Samuel Amorim, 2 months, who was born with microcephaly, is bathed by a family member in the kitchen of the family’s home in an impoverished neighborhood of Campina Grande, Brazil. Their neighborhood, which does not have running water for three days out of the week, is therefore infested with mosquitoes. Homes don't have screens on the doors or windows, and hardly anyone can afford bug spray. Last summer, when Alessandra de Sousa Amorim was pregnant with Samuel, she developed telltale symptoms of a Zika infection. When Samuel was born in December, scans showed damage to his brain.
Juggling her tired son Gilberto, who was born with microcephaly, single mother Josemary Gomes, age 34, cleans dishes at her kitchen sink. Gilberto must constantly be held or he will start crying again; babies with microcephaly tend to be more easily agitated than other infants and cry incessantly. Josemary’s days revolve around the 8-month-old, who is showing signs of developmental delays and has started having convulsions. She used to make a living as a cook and cleaner. “My only work now is taking care of Gilberto,” she says.
Josemary Gomes, age 34, reaches her hand out to Jorge, age 4, as she takes a rare moment to rest with Gilberto. Josemary was already raising four boys on her own when she met the man who would father Gilberto. She thought he would take care of them. But when she got pregnant, he told her that he was already married. Josemary is among a growing number of women in Brazil who are raising children affected by the Zika virus on their own. As many as a third of mothers are unmarried in this nation of 200 million, the hardest hit in an epidemic that has swept around the world. Studies suggest that the rate is highest in impoverished, rural villages and crowded slums, the places most affected by the mosquito-borne virus.
Alexandre Santiago holds his son, Samuel Amorim, who was born with microcephaly, in their home in one of Campina Grande’s poorest neighborhoods. Before Samuel was born, Alexandre and his wife, Alessandra de Sousa Amorim, both worked outside of the home. But now, Alessandra no longer has time to work cleaning houses. She says it is very difficult relying on only one income for their household, especially since there are so many new expenses like medical exams for Samuel, transportation, and other things they need for a child with microcephaly. “But when we’re in need,” Alessandra says, “I have no courage to ask.”
The day Josemary Gomes brought Gilberto home from the hospital, she laid him on her bed and wept. When there were no tears left, "I raised my head and carried on alone,” she said. Here, Josemary navigates her kitchen floor, littered with the toys of two of her young sons, after returning from a full day of medical appointments for Gilberto, who has microcephaly. Josemary was already raising four boys on her own when she met the man who would father Gilberto. She thought he would take care of them. But when she got pregnant, she said, he told her that he was already married. “I am Gilberto’s father now,” she says. “I am [his] mother and father at the same time.”
Juliano Herminio takes time each day to do physiotherapy exercises with his 3-month-old daughter, Heloyse, who was born with microcephaly, in their family’s home in Joao Pessoa. Many children born with microcephaly develop severe cognitive and physical disabilities and need expensive therapies and monitoring by specialists. These exercises, which can be done from very early on in a child’s life, are thought to help in their development.
Temperatures soar during the summer in northeast Brazil, and many homes cannot afford air conditioning. Here, Evellyn Mendes Santos, age 9, stands near a door that stays open in attempt to keep the family's home somewhat cool. But without screens on the doors and windows, mosquitoes enter their house easily, raising the chances of getting Zika. Evellyn’s sister, Heloyse, was born with microcephaly earlier this year.
Vivian Amorim, age 4, shrieks with laughter with one of her sisters, Valeria, age 16, in the kitchen of their family’s home. Vivian and Valeria are two of four sisters. Recently a fifth sibling, Samuel, who was born with microcephaly, joined the family. “I don’t let the sadness take over us,” their mother, Alessandra de Sousa Amorim, says. “If we think like that — only negative thinking -- we’d end up crazy! So I don’t get stressed, or get angry about life…about the world and everybody, I will not settle for that!” With four daughters, it was Alessandra’s dream to have a son. When she got pregnant with her fifth child last summer and learned it was a boy during an ultrasound, she screamed with joy. It took her a moment to realize that the doctor was tearing up. The fetus had an unusually small head -- a condition known as microcephaly -- that is one of the most visible defects caused by the Zika virus. When Samuel was born in December, scans showed damage to his brain. Despite the hardships that come with raising a baby with microcephaly, there is still a lot of joy in their home.
