Malaria Spreads through the Remote Amazon

The last months of 2016 and the beginning of this year report an increase in the diagnosis of malaria in the western margin of the Venezuelan jungle province. The economic crisis has caused Venezuelan, Colombian, and Brazilian inhabitants of the border - to regard the illegal exploitation of gold as a possibility of instant wealth. In addition to a security problem due to the control, the indiscriminate felling in the region has intensified the work of sanitary authorities. This is a trip to in the depths of Venezuela, the one that is not in the headlines of the media or the agenda of the political leadership.

12 February 2017

A man digs a hole with a shovel. Three others observe squatting while their companion disappears as the pit gets deeper and a mountain of dirt grows outside. The sun, implacable since a few hours ago, is saying goodbye. A warm breeze touches the bodies and moves the red sheet of zinc they have placed to cover the hole. "Is this for the one who died of malaria?" asks Argenis. "Yes, they will bring him in a while. They are holding the wake at his home," answers one of the gravediggers. "He knew he had malaria and started drinking spirits," Argenis whispers on the back of his motorcycle, just before leaving. It is five in the afternoon on November 27, 2016, in the cemetery of San Fernando de Atabapo, Amazonas state.

This is a recurrent scene since the end of last year because for eight years there has been a resurgence of malaria in that jungle south area of Venezuela. Samuel Iribertegui, a Salesian priest present in the area since 1974 and with 22 years of residence in San Fernando de Atabapo, knows it. In an area of ??feverish mining activity, the presence of the disease is common, characterized by high fevers and anemia due to the bite of the anopheles mosquito. Father Iribertegui -medium build, tall and white complexion- says that there is no record of cases diagnosed in the communities along the river, but based on a register kept by the educational institution where he serves, he guesses that the figure has increased. "We had 110 cases of malaria in late November," he says.

READ THE SECOND RELEASE HERE: "The Colombian Department with More Malaria Cases from Abroad"

In addition to the latent possibility of contracting malaria, now there are recurrent failures in the supply of medicines, precarious control of the vector causing it, problems of supplying a wild geography, and illegal mining. The statistics of the Directorate of Environmental Health of Puerto Ayacucho, the capital of the province, indicate that in 2016 there were 29,100 cases in the state of Amazonas, 20 percent more than in 2015. Of these cases, 4,157 patients sought medical attention in the municipality of Atabapo when diagnosed, 1,100 cases of which were foreigners. The blows of this epidemic, covering four municipalities, spread to Amanaven and Puerto Inírida, two Colombian towns. The sick, who mostly work in the illegal gold mines of Venezuela, come from those places in search of relief. But they can hardly receive consolation here.

On the Way to the Rubber Town

A mist curtain covers the sky of Puerto Ayacucho, capital of the state of Amazonas. It is six in the morning and there are forty-five minutes of road to reach the port of Samariapo, from where the river transport to San Fernando de Atabapo sets sail.

- Open there to measure the gasoline —says one of the guards in one of the three checkpoints that you have to deal with to get to the port.

- You can see it on the board —answers the driver, challenging.

The soldier looks through the window, checks the board, and lets the driver go. "If you have seven Harina Pan [precooked corn meal], they take one; if you have 200 thousand bolivars they ask for the invoices of the merchandise. They always come up with something. The rate is 15 thousand bolivars. If you do not have the papers in order they demand more," the transporter poured his heart out after passing the checkpoint.

In the Port of Samariapo, there are several food businesses and a small vegetable market that are closed this early in the morning. At ten o'clock the boat arrives, known as a flying boat. Passengers disembark in a houseboat, a metal structure, where there is a small warehouse. An official of the National Guard begins to check the luggage of the passengers boarding. When finished, the journey begins along the Orinoco River and the port is left behind. The boat goes a little sunken and some drops splash on the passengers. The vegetation delimits the winding current of water.

