• 29-year-old Danielle Santos with baby Juan Pedro. (SBS Dateline)
Danielle, Leticia and Cleane are all new mothers, but their children have birth defects. Dateline follows the devastating impact of the Zika virus in Brazil through their eyes.
Tuesday, March 22, 2016 - 21:30

It started with spots. A rash on the stomach, then a mild fever, headache and aching joints. It passed in a few days. In the Brazilian city of Recife, these are familiar enough symptoms.  

A year ago, 15-year-old Ruana would have assumed she had a mild version of dengue fever. The heavily pregnant teen certainly wouldn’t have been sitting in a hospital corridor anxiously awaiting an ultrasound.

The paint is peeling, and the walls are lined with those soft-focus photos of idealised mothers and babies by Anne Geddes. Ruana’s here to find out if her baby is likely to be born with birth defects as a result of her brief sickness.  

She’s been infected with a mosquito-borne virus, Zika – the four-letter word that now haunts the women of Recife, as well as millions of others across Latin America.

It’s believed to be behind a massive spike in the number of babies born with microcephaly, a condition where their heads are abnormally small, and their brains are underdeveloped.

“We just got scared because we don't know what's going to happen from now on,” Ruana tells me. “We don't know if the baby will be born sick or not. I'm just waiting to see what happens.”

Pregnancy and childbirth are often fraught with anxiety – mothers-to-be are warned off smoking and drinking alcohol, eating certain foods, gardening without gloves and even having a hot bath.  

But what do you do if you live in the tropics, surrounded by mosquitoes, and you’re told to avoid getting bitten – for nine months?  

Explainer: What is the Zika Virus?
As Dateline's Love in the Time of Zika meets three Brazilian mothers whose children have birth defects, read more about the virus, how it's spread, and its impact.

If you’re not wealthy enough to enjoy air conditioning, it’s simply not practical to cover up for that long in the oppressive humidity.  If you live in a favela, you probably can’t even afford repellent.  

How fearful would you be if you knew that because of an insect bite, your child could suffer from seizures, intellectual disability, hyperactivity, impaired motor skills, even blindness and deafness?  

I’ve travelled to Recife, the capital of the north-eastern Brazilian state of Pernambuco, because I want to know what it was like to live – and love – with questions like this hanging over your head.

“When you have a baby you hope that the baby is normal,” paediatric neurologist Dr Vanessa van der Linden tells me. “We idealise the ‘perfect baby’ and it’s difficult when you see that it’s not this.”

Much about the Zika epidemic, and its relationship to microcephaly, remains mysterious.

Jacqueline, who’s also waiting for an ultrasound, points out that that some women never show signs of Zika during pregnancy, but still have a baby with microcephaly.  

“Yesterday on TV they talked about one mother, pregnant with twins, and the ultrasound showed that everything was perfect. When the babies were born, the girl was born with microcephaly and the boy was perfect,” she tells me.

“But she had no symptoms for the whole pregnancy. Her pregnancy was all normal.”

The Intern Diaries: Love in the Time of Zika
What is it like to live in fear of a mosquito? Amos Roberts explains the challenges of covering the Zika virus outbreak in Brazil in the latest of our Intern Diaries podcasts.

In fact 80 per cent of people infected with Zika will never show any symptoms, so most pregnant women will never even know they’re infected.  Some will be in for a nasty shock.

When I ask 16-year-old Leticia what she thought when she was told her baby’s microcephaly was ultimately caused by a mosquito bite, her mother, Lourdes, butts in:

“We actually doubt it, because this mosquito exists for many years. And now, after all that time, the mosquito is ‘waking up’? We don’t understand it.”

Lourdes points out that their neighbour also had symptoms of Zika during pregnancy, but her child was born healthy in November. One month later Lourdes’ grandson was born with microcephaly.  

Unfortunately, Leticia can’t breast feed her son.

“I don’t have any breast milk. I think it’s because I kept thinking about him… because the doctor said he was going to have microcephaly,” she says.

