Black Plague May Wipe Out Brazilian Tribes

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.

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.