. J. et al. Evaluation of new serologic techniques for the diagnosis of Strongyloides stercoralis infections. American Journal of Tropical Medicine and Hygiene, Washington, DC, v. 81, n. 5, p. 89, 2009. Supplement 1.). Using eco-epidemiological theoretical tools (Susser and Susser, 1996SUSSER AND SUSSER, E. Chosing a future for epidemiology: from black box to Chinese boxes and eco-epidemiology. American Journal of Public Health, Washington, DC, v. 86, p. 674-677, 1996.) and critical medical anthropology (Menéndez, 2005MENÉNDEZ, E. El modelo médico y la salud de los trabajadores. Salud Colectiva, Buenos Aires, v. 1, n. 1, p. 9-32, 2005.; Suárez; Beltran; Sánchez, 2006SUÁREZ, R.; BELTRAN, E. M.; SÁNCHEZ, T. El sentido del riesgo desde la antropologia médica: consonancias y disonancias con la salud pública en dos enfermedades transmisibles. Antípoda, Bogotá, n. 3, p. 123-154, jul./dic. 2006.) we analyzed the problem of parasitic infestation linking economic activity in the zone with the inhabitant's living conditions. Socio-environmental contexts, housing and sanitation conditions and the perception of risk are described for the local population.

Understanding health and the environment

Parasite infestations affect people's daily lives, organizing parameters and images in their subjectivity (Menéndez, 2005MENÉNDEZ, E. El modelo médico y la salud de los trabajadores. Salud Colectiva, Buenos Aires, v. 1, n. 1, p. 9-32, 2005.). The ecological, socio-cultural and economic contexts in which the lives of the subjects/patients are spent can encourage or discourage the emergence of illness (Suárez; Beltran; Sánchez, 2006SUÁREZ, R.; BELTRAN, E. M.; SÁNCHEZ, T. El sentido del riesgo desde la antropologia médica: consonancias y disonancias con la salud pública en dos enfermedades transmisibles. Antípoda, Bogotá, n. 3, p. 123-154, jul./dic. 2006.). Epidemiological studies analyze elements of the surroundings, identifying which aspects of daily life pose health risks in terms of exposure to risk or risky habits. Risk, then, becomes a methodological tool, enabling descriptive maps of a health situation to be created, focusing on the patient population's practices that contribute to the probability of contracting a disease (Almeida Filho; Castiel; Ayres, 2009ALMEIDA FILHO, N.; CASTIEL, L. D.; AYRES, J. R. Riesgo: concepto básico en epidemiología. Salud Colectiva, Buenos Aires, v. 5, n. 3, p. 323-344, 2009., p. 325) but "does not enable us to understand the role such aspects play in the map of significance for the community" (Suárez; Beltran; Sánchez, 2006SUÁREZ, R.; BELTRAN, E. M.; SÁNCHEZ, T. El sentido del riesgo desde la antropologia médica: consonancias y disonancias con la salud pública en dos enfermedades transmisibles. Antípoda, Bogotá, n. 3, p. 123-154, jul./dic. 2006., p. 131). Social constructivism, in turn, argues that individuals perceive the sense of risk anchored in previous ideas that already have cultural significance (Joffe, 2003JOFFE, H. Risk: from perception to social representation. British Journal of Social Psychology, London, v. 10, n. 43, p. 55-73, 2003.). The risk category uses this focus as a methodological tool that includes meanings and interests belonging to the context and enables the rationality supporting the patient's logic to be deconstructed.

Thus, eco-epidemiology provides an epistemological framework for understanding interactions between humans and the environment, arguing that the surroundings should be defined according to their social and physical aspects (Susser and Susser, 1996SUSSER AND SUSSER, E. Chosing a future for epidemiology: from black box to Chinese boxes and eco-epidemiology. American Journal of Public Health, Washington, DC, v. 86, p. 674-677, 1996.). Ingold (1993)INGOLD, T. The temporality of landscape. World Archaeology, London, v. 25, n. 2, p. 152-174, 1993. explains how the environment is a representation created by individuals which regulates behavior and establishes individual and collective relationships with the surroundings. Thus, elements such as the earth and the water, protagonists in soil-transmitted helminth infestation, can be analyzed according to their physical, biological, social and economic dimensions through anthropological work, recognizing the variety of forms of human life from the perspective of the social actors themselves (Colángelo, 2008COLANGELO, M. A. La constitución de la niñez como objeto de estudio e intervención médicos en la Argentina de comienzos del siglo XX. Posadas: Universidad Nacional de Misiones, 2008. Disponível em: <http://www.aacademica.com/000-080/416.pdf>. Acesso em: 22 out. 2014.
http://www.aacademica.com/000-080/416.pd... ). Being aware of this type of knowledge has implications for preventing and controlling, as well as understanding the disease (Mastrangelo; Salomon, 2010MASTRANGELO, A. V.; SALOMON, O. D. Contribución de la antropología a la comprensión de un brote de Leishmaniasis Tegumentaria Americana en las "2.000 hectáreas", Puerto Iguazú, Argentina. Revista Argentina de Salud Pública, Buenos Aires, v. 1, n. 4, p. 6-13, 2010. Disponível em: <http://www.saludinvestiga.org.ar/rasp/edicion-completa/RASP%20Volumen-I-IV.pdf>. Acesso em: 22 dez. 2014.
http://www.saludinvestiga.org.ar/rasp/ed... ).

In the context of this study, labor is an organizing space in people's daily lives (Heller, 1998HELLER, A. 1998. Sociologia de la vida cotidiana. Barcelona: Península, 1998.). Labor relationships have implications for housing, access to basic health elements and access the communication means. Health and disease, then, emerge as issues that expose the patient population's living and working conditions (Menéndez, 2005MENÉNDEZ, E. El modelo médico y la salud de los trabajadores. Salud Colectiva, Buenos Aires, v. 1, n. 1, p. 9-32, 2005.).

