Blame game amid Rio dengue crisis

One woman's grief at losing her child to dengue fever
By Gary Duffy
BBC News, Rio de Janeiro

In one of Rio's poorest shanty towns, city fire officers make their way through narrow polluted lanes, in what is the front line of the fight against dengue.

Adeniria, whose daughter died of suspected dengue in Rio, March 2008
Adeniria's 36-year-old daughter died of suspected dengue

Their job is to treat the stagnant water and cover exposed tanks that are a breeding ground for the mosquito that spreads dengue, which in its extreme form can be fatal.

More than 60 people have died in the state of Rio de Janeiro so far this year, and more than 60 other deaths are being investigated. More than 40,000 people have been treated for dengue.

For the people who live in the Community of Coroado, especially the children, the risks are all too obvious. A large container filled with rubbish sits by the road, while there are large pools of water, as well as exposed drains and sewage.

Grieving family

"Everyone is afraid because we have to be scared for the children, as well as the way it kills children it kills too. What can we do? We are all afraid," said resident Dulcinea da Silva Galvao.


DENGUE FEVER
Transmitted by Aedes mosquito
Symptoms 3-14 days after bite
Symptoms range from mild fever to severe headache and rash
More than 630,000 cases in Latin America in 2007
183 deaths over same period in region
11% rise in cases over previous year
Source: World Health Organisation

The action in Coroado has come too late for one grieving family. Deise Marinho de Oliveira, a 36-year-old mother of six, had died the night before, and is believed to be another victim of dengue.

As her grandchildren stood around her, Deise's mother, Adeniria, spoke of her disbelief at the speed of events after her daughter took ill the previous weekend, and died a few days later.

She said the authorities in Rio should have acted sooner.

"The authorities are not taking action about dengue. Because if they were since the beginning, the epidemic would have finished. If everyone takes care, and they had taken action, the dengue epidemic would have finished."

And with tears in her eyes she referred to her daughter's death: "A simple mosquito to do that - it cannot be."

People in Brazil queuing for dengue treatment, March 2008
With many people sick queues have formed outside some hospitals

The pressures on the system are clear in other parts of the city.

At the Miguel Couto municipal hospital, the queue stretched from the entrance to the emergency room out into the street outside, where people with suspected cases of dengue had been waiting for hours for attention.

"I arrived here at 10.30 and look at the size of the queue," said Maria das Gracas Oliveira, as she waited with her 15-year-old son who was suspected of having dengue.

"Imagine how it will be inside. And then our governor turns round and says everything is under control - the worst has passed," she said angrily.

Anger

With thousands needing medical help, tents have been erected in a few parts of the city to provide fluids for dengue victims.

The army has set up field hospitals as well. A judge has also ordered the authorities to use private hospitals if necessary.

But at the Getulio Vargas hospital, in one of the poorest districts of the city, the beds are filling up.

A treatment tent in Rio de Janeiro, Brazil, March 2008
Tents have been set up round Rio to give patients fluids

Alongside many of the sick children were parents, who spoke of their anger at the way this disease has spread.

Tania Maria Mocinho da Silva was at the bedside of her 11-year-old son, Anderson.

"There is chaos in Rio and a lot of things lacking," she said.

"The president, the governor, have to do something for the people, especially in the public hospitals that sometime suffer the most, with the delay in care and sending people home, sometimes to die because of that."

Marcelo Soares, director general at the hospital, told the BBC News website: "It's been extremely hard work, tiring, driving everyone to exhaustion."

"It's been very strenuous, not only here in this hospital but all the other hospitals that are receiving patients. The medical staff are receiving a lot of people and sleeping very little."

Prevention

Doctors' representatives say this is a crisis which could have been avoided had the authorities done more to prevent an upsurge in dengue that had been predicted.

Dr Jorge Sale Darze is president of the doctors' union in Rio.

"The authorities have direct responsibility for what is happening in the dengue epidemic in Rio de Janeiro," he said.

"They should have taken measures to prevent this, and they didn't do this. The epidemic came, and thousands of people got sick, some have died."

Tania Maria Mocinho da Silva with her sick son, Anderson, in hospital in Rio, March 2008
Tania Maria Mocinho da Silva, whose son is ill, says the situation is chaotic
On the streets of Rio de Janeiro, the work of combating dengue continues on a daily basis. This includes inspecting drains, treating water and passing information to the public.

But city and state officials are divided over why Rio has been so badly affected, and who is to blame. Dr Mauro Blanco is city health co-ordinator responsible for the unit tackling dengue in Rio city.

"What is happening is that it is very difficult to mobilise the population in the period when there is no sickness. It's a lot easier to do it now," he said.

"In times of crisis things are very difficult but normally what we have seen from the official perspective is that people forget about dengue, forget about prevention when there is no sickness."

But Sergio Cortes, Rio's State Secretary for Health, says not enough work was done to prevent this epidemic, and the experience of cities nearby only serves to prove that.

Firemen in Coroado, Brazil, March 2008.
Firemen are working in the favela of Coroado, treating stagnant water.

"The city of Niteroi is less than 1km from the city of Rio de Janeiro - we have the same climate, same land, same mountains and same problems with shanty towns and we have a lot fewer cases and no death," he said.

"Why? Because there we have a basic system of health which is very advanced."

The people of Rio de Janeiro have long been troubled by dengue, which is thought to have first come here on boats bringing slaves to Brazil.

However, in the 21st Century, the public are impatient for a more efficient and effective response which they say they have yet to see.

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