There were no doctors on the morning of April 2 to see Milena Kaiabi, who was born in the Paranaíta village, in the Xingu Indigenous Park, north of Mato Grosso. The 4 days old newborn was crying, feverish and unwilling to breastfeed, but the nurse that visited the community said it was nothing serious. The baby would die less than a month later in the city of Sinop, 200 km away, on suspicion of meningitis and a victim of the “white man’s confusion”.
The term is used by Mairawê Kaiabi, the main leader of his people in the Xingu, to portray public policies for indigenous healthcare in Brazil. The issue was never a priority in Brasilia, “but with this new government it got much worse, it got really worse,” he says. The departure of Cuban doctors from the Mais Médicos program in November last year, and the cut in funds from the Special Secretariat for Indigenous Health (Secretaria Especial de Saúde Indígena – Sesai), both of which occurred after the election of President Jair Bolsonaro, aggravated the already precarious assistance in indigenous territories.
In addition to doctors, medicines such as antibiotics and anesthesia are lacking, which compromises basic care and generates costly air, river and land rescues to cities. Fuel is also insufficient for emergencies. Because of the cuts, health workers with unpaid salaries have abandoned their jobs – or are volunteering. Chaos seems to be installed in indigenous territories, but when they resort to the city, the Brazilian Public Health System (Sistema Único de Saúde – SUS) can be even more cruel.
The deaths of three Kaiabi babies in a period of 11 days in April reveal how Brazil takes care of the health of its indigenous children. Jaqueline Kaiabi, 2 months old, died of pneumonia at the General Hospital of Cuiabá, more than a month after entering the endless wait for cardiac surgery. Nare Pedro, 2 years old, died after his fight against malnutrition aggravated with a maltreated pneumonia. Milena lived for only 28 days. If there were no doctors in the indigenous park for her, in the rich cities of Mato Grosso State there were no vacancies in hospitals.
Sitting on a sack of chestnuts in the village where Milena was born and is now buried, Makatu Kaiabi, 23, says in a low voice that he does not understand how he lost his daughter. His account, in the Kaiabi language, is translated by an indigenous man who lives in the region. Beside his wife, Severina, 16, and first-born Tairu, 2, Makatu says that his daughter continued “fretful” in the days following the consultation with the nurse.
Sinop City Hall is refusing to assist the indigenous population in the municipal public health system
The family then decided to take the newborn to the Diauarum center, a reference in health among the Xingu. Milena was hospitalized for five days, according to her father, without seeing any doctors or undergoing more complex tests. No diagnosis.
A second nurse, recently arrived at Diauarum with the vaccination team, reevaluated the baby and asked for her immediate transfer. Milena arrived in Sinop at 11 days of age in serious condition, with generalized infection, according to a medical report.
The 7,500 indigenous people of the 16 ethnic groups living in the Xingu were left without doctors in early November, when Bolsonaro, then president-elect, proposed changes to the Mais Médicos program that were not accepted by Cuba. The departure of Cuban doctors directly affected health care in the villages, as of the 372 doctors who worked on indigenous lands, 301 were Cuban, including the six from Xingu.
It took the Ministry of Health more than five months to hire the six new doctors for the indigenous park, most of them Brazilians trained abroad. Repórter Brasil found that one of them has already given up the vacancy and another is on sick leave, which impacted the service in Diauarum in early April, when Milena was there. Asked, the Ministry of Health does not confirm whether there is currently a doctor on site. The office says that, of the 372 vacancies, 354 are occupied and 18 were offered in the May public notice for Mais Médicos program.
To make matters worse, Sesai froze part of the funds transferred to the country’s 34 Indigenous Health Districts, responsible for primary health care for 900,000 Brazilian indigenous people. The justification for the cuts is suspicion of corruption in service contracts, such as overpricing in car and plane rentals.
Tasks and contracts are managed by eight social organizations accredited by the Ministry of Health. The office did not reveal the amount blocked since January 2019, which mainly affected the payment of health workers serving indigenous communities. In 2018, the Brazilian government spent 1.6 billion BRL (US$ 411 million) on the indigenous health program – 45% of which was transferred to the accredited companies. Until May 23 of this year, expenditures totaled 490 million BRL (US$ 126 million) – 25% below the monthly average of last year.
“The service provided by professionals within the indigenous territory was the most affected. There were 3 months of overdue wages, so some were unsure whether they continued working or not”, said Loike Kalapalo, president of the Xingu District Health Council, which is in charge of inspecting the agreement. Late payments were repeated in May.
