Medical Emergency in Manuas

It was 7p.m. on Wednesday, the 15th of September, 2004, downtown Manaus. This capital of the state of Amazonas is not renowned for its evening cuisine. The temperature had dropped 12 degrees to a pleasant 25° Celsius, cool enough to amble around. I was checking out dinner options and not having much success. Finally, I settled for snack food on the corner of the square surrounding the Teatro Amazonas, the city’s world-renowned opera house.

Brazil’s President Lula was in town with a bunch of central bankers from Venezuela. On the balconies during intermission, politicians, bankers and special guests ambled gracefully in front of the bored business page journalists from the coastal cities. Photographic flashes lit up the tropical sky. The catering staff at the Teatro de Amazonas had their best silver out for the occasion. Security men, police and drivers from both countries stopped by our snack bar for a beer or a soda. Though tangible, security was very relaxed by Western standards.

1.5 Billion US was on the table, Chavez’s entrance fee into MERCOSUR. More than a billion of which had already been allocated to large Brazilian contractors for just three infrastructure projects in Venezuela including work on the Caracas metro. There is nothing like the ring of cash registers to bring out the political glitterati and grandiose numbers require a grandiose setting. There are few settings more grandiose than the spectacular Teatro Amazonas.

It was Chavez’s first trip abroad since he trounced the second presidential challenge of his first term but Lula had his back. All of the international newspapers, even the BBC, was quoting Lula as saying that Venezuela was a stable democratic state, a place to trust. The overt implication was that Venezuela was a great country with which to do business. As evidence, some of Brazil’s largest corporations were doing just that. It was that no-risk business that everybody loved, government loan guarantees making that oil money even more attractive!

The lighting on São Sebastião had been specially adjusted for the visiting Venezuelans, lit like a film set. Locals posed as happy extras, few even aware of the giant contracts being signed. Most of the industry that would fulfill these contracts was thousands of kilometers to the south.

Local attention was focused the newly-refurbished Baroque fountain, a reminder of the great days of rubber just 110 years ago when Manaus was the richest city in the world. In that era of extreme opulence, local Manaus businessmen had their shirts sent out to be laundered in Paris. When an opera played in the Teatro the were imported at great expense from Vienna or Rome just to play the same stage now viewed by Chavez and Lula.

Manaus had been chosen for this celebration because of its proximity to Venezuela. The Amazon poses a formidable barrier to land transportation in the north of Brazil; it may never be bridged. However one working road, BR-174, connects Manaus with Venezuela. In the eighties the situation was better. Brazil constructed a network of Amazonas highways that connected Manaus with the rest of Brazil to the south. However, since then, all except 174 north have been consumed by the jungle. For a brief period it was possible to take a barge at Manaus and drive from the southern bank some 1000Km to Porto Velho where you could travel on to the Brazilian coastal cities via the gleaming new transamazonica, or south overland into Bolivia. These options are now only open to the serious off-road adventurer and then only late in the year when river levels are very low. Manaus is now effectively cut off from the Brazilian road grid to the south. Only an extensive network of river traffic keeps it connected at all.

The working BR-174 barrels due North through the pristine jungle of the Amerindian reservation crossing the state border into Brazil’s most northern state. Roraima is a land hub for the transportation of goods passing to Venezuela and the smaller traffic with Brazil’s English-speaking neighbor, Guyana. 805 kilometers of gut wrenching potholes on BR-174 and you reach the proud new city of Boa Vista, capital of Roraima — the self-lauded “state of the immigrant”. From Boa Vista it is only four hours to the border with Venezuela and two to Guyana. Few people really use this road, most of the Venezuelan cross-border truck traffic is empty rigs from Brazil popping over the border to avail of the extraordinarily cheap diesel offered in Santa Elena on the Venezuelan side. Maybe after this deal gets going there might be some legitimate truck traffic between São Paolo and Caracas?

The state of Roraima is much smaller than its immense neighbor Amazonas but has better agricultural land. While much of Amazonas is inaccessible jungle, Northern Roraima is a tropical Savannah. Savannah land is flat with the occasional tabletop mountain and is ideal for cattle raising and large-scale agriculture. The state is marketing itself to immigrants from the south seeking cheap farmland. It is working, land prices are rising quickly with foreign investors from as far away as the U.S. pushing prices closer to the ‘new’ land prices elsewhere in Brazil. But agriculture is not all that is on offer in Roraima.

