RIO DE JANEIRO – Telltale symptoms began in late May, about a week after government medical workers made a routine visit to the Kanamari indigenous community in a remote part of the Amazon: Older members of the group were fighting for breathe.
For months, when the coronavirus passed through Brazil, the Kanamari had tried to protect themselves from the pandemic by strictly limiting access to their riverside towns in the isolated Javari Valley, one of Brazil’s largest indigenous territories.
But it seemed that even there, the virus had caught up with them. Panic set up.
“Many people grabbed some clothes, a hammock and ran into the forest to hide,” said Thoda Kanamari, leader of the indigenous peoples’ union in the vast territory, home to groups with little contact with the outside world. “But it was too late, everyone was already infected.”
And the vectors of the disease, according to interviews and federal data obtained by The New York Times, may have been health workers accused by the federal government of protecting the country’s indigenous populations.
More than 1,000 workers with the federal indigenous health service, known as Sesai, tested positive for coronavirus in early July, a Freedom of Information request and interviews with union representatives were found.
Working without the proper protective equipment or without access to sufficient evidence, these workers may have inadvertently endangered the very communities they were trying to help, medical workers and indigenous leaders said.
More than 15,500 Brazilian indigenous people have been diagnosed with the coronavirus, including at least 10,889 who live in protected territories, according to the Socio-Environmental Institute, an indigenous rights organization. At least 523 have died.
In the sparsely populated Javari valley in northwestern Brazil, the federal indigenous health care agency said it had identified 220 cases and one death.
Robson Santos da Silva, the army colonel in charge of Sesai, defended the agency’s response during the pandemic and dismissed the criticism as “a lot of misinformation, a lot of politics.”
“We are on the front line,” he said. “We are fighting this disease on a daily basis.”
In an emailed statement, Sesai said reports that health workers had exposed indigenous peoples to the virus were not “conclusive”. The agency said its employees were equipped with protective equipment.
“All of this early planning and research led to timely and efficient care that was provided in the villages,” the statement said.
But The Times found that in at least six field offices, the proportion of infected workers was above the Amazon region average of 8 percent for the general population. Two field offices, in particular, had extraordinarily high infection rates, according to counts compiled by health care unions.
The office that oversees Amapá state and the northern part of Pará state reported that 186 people, nearly half of their health workers, had tested positive for the virus. And at the office covering the Yanomami community, which stretches across both sides of the Brazilian-Venezuelan border, 207 workers, more than 20 percent of the medical staff, became infected.
Representatives of the health workers union and experts say the real workload among indigenous federal health workers is probably much higher. Many of those on the front line had requested tests on their own, but as of June 30, the indigenous health service had only evaluated 1,080 of its employees, about five percent of its workforce.
The large number of infected workers suggests that “there were failures in the protection of health workers at a critical moment, which affected the teams that serve a highly vulnerable population,” said Felipe Tavares, who investigates indigenous health in the Fluminense Federal University.
Health workers, indigenous leaders and experts described a fraudulent response beset by the broader deficiencies that have made Brazil a global epicenter of the pandemic. Brazil has registered 78,772 coronavirus deaths and more than two million confirmed cases as of Sunday, figures that are only surpassed by the United States.
The tests have been scarce and often unreliable, meaning that some doctors and nurses with asymptomatic or undiagnosed cases have traveled to and worked in vulnerable communities for days. Some teams have had to purchase their own masks and other protective gear.
Lax and poorly communicated quarantine protocols, and the absence of effective contact tracing, have allowed the virus to spread easily among people living indoors.
Indigenous leaders said it is impossible to determine with certainty how many cases were reported by health workers. Some indigenous people may have brought the virus to their communities after traveling to cities to collect supplies and emergency government aid. Illegal miners and loggers operating in indigenous territories may also have exposed some communities.
Luiza Garnelo, a doctor and anthropologist at Fiocruz Amazônia, a government health research agency in the Amazon, said the pandemic had exposed the helplessness of communities that had already been dealing with poor medical care, poverty, and often violent invasions of land.
“Long before the epidemic, investment in indigenous health care was insufficient and the available resources were not leveraged in a way that allowed for an effective response to the epidemic,” he said. “The indigenous population is socially and economically vulnerable.”
Some communities advocated for stronger health care when the pandemic took hold in Brazil.
“Since March we have been begging, we need help, we need help, we need emergency hiring of health workers,” said Junior Yanomami, who heads the indigenous council at the Yanomami health department in Boa Vista, the state capital of Roraima
But at least 90 of the 131 health workers assigned to Boa Vista during the outbreak have tested positive, according to Yanomami. They were unknowingly among the top vectors of infection for the 262 Yanomami people who had been diagnosed with the virus, he said. Five of the Yanomami have died.
When Mr. da Silva, the army colonel who heads the indigenous health agency, flew to several Yanomami villages in late June to deliver protective equipment and administer tests, tribal leaders said, they felt they were being used to take pictures.
“We want the government to help indigenous peoples, as it is their obligation to do so, but not so,” said Yanomami.
Carmem Pankararu, president of the indigenous health workers union, said the workers were hampered by a bureaucracy that was slow to obtain critical tests and supplies in regions where transportation and logistics are extraordinarily difficult even in normal times.
“They would only test when we showed symptoms,” he said. “We needed mass testing.”
Criticisms of President Jair Bolsonaro’s handling of the pandemic, within indigenous territories and beyond, are mounting.
After losing two health ministers who were doctors, in April and May, Bolsonaro placed the health ministry in the hands of an active-duty army general, who has filled the top ranks of the ministry with military officers who are not experts in medical attention.
Earlier this month, a Brazilian Supreme Court judge ordered the government to step up efforts to protect indigenous peoples from the virus by presenting a comprehensive plan within 30 days and establishing a “situation room” with officials and representatives natives.
More recently, another Supreme Court judge has sparked dismay in the Bolsonaro administration, warning that the armed forces could be held responsible for “genocide” for their handling of the pandemic in indigenous communities.
Several Sesai workers who spoke to The Times on condition of anonymity, fearing retaliation, described an exceptionally challenging mission, hurt by misguidance, the mistrust of many indigenous communities and the paucity of evidence.
Enoque Taurepang, coordinator of the Roraima Indigenous Council, said the doctors and nurses had been set up for failure.
“You can’t blame health professionals because they didn’t have the tools to act,” he said.
Meanwhile, the losses for the indigenous forest.
Edney Kokama, a leader of the Kokama tribe, lost his father and grandfather to the virus, which he says had killed at least 58 tribal members in Brazil. His grandfather and his grandfather’s wife, who also died, were among the fluent writers of the tribe’s language, which the younger members do not know either.
“My grandfather was editing a Kokama dictionary. He was one of the few who still spoke it, ”he said. “We have lost a lot of knowledge.”
