Science - USA (2021-12-24)

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coconutlike fruits of the babaçu palm. None
has access to running water, and only a few
have electricity from solar panels or diesel
generators for a few hours a day. Their com-
munities have no doctors and are days away
from a hospital. Four nurse technicians,
hired by the municipality with support
from NGOs during the pandemic, are the
only medical support for kilometers. They
are supposed to assist all families living in
the reserves in Terra do Meio. “God knows
how difficult it is to get medical assistance
here,” Freire says. “When a health team
comes, I am the first to run after them.”
It’s a dangerous environment for a
COVID-19 outbreak. “The vulnerability [of
these groups] is socio-epidemiologic,” says
Douglas Rodrigues, a physician at the Indig-
enous clinic at São Paulo State University’s
hospital, who has been working with Indig-
enous and riverine communities for more
than 30 years. Along with a lack of proper
health care, the riverine people have el-
evated rates of comorbidities such as diabe-
tes and infectious disease, which raise their
risk of severe disease and death from the
virus, he says. Their communal lifestyle, in
which large families often share a one-room
house, also makes it easier for SARS-CoV-2

to spread. Isolating the infected “is just not

possible in their way of life,” Rodrigues says.

Riverine and Indigenous communities

have restricted visitors to their territories

since the start of the pandemic to prevent

the disease’s arrival. But illegal activities

such as mining, logging, and land grabbing,

which have spiked in the past year, continue

to bring in outsiders. As a result, COVID-19

has spread with devastating consequences.

Among Indigenous peoples in the re-

gion, disease incidence and mortality dur-

ing the pandemic’s first wave in 2020 were

respectively 136% and 110% higher than

the national average, according to a study

published in April in the journal Frontiers.

There are no official numbers for riverine

peoples, as they are not tracked separately

by the Ministry of Health.

TO GET TO the expedition’s farthest stop,

the village of Lajeado in the Riozinho har-

vesting reserve, the vaccination crew must

travel more than 600 kilometers up the

narrow Riozionho do Anfrísio. Some parts

of the river look like a swamp, with shal-

low, dark water full of caimans. Others are

studded with rocks, rapids, and little water-

falls. Only small boats called rabetas—with

a retractable propeller attached to a long

shaft—can navigate these shallow waters.

“Hold on!” shouts one of the boats’ cap-

tains while lifting the propeller from the

water to avoid a fallen tree on the river’s

bottom. The co-captain stands on the prow

using a machete to chop away overhanging

tree limbs. Crew members duck as spiky veg-

etation along the shore sweeps past the boat.

Aboard are six people and precious

cargo: a box containing dozens of vials of

the AstraZeneca vaccine and a few single-

dose Janssen syringes. They must be kept

between 2°C and 8°C, and are carefully

stored on ice that is supposed to last 5 days.

By then, the team will have returned to less

treacherous waters, and can transfer to a

larger boat with a solar-powered freezer.

By the time the team has finished the

2-day-long journey from its previous vacci-

nation stop in Morro do Anfrísio to Lajeado,

one of the rabetas has broken down three

times. Arriving just before sunset, the crew

set up their hammocks. Vaccinations will

start early in the morning. A nurse tech-

nician jokes that she’s having withdrawal

symptoms from going so many hours with-

out vaccinating anyone. “My hands are

shaking to give these shots!” she says. GRAPHIC: K. FRANKLIN/

SCIENCE

Altamira

Maribel

São Francisco

Boa Esperança

Manelito

Califórnia

Jesus é Bem Vindo

Cachoeirinha

Morro do Gabriel

Furo do Fava

Sao Raimundo do Pati

São Jorge

Praia Grande

Morro do Anfrísio

Novo Paraíso

Lajeado

Iriri River

Riozinho do Anfrísio River

BRAZIL

Starting point Vaccination stops

0 50

km

Long and winding route
A vaccine expedition set out from the city of Altamira, Brazil, to remote riverine communities within the
federally protected territory known as Terra do Meio (Middleland). The team traversed roughly
1200 kilometers, following rough dirt roads to Maribel and continuing by river to vaccinate hundreds
of residents. It took 11 days to reach their farthest stop, Lajeado, and another 6 days to return.

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