How To Fight Zika When Your Country Is In Trouble: Improvise | KUOW News and Information

How To Fight Zika When Your Country Is In Trouble: Improvise

Apr 7, 2016
Originally published on April 7, 2016 12:19 pm

He asked for $7 million to fight Zika.

He got a few hundred thousand dollars.

That's the story that Jailson Correia tells. He's the health secretary for Recife, the city with the most cases of brain damage in infants linked to Zika. The virus began sweeping through Brazil last fall. In November, concerned about the scope of the outbreak, he asked the federal government for help. What they gave was a drop in the bucket.

Why so stingy? Because Zika isn't the only emergency in Brazil. Two other mosquito-borne viruses are spiking: dengue and chikungunya. Meanwhile, the country is going through an economic and political crisis as well, facing one of the worst recessions in its history. Its president is under attack. So health workers and officials have to scramble to do as much as they can with limited resources and a vacuum of power at the top.

"It was disappointing," Correia says of the allocation. "But it did not freeze us."

From the top down, leaders and workers in the health field are improvising solutions.

Correia says the city started using emergency funds destined for other things. That helped. But then, in the past few months, the political crisis blew up. President Dilma Rousseff is now in the process of being impeached. Her health secretary — the man coordinating the country's response to the Zika virus — will probably be replaced in the next few weeks because his party withdrew from the government.

Correia sighs at the flood of bad news.

"We'd love to have a situation where we'd face one crisis and not all these crises at the same time," he says.

But they don't. So they are doing what they can to cope.

Correia showed me around the Zika situation room in his office. Charts, maps and lists paper the walls. The data is updated regularly — and in a few weeks will all be digital, he says.

"We are now seeing things getting a little more stable," he says. "We understand a little bit more what is going on. We start to have the capacity to plan and predict better than we used to have."

And what's going on is this: New cases of microcephaly are dramatically down. Last November, Recife registered 125 cases. But since the beginning of this year, the numbers have hovered around 25 a month. Correia says the decline was expected: Women giving birth this spring would have become pregnant during the cooler winter period when there were fewer mosquitoes around to transmit Zika.

The lull has allowed doctors to start to get a handle on the situation.

At the AACD (Association for the Assistance of Children with Deficiencies) medical center in Recife, doctors Ana Van Der Linden and her daughter, Vanessa, are leading a study of microcephaly. They were the two doctors who first flagged the surge in birth defects in their city. The neuro-pediatricians have been working on the issue ever since.

On a single day, the medical center saw 116 mothers and babies with suspected microcephaly linked to Zika. They've come to get the microcephaly diagnosis confirmed. It's part of a national process: Brazil is investigating over 4,000 suspected cases of Zika-linked microcephaly.

Dr. Ana Van Der Linden says the cases in their state are being examined one by one. So far Zika-related microcephaly has been confirmed in about half of the babies. The rest, says her daughter, had been misdiagnosed.

Dr. Vanessa Van Der Linden says that after seeing so many cases, the Zika- related ones are now very easily recognizable: "When you see a CT scan, we know it's Zika. It's a pattern [of damage] that is specific for these patients."

I ask the doctors whether political and financial instability in the country has affected what they are doing. They acknowledge what's really holding the whole system together is that doctors and officials like the health secretary are coming up with ways to make things work.

Last week, for example, one of the microcephalic infants was very ill, suffering repeated convulsions. He had to be hospitalized.

Dr. Ana Van Der Linden says many of the children with Zika-related brain damage are developing an extreme form of epilepsy that's treated with a particular medication called Sabril. With this drug most of them improve, she says. But it's expensive — about $50 a box. Most families can't afford it. The government is supposed to provide it for free, but there are long delays in getting the medication. So both doctors have started hoarding it whenever they come across a box, so they can hand it out to the mothers who really need it

Dr. Ana Van Der Linden gave the mother of that hospitalized baby two of the four boxes she had in her stash, basically saving his life.

But it's a short-term solution to a long-term problem.

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

RENEE MONTAGNE, HOST:

In Brazil a massive economic and political crisis is having an effect on another emergency - Zika. The World Health Organization and the CDC have now confirmed the link between that virus and brain damage in infants. Brazil has been at the epicenter of that outbreak. Brazilian health workers and officials are scrambling to do as much as they can with limited resources and a vacuum of power at the top. NPR's Lourdes Garcia-Navarro reports from the northern Brazilian city of Recife.

LOURDES GARCIA-NAVARRO, BYLINE: It was last November, and Jailson Correia, the health secretary for the city of Recife, realized he had a big problem. There was a scary new disease that doctors believed was causing birth defects in infants. And it was hitting his city hard. Recife's over-stretched health service needed more resources. So he asked the federal government for around 25 million reals - $7 million.

JAILSON CORREIA: We received back about 5 percent of that amount.

GARCIA-NAVARRO: Only a few hundred thousand dollars. So Brazil's going through one of the worst recessions in its history. And he says it wasn't surprising that what they got back was a drop in the bucket.

CORREIA: It was disappointing. But it did not freeze us.

GARCIA-NAVARRO: Correia says they started using emergency funds destined for other things. And that helped. But then, in the past few months, the political crisis here blew up. Pres. Dilma Rousseff is now in the process of being impeached and her health secretary - the man coordinating the country's response to the Zika virus - will probably be replaced in the next few weeks because his party withdrew from the government. Correia sighs.