Material and methods

The field

The anthropological approach is within the framework of a medical investigation²2The Instituto de Investigaciones de Enfermedades Tropicales (IIET) at the Universidad Nacional de Salta (UNSA), headquartered in the city of Orán, Salta, Argentina, carried out a deparasitation plan between November 2010 and August 2011 together with the Salta Primary Health Program and financed by the Mundo Sano NGO(Socías, 2011). conducted in Orán (23°07'47"S 64°19'18"W) located in Alto Bermejo, on the Bolivian border in the north east of the province of Salta, Argentina. The subtropical climate, with a dry season, means the temperature between November and March averages 32.4 °C and annual precipitation is around 1000 mm. The environment of jungle covered foothills, also known as Yunga, high forests, is characterized by thick vegetation that functions as a water store during the dry season. These climate conditions, together with the process of land distribution in the province of Salta (Buliubasich; Rodriguez, 2009BULIUBASICH, C.; RODRÍGUEZ, H. Panorama etnográfico, histórico y ambiental. In: BULIUBASICH, C.; GONZALEZ, A. (Coord.) Los pueblos indígenas de la provincia de Salta: la posesión y el dominio de sus tierras. Salta: Universidad Nacional de Salta, 2009. p. 21-32. Disponível em: <http://redaf.org.ar/wp-content/uploads/2012/12/P-Ind-de-Salta_-La-posesion-y-dominio-de-sus-tierras_InformeDDHH.pdf>. Acesso em: 26 nov. 2014.
http://redaf.org.ar/wp-content/uploads/2... ; Rodriguez, 2009RODRIGUEZ, M. G. Barreras naturales: la conjunción de lo urbano y periurbano en San Ramón de la Nueva Orán: ciudad encajonada y dispersa. In: NEMIROVSKY, A. S. Globalización y agricultura periurbana en Argentina. Buenos Aires: Facultad Latinoamericana de Ciencias Sociales, 2009. Disponivel em: <http://www.flacso.org.ar/uploaded_files/Noticias/agriculturaperiurbana.pdf>. Acesso em: 29 jul. 2013.
http://www.flacso.org.ar/uploaded_files/... ) have made this zone an important hub of agricultural work to which, historically, Bolivian and Argentinian laborers of various ethnicities have migrated. Historically, this agro-industrial region was established from logging and sugar production, at the hands of the Tabacal sugar mill and farming operations - fincas - requiring intermittent labor to product and exploit hydrocarbons. In the last decade, agricultural technological advances - especially GM corn and soya - have advanced the cultivable boundaries and deforesting areas of the jungle covered foothills. This process has impoverished the local criolla, kolla and ava-guaraní populations (Lorenzetti, 2012LORENZETTI, M. La dimension política de la salud: las prácticas sanitarias desde las comunidades peri-urbanas wichí del Dpto. de San Martín (Salta). Publicar, Buenos Aires, v. 10, n. 11, p. 65-86, 2012.).

Life for the working population on the outskirts of the productive land (Rodriguez, 2009RODRIGUEZ, M. G. Barreras naturales: la conjunción de lo urbano y periurbano en San Ramón de la Nueva Orán: ciudad encajonada y dispersa. In: NEMIROVSKY, A. S. Globalización y agricultura periurbana en Argentina. Buenos Aires: Facultad Latinoamericana de Ciencias Sociales, 2009. Disponivel em: <http://www.flacso.org.ar/uploaded_files/Noticias/agriculturaperiurbana.pdf>. Acesso em: 29 jul. 2013.
http://www.flacso.org.ar/uploaded_files/... ) together with poor social indicators³3According to Indec data (2010), Orán has 138,838 inhabitants, in 31,859 households, of which 40. 2% are not linked to sewers., form the ideal setting for endemicity of various tropical diseases (Kroliewiecki et al., 2009KROLEWIECKI, A. J. et al. Evaluation of new serologic techniques for the diagnosis of Strongyloides stercoralis infections. American Journal of Tropical Medicine and Hygiene, Washington, DC, v. 81, n. 5, p. 89, 2009. Supplement 1., ²⁰¹⁰KROLEWIECKI, A. J. et al. Improved diagnosis of Strongyloides stercoralis using recombinant antigen-based serologies in a community-wide study in Northern Argentina. Clinical and Vaccine Inmunology, Washington, DC, v. 17, n. 10, p. 1624-1630, 2010.; Socias, 2011SOCÍAS, M. E. Tratamientos comunitarios de geohelmintiasis en zonas endémicas para Strongyloides stercoralis. ENCUENTRO NACIONAL SOBRE ENFERMEDADES OLVIDADAS, 2 y SIMPOSIO INTERNACIONAL DE CONTROL EPIDEMIOLÓGICO DE ENFERMEDADES TRANSMITIDAS POR VECTORES, 14. Libro de resúmenes… Buenos Aires: Fundación Mundo Sano, 2011, p. 34.; Gil et al., 2011GIL, J. et al. Reactividad del antígeno GST-SAPA de Trypanosoma Cruzi frente a sueros de pacientes con enfermedad de Chagas y Leishmaniasis. Medicina, Buenos Aires, v. 71, n. 2, p. 113-119, 2011.). Households without formally employed laborers receive Child Benefit⁴4This is a benefit for the children of the unemployed, those working in the informal market or earning less than minimum wage. It consists of a monthly payment of $ 460 for children under 18 and $ 1500 for disabled children regardless of age. Thus, the State seeks to ensure children and adolescents attend school, have regular health checks and meet mandatory vaccination schedules, as these are prerequisites to receive it (1/11/2009 decree 1602-09). Available: http://www.anses.gob.ar/destacados/asignacion-universal-por-hijo-1. Accessed 24/9/2012.. The Primary Health Care Program (PROAPS), which depends on the Ministry of Salta Province, is responsible for the medical care of such social groups. Territorially organize, PROAPS community health workers focus medical care on the mother-child population, mainly visiting households with inhabitants under age six. El Bananal,⁵5Fictitious name. which has one of the Primary Health Care Centers (CAPS), as well as stream and several Criolla and Ava-guaraní households, is located on a national highway. It was selected for the anthropological study as it is a population nucleus of Criolla, Kolla and Ava-guaraní families living inside and outside of the farmland.

Study design

The plan integrates qualitative and quantitative techniques. The specific objectives developed in this article are as follows: to describe the socio-environmental contexts and living and health conditions and investigate perception of risk in the affected population. The project was evaluated and approved by the Bio-ethical Committee of the Salta Province Medical Association.