The agonising wait of an expectant mother with Zika: 'Is my baby okay?'
Everywhere she goes, Ana Guardo Acevedo, 17 and seven months pregnant, has a worried look on her face and a folder full of medical tests in her hands.

So you may not even know you have Zika.  And if you do have it, you won’t know if your baby will have microcephaly.  And if your baby is born with microcephaly, you may not know what this will mean for years to come.  

It’s a time bomb set for slow release.  

The many unanswered questions fuel more fear, along with conjecture and conspiracy theories.  Some blame vaccines for the microcephaly. Another theory blames a chemical larvicide added to the municipal water supply. Both theories are easy to debunk, but persist nonetheless.  

Consensus emerges on Zika microcephaly link
The World Health Organization says there is now a "strong scientific consensus" that the Zika virus is a cause of microcephaly.

Obstetrician and gynaecologist Dr Adrianna Scavuzzi actually wishes these theories were true, because if, for example, a vaccine was to blame:

"It would be even easier to fix because we know - stop using this vaccine.  But if this problem is directly related to mosquito bites, we have to change the sanitary condition of people.  We have to change peoples’ lives.  It will take a decade to happen. That's why I'm so worried about this problem.”

Dr Vanessa van der Linden, the paediatric neurologist who first identified the spike in babies being born with microcephaly, knows that the scope of this crisis is yet to unfold.  

“It’s not like an infectious disease, like you have a problem for a time and then everything goes away,” she tells me.

“The consequence will be for the future of these children, these mothers, and this country. Because now they are children but soon they will grow and we have adults with severe neurological problems.  We need to follow these babies for the rest of their lives.”

The Brazilian health ministry has promised to provide the 7,500 extra health professionals who will be required to care for the children into the future.  But in the middle of a crippling recession, the government can’t even pay for the health workers it already employs.

In the meantime, mothers lavish their babies with all the love, hope and prayers they can muster.  

And those who want to have a child? Would-be parents pray for a vaccine, and the authorities advise them not to get pregnant.  As one woman asked me:

“Because of a mosquito, will I have to postpone a dream?”

See the full story, Love in the Time of Zika, at the top of the page.

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LETICIA ARAÚJO DA SILVA (Translation):   My name is Letícia, I’m 16 years old, my son Heitor turned 2 months today, and my mom is Lourdes.

DANIELLE SANTOS (Translation):  I’m Danielle Santos. I’m 29 years old and I’m the mother of Juan Pedro, two months old.

CLEANE SERPA (Translation):   My name is Cleane, I’m 17 years old, this is Maria Eduarda, we call her Dudinha, and she’s going be three months tomorrow.

This is the story of three mothers who fiercely love their imperfect babies,  Heitor, Juan Pedro and Maria Eduarda were all born with microcephaly. Their heads are abnormally small, their brains underdeveloped. That can mean severe intellectual impairment, frequent seizures, even blindness and deafness. The scary thing is no-one knows for sure yet.

ADRIANA SCAVUZZI, GYNAECOLOGIST AND OBSTETRICIAN:  There's no chance to fix it, so it's a problem that will affect that family forever, for years to come. So it's very, it's revolting.

The birth of these Brazilian babies and hundreds like them is sparking a global panic.

NEWS REPORTS:  The mysterious disease causing international anxiety. The Zika virus is not deadly. But it has been linked to birth defects.

Recife, a city famous for its beaches, finds itself at the epicentre of an international health crisis. Last year, it was struck by a mysterious mosquito-borne epidemic which doctors blame for the deformities in babies. Ever since, anxious mothers crowd into clinics and pregnant women rush to hospital for reassurance. The city's struggling against an enemy it can hardly see, leaving women who have very little even more vulnerable.

REPORTER:   Seeing soldiers on the street here, you could be forgiven for thinking there's a war going on.

JAILSON CORREIA, RECIFE HEALTH SECRETARY:  Well, it is a war against a tiny enemy which is proving to be very difficult to win.

Like many teenagers, Leticia Araújo da Silva dreamt of escape and longed for fun.

LETICIA ARAÚJO DA SILVA (Translation):   Me and my girlfriends would go out every night, always partying.

