The Great Epidemic of Manaus

Near the end of Albert Camus’ classic novel (1947), The Plague, Camus remarks through the narrator and protagonist, Dr. Bernard Rieux: “When he felt tempted to add some…

Near the end of Albert Camus’ classic novel (1947), The Plague, Camus remarks through the narrator and protagonist, Dr. Bernard Rieux: “When he felt tempted to add some confidence of his own to the thousands of voices of the victims, he was prevented by the thought that there was not one of those sufferings that was not at the same time that of others, and that in a world where pain is so often solitary, this was an advantage. Incontestably, he had to speak for all” (p. 232). And so, it is with me. I feel the need to speak out for the voiceless and the many with whom I worked with in Manaus, Brazil way back in 2009.

Now, Manaus is an epicenter where the COVID-19 pandemic is raging. I spent time with many urban Amerindian peoples, Apuriña, Kambeba, Kokama, Munduruku, Mura, Sateré-Mawé, Tikuna, and Tukano. It is sad to know that many of these Native friends and their relatives are subjected to such a horrendous disease and worse there than elsewhere in Brazil at the moment. Perhaps making the circumstances there direr, Manaus, is arguably a relatively isolated city in the middle of the Brazilian Amazon, which may be only reached by airplane or by boat.

By all epidemiological accounts, the health situation in Manaus is extremely critical and serious. In fact, the health system there has more or less completely collapsed. Hospital wards ran out of beds and oxygen by the end of January. And panic set in among the general Manauran population, whereby many resorted to buying oxygen at exorbitant prices on the black market. According to Reuters: “In Manaus, the capital of Amazonas State with 2.1 million inhabitants, more than 5,500 have died, or 261 per 100,000, the highest rate in Brazil, according to Health Ministry data.”

Statistics from Brazil in general have recorded deaths from COVID-19 at around 226,000 to date out of a population of about 211 million people. As CNN pointed out about the death rate in Manaus from the Coronavirus: “In May, 348 people were buried here, the worst month until now. Through just the first three weeks of January, that number stood at 1,333.” Such a horrific rise in cases and mortality from the disease may be driven by a new viral variant known as P1. As James Hamblin explains: “The new wave of COVID-19 cases in Manaus occurred about eight months after the initial wave. People might have lost some degree of immunity during that window.” Scientists are yet to determine whether present vaccinations will be successful against the evolved virus. Even perhaps more remarkable is the possibility that as many as 76% of the population of Manaus had been exposed to COVID-19 prior to this current second outbreak as published in the journal, Science.

Many directly lay blame on the lack of federal response of the Bolsonaro administration and President Jair Bolsonaro who himself contracted the virus last year but called it in one instant a little flu (gripezinha) and thereby downplayed its significance. Instead of increasing PPE (Personal Protective Equipment) as well as medicine, oxygen, bed spaces, and ventilators for Manaus since the terrible outbreak there in the spring, essentially Bolsonaro and his administration did nothing. Now the population is unnecessarily suffering from a lack of concern and an overall negligence.

And since Bolsonaro did not act, President Maduro of Venezuela, decided to send oxygen to the beleaguered city of Manaus in January as a kind of solidarity with the suffering and to thumb his nose at Bolsonaro. The dithering of the Bolsonaro administration and his health minister in failing to act is well-documented in a recent report by Brazilian Attorney General, José Levi Mello do Amaral Junior. As Noam Chomsky and Vijay Prashad have rightly iterated: “The latest development caused by the government’s toxic mix of privatization, ineptitude, and callousness should strengthen the case brought by Brazil’s health care unions against Jair Bolsonaro at the International Criminal Court (ICC) in July.”

Recently, health workers began vaccinating riverine communities along the Amazon River like the town of Manacapuru, a two-hour river journey westward from Manaus. These are communities of caboclos (those of indigenous and white descent) and mixed Native peoples. Likewise in order to combat the Coronavirus in Manaus, healthcare workers plan on vaccinating at least 7,000 people per day. In mid-January the Brazilian air force flew in emergency oxygen supplies to Manaus, while the Brazilian president, Bolsonaro, quipped he should be at the beach (“Eu deveria estar na praia”).

This is what Reuters reported about the healthcare desperation in the face of COVID-19 in Manaus: “Doctors in Amazonas [State] were using their own vehicles to transport patients, as locals sought to buy oxygen tanks on the black market, according to media reports. Desperate relatives, protesting outside hospitals in the state capital of Manaus, said patients had been taken off ventilators as oxygen ran out. Health authorities there said oxygen supplies had run out at some hospitals and intensive care wards were so full that scores of patients were being airlifted to other states. Doctors reported sharing oxygen between patients, alternating every 10 minutes.”