The quantitative component: based on a non-exhaustive bibliographical survey of Argentinian studies that approach the problem from a population perspective (Basualdo et al., 2000BASUALDO, J. A. et al. Screening of the municipal water system of La Plata, Argentina, for human intestinal parasites. International Journal of Hygienic and Environmental Health, Jena, n. 203, p. 177-182, Oct. 2000.; Fonrouge et al., 2000FONROUGE, R. et al. Contaminación de suelos con huevos de Toxocarasp. en plazas y parques públicos de la ciudad de La Plata, Buenos Aires, Argentina. Boletín Chileno de Parasitología, Santiago de Chile, v. 55, n. 3/4, p. 83-85, 2000.; Matzkin et al., 2001MATZKIN, R. J. et al. Parasitosis entéricas en una población escolar periurbana de Resistencia, Chaco, Argentina. Revista Científica, Resistencia, v. 1, n. 1, p. 25-37, 2001.; Zunino et al., 2002ZUNINO, M. G. et al. Contamination by helminths in public places of the province of Chubut, Argentina. Boletín Chileno de Parasitología, Santiago de Chile, n. 55, p. 78-83, 2002.; Soriano et al., 2001SORIANO, S. et al. Intestinal parasites and the environment: frequency of intestinal parasites in children of Neuquén, Patagonia, Argentina. Revista Latinoamericana de Microbiología, Ciudad de México, DF, n. 43, p. 96-101, 2001.; Lura; Beltramino; De Carrera, 2002LURA, M. C.; BELTRAMINO, D. M.; DE CARRERA, E. F. Prevalence of intestinal helminthiasis in primary school children in Santa Fe city. Medicina, Buenos Aires, v. 10, n. 62, p. 29-36, 2002.; Cordoba et al., 2002CORDOBA, A. et al. Presencia de parásitos intestinales en paseos públicos urbanos en La Plata, Argentina. Parasitología Latinoamericana, Santiago de Chile, v. 57, n. 1/2, p. 25-29, 2002.; Taranto et al., 2003TARANTO, N. J. et al. Clinical status and parasitic infection in a Wichi Aboriginal community in Salta, Argentina. Transactions of the Royal Society of Tropical Medicine and Hygiene, Oxford, n. 97, p. 554-558, Oct. 2003.; Ledesma; Fernandez, 2004LEDESMA, A.; FERNANDEZ, G. Enteroparasitosis: factores predisponentes en la población infantil de la ciudad de Resistencia. Revista Argentina de Pediatria, Buenos Aires, v. 8, n. 2, p. 9-17, 2004.; Milano; Oscherov, 2002MILANO, A. M. F.; OSCHEROV, E. B. Contaminación por parásitos caninos de importancia zoonótica en playas de la ciudad de Corrientes, Argentina. Parasitologia Latinoamericana, Buenos Aires, v. 57, n. 3/4, p. 119-123, 2002. Disponível em: <http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-77122002000300006&lng=es&nrm=iso>. Acesso em: 24 dez. 2013.
http://www.scielo.cl/scielo.php?script=s... ; Menghi et al., 2007MENGHI, C. I. et al. Investigación de parásitos intestinales en una comunidad aborigen de la provincia de Salta. Medicina, Buenos Aires, v. 67, n. 6, p. 705-708, 2007.; Navone et al., 2006NAVONE, G. T. et al. Parasitosis intestinales en poblaciones Mbya-Guarani de la provincia de Misiones: aspectos epidemiológicos y nutricionales. Cadernos de Saúde Pública, Rio de Janeiro, n. 22, p. 109-118, 2006.; Gamboa et al., 2003GAMBOA, M. I. et al. Distribution of intestinal parasitoses in relation to environmental and sociocultural parameters in La Plata, Argentina. Journal of Helminthiasis, London, n. 77, p. 15-20, 2003.; Bracciaforte et al., 2010BRACCIAFORTE, R. et al. Enteroparásitos en ninos y adolescentes de una comuna periurbana de la provincia de Córdoba. Acta Bioquímica Clínica Latinoamericana, La Plata, v. 44, n. 3, p. 353-358, 2010.) a questionnaire was designed to reveal housing characteristics, socio-economic profiles, provision of basic sanitation (drinking water, sewers), managing outcomes, local knowledge of parasitic infestations and relations with the official health care system.

Qualitative component: Participant observation techniques (Rubio, 2002RUBIO, M. I. J. Contexto etnográfico y uso de las técnicas de investigación en antropologia social. In: DE LA CRUZ, I.; PIQUERAS, A.; RIVAS, A. M. (Coord.). Introducción a la antropologia para la intervención social. Valencia: Popular, 2002. p. 5-25.) were used in various situations (rural harvest activities, domestic activities, community health worker home visits, health facilities and the regional hospital) and in-depth interviews were conducted with key informants (nurses in the rural health facilities, community health workers, working mothers and laborers and managers). To access the local people's knowledge about parasites and the environment in which they live, questions were drawn up concerning knowledge about them and about treatment and prevention methods. Recorders, notebooks and cameras were used to record.

Identifying and selecting the sample

The field work lasted for 42 days between November 2010 and May 2011. An intentional, non-probabilistic sample of households⁶6They are groups of people interacting on a regular and ongoing daily basis in order to jointly ensure the achievement of the following objectives: "biological reproduction, preservation of life; compliance with all necessary economic and non-economic practices to optimize material and non-material conditions of existence "(Torrado, 2006, p. 20). Members must share a house or a residential area, forming a common unit of consumption, income and expenses and some of them are related. (HH) was selected (N=43) and the questionnaire was administered in person. We contacted then men and women for the sample through community health worker visits. The interlocutors who were interested in participating in the study provided significant information on their daily life, and were then visited a second and third time without accompaniment by community health workers. The snowball process (Patton, 2002PATTON, M. Q. Qualitative evaluation and research methods. Newboury Park: Sage, 2002.) was used to contact women and children, as the field work was conducted during the day, a time when the majority of the men were at work. Anonymity was preserved during the field work process and in publications by using fictitious names.

Processing and analyzing the data

The ethnographic material (field diaries, recorded interviews and their transcripts, photos) were analyzed using Atlas.ti. A database was set up for the data from the questionnaires applied to the HH, which were triangulated with the information received from the PROAPS and from the specialist literature.

Results

The sample was formed of 43 HHs who responded to the questionnaire on housing and socio-environmental conditions. Of the HHs, 32 were located on farmland and 11 on the land between the route and the boundaries of the farmland. Of those interviewed in depth, 16 were mothers, 2 were farm managers, 4 were community health workers and 1 was a rural nurse.

