Zika Virus in the Americas:

Introduction

GroundTruth Films

In recent years, new infectious diseases have cropped up around the world that threaten to undo decades of progress improving human health. Temperature extremes brought by climate change and environmental degradation play a role in accelerating the spread of some of these diseases. The widespread emergence of the Zika virus in 2016 was the latest to cause global panic. The virus, carried by mosquitoes whose behavior is changing as our environment does, can be further spread through sex. It can cause devastating birth defects, some of which may only be noticed years after a child is born.

Women and children, who comprise the majority of the world’s poor, are the most vulnerable to climate change. But they are also agents of change. As part of our series, Living Proof: The Human Toll of Climate Change, our journalists have been following the spread of the Zika epidemic in Brazil and Puerto Rico. “A Matter of Time” is a documentary short that underscores how when it comes to protecting their children, mothers are building a new form of adaptation and resilience.  It’s a part of our series, Living Proof: The Human Toll of Climate Change.

Zika Virus in the Americas:

Motherhood in Puerto Rico

GroundTruth Films

Beth Murphy

A Matter of Time from GroundTruth on Vimeo.

SAN JUAN – Adriana and her husband started trying to have a family four years ago. Pregnancy came quickly.  Then, too, a miscarriage.  Another pregnancy. Another miscarriage. While grieving the loss of yet another baby—her third—earlier this year, Adriana, was bombarded with dire warnings from health officials. Don’t get pregnant, they said, informing women across Puerto Rico of a new virus called Zika.

It was February, and Zika, which can cause devastating birth defects, was already on the rise throughout Latin America and the Caribbean. That month, there were 298 cases on Puerto Rico, the first numbers to crop up in the U.S. Hundreds of thousands more were predicted.

“When the government said, ‘Don’t get pregnant because of Zika,’ we kept trying anyway,” says Adriana who is 34. “My husband and I weren’t thinking about the government. We were thinking about us.”

As U.S. lawmakers in Washington bickered about funding to halt the spread of Zika this summer, Adriana became pregnant again. This time, the pregnancy lasted. So, too, did Zika, infecting 50 pregnant women in Puerto Rico each day and accumulating a growing list of potential birth defects—microcephaly, seizures, facial abnormalities, feeding and vision problems.

I had come to Puerto Rico to talk with women and to understand how they were handling the stress of a public health crisis while making one of the most personal decisions of their lives—the decision to have a child. I’ve been researching the human impact of climate change for our series, “Living Proof: The Human Toll of Climate Change,” and have reached the conclusion that women and children are bearing the brunt of the climate change burden. Nowhere does that seem more clear than where Zika strikes, especially with Congress playing “political football”—as one lawmaker put it—with their lives.

In September, Congress finally approved a $1.1 billion package to address the virus. But even now, Puerto Rico will see only a fraction – $141 million (half of what was requested) – of the funding U.S. officials approved – and most of it not until 2017, nearly a year into the crisis. There is no doubt that politicians have played fast and loose with women’s and children’s health here over the past year. And with Donald Trump as the new U.S. president-elect, there’s no certainty in the future.  During his campaign, Trump referred to Zika as a “big problem”, but has since spoken out vehemently against America’s global climate commitments and women’s reproductive health rights.

While most people infected with Zika will never have any symptoms, Adriana had all the telltale signs. “I had a rash, headache. My hands were aching,” she said. All pregnant women in Puerto Rico are tested for the virus in their first or second trimester, even though research shows that infection in the third trimester can be damaging to the baby, too. Adriana was just 5 weeks along. “I got tested and then had to wait over a month for the results.”

Adriana wasn’t the only woman I met who experienced long delays after testing—a failure in part because of congressional inaction. Other signs of strains on the system: symptomatic pregnant women sent home from the ER without being tested, and pregnant women who never got any results at all. All of this has become a source of contention among health professionals. “This is our fight with the Department of Health,” says Dr. Carmen Zorrilla, Director of the Maternal Infant Studies Center at University of Puerto Rico Hospital and one of seven doctors on the island handling these cases.

Nine weeks into her pregnancy—the longest she’d ever carried a baby—Adriana was diagnosed with Zika.  

“I told my mom and she was hysterical… She was heartbroken. I’ve had three miscarriages. And now Zika.  She said, ‘Why is this happening to you?’ I said, ‘I don’t know, Mommy.’”  

Adriana is a social worker.  On the day I met her, she had spent the afternoon giving a young woman an HIV diagnosis and counseling her through it. She says the lack of mental and emotional support for women facing pregnancy in the time of Zika is making the crisis worse.  

“Sometimes I can’t think straight,” Adriana says.  “I was thinking about this constantly, waking up at two in the morning crying. I cried so much.”   

When Adriana’s OB-GYN referred her to a specialist, and she couldn’t get an appointment for more than two months, she took matters into her own hands, turning to pregnancy chat rooms online and using #zika to find other “Zika moms.”  

That’s how she met Leslie, a 21-year-old single mother also diagnosed with Zika in her first trimester.

“We wanted to share our experiences and comfort each other,” Leslie says, “We were both asking the question: What will I do if I find out my baby has birth defects?”

It’s a question to which Leslie and Adriana have found very different answers.