But there's no escape now. Young mothers have little time for adolescent dreams.

LOURDES, MOTHER (Translation):  It’s like this all day long. All day long it’s like this. He doesn’t sleep.

This is typical of babies with microcephaly. They cry a lot and sleep very little.

LOURDES (Translation): Now I’m holding him. But when I’m at work, she doesn’t even eat. She eats popcorn or whatever’s around.
LETICIA ARAÚJO DA SILVA (Translation):  Heitor is calm, but he cries a lot. Daily life with him is exhausting because he only wants to be in my arms.

Grappling with the needs of a disabled child would challenge any parent but Leticia is only a child herself and relies on her own mum for help. She was only 15 when she became pregnant. That's not unusual here.

LETICIA ARAÚJO DA SILVA (Translation):   I went out a lot, to dance. Now I can’t go anywhere - only taking care of him.

REPORTER:  Leticia, did you plan to get pregnant last year?

LETICIA ARAÚJO DA SILVA (Translation):   No.

REPORTER:   Was it a surprise then?

LETICIA ARAÚJO DA SILVA (Translation):   Yes.

LOURDES (Translation):  She says it was a surprise - it was no surprise. If you have sex you know you risk being knocked up if you don’t take precautions.

LETICIA ARAÚJO DA SILVA (Translation):   His father is not involved at all. He doesn’t care.

Lourdes had high hopes for her daughter. They've been shattered and she has trouble containing her disappointment.

LOURDES (Translation):  While he’s tiny, she has to dedicate herself to him. I don’t have the conditions to do it.  If you want children, you have to raise your child. I raised mine, now she has to raise hers.

REPORTER:   What upsets you the most?

LOURDES (Translation):  Her rebellion. She used to be a rebel and go out, now she’s at home all the time. She’s not going anywhere.

Looking at all the struggling mothers in his rehabilitation clinic, the scale of the crisis really sinks in. Last year, some specialists in Recife were seeing as many cases of microcephaly in a week as they used to see in an entire year. Sometimes a baby's distress makes treatment incredibly difficult. Today, Danielle Santos's son, Juan Pedro, won't stop screaming for long enough to have his eyesight checked. The therapist suggests she brings him back once he's settled down.

DANIELLE SANTOS (Translation):  Now you have to open your eyes my love, not just stop crying…

It's just as distressing for Danielle as it is for her baby.

THERAPIST (Translation):  Hey, let’s do it, young man!  Let’s do some work?

No-one can tell her exactly what's wrong with her son, or how the microcephaly will affect him as he gets older.

DANIELLE SANTOS (Translation):  Our pain is one that no mother wants to feel. Mothers want babies who aren’t disabled or retarded. We know for sure that at some stage he’ll have some difficulty.

ADRIANA SCAVUZZI:  In the very beginning we had no idea what had caused this microcephaly.

Dr Adrianna Scavuzzi is a gynaecologist and obstetrician on the frontline of this crisis.

ADRIANA SCAVUZZI:  It's really tough for the doctor to see a problem that we cannot fix and that we know that the children will have serious problems in their neurological development.

This is a nerve-racking time to be pregnant in Recife. 15-year-old Ruana has come to hospital for an ultrasound.

RUANA (Translation):  We just got scared because we don't know what's going to happen from now on. We don't know if the baby will be born sick or not.

DOCTOR (Translation): Is this your first examination here?  Your first time?

Last month, Ruana caught Zika, the virus that doctors believe causes microcephaly. It's spread by mosquitos, so if you're pregnant here you live in fear of something tiny doing permanent damage to your unborn child.

RUANA (Translation):  I was covered in spots, only in my tummy, with fever and headache, I couldn't walk.

ULTRASOUND OPERATOR (Translation):  Look at the mouth.  Can you see the little mouth? The heart…

You can see why she would be scared but at least she knew she was sick and came here. 80% of the people with this mysterious virus show no symptoms, so they don't even know that they're at risk. Ruana is about to find out if her baby has microcephaly.

ULTRASOUND OPERATOR (Translation):  Everything is normal.  Congratulations.