CORREIA: We would love to have a situation to fix one crisis, not all these crises at the same time.

GARCIA-NAVARRO: But they don't. So they're doing what they can to cope. What are we seeing here?

CORREIA: These are the...

GARCIA-NAVARRO: The health secretary, Correia, shows me around the Zika situation room in his office. There are charts and maps and lists all over the walls. It's updated regularly. And in the next few weeks, he says, all this will be digital.

CORREIA: We are now seeing things getting a little bit more stable in the way that we understand a little bit more what's going on. We start to have the capacity to plan and the capacity to predict - at least better than we used to have.

GARCIA-NAVARRO: And what's going on is this - new cases of microcephaly are actually dramatically down. Last November Recife registered 125 cases of microcephaly. But since the beginning of this year the numbers have hovered around 25 per month. Correia says that was expected as women giving birth now would have gotten pregnant during a period when there were fewer mosquitoes transmitting Zika. The lull has allowed doctors too though to start getting a handle on the situation.

(BABY CRYING)

GARCIA-NAVARRO: It's been a busy day at the AACD Medical Center in Recife. A hundred and sixteen mothers and babies with suspected microcephaly linked to Zika came to get their diagnosis confirmed. Ana Van Der Linden and her daughter, Vanessa, are leading the studies. They were the two doctors who first flagged the surge in birth defects in their city. The neuro-pediatricians have been working on the issue ever since.

ANA VAN DER LINDEN: (Speaking Portuguese).

GARCIA-NAVARRO: Brazil is still investigating over 4,000 suspected cases of Zika-linked microcephaly. Dr. Ana says they're going through the cases in their state one-by-one. And so far...

A. VAN DER LINDEN: (Speaking Portuguese).

GARCIA-NAVARRO: She says about 50 percent of the babies we're seeing we have confirmed as having Zika-related microcephaly. The rest, her daughter Vanessa says, had been misdiagnosed and were sent home.

VANESSA VAN DER LINDEN: Today it was a good day because we give a good news to the mothers. It was good.

GARCIA-NAVARRO: Dr. Vanessa says after seeing so many cases, the Zika-related ones are now very easily recognizable.

V. VAN DER LINDEN: When you see a CT scan we know it's Zika. It's a pattern that is specifically for these patients.

GARCIA-NAVARRO: Lots of doctors in this state and beyond are helping out. The Van Der Linden doctors say they have a system in place for now that works. I asked them if the political and financial instability in the country has affected what they're doing. They acknowledge that what's really holding the whole system together is doctors like them and officials like the health secretary basically improvising. Then they tell me this story.

A. VAN DER LINDEN: (Speaking Portuguese).

GARCIA-NAVARRO: Last week one of the microcephalic infants was very ill, suffering repeated convulsions. And he had to be hospitalized. Dr. Ana says many of the children with Zika-related brain damage are developing an extreme form of epilepsy that's treated with a particular medication called Sabril.

V. VAN DER LINDEN: Most of them are improving more with this.

GARCIA-NAVARRO: It's expensive, she tells me - around $50 a box, so out of reach for most families. And it's difficult to get on the national health system. So both doctors have started hoarding it so they can hand it out to mothers that really need it. Dr. Ana gave the mother of that hospitalized baby some of her stash of Sabril, basically saving his life.

A. VAN DER LINDEN: (Speaking Portuguese).

GARCIA-NAVARRO: "She gave him two of the boxes of the four that she had."

A. VAN DER LINDEN: Yes.

GARCIA-NAVARRO: "Yes." It's a short-term solution though to a long-term problem. Back at the Zika control center, Health Secretary Jailson Correia says no matter what happens to the government in Brazil, something has to change soon. Zika's not the only problem. There has been a huge spike in dengue and chikungunya, which has also overloaded the health system. And it's not getting the attention it needs.

CORREIA: Municipalities from all over Brazil, not only Recife, will have to have more support from whichever minister of health is there and whichever federal government is there.

GARCIA-NAVARRO: In the meantime, he says, they will keep working amid the uncertainty. In the health sector we don't have the luxury to quit, he says. We have to carry on and to find new ways to do our jobs.

MONTAGNE: And that report comes from NPR's Lourdes Garcia-Navarro, who is on the line with us now from Brazil. Good morning.

GARCIA-NAVARRO: Good morning.

MONTAGNE: One last question. Lulu, we've been hearing from doctors that the impact of the virus may not only be limited to the very young.

GARCIA-NAVARRO: That's right, Renee. Doctors in the north of Brazil that we have spoken to have seen a surge in cases of encephalitis, for example. You know, those are serious brain and spinal cord infections. There is a suspicion that these might be Zika-related, although it's too early to tell. But really across the board what doctors have been telling me is that the really visible signs of Zika infection, like microcephaly in infants or Guillain-Barre syndrome in adults, is probably just the tip of the iceberg. They're just learning about this disease and its repercussions.

MONTAGNE: Thanks much. That's NPR's Lourdes Garcia-Navarro speaking to us from Brazil. Transcript provided by NPR, Copyright NPR.