Land distribution

Orán has a terrain of 11,892 km² and 138,383 inhabitants (Indec, 2010INDEC - INSTITUTO NACIONAL DE ESTADÍSTICA Y CENSO DE LA REPÚBLICA ARGENTINA. Censo Nacional de Poblaciones, Hogares y Viviendas. Buenos Aires, 2010. Disponível em: <http://www.sig.indec.gov.ar/censo2010>. Acesso em: 26 nov. 2014.
http://www.sig.indec.gov.ar/censo2010... ). Agricultural activities and lack of town planning has had direct effects on land distribution and the current conditions of the land available for inhabitants on low income to live on, both in the town and in the countryside. It is estimated that more than 90% of the Yunga jungle, in which the urban center of Orán was located, with deep soil areas, disappeared, transformed into sugar cane plantations in the early 20^th century. The technologization of the San Martin de Tabacal Mill in the 1970s and its later sale to the multinational, Seaborg, led to thousands of workers who lived on company land being expelled, especially Kollas and Ava-Guaranies (Trinchero, 1992TRINCHERO, H. Privatización del suelo y reproducción de la vida: los grupos aborígenes del Chaco. In: BALAZOTE, A.; RADOVICH, J. La problemática indígena. Buenos Aires: Centro Editor de América Latina, 1992. p. 117-141.). Nowadays, 40,000 hectares are dedicated to the mill's production and 7,010 hectares are shared between 400 productors⁷7According to estimates from the Salta Ministry of the Economy Orán has 6460 hectares of field and 550 covered. Available: http://www.mecon.gov.ar/programanortegrande/documentos/Plan%20de%20Competitividad%20cluster%20horticola%20Salta%20Final.pdf. Accessed el: 21/2/2014.. The scarcity of available land on which to live contributed to settlements being extended into rural and suburban Orán and Pichanal (Rodriguez, 2009RODRIGUEZ, M. G. Barreras naturales: la conjunción de lo urbano y periurbano en San Ramón de la Nueva Orán: ciudad encajonada y dispersa. In: NEMIROVSKY, A. S. Globalización y agricultura periurbana en Argentina. Buenos Aires: Facultad Latinoamericana de Ciencias Sociales, 2009. Disponivel em: <http://www.flacso.org.ar/uploaded_files/Noticias/agriculturaperiurbana.pdf>. Acesso em: 29 jul. 2013.
http://www.flacso.org.ar/uploaded_files/... ).

In the rural areas "land is a fixed, non-replicable asset, and water a scarce one" (Flores, 2008FLORES, S. M. L. ¿Es posible hablar de trabajo decente en la agricultura moderno-empresarial en México? El Cotidiano, Azcapotzalco, v. 23, n. 147, p. 25-33, 2008., p. 26). Thus, productive land is in the hands of small and large⁸8Mean surface area of the farms vary between 500 and 1200 hectares (Rodríguez, 2009). producers who need the seasonal and permanent "farm" population inhabiting the farmland and who should invest in extraction pumps or drip irrigation in order to ensure water supply. The areas in which the workers live are located within the farms in housing administered by the owner, or in roadside settlements between the farm boundary and the highway. The water supply depends on installations constructed by the farmers, there is no connection to drinking water supplies or to sewers in that area. Even those who live outside of the farms depend on such installations for their water supply.

There are state and provincial legal frameworks that encourage work regulation, but the government has no plans concerning managing the construction of infrastructure (sewers, water supply) for inhabitants of the rural area. None of the inhabitants of Bananal is a landowner. Among the rural workers, only those belonging to the indigenous community have the legal tools⁹9Article 17, clause 15 of the Argentinian Constitution promotes "Recognition of the ethnic and cultural preexistence of indigenous Argentinian populations (…).Respecting the right to identity and the right to bilingual and intercultural education; recognize the legal status of their communities and possession and ownership of their lands …". to demand land ownership, after obtaining legal status. However, advancing cultivable boundaries place indigenous groups in a weak situation when confronted with political-economic and third party - private owners, farmers and business¹⁰10Only 18 of 97 communities from the National Register of Indigenous Communities (RENACI) own their land: 5 with individual titles, 13 with community titles, whereas the remaining communities have no title to their property (Buliubasich, 2008, p. 28). For further information on the ownership status of the occupied by indigenous communities in San Martin, please consult the survey conducted by the Human Rights Office and the Universidad Nacional de Salta (Buliubasich; Rodríguez, 2009). interests. In Bananal, an ava-guarani community initiated a reclamation of their land and had legal status, but underwent a process internal fragmentation, leaving the claim unacted upon.

Working the land

The five farms where workers were interviewed produce vegetables, and one also produces bananas for exportation. Of the vegetables cultivated, tomatoes are the most economically important, followed by peppers, zucchini and eggplants. These products are destined, almost exclusively, for the large cities of Rosario - capital of Santa Fe province - and Buenos Aires. Cultivating bananas and tomatoes is year-round work. Tomatoes can be produced by small scale producers, as no large investment in technology is required and the stages of the production cycle can be carried out by hand. Tasks such as tilling the subsoil, plowing, planting natural barriers, bagging fertilizer and setting up the watering system all translate into paid work for the laborers. Bananas can be planted at any time of the year, as long as there is humidity, also enabling year round work cycles. All of these cultivations are watered by drip irrigation.

The situation of those who live on the farms is that of dependent occupancy (Indec, 2014INDEC - INSTITUTO NACIONAL DE ESTADÍSTICAS Y CENSO DE LA REPÚBLICA ARGENTINA. Sistemas de estadísticas sociodemográficas: definiciones y conceptos utilizados en los cuadros. Buenos Aires: Ministerio de Economía de la Nación, 2014. Disponível em: <http://www.indec.mecon.ar/desaweb/ftp//nuevaweb/cuadros/7/sesd_glosario.pdf>. Acesso em: 19 jan. 2015.
http://www.indec.mecon.ar/desaweb/ftp//n... ) because they live, alone or with their family, in housing provided by the owner of the farm in exchange for their labor. Although they have housing, the work of agricultural workers in the area is characterized as "insecure" (Flores, 2008FLORES, S. M. L. ¿Es posible hablar de trabajo decente en la agricultura moderno-empresarial en México? El Cotidiano, Azcapotzalco, v. 23, n. 147, p. 25-33, 2008.). Laborers are contracted verbally and they receive no social benefits¹¹11For social benefits we refer to social security charges. Iin 91% of the HHs, children under 16 received AUH.. They are constantly at risk of losing their job and, consequently, their home¹²12There have been actions from the Ministry of Labor, Employment and Social Security and the Federal Administration of Public Revenue (AFIP) seeking to regularize the situation of rural workers. From the AFIP, the actions are based on fsicalization and from the Ministry they encourage Co-responsibility Union Agreements see http://www.trabajo.gov.ar/seguridadsocial/convenios.asp.. On this point, the type of agricultural work observed in Orán is comparable with that in other Latin American contexts (Guiarriaca; Bidaseca; Mariotti, 2001GUIARRIACA, N.; BIDASECA, K.; MARIOTTI, D. Trabajo, migraciones e identidades en tránsito: los zafreros en la actividad cañera tucumana. Buenos Aires: Consejo Latinoamericano de Ciencias Sociales, 2001. Disponível em: <http://biblioteca.clacso.edu.ar/gsdl/collect/clacso/index/assoc/D2484.dir/15bidaseca.pdf>. Acesso em: 26 nov. 2014.
http://biblioteca.clacso.edu.ar/gsdl/col... ; Silva, 1998SILVA, S. M. da. Errantes do fim de século. Sao Paulo: Unesp, 1998.), in which the contradiction between "modernization and intensified production" coexisting "with working conditions that had been considered abolished" (Flores, 2008FLORES, S. M. L. ¿Es posible hablar de trabajo decente en la agricultura moderno-empresarial en México? El Cotidiano, Azcapotzalco, v. 23, n. 147, p. 25-33, 2008., p. 26).