The indigenous organizations and their leaders say that for many years they have been reporting fraud in contracts with the accredited parties. “This is due to the political nominations for management positions in indigenous health care. Minister Luiz Henrique Mandetta has all the means to investigate these cases. What he cannot do is harm indigenous communities and stop contracts and transfers,” says Eloy Terena, legal advisor to the Articulation of Indigenous Peoples in Brazil (Articulação dos Povos Indígenas do Brasil – Apib).
“Municipalization will be the end of our people”, says Matari Kaiabi, coordinator of the health post in the village Sobradinho, in Xingu
When contacted, the Ministry of Health said that there were “legal difficulties” to make payments to social organizations. “The resources allocated to the accredited entities have already been authorized. However, the financial implementation schedule of the resources for Caiuá Evangelical Mission, SPDM and IMIP is being adjusted with the National Health Fund. The installments must be paid by the end of May. It is important to highlight that there was no interruption of activities in the 34 Special Indigenous Sanitary Districts (Distrito Sanitário Especial Indígena- DSEI)”, says the office, in a note sent to Repórter Brasil (see the complete statement).
Babies under threat
In the absence of doctors, nurses and nursing technicians take the front line of care, assisted by indigenous health agents. AIS, as these professionals are called for its acronym in Portuguese for “Agentes Indígenas de Saúde”, work in communities and maintain permanent communication with the health center, via radio. They are a reference in health in the indigenous territory.
One of them is Wyrasingi Kaiabi, 34, who faced an outbreak of pneumonia in communities located on the Arraias and Manito rivers, west of the Xingu river. Brought by indigenous people returning from medical care in the city, the disease spread rapidly during April, affecting at least 35 indigenous children.
Serious respiratory infections are common in indigenous lands in the Amazon, especially at the beginning of the year, with the rainy season. But in 2019, the infection that hit this region seemed stronger, progressing to severe pneumonia in a day or two, according to reports by indigenous people working in health. Despite this, deaths from pneumonia are considered “preventable”, according to Doctor Clayton Coelho, from the Xingu Project, a health program at the Federal University of São Paulo (Universidade Federal de São Paulo – Unifesp) that has worked in the park for more than 50 years.
Trained by the project, Wyrasingi can recognize pneumonia and start treatment still in the village. In mid-April, however, there was no amoxicillin, the most suitable antibiotic to fight the disease in children. “There were a lot of sick people and the medicine ran out,” says he, who works in the village Sobradinho, the largest in the region, with 150 residents. There is an improvised health post, which serves as an assistance point for its strategic location: it is a four hour drive from the municipality of Marcelândia.
The distribution of medicines in the villages is the responsibility of the Ministry of Health, through the indigenous health districts. With the budget cuts this year, the amount of medicines sent has also decreased. The batches that arrive at Diauarum are not enough to supply the communities, causing Sobradinho to lose anesthesia and antibiotics.
Without proper treatment, little Nare Pedro Kaiabi, 2, got worse in the village. With a history of low weight and fragile health condition, he was transferred to Marcelândia and later to Colíder, but he did not resist pneumonia. He died on April 18, the eve of Indigenous People’s Day.
Of the 461 babies who were born in the Xingu in the past four years, 20 died before they turned one year old. The infant mortality rate in the period, of 43 deaths per thousand inhabitants, is three times higher than the Brazilian average, of 13. The general rate of indigenous lands in Brazil is 30, according to data from the Ministry of Health.
The most frequent causes for deaths are respiratory infections, malnutrition, diarrhea, poor diet, poor sanitation and poor health care, explains Coelho.
The Ministry of Health says that “it has intensified death surveillance in all DSEIs, with the objective of promoting the reduction of maternal and child mortality”, and that “it carries out a series of actions aimed at fighting indigenous infant mortality, such as food and nutritional surveillance, in addition to immunizing children ”. The office also states that it sent the antibiotic amoxicillin to the Diauarum center. Health officials in the village Sobradinho, however, claim that the drug had not reached the village in early April, when Nare Pedro caught pneumonia.