Boa Vista has recently cleaned up its act, the result of a federal moratorium on small-scale prospecting operations. The gold, diamonds, and precious gems are still to be found there you just can’t do it officially on a small scale! Only five years ago, this now sleepy city was renowned for its high levels of violent crime. Miners came to town to sell their gold for cash and to have a good time — some got more than they bargained for. The gem stores still operate, doubling as exchange houses for Guyanese Dollars, Venezuelan Bolivars, Brazilian Reais, Dollars and Euros. Boa Vista also has some extraordinary hardware stores where you can back in a truck and leave with a working mine, (illegal though it might be to operate the new equipment locally).

The sale of mining equipment trade is legitimized by the fact that small-scale prospecting across the border in Guyana is still legal. Across the border in southern Guyana’s Rupunumi savannah prospecting is possible even on indigenous land. The outsider is expected to request permission stopping by the elected chief, the ‘tuschau’ in Carib (‘Captain’ in English). Occasionally the captain will check whether you have your permit from Georgetown to enter indigenous lands where your intent is registered with the central government but usually he won’t even bother, and in most cases he doesn’t really care. Access to tribal land is based on a Gentleman’s agreement and has more to do with the right introduction than any fees that may be requested. If a fee is involved the visitor must suggest the number of Guyanese dollars that might be appropriate and should expect to be given a written receipt. A short conversation suffices as a test of good character before written permission is given and the visitor and their vehicle is registered by being written into the tribal role book as a guest on their land.

Roraima is Brazil’s Wild West and the complex interplay of indigenous rights with industrial lobbies such as mining and tourism seem OK for now. The population is still small and there is still enough space for everyone. The indigenous Carib are less inclined to slaughter prospectors invading their land as has been happening more regularly in Amazonas to the south.

But back to Manaus and the party at the square.

As the concert proceeded I found it vaguely amusing to spot out the security men stopping by for a snack, their bulky loose fitting suits loosely concealing the tools of their trade. It was a night out for them too and a snack or a beer made the theatrical performance pass more quickly. Soon there were the final photo-ops, official cars sped away to the posh hotels, police and army dispersed and we were left alone on the film set.

The square was quieter but all was not well in my world. I started to experience what I first thought was severe indigestion. By 4 A.M. back in my not-so-posh hotel my temperature reached 102 degrees Fahrenheit and I relented. Waking my companion, I explained that a race to the nearest tropical clinic was in order. I feared my first bout of malaria and that requires prompt action. My whole torso was swollen hugely and I had extreme difficulty breathing. The pain spread from my lower right side to my neck was becoming unbearable.

I mustered the last of my energy to descend the steep stairways of the hotel and lifted myself into my car outside. Shortly before dawn, with her valiant driving we made it to the Foundation for Tropical Medicine, suburban Manaus.

By this time, my condition was critical and it was all that I could do to walk at all. My pathetic Portuguese was insufficient to convey the emergency but a deep moan of pain sufficed to relate the levity of my emergency. A friendly outpatient worker led me right to the door where I was immediately offered serious attention. For a few hours I had my own room and was visited by various doctors, nurses and orderlies. By 9 AM I was somewhat of a celebrity, the Irish guy who didn’t speak Portuguese and moaned a lot. I had been fitted with a temporary drip, blood had been taken and various doctors and nurses had attempted to interrogate the obviously perturbed foreigner.

At 11 AM a small baby, its body covered in horrendous scabs, usurped my private room and I was shunted to a ward with five others. This was to be my home for the next 30 hours where I received intensive care on a level I have never before experienced.

The tests began in earnest: two X-Rays, chest and abdomen, various blood tests, umpteen physical examinations, an ultrasound, IV drugs and glucose, free food and lodging. The care, attention and hospitable treatment was more than I could expect of a five star hotel even if the bed was slightly more primitive. My diagnosis proved somewhat of a conundrum and took almost two days by which time I was starting to feel better and my companion much worse.

The interim diagnosis is rotavirus a nasty bug responsible for some 50% of all Gastroenteritis worldwide. Once rotavirus was diagnosed I was politely asked to leave as isolation would be difficult and it was believed that I would be OK. This diagnosis was later disproven and my state was put down to ingesting amoeba. I was offered the diagnosis with my records (X-Rays included), the doctor taking much time to explain my prescriptions and care instructions to tide me over till I could return for a check up on Monday.

If the Unified Health System of the state of Amazonas is representative of the treatment offered to patients in this giant country I can only recommend Brazil as one of the worlds greatest places to be ill.

Thank you Brazil and thank you even more for the zero price tag! I owe you one.

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