Dr. Brian Goldman: My Visit to Zika's 'Ground Zero'

I feel fortunate to live in a prosperous country like Canada.  But seldom do I stop to take stock of the things we take for granted that make ours such a livable society.  When was the last time you said "thank you" for free medical care, food on the table, clean drinking water and proper sanitation?  Until quite recently, I hadn't given them a passing thought. 

But then, I visited Campina Grande.
 

• Listen to Dr. Brian Goldman's documentary, Stray Bullets
   

​Campina Grande is the second largest city in the state of Paraiba — located in the northeastern part of Brazil. The city of just over 400,000 is a major industrial and technological hub.  But a deep recession across Brazil has rendered the entire northeast part of the country impoverished.  

Poverty and poor sanitation

You see the signs of poverty everywhere.  Infrastructure is crumbling.  Far too many homeless people live on the street.  The lineup for a soup kitchen serving a noontime meal stretches three quarters of a block; many of those lining up are seniors.

Add to that favelas, or shantytowns, with poor sanitation plus a drought that requires residents to store standing water for washing, cooking (and in some cases drinking), and you have all the ingredients for an infestation of mosquitoes — and an outbreak of the Zika virus.  

Zika was first reported as a mosquito-borne disease in Uganda back in 1947.  For decades, virologists and entomologists described Zika as a mild flu-like illness with fever, chills, joint aches and pains and a skin rash.  Three or four years ago, the virus began a journey to Micronesia, then French Polynesia, before arriving in the northeastern city of Recife in 2013.  

By the time it reached that region of Brazil, Zika had mutated into a pathogen that destroys the brain tissue of developing fetuses.  In that part of the world, the newly-minted Zika virus found conditions in which it has thrived — and a ready population of millions at risk. 

Zika causes microcephaly: CDC 

Just last week, the U.S. Centers for Disease Control concluded that there is no longer any doubt that when the Zika virus infects pregnant women, it causes their babies to be born with microcephaly (abnormally small heads) and other severe brain defects.

In an alcove at Hospital Pedro I, the main public hospital in Campina Grande, I saw at least a dozen babies with microcephaly and their mothers and other family members. The alcove is part of an entire hospital wing that has been turned over to babies with microcephaly.  Right now, more than 40 of them receive treatment at the hospital, and hospital officials expect another 40 to 50 more by the end of June.

The babies I have seen are between two and four months of age.  Already, I can see the hallmarks of severe brain damage.  My fear is that these babies will grow into older children who will need special care — perhaps institutional care — for the rest of their lives. 

From the first time I saw a little baby with microcephaly, the word "thalidomide" popped into my head.  Thalidomide was a drug approved in Canada for pregnant women as a sedative and as a drug for morning sickness — until it was pulled from the shelves after reports of babies being born with malformed limbs — a direct effect of the drug on unborn children.

But, in a country where it's estimated that 70 per cent or more of pregnancies are unplanned, experts in Rio de Janeiro and across Brazil are bracing for many more babies with microcephaly before the crisis passes.  Many fear the Zika virus will become endemic to Brazil, in which case the threat to uninfected pregnant women will be indefinite.

'Socioeconomic determinants of health'

I began by musing about the things we in Canada take for granted.  Experts call these the socioeconomic determinants of health.  And some of the most influential believe they played a pivotal role in making places like Campina Grande "Ground Zero" for Zika.

"Most of the cases of microcephaly were in populations of very low income," says Dr. Paulo Gadelha, President of Fundação Oswaldo Cruz (or Oswaldo Cruz Foundation, known as Fiocruz), Brazil's version of the Public Health Agency of Canada.

"This is one question that we'll be studying: whether this is related to social determinants, sanitation, sewage, toilets, standing water, homes that are open to mosquitoes and so forth played a role."     

If the research pans out, it's possible that a staggering 90 to 95 per cent of the cases of Zika and microcephaly could have been avoided in places like Campina Grande had those socioeconomic determinants of health been addressed. 

Back safely in Canada, I notice that a lot of people here are worried about Zika.  Knowing what I know now about what happened in Campina Grande — and the reasons why it happened — I'm less fearful about Canada than I was before.

And, a lot more grateful.   

Listen to Dr. Brian Goldman's documentary, Stray Bullets