Yet, Brazilian health officials had been warned at least six days in advance of the severe outbreak of the Coronavirus and the impending oxygen crisis as well as knowing well beforehand how delicate the Manauran health system was in the spring. CNN recounted: “Doctors and nurses have been quoted in local news reports as saying patients are dying of asphyxiation in the city’s hospitals because of a lack of oxygen.” One Brazilian epidemiologist remarked: “Manaus is lost!” (Manaus está perdida!) and asked for an international healthcare emergency mission to be sent to the besieged city. Likewise, there was a rush to save premature babies in Manaus hospitals and send them to other Brazilian state hospitals as described by The Guardian.

On February 1st, the Health Surveillance Foundation of Amazonas (Fundação de Vigilância em Saúde do Amazonas, FVS-AM) conveyed information there were 1,323 new COVID-19 cases as well as 149 new deaths, totaling 268,717 positive cases for the entire state of Amazonas. As of now, there have been a total of 8,266 deaths in Manaus. Even so, supposedly as of February 1st, healthcare workers have so far applied 50, 216 doses of vaccine to indigenous peoples living on Native reservations in the interior of the state; the elderly of 80 years and above; elderly between 75 and 79 years; and institutionalized individuals over 60 years. Nonetheless, the health calamity persists and may become even worse.

President Bolsonaro claims millions of vaccines will be given in the coming months but in Manaus according to The Guardian’s Tom Phillips residents there have been taking matters into their own hands and buying oxygen on the black market to save family members from the disease. There is an overall lack of trust in the hospital system. Moreover, most hospital wards are completely full. Yet, Bolsonaro has also cast doubt on the efficacy of taking a vaccine by declaring it is not mandatory and by saying “we don’t know whether or not it is effective” in a press conference.

All of this has not gone unnoticed by Native peoples, not only in Brazil, but by indigenous leaders in North America as well. In an “Open Letter from Indigenous Peoples to Indigenous Peoples in Brazil on Surviving COVID-19” is a recent and significant communication about such Native concerns corresponded from North American Indians to their brethren and sisters in Brazil published by Cultural Survival and SALSA (Society for the Anthropology of Lowland South America). In my view as an anthropologist, these critical views need to be heard and broadcast to a wider audience. So, I would like to excerpt some of these important thoughts here to make clear why the Native standpoint is essential, not only in expressing their concerns to each other but how such viewpoints may aid all of us.

Dearest Indigenous Brothers and Sisters in Brazil,

Let the words of this Open Letter to you be a testament to the love and concern that we have for one another during the uncertain times of this pandemic that is spreading through our territories and sickening and killing our people. The COVID-19 (coronavirus) pandemic has been with us for nearly one year and has taken a terrible toll on Indigenous communities in our part of the world. Some have fared better than others…The rise in epidemics and pandemics have been traced to human encroachment and destruction of wildland habitats which increases contact between humans and wild animals; an increasing human population which makes the transmission of disease between humans much easier; the growth of global domestic livestock (animals) that are raised in unsanitary corporate animal factories that spawn disease, but are used for human consumption; and a rapidly changing climate, each in their own way a part of the colonial crucible which provides fuel for the next dangerous infectious outbreaks…We are thinking of you and wish to share not only our concerns, but also our belief that through our collective actions and common alliances to protect our people, lands, and cultural knowledge, we will overcome this pandemic and be prepared for the next…Infectious diseases did not exist among our ethnic groups prior to the European invasions into our homelands.

Because of the lack of infectious diseases among our peoples, we did not develop widespread immunity to the European diseases. It is estimated that there have been as many as 93 serious epidemics and pandemics of Europe pathogens (European infectious diseases) spread among North American Indians from the early sixteenth century to the beginning of the twentieth century. Among the diseases are smallpox, measles, the bubonic plague, cholera, typhoid, scarlet fever, diphtheria, mumps, whooping cough, colds, pneumonia, influenza and respiratory diseases. Before 1492 there were at least 60.5 million Indigenous Peoples in the Americas. Between 1492 and 1600 it is estimated that 55 million (or 90 percent) of our people had been wiped out by European diseases and violence. A recent study published in 2019 says that the huge population decline of Native Americans caused a reduction in land use by Indigenous Peoples and contributed to the global cooling trend or “little ice age”…The death of Indigenous People due to European diseases continues. Diseases such as depression, obesity, diabetes, high blood pressure, cancer, and alcoholism, which are often referred to as non-communicable diseases, have also spread widely among our Peoples and have made us sick, vulnerable to contagious diseases such as COVID-19, and have caused a substantial amount of premature death. These non-communicable diseases are new (novel) diseases among Indigenous Peoples since we did not have them before colonialism and its settlers entered our territories…The connection between colonialism and trauma is deep-rooted. In this time of the COVID-19 pandemic, it is up to us to transmit our experiences and tell our stories of how the pandemic has and is affecting us. We must openly chronicle what settler governments did or did not do for us in our time of need, what we asked of them, and how they responded. As Indigenous Peoples, we have always had to fight to get the world to acknowledge the violence of colonialism and its destruction of our people, lands, and way of life.