In 16 of the HH, en blanco-legal - workers were found, implying social security charges. These employees reported that their length of time in the position meant "having won the owner's confidence"¹³13Phrases in italics are those of the interviewees. and "becoming effective". Being effective means greater labor security and stability, but lower net wage. Thus, transient workers, the majority of whom are Bolivian, have even more precarious living conditions but, according to the Argentinians "they get more money". They arrive in March with timber and polyethylene bags to erect housing in the middle of the plantations, thus avoiding state inspections¹⁴14Available at: http://www.estudiocontableaeh.com.ar/novedades9/la_afip_detecto_empleo_rural_esclavo_en_salta-3437; http://www.elpaisdehoy.com.ar/nota/5515. Accessed 9/11/2012. returning to their location of origin in October/November. Agricultural workers and Argentinian state employees working in the health sector express it thus "they come in March, work, and leave, using the school and the health facilities" and, moreover, "they earn more money" (Health facilities nurse, 21/11/2010). Such tensions between nationalities and ethnicities are expressed in low union membership even confronted with the lack of social protection experienced. The type of work is linked with the laborers travelling great distances and the dependence on a network of contractors who bring together supply and demand for work (Flores, 2008FLORES, S. M. L. ¿Es posible hablar de trabajo decente en la agricultura moderno-empresarial en México? El Cotidiano, Azcapotzalco, v. 23, n. 147, p. 25-33, 2008.).

Labor relations and housing

Once "contracted", the workers establish relationships with the overseer, who receives his orders from the owner of the farm's economic output¹⁵15The owner of the property might not be the owner of the land, but a landlord.. The characteristics of this labor relationship has implications not only for income but also on the types of housing used. Those with posts of greater responsibility live on the farm year round in brick and cement houses, whereas those of the casual labor¹⁶16Local name given to employees who earn per working day. are largely wooden constructions with a dirt floor and may be used by more than one family during the year, if the work is seasonal.

At least one casual worker lived in 74% of the HHs sampled. These workers start at 6am and finish at around 5pm. At the time of the study, they earned between 50 and 60 Argentinian pesos per day for working Monday to Saturday, or working every day¹⁷17The value of the peso has fluctuated in recent years. In 2010, when the investigation was conducted 1USD = $ 3.92 Argentine and currently 1USD = $ 7.82 at the official exchange.. The sectors where the casual workers live are tenements¹⁸18The local name for the groups of houses of day laborers. where their families can stay during the period they work on the farm. Those who work permanently on the farms are managers (n=8) who have direct contact with the overseer and have tasks involving greater responsibility than those of the casual workers. Managers earn a monthly salary (between $30 and $35 per day). Their working day is around 12 hours, with a lunch break between 12 and 1pm. Their housing is separated from the tenements and are usually constructions provided by the farm owner which had been used to store machinery. This housing may be on the land nearest to the highway, by the café - pension¹⁹19The pension is a place where food and drinks are for sale to the public, working on the farms or otherwise..

All household members participate actively, even the children have paid tasks. For their part, the 36 women stated they worked casually on such tasks. This labor consists in carrying out specific tasks for the overseer, such as cutting canes to support the tomato plants. Such tasks can be done within the home with the help of the children. Moreover, the women can organize a café in their residence or prepare snacks to sell to the workers when they finish work, or even care for the children of those mothers who work in the fields. They may also buy goods in Tarija (Bolivia) to later sell in Argentinian cities and settlements.

Life on the farms is, above all, communitarian, with little room for privacy or individuality. The material from which the tenement housing is constructed are permeable, everything that goes on within can be heard and the sanitary spaces (laundries and bathrooms) are shared. Community life can require bonds of cooperation and competence. The families and the rural workers must organize the cleaning of the community areas and the provision of water among themselves; both of which can lead to conflict. Thus, workers who achieve some stability choose to construct their houses beyond the farm land, in the settlements close to the highway or the health facilities, no longer having to share walls, bathrooms and laundries. "Since we left the farm, we're doing much better, the house and bathroom are clean, I know my children can go to the bathroom without catching anything" (4/03/2011) explained a mother of four who lives with her family by the side of the highway in a prefabricated wooden house. Many mothers associate the parasites with the sanitary facilities at the farms. Moving away from them means the family group gains individuality and privacy, a step up the social ladder for the population of the town.

Living Spaces

The houses in the housing units consist of dormitories with wings. The dimensions of the eaves can vary, forming galleries or covered spaces with dirt floors. Beneath them, one can find the space dedicated to domestic activities such as cooking, and may contain a fireplace, a clay oven, water storage containers, tables and chairs, cutlery or food, among others. In the literature, this space is denominated the peridomicile (WHO, 2007WHO - WORLD HEALTH ORGANIZATION. Control de las helmintiasis en los países del Caribe inglés y francés: hacia la resolución 54.19 de la Asamblea Mundial de la Salud: 2007. Kingstone, 2007. Disponível em: <http://www.paho.org/Spanish/AD/DPC/CD/psit-sth-jamaica.htm>. Acesso em: 8 jan. 2013.
http://www.paho.org/Spanish/AD/DPC/CD/ps... ). "You may not go out to play until you've finished your tasks here on the ranch" (22/05/2011) said Juana to her 11-year-old son who was seated by the fire beneath the eaves, cutting canes for the tomato plants. On this farm, Juana and other mothers cared for the children whose mothers were working. The peridomicile is the environment in which this group's daily activity takes place.

On the farms, we observed intensive use of living space in terms of the housing layout and in the quantity of people per habitation (crowding²⁰20It is the ratio between the amount of areas of the home and the number of people: critically overcrowded households are those with more than three people per room, excluding bathrooms and kitchens (Indec, 2014).). There are farms where a specific space is destined for constructing houses, which are located close to the sanitary sectors, but there are others in which the space dedicated to housing "is formed as and when workers arrive for the harvest" (Manager, 5/03/2011). In the latter cases, the housing needs to be constructed in the small spaces "left over" between the plantations, the sanitary facilities and the pathway around the farm. Thus, the space dedicated to housing caries widely between the different farms. Of the 43 HH, we found 17 that were not crowded and it is worth noting that these belonged to young couples with only one child, or to adult couples. All of the families we encountered with children between 2 and 15 years old sleep together in the same room.

Water supply

Access to water depends on extraction pumps that the workers construct following the owners orders. The "farm pump" is a mechanical of raising water using an electric motor, enabling water to be extracted through a 50 meter deep hole in the ground. The fountain is in a cement tank in which the water not carried away remains "standing". On two of the farms we visited, the electricity supply is cut when there is no activity involving agricultural machinery, meaning the workers cannot activate the pump. "When we are not working, the electricity is cut off, so no water comes out of the pump and we use the standing water" (21/5/2011) explained the farm manager.

