Brazil’s National Health
Foundation is being accused of neglect
for letting scores of Amazon Indians die from an acute syndrome
caused by hepatitis. According to backwoodsman Sidney Possuelo,
from the National Indian Foundation, if the same situation
occurred any place else, authorities would order a quarantine.
by: Beth
Begonha
An acute syndrome, probably caused by the mixture of hepatitis B and D (delta)
viruses, can, over the course of 20 years, wipe out the communities that occupy
the second largest Indian reserve in Brazil, the Javari Valley.
The alert is being sounded
by Jecinaldo Satere-Mawé, president of the Coordination of Brazilian
Amazon Indigenous Organizations (Coiab). There are no official statistics,
nor even estimates, but, according to the Javari Valley Indigenous Council
(Civaja), each week Indians are removed from the reserve to receive health
care.
In 2003, 15 Indians from
different communities died from the syndrome. According to the Civaja, the
diagnosis is always the same: Acute Hemorrhagic Fever and Jaundice Syndrome.
The organization reveals that blood tests to identify the presence of hepatitis
virus were performed on only two of the victims. The results were positive.
The Javari Valley reserve,
the second largest in Brazil, is about the same size as Portugal. 3,500 Indians
from the Kanamari, Kulina, Matis, Mayuruna, and Maruba ethic groups live there.
There is only one health post in the entire territory, in the city of Atalaia
do Norte. Access to the region is difficult, and transportation possibilities
are limited, especially at certain times of the year.
Hemorrhagic Hepatitis
Dr. Thor Dantos, a specialist
in infectious and tropical diseases and director of the Rio Branco General
Clinical Hospital, in the state of Acre, confirms that the Javari region is
highly contaminated by various types of hepatitis virus.
Among them, the virus
responsible for hepatitis delta, a form of the disease that is very aggressive
and hard to cure and which, in its acute form, is known to history as the
"black plague of Labria."
The hepatitis delta virus
can only manifest itself when it coexists in the organism with the hepatitis
B virus. It is the union of these two infectious agents that causes the acute
syndrome. The medications designed to combat the delta virus have proved ineffectual,
achieving success in fewer than 10 percent of the cases and producing serious
side effects.
Nevertheless, the vaccine
against hepatitis B is highly effective. This, in Dantos’s opinion, can prevent
the onset of "superinfection," the result of the combination of
the two viruses in the human organism.
The manifestation of hepatitis
delta leads to fever, general hemorrhaging, and numerous other symptoms. Various
examinations are necessary to confirm the diagnosis.
"Once the syndrome
has appeared, the chances of saving the person’s life are always close to
zero. Only prevention, through vaccination and the use of condoms during sexual
intercourse, can save these people, by avoiding simultaneous infection by
types B and delta," the specialist warns.
Funasa’s Responsibility
The National Health Foundation
(Funasa), the federal organ responsible for Indian health, is accused by the
organizations in the Javari Valley of neglect in caring for victims of the
syndrome. A charge with which backwoodsman Sidney Possuelo, general coordinator
of Isolated Indians in the National Indian Foundation (Funai), concurs. In
his view, if the same situation were confirmed in "any of the country’s
tiny towns," the health authorities would order a quarantine.
Iraneide Barros, general
coordinator of Indian health care in the Funasa, refutes the criticisms. He
claims that the organ has a policy for the region but encounters difficulties
in putting it in practice.
"We are working with
only one boat," he declares, admitting that the institution is aware
of the high degree of hepatitis contamination in the region.
"However, not all
of them showed symptoms of superinfection, a mixture of B and D-type viruses.
They didn’t die of hemorrhagic fever. We need to test for other diseases,
such as hantavirus and even malaria," he argues.
Jungle Health Care
During a period of one
week, last April, a group of Brazilian Air Force healthcare officials visited
over a thousand people in some of Brazil’s most remote areas. The inhabitants
got medical care and medicine.
This was the inauguration
of a new CAN (Correio Aéreo Nacional) airline route that runs through
five isolated municipalities in the Amazon region in the state of Acre. The
idea of the new CAN is to bring health and social services to distant parts
of Brazil.
The C-98 Caravan aircraft
left on April 5. But for the medical team to actually arrive in the locations
they were to assist, they had to use boats, walk long distances through the
jungle and frequently cross bridges that were far from safe.
One of the locations they
finally reached was Marechal Thaumaturgo, just 13 kilometers from the border
with Peru and 850 kilometers from the state capital, Rio Branco. All the obstacles
the group met were overcome with the help of local people, like when the plane
got stuck in mud on the local dirt runway that is usually used by drug lords.
The local population is
3,000—many of them Ashinika Indians. The medical group stayed in Marechal
Thaumaturgo for only four hours—enough time to assist 140 people. Pediatrician-29,
dentist-27, gynecologist-45, general clinic- 31 and urology-8.
First Gynecologist
Another location was Tarauacá,
located 300 kilometers from Rio Branco. It is so isolated that most of the
30,000 inhabitants will raise their heads to look at an approaching airplane.
It is a place where an Indian, Maspã, 34, got her first ever visit
to a gynecologist although she has been pregnant six times.
Two of her babies died
because of miscarriages, and she is pregnant again. She saw lieutenant Ana
Paula who gave her some medicine. "I will do everything she told me to
do. She is a good person," said Maspã, very pleased with the doctor.
As for doctor Ana Paula,
she said that what most surprised her was the number of women who had never
seen a doctor before. "They sure pay attention to what we say. That is
good for us and good for them. Another thing is that here couples normally
have six or seven children. So we have pregnant women who are in their late
thirties, and pregnant teenagers, as well," she said. The total number
of people assisted in Tarauacá was 217.
The last stop on the CAN
flight was a land reform settlement almost 100 kilometers from Rio Branco.
In this case, the medical team, led by major Marcus Vinicius Bergo Coelho,
arrived by bus.
A very long line formed.
"So many kids," said pediatrician Renata Mariscal (an Air Force
lieutenant). "We just have to see them all."
The dentist, Dina Berman
(also a lieutenant) had to show the kids how to brush their teeth. All of
them.
Major Bergo Coelho says
the trip was rewarding because over a thousand people got medical attention.
"It was extraordinary. We sure got a warm welcome," he said.
Beth Begonha works for Agência Brasil (AB), the official press agency
of the Brazilian government. Comments are welcome at lia@radiobras.gov.br.
Translated
from the Portuguese by David Silberstein.