REPORTER:  Ruana, how are you feeling now to get the news?

RUANA (Translation):  Fine. Now I'm fine.

For hundreds of Brazilian women, ultrasounds like this haven't ended so happily.

REPORTER:   How do you feel about the fact that one mosquito bite while you were pregnant did this to Juan Pedro?

DANIELLE SANTOS (Translation):  It’s still kind of hard to believe it. The population is so big, so why are only the less well-off affected? So many people who are better off, with more money, a higher social class… Why wouldn’t it bite them?

Visiting the favelas, it becomes very clear why poor women are bearing the brunt of this crisis.

REPORTER:  The government has been advising women to cover up so that they don't get bitten. Is that something that you can do here?

PREGNANT WOMAN (Translation):  It’s not possible to wear long sleeves, because of the heat.  It's too hot, isn't it?  No way.

The locals know they're exposed and vulnerable for disease-ridden mosquitos. They can't even afford repellent and although they're told to move out while their homes are fumigated with a toxic spray, there are bigger things to worry about.

ADRIANA SCAVUZZI:  I can tell you for sure that a family that cannot buy food, they may think about microcephaly, they may think about Zika infection, but it's not the priority.

The biggest problem for the authorities and the fight against Zika, in fact the main reason for its rapid spread, is a lack of plumbing and sanitation. People live next to open drains and store their water in containers, perfect spots for mosquitos to lay their eggs.

ELIANA MORAIS (Translation):   Good morning.  As you know we are living through an emergency period we are asking people to keep exposed water to a minimum. Please leave that water the longest for two days and preferably keep all the water covered.

MAN (Translation):  Yes.

ELIANA MORAIS (Translation):  Do you have any kind of water tank around?

MAN (Translation):  No.

ELIANA MORAIS (Translation):  No water stored here?

MAN (Translation):  No.

ELIANA MORAIS (Translation):  OK thank you good morning.

There's water everywhere and it feels like an impossible task for the city's health agents. If the water can't be sealed or emptied, they add some organic larvicide. The army's also been brought in to help across the country. Almost a quarter of a million soldiers called up when the President declared this a national emergency.

SOLDIER (Translation):  It looks like there’s no larvae.  We have to beat this mosquito.

ADRIANA SCAVUZZI:  I got angry because it could have been prevented if the government had invested the amount of money necessary to improve the quality of people's lives.

But the money's been spent elsewhere.

NEWS REPORT:  At the existing Rio Centre, the Olympics and Paralympics will take place.

The Olympics sporting in August have cost $14 billion. And the government's been rocked by corruption scandals. The economy is also deep in recession and many hospital staff haven't been paid in months. It's the worst possible time for a public health emergency. But the city's passionate health workers are doing their best, even when it means they also come down with Zika and Dengue.

ELIANA MORAIS:  This is a problem too.

Agents like Eliana Morais know that all it takes is a small act of carelessness – some rubbish left to collect rainwater – to compromise the health of everyone who lives within the neighbourhood.

ELIANA MORAIS:  Every day, we find all these kind of problems and it's impossible to believe that we are going to combat completely the mosquitos.

For mothers like Danielle Santos, struggling to care with a baby like microcephaly, prevention comes too late. More than anything else they need support. Danielle's 11-year-old daughter helps out, but her husband - well, he's a different story.

DANIELLE SANTOS (Translation): I was sleeping with the baby and I suddenly noticed his father taking his clothes, the TV set and DVD player, and going away. So I asked him: “Are you going to leave me here alone, with the baby? You know he cries a lot”.  And then he said: “You should have thought about this before because I also need attention. You’re doing your job as a mother but you’re forgetting your job as a wife.”

The Brazilian media is full of stories about fathers abandoning mothers with babies with microcephaly. They are calling it male abortion.

REPORTER:  What did you expect, what did your husband expect from you?

DANIELLE SANTOS (Translation):  When he got home, he wanted me to ask him how was his day, fix his lunch and dinner… He wanted me to eat dinner with him and ask about his day. And at that moment I didn’t have the time for it.