“All the doctors said that she wouldn’t make it,” Maria da Luz Mendes Santos, age 29, says, referring to when she was pregnant with her youngest daughter, who has microcephaly. “I cried for 24 hours…I didn’t want to do the baby shower anymore.” Today, she says, she is “very happy…for having her by my side.” Here, Maria holds Heloyse as she visits with neighbors on their street at dusk.
Children kill mosquitoes with their hands behind an abandoned home in an impoverished neighborhood of Campina Grande, as mosquito control agent Danilo de Cavalcanti, right, inspects and drops larvicide into a water hole teeming with mosquitoes and the larvae of the Aedes aegypti mosquito, the species that spreads the Zika virus. With no vaccine or treatment for Zika, Brazil’s government has few options other than sending teams to every infested region to hunt down and kill the insects that carry the virus.
Maria Carolina Silva Floa, age 20, holds her baby, Maria Gabriela Silva Alves, 2 months, who was born with microcephaly, as she waits for her daughter’s physiotherapy appointment at Pedro 1 Municipal Hospital in Campina Grande, Brazil. Maria and other mothers of children with microcephaly bring their babies to physiotherapy appointments two times a week. This type of therapy is thought to help in the development of babies with microcephaly.
The wait is long for physiotherapy appointments for babies with microcephaly, so in the hallway outside of the therapy room, mothers gather and share coffee, cake and news about their babies. The hospital has become a refuge for families, a place where parents can find comfort and camaraderie amid all the uncertainty. “We’ve become a family here,” one mother said.
There is much that scientists still don’t know about Zika and microcephaly, such as how high is the risk? Is exposure more dangerous in certain trimesters? Are there other factors that increase the chances that Zika will cause birth defects? Because of this, the U.S. Centers for Disease Control and Prevention in February dispatched researchers to Brazil to help unravel the mystery. Here, Dr. Megumi Itoh, left, an epidemic intelligence officer with the U.S. Centers for Disease Control and Prevention (CDC), measures the head of 5-month-old Adrielly Rutino, as she is held by her mother. The information they collect will be part of a case-control study, examining the association between women who may have had Zika when they were pregnant and microcephaly in babies. This child did not have microcephaly and was used as a “control” case in the study. For each mother who did have a baby with microcephaly, the researchers wanted to enroll, as a control, three others whose babies were born at around the same time and in the same place but who did not have the condition.
Dr. Megumi Itoh, left, an epidemic intelligence officer with the U.S. Centers for Disease Control and Prevention (CDC), takes a photo of the back of the head of 5-month-old Adrielly Rutino, who does not have microcephaly, as she is held by her mother, Maria Girdielly, age 17. Because there is so much that scientists still do not know about Zika and microcephaly, the CDC dispatched researchers to Brazil to help unravel the mystery. They are collecting this data for a case-control study examining the association between women who may have had Zika when they were pregnant and microcephaly in babies. For each mother who did have a baby with microcephaly, the researchers wanted to enroll, as a control, three others whose babies were born at around the same time and in the same place but who did not have the condition.
Kalissandra de Olivera, age 17, whose days are now packed with medical appointments and meetings, rests on an exercise ball as her son, Nicolas Felipe Alves de Olivera, 3 months, receives physiotherapy at Pedro 1 Municipal Hospital. During her pregnancy, Kalissandra had a normal ultrasound and didn't find out that her child had microcephaly until he was born. She had never even heard of the birth defect and was told to come to Pedro 1 to hear an explanation. She started bringing Nicolas Felipe to physiotherapy when he was 17 days old.
After taking the measurement of a child's head who has microcephaly, Dr. Megumi Itoh, with the U.S. Centers for Disease Control and Prevention (CDC), shows mother Sabrina Mateus, age 17, where her baby's head measurement of 34.2 cm falls on a growth chart -- well below the 1/3 percentile of babies that age and a trait of babies with microcephaly. Sabrina Mateus and her child took part in the CDC and Brazil's Ministry of Health case-control study investigating the association between women having the Zika virus when they are pregnant and microcephaly in babies.
