by Guillermo Jaimes
In Brazil, the problems of the developing world exist side-by-side with the problems of the developed world. The country has a high incidence of both infectious diseases associated with a lack of basic sanitation and so-called “first-world diseases” such as hypertension and heart disease.
Leptospirosis is an infectious disease that has had devastating effects in Salvador, Bahia. People are typically exposed when they step in pools of water that have been contaminated with the urine of infected rats. One of the hallmarks of the disease is the similarity of its symptoms to dengue fever. Dengue is transmitted by mosquitos and leads to high fever and severe muscle aches that some patients describe as having the sensation of their bones being crushed. Though incredibly painful, dengue often goes away with minimal care. And, since there is no known cure other than relieving the symptoms of the disease, few people bother to seek medical treatment. Leptospirosis, on the other hand, is deadly. However, unlike dengue, antibiotics can treat the disease when diagnosed early enough. To complicate matters, both dengue and leptospirosis are more likely to occur during the rainy season when pools of stagnant water provide breeding grounds for mosquitoes and rats.
Researchers from the Fundação Oswaldo Cruz (Fiocruz) and Yale University have partnered with community members from Pau da Lima — a neighborhood in Salvador, Brazil that is severely affected by leptospirosis — to come up with a multi-pronged approach to combat the disease. My research focused on documenting the organizations that have been involved with the project over the last decade. By interviewing various stakeholders, I got to see how local knowledge was not only vital to the work that Fiocruz has been doing but has changed the lives of many residents who have gone on to pursue higher degrees.
Pau da Lima is the third-largest neighborhood in Salvador, with a population of approximately 120,000. New settlements at the base of the valleys and the tops of the hills have worse infrastructure than those in the more established portions of the neighborhood along the major commercial streets. In the new areas, makeshift bridges crisscross open sewers, and during heavy rains, many homes flood because of poor drainage. On the valley floor, many homes sit beside open sewers that carry trash from the streets and homes above. Without municipal garbage collection, there is nowhere else for it to go. Getting around can be challenging, as roadways in the community vary from steep narrow passageways with uneven pavement to unpaved dirt steps that can be slippery after the rain. To make matters worse, most residents walk around in sandals, which leave them susceptible to leptospirosis infection, especially if they have any open wounds.
Researchers at Fiocruz Salvador have partnered with the Centro de Controle do Zoonozes (CCZ), the city animal control agency, to collect rat specimens in the community. Their goal is to identify where rats infected with leptospirosis are concentrated in order to determine where rat control efforts should be targeted. The researchers, dressed in lab coats, go out in teams of two. One team member is always either a community resident or someone who has worked in the community for a number of years.
The community members I spoke with had many positive experiences with the research team. In fact, several research team members used to live in Pau da Lima and have gone on to pursue degrees in nursing as well as biomedical research. Although leptospirosis continues to infect and kill residents who are not diagnosed and treated quickly enough, the progress made by researchers and community members working together has led to the development of a quick test for leptospirosis that will be manufactured and used by the community clinic.
Guillermo Jaimes is a graduate student in the Department of Environmental Science, Policy, and Management at UC Berkeley. He received at Tinker Grant from CLAS to travel to Brazil in the summer of 2013.