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Brazil: Zika, Chika, coup d’état

Nancy Scheper-Hughes, anthropology professor | August 22, 2016

The Brazil Olympic games just ended their two-week run. Cal athletes were well represented, and on Berkeley’s campus we are celebrating Cal student Ryan Murphy’s third gold medal in Rio de Janeiro.

Yet, as we cheer on one of our own and take part in the pageantry, we read about the alleged mugging of another Olympic medalist, Ryan Lochte, who along with three other Team U.S. swimmers said they were attacked coming home from a party Sunday morning. The story turned out not to be true. But police and vigilante violence (often in tandem and in collaboration) runs rampant in Rio, and there are real dangers for those infected in the Zika-Chikungunya epidemic.

In such an iconic setting as Rio de Janeiro, a wondrous city with almost mythical standing in the imagination, it seems things have gotten really real.

The wondrous city

The true and full story of what happened in the Lochte incident is still to be told. But the video shows evidence of four U.S. Olympic swimmers on a rampage and behaving like vandals. What ever happened to sportsmanship and global diplomacy? In covering up their disgraceful behavior by fabricating a kidnaping by men dressed as police  — who happened to be security guards at a gas station —  the athletes violated the Olympic code of ethics: respect for human dignity; maintaining harmonious relations with host authorities; and rejecting all forms of harassment, physical abuse and violence. They should be removed from the team and the ringleader, Lochte (despite his weak apology)  should be stripped of his Rio gold medal.  What a sad moment for Brazil and the US.

mosquitoBut the story rang true, at first, because there were other street attacks during the games including the mugging of an Australian Paralympian, Liesl Tesch, and the bungled mugging of the chief of security for the games.

Rio’s mayor, Eduardo Paes, apologized several times for these incidents. He noted that they are to be expected in a “third world country” — a term that had been abandoned during the past decade as Brazil’s fortunes and economy soared. Paes lamented, “This is not the best moment to be in the eyes of the world.”

Recently, my colleague, Frederic Vandenberghe, a professor at UERJ, the state university of Rio de Janeiro, sent me a message to pass along to anyone I knew traveling to the games:

“Welcome to Brazil! We are happy you are here and hope you will enjoy the Olympic Games™©®. We wish we could have received you under better circumstances. As you might know, we had a coup d’état over here. It’s not a classic military coup, as in the ‘60s, but the result is the same. Democracy in Brazil is under siege and you will see Brazil’s military forces everywhere. They are there to guarantee your security, but also to repress an opposition to the illegitimate government…. I hope you will quickly notice that Brazil is a racially diverse country. The majority of the population is black. Our ‘new’ government, however, is all white, all male, and all corrupt… The new government is defending the interests of the banks, privatizing the economy, repressing minorities, exterminating indigenous populations and otherwise doing everything it can to abolish the rights won by the majority of the population… Enjoy your stay!”

Then there is the issue of the Zika-Chikungunya epidemic that arrived in Brazil in February 2015 — just in time for the collapse of Brazil’s national health care system, the Sistema Unico de Saude.

The U.S. Centers for Disease Control and the U.N. World Health Organization disagreed on the threat of the epidemic for athletes and tourists visiting Rio de Janeiro. The former strongly suggested caution, while the latter — embracing medical global diplomacy — urged the show to go on.

Moreover, Dr. Margaret Chan, chief of the WHO, said that she planned on going to the Olympics herself, though she warned the athletes and tourists to take measures to avoid mosquitoes.  “You don’t want to bring to a standstill the world’s movement of people,” Chan said. “This is all about risk assessment and management.”

Immediately after, 240 health professionals from 40 countries signed an open letter to the WHO chief expressing their deep concern about the real threat of Zika to the global visitors and thus to the world.

Zika and Chika

Healthy, pregnant women infected with Zika may have minor symptoms: a rash and a low-grade fever for a few days. But the virus can be lethal to an embryo or fetus, producing serious neurological disabilities, most visible, microcephaly. Neuroscientists do not know what later neurological problems could emerge, according to Berkeley epidemiologist, Lee Riley.

(Photo by Nancy Scheper-Hughes)

(Photo by Nancy Scheper-Hughes)

The dangers of Zika have been well publicized. Lesser known, however, is Zika’s evil stepsister, Chikungunya. Referred to in rural Northeast Brazil as “Chika,” it is transmitted by the same mosquito. Chika can be lethal to older people with heart conditions.

Endemic in parts of Africa, the Swahili term for Chikungunya means “the sickness of crooked walkers” as Chika produces severe arthritic symptoms, pain and swelling of fingers, toes and joints.

