Tears and Bewilderment in Brazilian City Facing Zika Crisis
Tears and Bewilderment in Brazilian City Facing Zika Crisis
Micaela de Souza took her 3-month-old daughter with microcephaly to see a doctor for a test result in Recife, Brazil, on Friday.
Credit
Mauricio Lima,
RECIFE,
Brazil — So many distraught mothers stream into the infant ward
clutching babies with abnormally small heads that the receptionist sends
them outside, to see if they can find a chair to wait under the mango
tree.
“There’s
shade there, at least,” said Maria Helena Lopes, 66, as she greeted one
young mother after another. “We’ll call you when we’re ready.”
Roziline
Ferreira took three buses to get here, grasping her 3-month-old son,
Arthur, all the way. Tears swelled as she looked at him, recalling how
the symptoms of the Zika virus had struck her during the second month of
her pregnancy. How would she ever be able to care for him, she wondered? What kind of life would he have?
“It
gets me angry when someone on the bus looks at Arthur and asks, ‘What’s
wrong with his head?’” Ms. Ferreira said. “I tell them, ‘Nothing’s
wrong, he’s just different.’ But then I think to myself, ‘Yes,
something’s wrong. My son will neve
This
poverty-stricken city near the Equator is at the center of a
nightmarish health crisis that has set off alarms across the Western
Hemisphere. Mothers began showing up at the Oswaldo Cruz Hospital with
their affected babies as early as September, stunning doctors and
leaving even the most experienced among them scrambling to figure out
what was going on.
“I
would like to dream it isn’t happening,” said the head of the infant
care unit, Dr. Angela Rocha, who began working at the hospital in 1973.
“We’ve had our share of epidemics, but this is unprecedented.”
Before last fall, medical reports of babies born with brain damage and unusually small heads — a condition known as microcephaly — were so uncommon in Brazil
that only about 150 cases were registered each year in the entire
country. Now Brazilian officials are investigating thousands of them,
and they contend that the mosquito-borne Zika virus is the cause.
Virus specialists are racing to understand the connection, if any, between Zika and the rash of microcephaly cases in Brazil, an undertaking that international officials warn could take six months or more.
But
whatever the cause, “There is no doubt that Brazil is experiencing a
significant increase in microcephaly,” said an official for Brazil’s
Health Ministry who was not authorized to speak publicly. “We wouldn’t
have declared this situation a health emergency if this increase had not
been detected.”
The
Zika epidemic has spread much faster than science’s understanding of
it. Researchers here believe that the virus made the leap from Polynesia
to Brazil during the 2014 World Cup soccer tournament. Since then, as
many as 1.5 million people in Brazil are believed to have been infected,
and the virus has spread to more than 20 countries and territories in the Americas.
The most common symptoms are relatively mild, like fever and joint pain, and most people with the virus feel no ill effects at all.
But
as Zika continued to spread across Brazil, particularly here in the
northeast, doctors began to encounter a steady stream of women cradling
babies with unusually small heads.
“I
saw this dramatic increase in cases with my own eyes,” said Dr. Vanessa
Van Der Linden, a neurologist in Recife who was among the first doctors
to detect an increase in microcephaly cases last year.
She
said she was shocked when the babies began appearing at the public
hospital where she works, the Hospital Barão de Lucena, and at her
private practice. Altogether, she has examined about 60 cases in the
last six months, she said — 10 times the rate of cases she came across
in previous years.
“I never witnessed anything like it,” Dr. Van Der Linden said.
She began suspecting a new cause for the microcephaly after testing the mothers for other possible factors, like toxoplasmosis, H.I.V. and rubella. None of the tests showed that these ailments could have been responsible, prompting researchers to examine the link to Zika.
“This is an emergency because the situation is unprecedented,” Dr. Van Der Linden said.
Dr.
Rocha, at Oswaldo Cruz Hospital, said that she and her team had also
examined about 10 times as many babies with signs of microcephaly as
they normally would, turning Recife into a harbinger of what officials
fear could unfold on a much broader scale.
Many of the mothers were already overwhelmed by poverty. Now they are grappling with an incurable condition that can involve seizures, impaired cognitive development, delayed motor functions, problems with speech and dwarfism.
“Some
of the mothers hope the microcephaly is something that will pass, and
just have an empty gaze when I tell them it will not,” said Dr. Rocha,
67, a pediatrician. “Others simply start to cry when the reality sets
in.”
Two
months ago, Selma Alves de Oliveira, 38, gave birth to a daughter,
Maria das Graças. It was her eighth child, inevitably increasing the
strain on her and her husband, who farm beans and potatoes on a small
plot of land near Recife.
But
unlike her others, this child was born with microcephaly, requiring
multiple bus rides or paying someone to drive them to Recife for medical
care.
“Our
lives have been turned upside down,” she said. “The time spent coming
here, waiting here for hours, is time I can’t spend feeding my family. I
love my daughter and want the best care for her, but this is hard.”
The
full extent of the crisis is still far from clear. Reporting
microcephaly became mandatory across the country only in the last few
months, after officials documented the jump in cases here in the
northeast. Brazilian officials said this week that reported cases of microcephaly had now climbed to 4,180 since October, a 7 percent increase from the previous tally last week.
Officials
have examined more than 700 of the cases. In 462 of them, either no
microcephaly was found, or it was caused by something other than an
infection, like alcohol or drug abuse by the mother during pregnancy, a spokeswoman for the Health Ministry said.
So
far, infections have been confirmed as the cause of 270 cases of
microcephaly. Yet even in that group, the Zika virus was found in only
six infants.
Officials
warned against reading too much into that number, though, because the
Zika virus has a very short period during which it can be detected
properly.
“When
an infant is identified as a suspect, the infection had to occur six to
seven months earlier,” said Claudio Maierovitch, director of the
department of surveillance of communicable diseases at Brazil’s Health
Ministry.
“The chances of detecting it are tiny,” he said.
Officials are still investigating 3,448 other cases.
Even
under normal circumstances, the Oswaldo Cruz Hospital, founded in the
1920s and named for the legendary Brazilian epidemiologist who led
sanitation campaigns against the bubonic plague, embodies the challenges of the country’s public health system.
Waiting
rooms lack air-conditioning. Weeds threaten to envelop a rusted swing
set perched behind the infant care unit. Puddles of stagnant water where
virus-carrying mosquitoes can breed persist along sidewalks.
Even
so, Arlindo Batista, who manages the snack bar outside the ward for the
babies with microcephaly, said he had been shattered by the influx of
babies.
“It’s
one of the saddest things I’ve ever seen,” said Mr. Batista, 43, who
tried to lighten up the area by hanging decorations from the ceiling for
the coming carnival celebrations. “Sometimes the women come to sit down
here for a little cup of coffee. They hold their babies and turn quiet.
I don’t know what to say.”
Faced
with so many cases, doctors here in Recife say that Brazil needs to
intensify its battle against the virus on many fronts, from expanding
mosquito-eradication campaigns to developing a vaccine.
“It’s
fine and it’s necessary to have an academic discussion about the
statistics, but we’re here on the ground dealing with the increase in
microcephaly cases,” Dr. Van Der Linden said.