Three hours later, the port of San Fernando de Atabapo appears, a short shore of white sand where there are other boats stranded. The most striking are the words "God exists" written in large font on the wall. Right next to it, seated at a table, is an immigration officer listing the newcomers and a soldier at another table checking the luggage again. With such control, it is ironic that this town is one of the main entry gates to the illegal gold mines, which are concentrated around Cerro Yapacana National Park. Through San Fernando de Atabapo sail boats full of food, gasoline and people, everything for the mine. There are already over 20 dredgers biting the Atabapo River bed from top to bottom and approximately 10 thousand people working in the illegal mines.

San Fernando de Atabapo was the first capital of the state of Amazonas. It seems a place stopped in the times of Tomás Funes, a military man and rubber exploiter, who abused the settlers and ran roughshod over the indigenous people, slaughtering them and turning them into slaves. With him began a period of terror until he was shot in 1921. It is here, in this place without time, where the terrible malaria epidemic is nesting and decimating its inhabitants. There are 9,228 people, locals and indigenous, who, in recent months, when they see the symptoms of the disease, do not know if they will survive to share their experience.

The increase of malaria cases could have its origin in the disputes over the control of the deposits. "There was a confrontation in a mine and the miners poured in San Fernando de Atabapo. We have illegal mining in the state and that is a serious problem," says Magda Magris, coordinator of the malaria research unit of the Amazonian Center Autonomous Service for Research and Control of Tropical Diseases (Caicet).

The illegal mining practices (with motor pumps) used in these places favor the formation of the habitat of the mosquito that transmits malaria. In the huge holes that adventurers dig, standing water forms pools. The illegal settlements of the miners lack utilities and basic sanitary conditions, which favors the breeding of insects.

Unanswered Letters

Nobody seems to care about what is happening. On October 11, 2016, José Largo, coordinator of Health District No. 2 of Atabapo municipality, which is in charge of 16 rural type-I outpatient clinics, delivered a letter to the Fuel Control Committee, requesting for health security and defense three thousand liters of gasoline and another 660 liters of gasoil from the reserve for the mobilization to different sectors of San Fernando de Atabapo and the parishes of Hucata and Yapacana, with the objective of conducting an epidemiological fence and the respective fumigations. But there was no response.

On November 4, Largo and the health team of Hospital María Garrido in San Fernando de Atabapo resumed their intention with another letter, this time addressed to the commander of the border detachment and representative of the Comprehensive Defense Operating Area (Zodi) in Atabapo. The coordinator of Health District No. 2 of Atabapo municipality counted then 595 positive cases and one death that occurred in late October. A week later, on November 15, an environmental health commission was formed by Juan Carlos Moreno, deputy director of malaria in the state of Amazonas, Arvey Garrido, public health inspector, and a fumigator. According to Largo, by this time, there were over 900 diseased in the town.

Moreno warned that patients not only came from San Fernando de Atabapo, but from more distant communities such as Carida, three hours by boat. The majority were children infected with plasmodium, the parasite that enters the blood after the bite of the mosquito. In view of that, the group moved to those places.

There is a military base in Carida. From this area, there are paths made of boards for the motorcycles that reach the illegal gold mines, which turns the town into one of the main focuses of malaria (86 out of 137 slides taken were of different types of plasmodium). They continued to Macuruco, where they detected that there was no good sanitation. In La Venturosa, where the tour continued, they only sprayed because they arrived too late and no samples could be taken. In Santa Bárbara, where there is a military post, three officers were positive. In each village they found a panorama that overflowed their response capacity. "We were not prepared for this malaria epidemic. Since in 2015 we did not have so many cases of malaria, we bought supplies projecting a similar scenario for 2016. Now we are cutting treatment, supervising and monitoring," says William Velásquez, who after six years in the position of director of Environmental Health of Amazonas resigned on February 9, 2017.

An Epidemic Foretold

A Neem tree —a plant containing an ingredient used for the treatment of malaria— is planted behind the headquarters of Environmental Health of Puerto Ayacucho. Its branches shade several people, pregnant women, children, the elderly and men, who are sitting in a row of chairs in one of the corridors. Some have their eyes lost, isolated from everything happening around them. Others hold their heads trying to control the pain. Some others tremble and are wearing sweaters and jackets despite a temperature of almost 29 °C (84 °F).