Of the HHs, 90.7% received their water supply from the "farm pump". The farm trucks are used to transport 200ltr PVC tanks full of water to the homes of workers in the town. Once in the peridomicile the tanks are covered with plastic. The HHs in the Ava-guarani community (9.3% of the HHs) received water from a tanker weekly. Their unusually close links with the Salta Provincial Institute of Indigenous Populations (IPPIS), through the action begun to obtain legal status and their complaints about the lack of water in the zone, have enabled them to have their water provided in this way. As some Criolla mothers commented, when the tanker arrives the meet it with plastic containers and ask the municipal worker responsible to fill them. Others complain about the situation "some people are privileged, I don't understand why, they have water delivered to their houses" (22/05/2011).

Of the 90.7% that used water from the water pump, 48% of the HHs (n=18) explained that they organized water use at the farm. Some explained that they differentiated between rainwater, which they stored to clean the house, water plants and for personal hygiene, and the water they stored that came from the pump and can be used for consumption. Others chose to buy drinking water from the water wagon, selling 5 liter bottles of water for 10 Argentinian pesos. It is worth noting that we observed this pattern of use in households with children and some mothers commented that they tended to give their children soft drinks more often than water "as it is cheaper and better value for money" (17/11/2010). Thus, in those households were water for consumption and for cleaning is differentiated, the adults tend to drink water from the pump, of soft drinks, while the children drink bottled water or soft drinks.

As for washing, several of those living in the settlements explained how they used stream water to bathe. The stream's flow has decreased noticeable in recent years, as it has been diverted to water plantations at one of the farms. In spring and summer, children can often be seen bathing and adults washing clothes there.

Sanitary conditions

None of the dwellings in the rural sector were connected to sewers and disposal of excreta is, therefore, self-managed. The latrines are outside of the home, with walls built of cane, timber or plastic. As 32 of the HHs explained, they had manually constructed pipes draining into a so-called cesspool meters away from the housing. We make this qualification, as a cesspool requires a septic tank, which was not the case in 10 of the HHs that reported having a cesspool. On the other hand, we encountered dwellings in which the inhabitants had dug a well in the earth meters from the entrance to the house, sprinkling ashes or dry leaves into it. When they see that the well "is totally putrid", they decide that its usefulness has come to an end and dig another, providing a "new bathroom". It is worth noting that in homes with latrines and cesspits, we saw that members of the household emptied their bowels in the open air in a plantation.

Sanitary conditions differ if the dwellings are part of a settlement or set of houses within the farms. In the latter, constructing latrines "depends on the owner's good will' (Community health worker, 17/03/2011) whereas in the settlements it depends on each house owner. Moreover, intensity of use varies. There are farms in which each family has a bathroom connected to a cesspit, while in others we observed as few as six latrines per thirty families.

Managing waste

None of the households we visited were served by a waste collection service. In those in settlements, inorganic waste that could not be reused was burnt and organic waste was buried at a distance from the peridomicile. On the farms, there is a variety of situations and it depends on the workers to organize themselves and on the organization and maintenance of the installations provided by the owner. On four farms, we found piles of organic and inorganic waste by the community toilets. On only one form did we fins organic waste separated from organic, with the latter being burned.

Discussion

The physical and biological interactions that enable parasitic infestation occur in a specific social and cultural context that should be analyzed in order to understand the problem (Redpaith; Allotey; Pokherl 2011REDPAITH, D.; ALLOTEY, P.; POKHERL, S. Social sciences research in neglected tropical diseases 2: a bibliographic analysis. Health Research Policy and Systems, London, n. 9, p. 22-45, 2011.). Sy (2009)SY, A. Una revision de los estudios en torno a enfermedades gastrointestinales: en busca de nuevas alternativas para el análisis de los procesos de salud-enfermedad. Salud Colectiva, Buenos Aires, v. 5, n. 1, p. 49-62, 2009. suggests that epidemiological studies of gastrointestinal pathologies provoked by parasites incorporates patients' social dimensions "in a subordinate form, reduced to indicators such as sex and age" without arguing for the need to "seek new parameters that account for the situation in the particular context being investigated" (2009, p. 51). According to the epidemiological literature, the social components of parasite problems are incorporated quantitatively (Córdoba et al., 2002CORDOBA, A. et al. Presencia de parásitos intestinales en paseos públicos urbanos en La Plata, Argentina. Parasitología Latinoamericana, Santiago de Chile, v. 57, n. 1/2, p. 25-29, 2002.; Ledesma; Fernandez, 2004LEDESMA, A.; FERNANDEZ, G. Enteroparasitosis: factores predisponentes en la población infantil de la ciudad de Resistencia. Revista Argentina de Pediatria, Buenos Aires, v. 8, n. 2, p. 9-17, 2004.; Milano; Oscherov, 2002MILANO, A. M. F.; OSCHEROV, E. B. Contaminación por parásitos caninos de importancia zoonótica en playas de la ciudad de Corrientes, Argentina. Parasitologia Latinoamericana, Buenos Aires, v. 57, n. 3/4, p. 119-123, 2002. Disponível em: <http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-77122002000300006&lng=es&nrm=iso>. Acesso em: 24 dez. 2013.
http://www.scielo.cl/scielo.php?script=s... ; Navone et al., 2006NAVONE, G. T. et al. Parasitosis intestinales en poblaciones Mbya-Guarani de la provincia de Misiones: aspectos epidemiológicos y nutricionales. Cadernos de Saúde Pública, Rio de Janeiro, n. 22, p. 109-118, 2006.) in order to explain levels of infestation in the population, making the patients responsible for the pathologies from which they suffer (Menghi et al., 2007MENGHI, C. I. et al. Investigación de parásitos intestinales en una comunidad aborigen de la provincia de Salta. Medicina, Buenos Aires, v. 67, n. 6, p. 705-708, 2007.). On the other hand, as long as explanations fail to incorporate the factors that have operated over time to form the landscape (Sy, 2007SY, A. La enfermedad en un contexto pluriétnico: parásitos y enfermedad parasitaria en el Valle del Cuña Pirú, provincia de Misiones (Argentina). In: MOLINA, I. Los caminos terapéuticos y los rostros de la diversidad: la selección y combinación de medicinas en Argentina. Buenos Aires: Espacio Editorial, 2007. p. 145-164., ²⁰⁰⁹SY, A. Una revision de los estudios en torno a enfermedades gastrointestinales: en busca de nuevas alternativas para el análisis de los procesos de salud-enfermedad. Salud Colectiva, Buenos Aires, v. 5, n. 1, p. 49-62, 2009.), the existence of parasites in the environment is naturalized, leading to a series of ramifications (Grimberg, 1997GRIMBERG, M. De conceptos y métodos: relaciones entre epidemiología y antropología. In: ALVAREZ, M.; BARREDA, V. Antropología y práctica médica. Buenos Aires: INAPL, 1997. p. 11-23.) concerning the environment, risks and the disease on which we are reflecting.