After receiving the news that her son has microcephaly, Francinelma Santos, age 29, holds Jhin Pirlo, 2 months, as she waits for a car to drive them home from the hospital. Because her son has a larger head than most babies with microcephaly, Francinelma was not sure if he had the neurological condition. But during a neurologist consultation appointment with Dr. Alba Batista, it was confirmed. ”Is it really microcephaly?" Francinelma asked, "Yes," replied Dr. Batista. Dr. Batista said only time will tell if Jhin will have developmental problems in the future.
Claudenice Batista, who is eight months pregnant, waits for her appointment in the microcephaly wing of Pedro 1 Municipal Hospital to go over the results of her ultrasound, showing whether or not her baby has microcephaly. Room 117 is where pregnant women come to learn the results of their ultrasound tests. At one time most just wanted to know: Is it a boy or a girl? These days, the first question they ask is: How big is the head?
Amanda Santos, age 19, watches her baby, Emanuel, 3 months, as a nurse and radiologist technician try to calm and prepare her crying son in order to take a CT scan of his head. Emanuel was born with microcephaly, and Amanda believes she had Zika early on in her pregnancy — before she knew she was pregnant. After she found out she was pregnant, she started wearing bug spray, but only occasionally, as she and her family can only afford to buy it every now and then.
Kalissandra de Olivera, age 17, naps next to her son in a hallway of Pedro 1 Municipal Hospital. Between medical exams, physiotherapy appointments, and support group meetings, parents of babies with microcephaly spend long hours — for several days each week — inside this hospital. Pedro 1 is one of Brazil’s first hospitals to open a microcephaly ward.
In the six years that physiotherapist Jeime Leal worked at a pediatrician’s office, she never had a microcephaly case. When she started at Pedro I Municipal Hospital in December, there were seven cases in the wing that was created for patients with microcephaly due to the spike of cases in the region. She now sees twice that number in a single day. Here, Nicolas Felipe Alves De Olivera, 3 months, looks up at Jeime during a physiotherapy session at Pedro 1 Municipal Hospital.
Ianka Barbosa, age 18, left, shares a laugh with Maria da Silva, as they wait for their babies’ physiotherapy appointments at the Pedro 1 Municipal Hospital. The hospital is more than a treatment center: It has become a refuge for families, a place where parents can find comfort and camaraderie amid all the uncertainty. In the hallway outside the physiotherapy room, mothers share coffee, cake, and news about their babies. “We’ve become a family here,” one mother said.
Evellyn Mendes Santos, age 9, kisses her baby sister, Heloyse, who was born with microcephaly, outside of their home in Joao Pessoa, Brazil. “My biggest dream was to have two girls,” their mother, Maria da Luz Mendes Santos, said.
Behind their home, Carla de Sousa, who is pregnant, left, and her mother, Maria de Sousa, listen as mosquito control agents give tips on how to prevent mosquitoes around their home. An agent drew a sample of water being stored in a broken washing machine near their back door; it was full of writhing mosquito larvae. Agents pointed to other places where water had pooled, creating prime habitat for mosquitoes to lay their eggs: old cinder blocks, the dog’s water dish, even a discarded bottle cap. Everything would have to be drained or treated with larvicide, they told the family. Before heading to the next house, one of the mosquito control agents urged Carla to get an ultrasound to be sure that her fetus was developing normally.
After fumigating a neighborhood in an attempt to eradicate the mosquito that causes the Zika virus, a health worker with Campina Grande's Municipal Health Department prepares to remove his gas mask. With no vaccine or treatment for Zika, Brazil’s government has few options besides sending teams to every infested region to hunt down and kill the insects that carry the virus.
Alexandre Santiago hands his youngest daughter, Vivian, age 4, one of the family’s chickens in the backyard of their home. Alexandre is now the sole provider in the family because his wife, Alessandra de Sousa Amorim, no longer has time to work as a house cleaner due to the amount of extra time and care a baby with microcephaly involves. Alessandra says it is very difficult relying on only one income for their household, especially since there are so many new expenses like medical exams for Samuel, transportation, and other things they need for a child with microcephaly. “But when we’re in need,” Alessandra says, “I have no courage to ask.”