“Minister Luiz Henrique Mandetta has all the means to investigate suspected fraud. What he cannot do is harm indigenous communities and stop contracts and transfers,” says Eloy Terena, of the Articulation of Indigenous Peoples in Brazil (Articulação dos Povos Indígenas do Brasil – Apib)
Another sensitive group in the villages are pregnant women. On a hot Sunday afternoon, Naiara Kaiabi, 33, started experiencing severe pain in her lower abdomen and difficulty walking. With 32 weeks of gestation of her fourth child and risk of premature birth, she traveled three hours by boat at night to Sobradinho, on a trip guided by an indigenous volunteer, since the official boatman left the post after three months of overdue wages.
Then there was another 130 km by land to Marcelândia. In a pickup truck from the Ministry of Health, the volunteer driver took four hours to drive through the drenched and potholed road. The rescue, accompanied by the reporter, ended at 4 am in the emergency of the Municipal Hospital Maria Zélia. “I got sick on the car trip, but now I’m feeling good,” said Naiara the next day, no longer in pain and with a smile on her face.
In the city, chaos
The healthcare void created in the villages forces the Xingu Indigenous people to seek assistance in urban areas, where city halls and the government of Mato Grosso are also facing a chaotic situation. In some cities, city governments prohibit health care for indigenous people. “In the past, we had a mini-hospital inside Xingu and the population did not go out so much. Now they go out to the city a lot, but it’s not working. People are dying,” says chief Sirawê Kaiabi, 69.
Born in a village that no longer exists, on the outskirts of the city of Sinop, Sirawê and his family were taken from their lands more than 50 years ago to live in western Xingu, due to conflicts with the rubber tappers who occupied the Mato Grosso border of the Amazon.
Known as “the capital of Nortão”, Sinop is one of the richest agricultural cities in the country. Created in the 1970s in the wake of the BR-163 (Cuiabá-Santarém), the city with a timber tradition saw the surrounding Amazon be transformed into huge cattle farms and soybean and corn plantations.
However, wealth does not reach public health services. Since January, the local city government has prohibited indigenous patients from being assisted at the Basic Healthcare Unit (Unidade Básica de Saúde – UBS) and at the city’s medical center, where until last year around 40 indigenous people were tested and seen by specialist doctors every month. “This will be a surge in deaths,” says an indigenous health worker, who prefers not to be identified for fear of reprisals.
Sinop’s health secretary, Gerson Danzer, admits the end of the services in the municipal network and says that one of the reasons is the fact that the city does not have indigenous lands in its perimeter. “Today, Sinop does not receive State of Federal resources to serve the indigenous people, or from the municipalities to which the indigenous people belong.” he says. The leader Mairawê Kaiabi confirms the lack of funding for the municipality, but points out that Sinop’s borders have had an indigenous presence since long before the city’s emergence.
Medical care is getting worse at a time when the Ministry of Health is re-discussing the indigenous health model. A decree signed by Bolsonaro on May 17 , extinguished Sesai positions and abolished the secretariat’s management department. The decision paves the way for the controversial “municipalization of indigenous health”, which provides for transferring the management of the service from the Nation to the municipalities. The indigenous movement has taken to the streets since February to criticize the proposal. “Municipalization will be the end of our people”, says Matari Kaiabi, coordinator of the health post in the village Sobradinho, in Xingu.
When contacted, the Ministry of Health did not comment on cuts in funds, municipalization, the deaths of children in the Xingu and the interruption of medical assistance in indigenous healthcare.
In the middle of the “white people’s confusion”, Sinop’s Emergency Care Unit was the only available to receive the newborn Milena, 11 days old. She was seen by a doctor, underwent tests and started treatment for meningitis. With generalized infection, the baby needed neurological assessment and a bed in the neonatal ICU.
The request made by the Emergency Care Unit (Unidade de Pronto Atendimento – UPA), however, was denied by the State Department of Health due to lack of vacancies. “Difficulty with ICU beds is a latent issue in Mato Grosso, a state that, in recent months, has been experiencing an unusual situation involving the closure of a philanthropic hospital, which had 30 ICU beds”, says the secretary in a note sent to Repórter Brasil. The Ministry of Health says the death is still under investigation and that meningitis could not be confirmed because the baby’s Cerebral spinal fluid was not collected in Sinop, a standard procedure in cases of suspected disease.
Milena spent her last 15 days in the UPA. Tests revealed an increase in pressure inside the skull. The child had decreased reflexes and suffered severe spasms. A court injunction forced the state government to hospitalize the baby. But it was in vain. Even the private hospitals in Mato Grosso did not open the doors to the small Native Brazilian. When Goiânia accepted the request, it was too late. Milena died on April 23, five days before completing a month.
This story was originally published on 2nd June 2019