“What I knew about Zika before getting pregnant was only that it was a virus I could get. I wasn’t using any kind of protection, though.” By protection, Leslie means a condom. Zika can be transmitted sexually, from man to woman and woman to man.  Perhaps most alarming is that the virus can live in semen for 6 months or more.

“Was it that or a mosquito bite? I don’t know. It’s confusing. They should reach an agreement with the information they have,” she said of the government and media. “Be honest with us. Tell us the truth.”

The problem is that nobody knows the truth about Zika yet. It’s like HIV/AIDS in the 1980s—frightening in our uncertainty about what the disease actually is, and in our inability to prevent or treat it.

I met Leslie at her apartment complex in Ponce, Puerto Rico’s second-largest city.  Outside, she pointed out pools of standing water that are breeding grounds for the primary mosquito that spreads Zika, Aedes aegypti.  According to scientists on the island, increased flooding and higher temperatures caused by climate change are accelerating the spread of mosquito-borne illnesses.  

“We know the climate is changing in Puerto Rico,” says Pablo Mendez-Lazaro, an environmental scientist who specializes in the public health consequences of climate change. “These are the perfect conditions for [mosquitoes] to reproduce.”

Inside her sparsely decorated apartment, Leslie points to the open windows. “I can’t afford screens,” she says. Repellant and air conditioning—two other preventive measures recommended by the government—

are also beyond her means.

During our conversation, Leslie swats a mosquito. She looks down at her 16-month-old daughter playing at her feet and the baby growing in her womb. “I have to move forward for them,” she says. “I’m determined to move forward with my pregnancy and accept my baby with whatever problem she may come with.”  

Adriana feels less certain. She has begun to gather information about how to terminate her pregnancy. She is anxious as week 18 of her pregnancy approaches—it’s the time doctors say they’ll know whether Zika has caused serious birth defects, like microcephaly, the stunted development of the brain.  

On a Catholic island where abortion is divisive, the number of clinics performing them has dropped from eight to six since the beginning of the year. Dr. Yari Vale, who operates one of the remaining clinics, says she’s seeing at least one woman a week who wants to terminate her pregnancy because of Zika.

Adriana’s conversation with Dr. Vale was filled with emotion. She was just 12 weeks along.

“After my conversation with the abortion clinic, I knew I needed to go somewhere to help clear my mind. I had to make a choice and be firm in my choice,” Adriana says. “Could I live with my decision? Could I live with the idea of terminating at 12 weeks with just having a Zika diagnosis and not knowing if my baby has any birth defects? Or could I better accept the consequences of the decision if I waited until week 18, so that it would be based on more certainty.”

“The test takes so long, and they don’t want to wait,” Dr. Vale says of women who think they’ve been exposed to Zika but haven’t been tested yet. “The decision becomes harder as the weeks pass, and it makes termination more expensive as well.”

Dr. Vale—who was once told by a colleague “that I was going to hell”—understands the stigma women feel, and how that stigma makes it difficult for women to talk about their experiences openly.

Adriana will terminate her pregnancy only if she discovers something is wrong with her baby. But her decision will be kept private. Only her mom and aunt know she is pregnant. She’d waited to share the news because of her three previous miscarriages, and then stayed silent after the Zika diagnosis. She asked me to use a pseudonym.  

“What do I do while I wait?,” Adriana asks.  “Read.  Educate myself.  Advocate for myself and others. Because if women don’t empower themselves about Zika, it will drive them crazy.”

A version of this story also appeared in Cosmopolitan on January 12, 2017

Zika Virus in the Americas:

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(Photo by Beth Murphy/GroundTruth)

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Behind the Science

Mosquito bites result in more than a million deaths each year, according to the World Health Organization. That’s because they’re the primary carriers of diseases like malaria, dengue fever – and the Zika virus. Scientists say climate change is affecting the life cycles of mosquitoes and, as a result, could be amplifying the spread of Zika.

“Climate change has profound impacts on public health, including infectious diseases,” says physician and epidemiologist Barry Levy. “Warmer temperatures increase the breeding season and also the rate at which mosquitoes multiply. It’s of great concern that climate change may impact the spread of Zika virus.”

It’s not just Zika that doctors are worried about, as the climate gets friendlier for disease-carrying mosquitoes.

“There are places, for example, in East Africa where malaria never occurred because they were at higher elevations and now that temperatures are warmer, malaria is occurring for the first time,” Levy says. A 2014 study found that “future climate warming will result in a significant increase in malaria cases in densely populated regions of Africa and South America, unless disease monitoring and control efforts are boosted and sustained.”

The impact of this rise in infectious diseases won’t be felt equally. Women and children are more vulnerable, and poor countries and poor people will be hit harder

“Climate change is a risk multiplier in many ways, and a number of diseases already occur more frequently in children and some of them also occur more frequently in women,” said Levy. “In addition, in terms of raising awareness of the population about how mosquitoes breed, about steps that people individually can take, these are resources that are not as available in many of the low-income countries.”

Warming temperatures aren’t the only way climate change is affecting mosquito life cycles. The increased storms associated with climate change can lead to more flooding and standing water, which mosquitoes require in order to breed. Conversely, if climate change exacerbates drought, as it has in Brazil, people without access to running water will store water, which can become a mosquito breeding ground.

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