“I’m not going to stop buying food in order to buy [bug] repellent,” says Alessandra de Sousa Amorim. The family lives in one of the most impoverished neighborhoods of Campina Grande. Water is stored in containers outside, creating a prime breeding ground for mosquitoes. Homes don’t have screens on the doors or windows, and hardly anyone can afford bug spray. Here, one of Alessandra’s daughters, Valeria, age 16, sorts beans to cook for their family’s dinner.
Evellyn Mendes Santos, age 9, rests on the lap of her mother, Maria da Luz Mendes Santos, age 29, inside their home in Joao Pessoa, Brazil. “Mother, your child won’t survive,” the doctor warned Maria during an ultrasound when she was pregnant with her youngest daughter, Heloyse. “She is too little, she’s not developing, and she will have many more problems,” the doctor went on. “I ask God everyday,” Maria says now, “that she grows up, and walks and studies, and that she’s studious, like her sister.”
Only time will tell what the future is for children born with microcephaly: There are varying degrees of the condition, and at this early stage the babies can often do the same things as babies without the condition. But many children with microcephaly develop severe cognitive and physical disabilities and need expensive therapies, monitoring by specialists, and lifelong care. Some mothers at Pedro 1 Municipal Hospital, where Alessandra de Sousa Amorim, pictured here, takes her baby, have been arriving with questions for the neurosurgeon: Will their children ever learn to walk? Will they ever speak? Dr. Alba Batista wishes she had answers. “Who knows? Only God,” she says. “Here, we are humans.”
According to the Human Rights Watch, 70-90% of women in Pakistan have experienced some form of domestic violence. Government-run shelters throughout the country house women from all walks of life who have come to seek protection.
Some women are brought to the shelter by a family member who has shunned them in the name of honor. Some women come to the shelter on their own, fearing for their lives. If a woman refuses to marry a man of her parents choosing, or marries a man she loves and has chosen on her own, or seeks a divorce from her husband, her family may deem her action dishonorable -- perhaps even punishable by death. Pakistan's Interior Ministry acknowledges more than 4,100 honor killings between 2001-2004.
Many women come in alone, with little hope and once inside they are nearly cut off from the outside world. They are separated into rooms according to their legal circumstances, and leave the shelter only when their court order comes through. Because lawyers are costly, and can only be arranged by relatives or the government, many women end up having no choice but to stay in the shelter for months or even years. But still, inside, they find friendship and support in one another; cultivating hope and rebuilding their lives for when they begin life outside the walls of the shelter.
A Lasting Toll
Two years since the official end of the recession, Californians from all socioeconomic levels remained some of the hardest hit. Still struggling to find work, pay mortgages or simply make ends meet, many are confronting the fact that they may never fully recover.
Reduced earnings, strained relationships and shattered dreams are among the lingering effects on these three southern California families as they continue to endure the hardships brought on by the worst financial crisis since the Great Depression.
Health Care in America
Remote Area Medical (RAM) is a nonprofit organization established to provide medical care in third-world countries. But in the United States, the cost of health insurance has become so high, and the need for care so great, that over half of RAM's free clinics are now in the U.S.
Every summer, RAM comes to the Wise County, Virginia, fairgrounds to hold its largest U.S. clinic, providing close to 3,000 people in one weekend with free dental, vision, and medical care. Most of these people would go without this vital care if it were not for RAM; they simply could not afford it.
People drive hundreds of miles and wait for hours, even days, sleeping in their cars and tents outside the fairgrounds gate. Still, at the end of the weekend, some people are turned away.
Growing Up in a Madrassa
When the Soviets invaded Afghanistan in 1979, many who joined the resistance arrived as schoolboys out of Pakistan. Religious academies there had prepared young bodies and souls for the deadly fight, but since September 11, 2001, these same madrassas stand accused of breeding suicidal extremists.
Students spend their days memorizing scripture, praying five times a day and sharing simple meals. In 2002, the government of Pervez Musharraf required the schools to add subjects such as math, science and English, but, as of yet, most madrassas do not offer the changes. The backbone of all learning, and the ultimate goal of each student, is to memorize the Koran.
In the current generation, Pakistan madrassas house and educate somewhere between 600,000 to 2 million students. Each year, thousands more graduate to become part of the Muslim clergy. Others, however, eagerly join the armed jihad, heading straight for insurgent training camps and on to any target that displeases their elders.