Negotiating risks

According to the specialist literature, overcrowding and "promiscuity, understood here as more than one individual to a single bed" (Gamboa et al., 2003GAMBOA, M. I. et al. Distribution of intestinal parasitoses in relation to environmental and sociocultural parameters in La Plata, Argentina. Journal of Helminthiasis, London, n. 77, p. 15-20, 2003., p. 2) are factors that promote parasite infestation, being, therefore, risky habits (Soriano et al., 2001SORIANO, S. et al. Intestinal parasites and the environment: frequency of intestinal parasites in children of Neuquén, Patagonia, Argentina. Revista Latinoamericana de Microbiología, Ciudad de México, DF, n. 43, p. 96-101, 2001.). The idea of such explanations is that in avoiding such behavior the parasitic load can be reduced. Following the field work carried out, we argue that those who live in overcrowded conditions without running water or sewerage are aware that such issues are not good for the health. Being aware of the risks influences the way in which the subjects live and in which they plan their activities (Giddens, 1995GIDDENS, A. Modernidad e identidad del yo: el yo y la sociedad en la época contemporánea. Barcelona: Península, 1995.). The issue is to see how they perceive risk, as it is often accepted and experienced within "tolerable limits" as long as one can continue to live (Sy, 2009SY, A. Una revision de los estudios en torno a enfermedades gastrointestinales: en busca de nuevas alternativas para el análisis de los procesos de salud-enfermedad. Salud Colectiva, Buenos Aires, v. 5, n. 1, p. 49-62, 2009., p. 23). For the inhabitants of Bananal, these limits are constantly moving and being negotiated: when cooking, water is separated into water for adults and water for children, when bringing up children or in what is said when the community health agent visits, on visits to the doctor or in responding to questions posed by a researcher: "I know the water is not good, it's yellowish and I know I should boil it but, when you're working in the field, even if that trickle of water is not good, I'll drink it and, yes, I know to have disorders²¹21Desarreglo – disorder - is the name for any type of feeling ill, but it most often refers to diarrhea. (Reveer que en le texto figura como 1)" (9/3/2011) explained a mother of four who has worked at harvests for 15 years, in her interview. She said that even knowing that the water is bad, she drinks it and faces the possibility of suffering diarrhea.

Not disposing properly of excreta is another risky habit. Describing and assessing the bathrooms, then, is used as a key parameter in understanding STH infestation (Soriano et al., 2001SORIANO, S. et al. Intestinal parasites and the environment: frequency of intestinal parasites in children of Neuquén, Patagonia, Argentina. Revista Latinoamericana de Microbiología, Ciudad de México, DF, n. 43, p. 96-101, 2001.). In Bananal, attention to the population's perception and use of the sanitation services is as important as describing the functioning of the system of evacuation. It is the availability and use of latrines that define their conditions rather than the material of which they are made. "I know it would have been better to have built a homemade cesspit of sewer, we had one at the other farm, but it was so horrible, so stinking, that I prefer living here and digging more holes when we need them. Only my family use this, not other dirty people like at the other farm" (6/3/2011) explained a Criolla, mother of three. She lives in a prefabricated house between the boundary of one of the farms and the highway. She and her partner constructed the bathroom, digging the hole in the ground and setting up walls of wood and plastic. After use, they sprinkle ashes to cover it. She knows that the bathrooms at the farm were constructed of better materials, but their use and conflictive relationships with other residents meant that no cleaning was organized. Thus, an aspect to consider in studying and describing sanitary conditions is the intensity of their use, what that tells us about the appropriateness, access and availability of the sanitary services (Ziegelbauer et al., 2012ZIEGELBAUER, K. et al. Effect of sanitation on soil-transmitted helminth infection: systematic review and meta-analysis. Plos Medicine, San Francisco, v. 1, n. 9, 2012. Disponível em: < http://www.plosmedicine.org/article/fetchObject.action?uri=info:doi/10.1371/journal.pmed.1001162&representation=PDF>. Acesso em: 3 mar. 2013.
http://www.plosmedicine.org/article/fetc... ). In this situation, it is relevant to conduct corresponding medical studies that reveal the levels of parasite infestation of the family members, comparing them with those who use the bathrooms in the farms and thus observe how these aspects influence the probability of infestation.

On the other hand, the farm latrines are shared by the inhabitants and the casual workers who do not live there, thus use is intensified and represents another risk for the farm inhabitants. "I'm worried about my daughter going to the bathroom where there are strange men, I prefer her to go into the plantations" (22/05/2011) explained a 25 year old mother in her interview. This statement tells us about age and gender inequalities, as well as vulnerability and risk. Alcohol linked situations of violence, domestic violence or between men, are common in the area and represent a risk to be prevented. Women, especially minors, are the most vulnerable. Fear of violence and/or sexual abuse against minors is a risk to be avoided, in this case, by allowing the young girls to empty their bowels in the open air. Far from being an objective and neutral fact, risk is an emotional dimension of transgression (Douglas, 1966DOUGLAS, M. La impureza ritual. In: ________. Purity and danger: an analysis of concepts of pollution and taboo. London: Routledge & Keagan Paul, 1966. p. 21-47.) expressed in terms of anger, fear and anxiety (Lupton, 1999LUPTON, D. Risk. London: Routledge, 1999.). When constructing risks locally, a violent situation represents a greater fear than a parasitic infection, and is thus negotiated in daily behavior. The negotiation does not imply ignorance of the risks, but rather running the risks as far as the tolerable limits.

Based on their study of leishmaniasis outbreaks and working conditions, Mastrangelo and Salomon (2010)MASTRANGELO, A. V.; SALOMON, O. D. Contribución de la antropología a la comprensión de un brote de Leishmaniasis Tegumentaria Americana en las "2.000 hectáreas", Puerto Iguazú, Argentina. Revista Argentina de Salud Pública, Buenos Aires, v. 1, n. 4, p. 6-13, 2010. Disponível em: <http://www.saludinvestiga.org.ar/rasp/edicion-completa/RASP%20Volumen-I-IV.pdf>. Acesso em: 22 dez. 2014.
http://www.saludinvestiga.org.ar/rasp/ed... explain that losing employment is a greater risk than catching a disease. Thus, we observe that the individuals create strategies to deal with the risk of losing employment and the health risks to which their lives are exposed working on the farms.

