by Nadia Sussman
Galante, Paraíba state (Brazil)-- Francileide de Lima Ferreira doesn't walk, she runs. Baby Rafael, her fifth child, wants to be in her arms. His penetrating cry sends her rushing to make his formula, to wash him, to keep the dust from bothering him at her small, tidy house in northeastern Brazil.
Just last year Francileide, 30, was building a new future. She had moved from her rural village in Paraíba state to Rio de Janeiro. She was living with her husband and pregnant with Rafael. Everything changed with a rash, a fever and her first ultrasound.
"They said there was liquid in his head,” Francileide said. “I never thought it would be this illness. I had never even heard of microcephaly."
Francileide is one of thousands of Brazilian women who contracted zika virus while pregnant. Baby Rafael was born with microcephaly, an under-developed brain and skull, one of the most visible disabilities resulting from zika infection in the womb.
As zika spreads in Brazil and to other nations in the Americas, mothers around the hemisphere are beginning to give birth to children with a range of neurological problems. In Colombia, authorities confirmed two cases of microcephaly linked to ika, and the Ministry of Health estimates that the number of cases could be up to 300. In Puerto Rico, where there is also active transmission, the Health Department reported a few days ago the first case of microcephaly associated with the virus: the mother lost the baby, who also displayed severe calcifications in the brain. In early May, Venezuela reported the first case of microcephaly in a baby whose mother had Zika during her pregnancy.
Scientists are just starting to understand the effects of the virus on the developing brain.
In Paraíba, Francileide supported her family by cleaning houses when she could find work. The apparently minor virus she caught at two months pregnant didn't worry her much. Her neighbors had it, too, and it passed without incident.
Francileide moved to Rio as planned, hoping to earn a better wage, like so many migrants from Brazil's drought-stricken northeastern states.
“My husband's cousin is a teacher,” she said. “I thought about working with her, of us opening a daycare. I would bathe the children, because I don't know how to read, I'm illiterate. But I was still going to work with her and help her.”
The zika epidemic disrupted her dreams.
Brazil: the country where the outbreak started in the Americas
The first case of zika in Brazil was recognized in March 2015, but researchers now believe the virus likely arrived in Brazil ifrom French Polynesia in 2013 and went undetected for more than a year. Last year, obstetricians—especially in the northeast--observed an alarming increase in babies born with under-developed brain structures. In November 2015, obstetrician Adriana Melo in Campina Grande tested the amniotic fluid of two mothers with microcephalic babies. The result came back positive for zika virus, strongly suggesting that zika in the womb was causing the neurological damage. In April, the U.S. Centers for Disease Control confirmed the link between zika and birth defects.
Only about one percent of babies born to mothers who had zika while pregnant suffer from microcephaly. But many more may develop serious neurological conditions ranging from convulsive disorders to hydrocephaly, an excess of fluid in the head. Since the Brazilian government started gathering data last year, there have been 1,326 confirmed cases of microcephaly or other changes to the central nervous system due to infection in the womb. More than 3,700 suspected cases of congenital zika are still under investigation.
After her ultrasound in Rio, Francileide returned to Paraíba, so she could care for Rafael closer to her family when he was born. She no longer works, staying at her baby's side around the clock. She survives on the modest welfare program called Bolsa Familia or Family Allowance.
Twice a week, a municipal government car takes Francileide and Rafael to a hospital in the nearby city of Campina Grande, where about thirty mothers receive treatment for babies affected by zika virus. Rafael meets with a physical therapist and other doctors, and he and Francileide attend a psychological support group where mothers can share their troubles and triumphs with one another.
Children with microcephaly grow up with a wide range of outcomes, a source of hope and also anxiety for mothers who don't yet know the extent of the children's disabilities. Early intervention is critical to help babies meet milestones like walking and talking. But many children will always have special needs, almost certainly mental disabilities.
For now, congenital zika has no cure. The only hope is to prevent new cases by trying to eradicate the Aedes Egypti mosquito which carries the disease. Public health agents in many cities now make home visits looking for mosquito breeding sites and applying larvicides. But it is an uphill battle against puddles and planters, buckets and discarded soda bottles and tires, all of which gather water where mosquitos can breed.
In Brazil, with its dramatic social inequalities, low-income communities suffer disproportionately from mosquito-borne diseases like zika and dengue. The poor have less access to clean and consistent drinking water, and more than half of Brazilians don't have basic sewage collection and treatment.
The federal government has pledged roughly $175 million USD for research, mosquito eradication, vaccine development, treatment, and sanitation infrastructure. But faced with a deep recession, a massive corruption scandal, and a president facing impeachment, the country's ability to deliver those resources in the coming years remains to be seen.
In Francileide's home, the crises of the nation are recounted in the quiet background noise of TV news. Here, the troubles of a little boy are far more pressing. Doctors stop by to check on Rafael's growth. His had has gotten bigger, but not as much as they had hoped. Time passes slowly and yet all too quickly for Francileide to catch her breath.
Still there are the little joys.
“I felt happy when he began to laugh,” Francileide said. “I was sad when he wasn't laughing. After he laughed, the air felt different.”