When in the first months of her pregnancy Silvana Nascimento began to see reports on Brazilian television about the spread of the mosquito-borne Zika epidemic across the country, she was not unduly worried.
“No one in our area was giving birth to babies with small heads,” says the 23-year-old mother of four, referring to the spike in cases of microcephaly, the neurodevelopmental disorder that causes new infants to have abnormally small heads because the brain fails to grow normally, a condition linked to the spread of Zika.
A government programme to distribute free insect-repellent to poor expecting mothers did not reach Nascimento's poor village of Sertãozinho de Baixo, deep in the countryside of the state of Pernambuco where the local public health clinic is she says "closed more often than it's open".
Tell-tale signs
Though she does not remember falling ill with Zika, when she was transferred to the state capital of Recife because of complications due to diabetes, doctors performed the second ultrasound of her pregnancy and picked up the tell-tale signs of microcephaly.
Now her day-old daughter Elizabele faces a series of tests to determine just how serious is the brain damage that leaves infants requiring years of special therapy from the SUS, or Unified Health System, Brazil’s often ramshackle public health service. “The SUS in the interior is very precarious,” says Nascimento. “The politicians should see how we live. You see on TV them spraying against mosquitoes in the cities but we have none of that.
"Instead our village's only ambulance has been broken for months and will only be fixed just before the next election. I will fight with all my strength to get the treatment my daughter might need but we'll be relying on God and luck." Decades of underinvestment worsened by corruption meant the SUS, created in 1988 after the return of democracy, was struggling even before being hit by a recent funding crisis caused by Brazil's severe economic downturn. Though the World Health Organisation has praised Brazil's response to Zika, stories like Nascimento's highlight how the crisis has exposed structural failings in its public health system. Its reach is uneven and often leaves poorer Brazilians without adequate health coverage, driving those who can afford it into the arms of private health plans.
Ideology vs reality
“Zika hit a maternity system that was already chaotic. It is desolating to see these women going through this situation when they are being so poorly looked after,” says Dr
Adriana Scavuzzi
, women’s health co-ordinator at
Imip
, the maternity hospital looking after baby Elizabele.
“Ideologically the system is very good. The concept of free universal access for everyone is fantastic,” says Dr Scavuzzi. “But there is very little investment by the government in this system. The SUS does not give us doctors what we need to confront this crisis. We lack hospitals, we lack beds, we lack medicines. You cannot say it is a system that works.”
Staff and patients are already feeling the impact of the crisis. Results from blood and urine tests can take months to be known, while the waiting lists for the few therapists available to treat babies with microcephaly grows. "The demand for ultrasounds is now greater than we can meet but we are trying to do as much as possible, working extra hours, doing what we can to help the mothers," says Dr Alex Souza of Imip's foetal health unit.
The government’s financial problems, which have seen several billion euro slashed from health budgets since last year also mean that in many regions health workers being asked to tackle the crisis are not being paid on time or in full.
At the start of the year the public health system in Rio de Janeiro, Brazil’s third most populous state – whose capital will host the Olympics in August – was on the verge of collapse until it received an emergency cash injection from the state.
Doctors warn that until Brazilian society tackles the problems within the SUS, the number of professionals quitting the system will increase. “The situation now is very demanding,” warns Dr Scavuzzi. “Because of Zika what I thought were the worst conditions possible have become even worse.”
