Beyond the Capacity to Cope in Ecuador

"The situation is dire in Guayaquil at this moment."
"There are dead bodies in the streets, and the health system is collapsed, so not everybody who has symptoms can get tested or treatment."
Tati Bertolucci, director, Latin America and the Caribbean, CARE

"I work in a very wealthy part of the city, north of Guayaquil."
"I can tell you that people are starting to understand that even having all the money and political contacts, you might not survive this."
"People are dying like flies here."
"I don't have a single colleague not telling me they don't cry every day after a shift. This is overwhelming."
Marcelo Castillo, intensive care physician, Kennedy Clinic Hospital, Guayaquil

"She was coughing, and I had to fight for her to even enter to the hospital."
"I fought with all the doctors and nurses. There were so many people there."
"I should have taken her to a private clinic. I thought that as a hospital they would be more prepared for this."
"Before leaving her at the hospital that day, she told me her vision was blurry and I remember saying that everything was going to be OK. I didn't know it was going to be the last time I would see her face."
"If I saw her now, I would tell her, I will love you forever. And that I'm sorry it wasn't me."
Dante Logacho, 49, publicist, Guayaquil, Equador

"The lockdowns were less effective in Guayaquil."
"In other parts of the country, more people complied. In Guayaquil, you also have areas with no basic services, really small housing units and denser living."
Sebastian Hurtado, head, Ecuadoran political consulting firm, Profitas

Men with protective suits load a coffin into a car in front of a Guayaquil hospital.

It is in the largest city in Ecuador, a city of close to three million population where the most intense infection rate and swiftest collapse of the medical system is taking place as the epicentre of the novel coronavirus outbreak in Latin America. Aid workers, officials and others in the metropolis are all reporting dead bodies being left uncollected on sidewalks, or corpses left to decompose within homes for days at a time, where temperatures rise to 90F.

The country's initial case of COVID-19 was brought in by a 71-year-old Ecuadoran women returning from Spain on Valentine's day, to Guayaquil, with the disease emerging on February 29. The infection rate has climbed steadily since then, to the current 2,200 cases representing about 70 percent of Ecuador's total numbers; far in excess of the numbers infected in the capital, Quito.

Hospitals in the city were swiftly overrun with cases and mortuary workers refused or were unable to collect bodies from homes. In the overheated atmosphere where decomposition is swift, families saw little option but to remove the bodies of their dead ones from their home interiors to the street beyond, waiting for them to be taken away. And they haven't been.

Where the Italian army mobilized to haul cadavers out of Bergamo, the epicentre of the epidemic in Italy when the crematoria there were overwhelmed, and authorities in Iran dug mass graves, and the Spanish military discovered elderly patients in care homes dead in their beds, abandoned, Guayaquil now adds to the inventory of hard-hit countries incapable of coping with overwhelming numbers of seriously ill and dying citizens.

Relatives wait outside of a hospital for information on family members infected with Covid-19 in Guayaquil on April 1.

In Guayaquil, about 30 bodies daily have been recovered by a joint military-police operation. A citywide curfew interfered with mortuary workers' efforts to remove bodies, according to Jorge Wated, co-ordinator of a government task force with the assignment of managing the crisis. "We recognize any errors and ask for forgiveness from those who have had to wait to remove their loved ones", he announced, while warning the death toll could reach 3,500 dead in Guayaquil alone.

As an international port city, impoverished harbour workers feeling little option left to them but to continue earning a living despite calls for social distancing, helped to fuel the infection rate. Gallons of soapy water have been poured on city streets by dump trunks, in a sanitation effort. Shipping containers had been placed at hospitals to store cadavers.

"The images (of bodies in the streets and corpses left in homes for days) that are going around the world are real", said the city's mayor, Cynthia Viteri, herself struck by the novel coronavirus. "Why? Because our health system is the same one we had before the pandemic, a health system that in the midst of a pandemic has collapsed."

A coffin containing the body of a person who is supposed to have died from Covid-19 lays wrapped in plastic and covered with cardboard, outside a block of family apartments in Guayaquil on April 2.

