The vast area of the Amazon Basin in Brazil has always presented challenges when it comes to providing health care to the Indigenous people living there. In recent years, the situation has become even more complex. The absence of measures to protect Indigenous communities, along with cuts to health care budgets, posed serious threats to the welfare and, in some cases, the very survival of these communities.
The health crisis among Indigenous people has become so severe that in January 2023, the new Brazilian government declared a state of medical emergency in Yanomami territory.
In February, Doctors Without Borders/Médecins Sans Frontières (MSF) joined the the Ministry of Health in responding to the crisis, sending a team to provide medical care and mental health support at the CASAI, a health center for Indigenous people in Boa Vista, the capital of northern Roraima state. When medical care is unavailable locally, Indigenous people are referred to the CASAI, where they can receive basic health care as well as a place to stay while waiting for medical consultations at hospitals or clinics in Boa Vista.
Gold mining has caused spikes in malnutrition and malaria
The environmental degradation caused by mining has especially impacted the estimated 30,000 inhabitants of Yanomami territory— an area larger than Portugal—whose health and traditional lifestyles are in danger. Much of the destruction has been at the hands of illegal miners in pursuit of gold. They have invaded Yanomami territory, using heavy machinery to clear swathes of forest along riverbanks and make way for mines. These activities have scared away animals that were previously hunted for food, while pollution from the mines has poisoned fish in the rivers, threatening the local community’s ability to feed themselves and resulting in an increase of malnutrition cases.
The environmental degradation caused by mining has also left the ground scarred with holes, which fill with rainwater, creating ideal conditions for mosquitoes to breed. As a result, malaria is a growing health problem in the region. At the same time, violence associated with the illegal miners has resulted in some health staff abandoning medical facilities, leaving people without health care altogether.
MSF has recently increased its medical activities in response to a rise in malaria cases across Yanomami territory, sending a team to Auaris region in northwest Roraima state—home to more than 4,000 people and one of the territory’s most populous areas. MSF’s work in Auaris is being carried out in partnership with the DSEI—a branch of Brazil´s Ministry of Health that deals specifically with the health of Indigenous groups.
Malaria was already endemic in the Auaris region, affecting both adults and children, but the problem has grown in recent years as medical resources and health staff dwindle across the region. Between January and June 2023, there were 12,256 cases of malaria in Yanomami territory, a 70 percent increase compared to the same period in 2022, according to data from the Ministry of Health.
Responding to the spike in malaria cases in Yanomami territory
To tackle the spike in malaria, MSF has adopted an active case detection strategy, with its team traveling long distances each day, by boat or on foot, to reach remote villages and test people for the disease.
“We are testing as many people as possible, even the ones who have no symptoms,” said MSF’s Dr. Raquel Simakawa, who was part of the team that launched activities in Auaris in May. “This is one of the best ways to diagnose and treat malaria as quickly as possible. It lowers the risk of complications as well as transmission rates.”
Team members collect large numbers of blood samples, which are analyzed on the same day by a microscopist, who can process up to 100 slides daily. During the first two weeks of activities, the MSF team in Auaris tested more than 1,000 people for malaria, with 200 positive results.
Patients who test positive start taking antimalarial medication immediately. The treatment lasts between three days and two weeks, depending on the kind of malaria detected and whether or not the patient has had the disease previously. Without timely and proper treatment, infection with malaria can lead to complications such as severe anemia, respiratory discomfort, and extreme physical weakness. For people with severe cases and those with immune systems already weakened by other health conditions, malaria can kill.
“Our case detection and treatment strategies need to be very consistent,” said Dr. Simakawa.“That is why our health teams make weekly visits to communities so the testing can be repeated. The test frequency is only decreased once the disease is effectively under control.”
Working in partnership to address the needs
MSF’s team of 10 in Auaris includes doctors, nurses, a microscopist, an anthropologist, and a logistician. They work alongside DSEI doctors, nurses, and Indigenous community health agents. “Working in partnership is essential to ensuring we have good access to communities, which is vital for reaching patients and preventing the disease from spreading,” said Fábio Biolchini, MSF coordinator for South American operations.
Despite the fact that MSF is working with limited resources inside a very large territory posing many logistical challenges, Biolchini believes that MSF’s previous experience treating malaria stands it in good stead. “MSF has a long history of successfully implementing strategies to prevent and treat malaria,” said Biolchini. Last year, MSF treated more than 4.2 million cases of malaria worldwide.
MSF has also treated malaria elsewhere in Brazil. “In the 1990s, we had strong support from Indigenous communities in Roraima state to implement a successful strategy to detect and treat malaria,” said Renata Reis, MSF Brazil general director. “The severe health crisis affecting Yanomami territory is an immense challenge, but we believe we will be able to face it in a more efficient way if we do it in coordination with our partners and, most of all, in line with the needs expressed by the communities we are assisting.”
About MSF in Brazil
MSF has been working in Brazil since 1991, when its teams responded to a cholera outbreak in the Amazon region. Soon after, MSF helped contain a malaria epidemic in Roraima state, working alongside Indigenous health promoters and microscopists. More recently, during the COVID-19 pandemic, MSF assisted Indigenous populations in the states of Mato Grosso do Sul, Amazonas, and Roraima.
As well as its current activities in Yanomami territory and at the CASAI in Boa Vista, since 2018 MSF has been running a project to support Roraima’s health system following the arrival of Venezuelan migrants in the state. An MSF team also works in the town of Portel, in Marajó island region, Pará state, to help strengthen the local health system and improve access to health care in vulnerable communities.