I was lucky enough to stumble upon one happy story in Recife, the story of Cleane Serpa and her baby. Unlike the other mothers, Cleane never had Zika, in fact, she was never pregnant.

CLEANE SERPA (Translation):  Eduarda is not my biological daughter. I’m not her biological mother. I adopted her because her mother has no means.  Her father is an alcoholic. Her mother is unable financially or psychologically to look after a child like her.  She can’t take care of a normal child, imagine a special one! She’s special.

Cleane knows the biological parents and first saw her in hospital after the birth. She found herself repelled and attracted at the same time.

CLEANE SERPA (Translation):  At first I wasn’t thinking of adopting her. When I first saw her, I had a shock. I’d never seen it. I got used to it once I’d spent a whole day with her. Her mother said she didn’t want her, she wouldn’t take care of her because she was born like that. I said “I want her. Don’t give her to anyone else.”

REPORTER:  So tell me what you're doing now?

CLEANE SERPA (Translation):  I’m giving her medicine. It’s an anti-convulsive medicine. I hate it, mummy.  Yeah, hate it.

Cleane was actually studying to become a nurse but dropped out of her course in order to nurse Maria Eduarda.

CLEANE SERPA (Translation):  She can’t hear well. She lost her hearing. And she’s lost her eyesight.  We’d like her to be able to see so she could smile and recognize us. And if she listens she could talk. Making sounds with her little mouth - she’s still not able to do that. Many babies can do it, but she still can’t. 

Everything day's part of a never-ending routine of care and medical visits for this young mother, I first met Cleane at the rehabilitation centre in Recife, it's also where I met Danielle. It takes them each two to three hours on public transport to get here. Access to therapy for many mothers will be very difficult.

THERAPIST (Translation):  Mother, she’s angry.

CLEANE SERPA (Translation):  She has appointments all week long. I’m with her at the doctor every day. Every day, any time they call, I'm with her at the doctor. When she’s in some pain she cries a lot on her side.

It was here at the clinic when this 17-year-old first told me that she had adopted a baby with microcephaly. I was stunned.

CLEANE SERPA (Translation):  When I say I adopted her, nobody believes it. But she is mine.  I adopted her, she’s mine.  I’ve never regretted adopting her, never.

THERAPIST (Translation):  Hear this. This sound here has a higher pitch than this one.

Microcephaly isn't something that can be cured but early regular stimulation is essential to develop the brain as much as possible.

THERAPIST (Translation):  Through sounds, we’re neurologically stimulating the child, and it's a nice sound, a sound that they enjoy.

These mothers are hungry for expert advice and soak up everything on offer. I came to Recife expecting to find despair. But in this group, I see determination. While the world panics about its spread, women like Danielle are living the reality of Zika. Back for a third attempt at the eye test, she knows she has to adjust her dreams for a child with microcephaly.

DANIELLE SANTOS (Translation):  My dream was having a son who could play well, who could become a soccer player. So today I don’t think about him becoming a soccer player, but about him being able to walk. So if he’ll be able to walk, that’ll be a conquest! And from walking we can start planning new paths for him.

No-one knows how big this pandemic will become but on the streets of Recife, some Brazilians are struggling to accept the new arrivals. Clean says she thinks of her baby as a blessing but these unusual-looking children often attract hostility and even disgust.

CLEANE SERPA (Translation):  There are lots of prejudices on the streets. Once I was walking by and this lady said “Is this a girl? It looks like an animal.”

DANIELLE SANTOS (Translation):  This city has to realize that we’re living in a new era. It won’t be rare to see a kid, that’ll later be a teenager, with microcephaly. So they’re going be a part of the society mixed with others.

A specialist who has treated many of these babies told me she was really struck by their mother's strength they are 100% for the children, she said. "I think they are warriors."

DANIELLE SANTOS (Translation):  The lack of a male presence won’t make me stop fighting for the wellbeing of my son. Looking into his eyes, at his difficulties, I find my strength. He needs me, so I can’t feel sorry for myself, be weak, cry or anything else.  Life goes on and I’ll do everything I can for him.

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22nd March 2016