The Profitability Factor in Obesity

"Everyone here knows that Nestle products are good for you."
"[Look, Muciolon infant cereal's label says it is] packed with calcium and niacin."
Celene de Silva, 29, door-to-door Nestle vendor, Fortaleza, Brazil

"The essence of our program is to reach the poor."
"What makes it work is the personal connection between the vendor and the customer."
Felipe Barbosa, Nestle supervisor

"On one hand, Nestle is a global leader in water and infant formula and a lot of dairy products."
"On the other hand, they are going into the backwoods of Brazil and selling their candy."
Barry Popkin, professor of nutrition, University of North Carolina

"When he was a baby, my son didn't like to eat -- until I started giving him Nestle foods."
"Every time I go to the public health clinic, the line for diabetics is out the door. You'd be hard pressed to find a family here that doesn't have it."
Joana D'arc de Vasconcellos, 53, Nestle vendor, Fortaleza, Brazil

"It's a crisis for our society because we are producing a generation of children with impaired cognitive abilities who will not reach their full potential."
Giuliano Giovanetti, outreach and communications, Center for Nutritional Recovery and Education, Brazil

In 2014, almost 9 percent of children in Brazil were deemed to be obese, representing over a 270 percent increase since 1980, a recent study at the University of Washington revealed. As in North America, parents are busy, and to save time they give their toddlers instant noodles and frozen chicken nuggets, and oh yes, soda to drink instead of the culturally normative rice, beans, salad and grilled meats.

Brazil's traditional eating style has evaporated with the rapid rise of fast food and the wide and eager acceptance of convenience foods.

Nestle had so kindly sponsored a river barge to deliver cartons of milk powder, yogurt, chocolate pudding, cookies and candy to communities in Brazil that are isolated in the Amazon basin. Just because it was difficult for people living in inconvenient places to access convenience foods, avuncular Nestle felt they shouldn't be deprived of the opportunity to treat themselves to the same wonderful grade of food accessible to those living in urban centres.

Nestle no longer operates that river barge delivering tens of thousands of such food preparations. Taken out of service, private boat owners, recognizing a wonderful retail opportunity for themselves have taken up the slack. See what Nestles does for under-served communities? Their initial presence gifts people whose traditional diets are soooo boring with sweet, salty, mouth-watering treats, convincing them they've discovered food heaven; once addicted, private enterprise can take over...



In 2006, the government of Brazil took the initiative to enact food-industry regulations in hopes of curbing obesity and disease with measures included to notify Brazilian consumers through advertising alerts alerting people about quasi foods, and with the intention of installing marketing restrictions to diminish the attraction to highly processed foods and sugary drinks, aiming in particular at products marketed to children.

At public hearings the food industry appeared cooperative. According to health advocates however, corporate lawyers and lobbyists were involved in a multi-pronged campaign to scupper the government's intent. Food industry representatives went so far as to accuse Brazil's health surveillance agency of subverting parental authority; mothers, after all, have the right to determine how and what their children should eat....

Lawsuits were filed by industry groups against the health authority representing chocolate, cocoa and candy companies claiming the proposed regulations would violate constitutional protections of free speech, and that the agency was absent the authority to regulate the food and advertising industries. And then the federal government's premier lawyer, its Attorney General, made common cause with the industry and the regulations were suspended.

Elisângela Ferreira, 36, Luiz da Silva, 42, Lisyane Soares, 39, Cristiane do Nascimento, 34, Carlos Cordeiro, 50, Veronica Cabral, 28, (face hidden), her baby Lidia and daughter Debora, 8, take part in an exercise class for obese people at the nonprofit GRACO on Nov. 17. (Dom Phillips/For The Washington Post)

According to Dirceu Raposo de Mello, a former director of Anvisa, the health surveillance agency for Brazil: "The industry did an end run around the system". Food companies spent $158-million in 2014 as donations to members of the nation's National Congress, according to Transparency International Brazil whose study released last year revealed that over half of the current federal legislators had been favoured with donations from the food industry enabling their election wins.

In 2015 the Supreme Court finally banned such corporate contributions to democracy.

Mrs. da Silva, one of many Nestle's devoted food vendors delivers their comestibles on her sales route to poor households bringing them the packaged foods they have learned to depend upon. One of thousands of such door-to-door vendors whose role in expanding Nestle's reach to a quarter-million homes in far-flung corners of Brazil is herself obese at 100 kilos, with high blood pressure; without doubt owing much to her addiction for fried chicken and Coca-Cola.

She was delivering variety packs of Chandelle pudding, Kit-Kats and Mucilon infant cereal to customers as visibly overweight as she herself, including their children. Nestle representatives claim their products are important in the alleviation of hunger and the provision of vital nutrients, that it has reduced salt, fat and sugar from many of their formulae. "We didn't expect what the impact would be", Sean Westcott, head of food research at Nestle admitted of the obesity-and-disease side effect of processed food becoming more widely available.

Nestle, after all, cannot control peoples' tendency to overeat once they can afford more food. And Nestle has made their products affordable to the poor. In China, South Africa and Latin America. Where food giants lobby governments and attain political influence. Packaged foods sales grew 25 percent worldwide in five years, from 2011 to 2016, said Euromonitor, a market research firm.