This was a report from Marcela, a mother of two who lives with her partner on the farm. Both work there, he as a casual worker and she doing other tasks. They used to live in the tenement, where all the casual workers' families are gathered and where the bathroom has cement walls and the latrines are close by. Little by little the surroundings of these bathrooms came to be used for dumping agricultural waste from the farm (cardboard boxes and rotten produce). Marcela began to complain to the boss about inadequate waste management and was threatened with losing her position. So she decided to construct a dwelling away from the tenement, on the boundary of the farm, between the fence and the crops. She says she prefers to be further from the community sectors to be able to "keep clean" and make sure her children do not play near the farm waste every day. Another important thing that stands out in this report is the capacity of agency deployed by the social actors and their awareness of the situation of vulnerability in which they live.

Contact with the earth

The material of which the walls and floor of the dwellings are made is quantified and described as this can encourage or discourage parasite infestation (Navone et al., 2006NAVONE, G. T. et al. Parasitosis intestinales en poblaciones Mbya-Guarani de la provincia de Misiones: aspectos epidemiológicos y nutricionales. Cadernos de Saúde Pública, Rio de Janeiro, n. 22, p. 109-118, 2006.; Menghi et al., 2007MENGHI, C. I. et al. Investigación de parásitos intestinales en una comunidad aborigen de la provincia de Salta. Medicina, Buenos Aires, v. 67, n. 6, p. 705-708, 2007.; Gamboa et al., 2003GAMBOA, M. I. et al. Distribution of intestinal parasitoses in relation to environmental and sociocultural parameters in La Plata, Argentina. Journal of Helminthiasis, London, n. 77, p. 15-20, 2003.). From the ethnographic study, we observed that the room in which the beds were was used for sleeping and those who were ill rested there. The rest of daily life occurred in what is known as the peridomicile, the space that forms part of their housing. Housing is not simply what is between their four walls. All the zone of what the researchers understand as "outside" is a fundamental part of the home, where they cook, play, do their chores and eat, among other activities. Thus, the existence of cement floors in the dwelling does not guarantee that there is no contact with the earth. Earth is not just on the floor. If it does not rain, the dust flies, coming into contact with the skin, mouth and nasal passages. Contact with the earth, then, is not exclusively through the habit of working barefoot (Menghi et al., 2007MENGHI, C. I. et al. Investigación de parásitos intestinales en una comunidad aborigen de la provincia de Salta. Medicina, Buenos Aires, v. 67, n. 6, p. 705-708, 2007.) but also through other activities, such as harvesting by hand. This population makes their living from harvesting fruit and/or vegetables by hand, for which they do not always use gloves.

Labor relations and sanitary conditions

Power relationships within the work structures directly influence access to basic health care elements. In Bananal, life on the farms is organized according to power relationships in which not all have the same access to water. Those workers who do not have access to electricity only have access to "standing" water. On the other hand, the managers usually enjoy greater employment stability and occupy dwellings provided by the owner and constructed of better materials (cement and subflooring) than those occupied by the casual workers (timber walls and dirt floors). Not all of the housing, however, has had the necessary maintenance to offset the effects of the subtropical climate. "This is not a house for people, it is a house for vegetables, but, well, here we are. Just us" explained the wife of one of the managers, sitting in the storehouse that they used as a house, where there were visible cracks that let the water filter through and insects on the ceilings and cement walls. Approaching the precariousness of the population's worker's rights gives tools for understanding the spiral of vulnerability (Flores, 2008FLORES, S. M. L. ¿Es posible hablar de trabajo decente en la agricultura moderno-empresarial en México? El Cotidiano, Azcapotzalco, v. 23, n. 147, p. 25-33, 2008.) around which parasite infestations in this zone are constructed.

Final reflections

In this study methodological theoretical guidelines from eco-epidemiology and medical anthropology were used to approach the sanitary problem of STH infestations in the rural context of Orán. Unequal distribution of land in the zone, together with productive activities, define work positions and the land available to the population affected by STH. Thus, work relationships define housing to be used within the areas of the farm and proximity to water sources. Living on the "margin of the productive zones" (Rodriguez, 2009RODRIGUEZ, M. G. Barreras naturales: la conjunción de lo urbano y periurbano en San Ramón de la Nueva Orán: ciudad encajonada y dispersa. In: NEMIROVSKY, A. S. Globalización y agricultura periurbana en Argentina. Buenos Aires: Facultad Latinoamericana de Ciencias Sociales, 2009. Disponivel em: <http://www.flacso.org.ar/uploaded_files/Noticias/agriculturaperiurbana.pdf>. Acesso em: 29 jul. 2013.
http://www.flacso.org.ar/uploaded_files/... ) and soil erosion produced by agriculture are physical and social dimensions of the environment that provide relevant data when explaining cycles of infection.

Explaining the housing context and the complex power relationships within the working environment in which these workers/patients find themselves living aims to complement epidemiological explanations. The work activities define the patient population's daily life and are not always considered in epidemiological studies or in public health censuses. It is worth conducting future investigations in which the results of the epidemiological perspective are crossed with those from anthropology to account for the precarious labor situation in which this population finds itself.

The ethnographic focus provides detailed information on sanitary practice and local construction of risk, associated with the gender and age of the affected population. These data enable us to understand health and disease as experienced in the particular contexts in which they occur (Sy, 2009SY, A. Una revision de los estudios en torno a enfermedades gastrointestinales: en busca de nuevas alternativas para el análisis de los procesos de salud-enfermedad. Salud Colectiva, Buenos Aires, v. 5, n. 1, p. 49-62, 2009.). It is important to consider the patients as subjects with rights and reflect on the concept of health underlying scientific explanations. The issue is not to encourage subjects to "participate correctly in managing their own health" (Milano; Oscherov, 2002MILANO, A. M. F.; OSCHEROV, E. B. Contaminación por parásitos caninos de importancia zoonótica en playas de la ciudad de Corrientes, Argentina. Parasitologia Latinoamericana, Buenos Aires, v. 57, n. 3/4, p. 119-123, 2002. Disponível em: <http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-77122002000300006&lng=es&nrm=iso>. Acesso em: 24 dez. 2013.
http://www.scielo.cl/scielo.php?script=s... ) but rather about understanding their health and how to negotiate the sanitary risks to which their lives are exposed. These data may be useful in regulating labor risk and planning prevention strategies to protect the health of rural workers.

Acknowledgements

Thanks to the families of Bananal, to Lic. Nadia González, to the Fundación Mundo Sano, Lic. Sonia Tarragona, Lic. Marcelo Abril, Dr. Alejandro Kroliewiecki, Lic. Marisa Juarez and the other members of the Instituto de Investigaciones de Enfermedades Tropicales at the Universidad Nacional de Salta.

References

Publication Dates

History