It is important that we engage in memory work to tell our stories…Trauma has led our people to disconnect, forget, and normalize the diseases and ill health within communities. Remembering offers us a time and space to share the entanglements of our traumatic past, while at the same time, our insistence on telling our stories means that our oppressors and the bystanders have no choice but to see, hear, and acknowledge their complicity in our suffering. Restoring balance means understanding the processes by which historical trauma, oppression, and colonization manifest today. Recovery of our historical memory is linked to ancestral strength and is critical to restoring our physical and emotional balance and well-being…The trauma brought on by over 500 years of abuse and passed down through/across generations is alive today. Since healing is historically connected to traditional ceremonies, sacred land spaces, and community, for many of us who have lost a lot of our ceremonials, there has been little opportunity to repair the damage of this historical trauma due to the banning of our healing ceremonies. To protect themselves, our ancestors hid their ways and their knowledge. In spite of this, we, Indigenous Peoples, hold onto who we are and whatever ways we can, even if this has meant guarding just a small piece of the basket…We believe that Indigenous Peoples from all over the world can come together to help one another to overcome the present pandemic and prepare for future epidemics and pandemics. Our ancestors’ wisdom, prophecies, and teachings have always given us what we need to survive an uncertain future. It is necessary for us to increase our understanding of the failures of Western ideologies and lifestyles, to develop a greater ability to walk and navigate between Indigenous and non-Indigenous worlds, and to work together to create a global ethos where Indigenous values, beliefs, ways of knowing, and ethics are embraced, valued, and realized. We believe that the crises of the COVID-19 pandemic, while destructive and demoralizing, offer us an opportunity to come to strengthen our relationships with Indigenous and non-Indigenous Peoples so we can contribute our knowledge and wisdom with others in the hopes of making the world a better place…Then, something happened to create a disconnect between the people we now consider to be “Indigenous” and the people who are not; the latter began living in disharmony with everything around them…The world needs our collective values to understand that everything is connected.

We all depend on one another. We all are one. To postpone the end of the world, as one of your wise men says, we need to see ourselves as a community. To postpone the end of the world, to hold up the sky, as Davi Kopenawa and Ailton Krenak say, we must see ourselves unified and of one mind…The Arikara have prophesied that the continued foolish behavior of people as they destroy the lands, animals, waters, forests, and plants will result in the collapse of human societies around the world…Like you, we, Indigenous Peoples living in the north have been the victims of invasion, genocide and abuse. We have suffered many egregious and inhumane acts from our oppressors. We share a common history with you. Since the invasions of Christopher Columbus, Pedro Álvares Cabral, and other Europeans more than 500 years ago, our numbers have thinned, as have the size of our lands, waters, and forests. Unfortunately, pandemics and epidemics of disease are nothing new to us…It is important that we engage in actions to resist the spread of COVID-19 into our communities by our own people and outsiders. We must engage in actions to live, survive, and overcome…There is an opportunity to change the course of history by surviving and thriving during the COVID-19 pandemic. We are now in position to envision a new Indigenous world, one that is even more resilient, courageous, and determined to survive. We envision and foresee a world where Indigenous Peoples join the ancient and contemporary practices to meet and overcome the challenges that lay ahead. We have done it before and we can do it again.

The entirety of the letter is much longer and worth reading in full. The authors are: Michael Yellow Bird, Arikara (NeshunNuunat’ Taawaay Ti Naahuun’); Jim Wikel, Haudenosaunee (Hah no Nigahoa Esh); Lianna Constantino, Cherokee; Renda Dionne Madrigal, Chippewa; Eliane Potiguara of Brazil and the editor is Laura Graham, anthropologist and coordinator Edson Krenak of Brazil.

So, Brazil has a long road ahead before it has the Coronavirus disease under control, and an especially tenuous time for its Native peoples.

In returning to Manaus, Brazil, the enormity of COVID-19 impacting the general population cannot overstated. Most vulnerable of all are its urban indigenous peoples like the ones I knew and still presently maintain contact with. By the authorities, they are still not considered to be Natives because they moved to the city. They are regarded as “civilized” (civilizados) and so such populations in Manaus are even more vulnerable still.

As Camus observed in The Plague (1947): “A pestilence does not have human dimensions, so people tell themselves that it is unreal, that it is a bad dream which will end. But it does not always end and, from one bad dream to the next, it is people who end, humanists first of all because they have not prepared themselves” (p. 30).

May this pandemic have an end soon for the sake of the Manauran people and its indigenous populations.

***

If you are concerned about Native peoples in the Americas and elsewhere please make donations to Cultural Survival: https://www.culturalsurvival.org/get-involved

And to: Survival International: https://www.survivalinternational.org/donate

Thank you.


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