Both Zika and Chika are not easily distinguished by confirmatory blood and urine clinical tests. Chika is a transient and mild problem for the young, but can be fatal for elderly persons with preexisting heart disease.

In March 2016, I received an urgent e-mail from my companheiro in the field, Patricio Silva of Timbaúba:

“Dear Nancy, I just returned from Timbaúba. I was called home because my father got very sick with Chikungunya, a serious disease related to the Zika virus. Today 30 percent of the population of Timbaúba is sick with Zika or Chika. It is a terrible time for us. We want you to come immediately…”

A letter from the secretary of health of the municipality followed, asking me to help the 120 stranded community health agents of Timbaúba who were the “face” of medicine in the municipality of 55,000 people.

hospital room

Hospital room (Photo by Patricia Silva)

The situation was grim: Dedicated, yet underpaid and under-trained, “barefoot” community health workers managed the epidemic in the absence of any resident public health SUS doctors. The only exception was a single Cuban doctor working in a small peripheral rural villa.

These first responders to the Zika-Chika epidemic worked without basic medical equipment, local hospital beds or laboratories to confirm suspected cases. As a result, literally thousands of suspected cases of Zika and Chika in Pernambuco went unconfirmed. The municipality was so hard hit in the weeks following Brazilian carnival that shops and restaurants closed, the streets were empty, and there were no soccer games. The players said their joints hurt too much.

A mother’s legacy

The dozens of teenage pregnant girls I interviewed at the local health posts in the poorest communities were ready to admit that they had been sick with Chika, but in denial about whether they had possibly been infected with Zika. Confirmatory test kits were as scarce in the capital city as mosquito repellant. The shelves at local pharmacies were bare.

Sign about mosquito control

(Photo by Michael Hughes)

The only solution for the infected and pregnant patients of Timbaúba was to outsource them all –- the pregnant, the infected and the dying — to public hospitals and clinics elsewhere.

Recife, the capital city, roughly 60 miles away, was the first option. For those pregnant women who had been confirmed infected with Zika and with signs of fetal microcephaly, Oswaldo Cruz Hospital in Recife offered the best care. But with only one public ambulance to transport women in labor and the sick, private cars, taxis and motorized bicycles were making do.

Health workers

Health workers. (Photo by Michael Hughes)

Some pregnant women gave birth in taxicabs. Other patients, not pregnant but infected, had to wait for hours. Sometimes they waited overnight to see a doctor or to be interned in public hospitals that had no vacant beds.

Dr. Humberto Graça, who took down a death squad in Timbaúba a decade ago, works today as a promotor for Ministério Publico in Recife. He was outraged about the destruction of the public medical system in Brazil. He told us:

“Today we are facing the fact that the level of medicine we thought we had attained has been dismantled.… Going to the hospital we now see the same depressing scenes of people waiting in queues, people sleeping in the hospital corridors, or put on improvised beds. And people are coming to us for help. We are asked to decide who lives, who dies, because there is only one bed or no beds at all and we [Ministerio Publico] have to decide who will get that bed. So one of our afflictions as prosecutors, judges, and public defenders is to decide how to respond to all the people who come to us for a judicial order to obtain a needed hospital bed. But there are no vacancies. So, I have to ask myself if it is the right for a judge or a public defender to decide who will live and who will die as a consequence? When hospital doctors receive a judicial order to intern a very sick person, they are put into a terrible fix: Either they disobey a judicial order (and face prosecution), or they accept it and vacate a bed being used by another mortally sick person… That is the reality of public hospitals and SUS today.”

mother and child

(Photo by Michael Hughes)

As for the young women in Timbaúba who were suspected of infection with the virus today, their legacy has been compromised. Previously believed to be the first generation that could trust in their future children’s health and well-being thanks to programs that Lula and Dilma put into place (zero hunger, the bolsa familia), they are stalwart about facing the possible threat of giving birth to an infant with special neurological needs.

They said plainly that they would not consider abortion, even if it were made legal in cases such as theirs. They will instead, they said, hold on to their infants and defend their sweet “angel babies,” their anjelinhos, no matter what.

They had adamantly reversed the meaning of a folkloric term that their mothers and grandmothers once used to suggest that a sick or puny infant might, after all, be better off in heaven than on earth.

Nancy Scheper-Hughes is the Chancellor’s Professor of Medical Anthropology at UC Berkeley and chair of the doctoral program in critical medical anthropology. Her research and writings focus on the violence of everyday life examined on the ground from a radical existential and critically engaged perspective.

Cross-posted from the blog of CLAS, the Center for Latin American Studies at UC Berkeley.