As for sales of carbonated soft drinks, Latin American sales have doubled since 2000, exceeding even sales in North America by 2013, reported the World Health Organization. Fast food has almost kept pace, with 30 percent growth worldwide from 2011 to 2016. So the people living in the slums of Fortaleza are fortunate; without access to a supermarket they have packaged food delivered directly to their door via Mrs. da Silva. Representing a campaign that serves 700,000 "low-income consumers each month", according to Nestle's website.

Good global corporate citizens. Low and falling incomes among Brazil's poor and working-class has actually spurred direct sales. How so? Nestle allows customers a full month to pay for whatever they buy and the saleswomen are very aware of when their clients are scheduled to receive their monthly government subsidy given to low-income households. Though Nestle cites 800 products available through its vendors, Mrs. da Silva points out that her clients for the most part are interested in sugar-sweetened products such as Kit-Kats, Nesle Greek Red Berry and Chandelle Pacoca.

As for Mrs. Vasconcellos, she has diabetes and high blood pressure as well, while her 17-year-old daughter weighs in at over 115 kilos, with hypertension and polycystic ovary syndrome, linked to obesity. Others of her relatives have a variety of ailments associated with poor diets, including her mother, two sisters and her husband. And then there's Elaine Pereira dos Santos, 35, mother to two, 9 and 4 years old, both overweight.

The 9-year-old weighs 62 kilos: "I always thought fatter is better when it comes to babies", so she encouraged him to eat at fast-food outlets. She finally realized something was fundamentally wrong, when her son could no longer run as young boys should. "Unlike cancer or other illnesses, this is a disability you can't see", observed Juliana Dellare Calia, a nutritionist at a Sao Paulo nursery where children are enrolled who have dangerously fatty livers, hypertension -- and poorly nourished toddlers unable to walk properly.

One in three children in Brazil are overweight because of processed food. Photograph: Stefano Rellandini/Reuters

csmonitor.com

The fattening of Latin America mirrors a global pattern that has left some 1.5 billion adults overweight. Now, from Mexico to Chile, it's triggering a political response.

Pregnancy Prevention and Birth Outcomes in Latin America

"Some of the emails that come in [to website Women on Web] were heartbreaking. [A woman from Venezuela wrote:] I contracted Zika four days ago. I don't know who to turn to."
"Please help me ASAP!"
"When you issue these kinds of advisories [notifications to the public by national health authorities to avoid pregnancy due to Zika], but you uncouple them from pathways to safe and legal care, you create a really difficult situation for women. Many of these women felt underinformed and very scared."
Dr. Abigail R.A. Aiken, reproductive health expert, University of Texas, Austin

"The increase in demand for abortion observed by the [study] authors in countries affected by Zika could be spurious because Women on Web accounts for a small share of all abortions in that part of the world."
Dr. Gilda Sedgh, principal research scientist, Guttmacher Institute

Material to prevent Zika infection by mosquitoes are displayed at the 69th World Health Assembly at the United Nations European headquarters in Geneva, Switzerland, May 23, 2016. Reuters/Denis Balibouse

Women in seven Latin American countries that have suffered Zika outbreaks have frantically been ordering abortion pills on line, since fear and discretion go hand in hand for these women living in countries where abortions are illegal. That would include countries that have officially given warning to their citizens that the Zika virus may cause severe birth defects. Websites like Women on Web have noted a considerable increase in contacts requesting help to interrupt pregnancy.

According to a study published by The New England Journal of Medicine last month whose authors includes a leader of the Amsterdam-based group supplying the pulls, increased numbers of requests have come in from Brazilians, Ecuadorians and Venezuelans. While requests have doubled from those sources, women making contact from Colombia, Costa Rica, El Salvador and Honduras rose from 35 to 75 percent.

Yet orders received by Women on Web emanating from Latin America and the Caribbean in the period between November 2015 and March 2016 represent a minuscule proportion of the number of abortions that actually take place. Women find ways to abort unwanted pregnancies, and they may not always be successful outcomes. There is an estimated 3.5 million abortions annually in countries where authorities issued Zika warnings.

The pathology of Zika's threats to health give impetus to a new look at strictured access to abortion in the many countries now affected by Zika. In Latin America and the Caribbean about 6.5 million abortions take place each year, and most of them are illegal; in those places where abortion can take place legally if a foetus is felt to be compromised, only in the first trimester is abortion permitted.

The study authored by Women on Web studied orders for abortion pills from the time the Pan American Health Organization issued their alert stating that Zika could be linked to a disastrous surge in infant deformities. The study authors found statistically significant increases in requests for abortion in seven of the eight countries where Zika is circulating, where abortion is limited and women had been warned by authorities of the risk of Zika in pregnancy.

And the stark reality is that the current Zika outbreak has been linked to over one thousand, four hundred cases of microcephaly, a rare birth defect that can lead to severe developmental problems.