"I have been affected five times. Now my wife has it," says a man who is sitting on a pile of blocks next to the tree. "'Hold me, I'm going to fall!' I was screaming at my wife the last time I got malaria. The world closed up on me." He lives in the neighborhood of Ojo de Agua, at the exit of Puerto Ayacucho, and says that "there are too many cases of malaria."

Four municipalities of Amazonas (Atures, Autana, Atabapo and Manapiare) are in epidemic, one (Alto Orinoco) in alarm, and two (Maroa and Río Negro) under security. In all municipalities there is a presence of illegal mining, except in Atures, where this activity is not practiced, but it does receive all people from the mines with malaria, who travel to stock up on food and other services.

On September 21, 2016, William Velásquez, former director of Environmental Health, sent a letter to the then director of regional health, Diony Herey, with a copy to the Minister of Health, where he declared an epidemic outbreak in the state of Amazonas. But he did not receive an answer. At the end of November, the minister visited the entity and Velásquez raised all the problems they had: "We work well, but there have been problems to control the vector. We do not have supplies to spray on the walls or a biological insecticide to throw in breeding sites. We have to use a chemical substance that destroys flora and fauna. We do not have a car, outboard motors; there is the basic problem of gasoline and diesel to spray the insecticide, spark plugs and batteries for the machines. I have had to pay for things with my own resources. No one has given anything here, neither the national nor the regional or municipal government."

By December 2, 2016, there were six registered deaths of people with malaria (one in Atabapo, one in Alto Orinoco and four in Atures), some with complications of hemorrhagic dengue and pulmonary thromboembolism. Velásquez warns that they may have an underreporting of cases because there are many people who do not register, self-medicate, or the same microscopists make the diagnosis, but they do not register it or send the information. That same month, 5,000 miners arrived at the municipality of Atures and the institution ran out of treatment. "We had to give medication for three days only. People have come up from Táchira to work in the mines. Things are worse," the doctor expresses with grieve.

Hope a Few Minutes Away

Amanaven is a Colombian town in the department of Vichada, which rises on a mountain of land, and is just in front of San Fernando de Atabapo, five minutes by boat. To enter the town, you have to climb some stairs made of boards. The few houses of the place are built with wood, in the form of stilt houses. Under one of the structures, a woman is filling bags with dirt that serve as a retaining wall. This makeshift town seems like it can sink at any moment, but not its economy. Sale of clothes, food, toys, and posters of "We buy gold" can be seen in several houses.
In Amanaven, the only clinic is closed because the nurse died three months ago. But a few steps away, there is a small pharmacy where the nurse, Ancisar López, 56, makes general consultations and sells medicines, including the medicine against malaria, which by the end of November were at eight thousand bolivars. A girl enters with her mother: "She has two days with fever." López takes a shot on her finger and takes the blood sample. Both went out. "Next". Other people start arriving. 

López says that during the day, he treats up to twenty cases among Venezuelans, Colombians and Brazilians coming from the mines. The majority are from the Atabapo municipality. "All those coming say that there are no medicines and bring the prescription. Nothing is done until they fumigate," he says. He also comments that many people from the mines have gonorrhea and that women practicing prostitution are always reluctant to be examined.

William Velásquez, former director of Environmental Health in Puerto Ayacucho, says that there has never been lack of treatment in Amazonas. The problem is that the municipalities have to send the statistics that support the request for medicines to cities where treatment does exist, like Maracay, the capital of Aragua state (central Venezuela). It is a bureaucratic process that is often complicated by the lack of communication with remote Amazonian communities and adds to the complaints about the sale of treatment against malaria, which in Venezuela is free, and the stalking of criminals. In October, they stole three boxes (each with 30 treatments) from the pharmacy that is in the Environmental Health office in Puerto Ayacucho. Velásquez file the complaint before the prosecutor's office and submitted the batch number of the boxes, which they found on the street without the treatment.

As malaria cases increase, people are still looking for a solution on the other side of the river or other ways to make ends meet in the mines, often putting their own health at risk.

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