After the Mosquitoes Went Away: A Review of Debora Diniz’s Zika

In April 2015, Géssica Eduardo dos Santos — a Brazilian woman who lived in Juarezinho, a small town in the interior of the northeastern state of Paraíba — became pregnant for a second time. Géssica already had a young daughter, and this time she and her husband Silvandro da Silva Lima were hoping for a son. When she was five months pregnant, Géssica got a fetal ultrasound. The results were devastating. It showed that “the fetus was accumulating liquid and part of the brain was missing.”1

Géssica had contracted Zika early on in her pregnancy — before anyone knew that it could affect fetal development. After the ultrasound, Géssica donated amniotic fluid to clinicians and laboratory scientists who confirmed the presence of the virus. When she gave birth to her son, João Guilherme, four months later, he died soon after. Géssica then donated his body to scientists working on the link between Zika and fetal development.

Géssicais just one of the women that professor, bioethicist, and documentary filmmaker Debora Diniz highlights in her new book on the Zika virus, which explores in a lively and easy-to-read fashion the 2015 unfolding of the virus in Brazil and beyond. Diniz presents the story of Zika as one that happened in three stages.

A female Aedes aegypti mosquito feeds on a human host in Dr. Grayson Brown’s lab at the University of Kentucky in Lexington, Ky. (UK College of Agriculture/Flickr)

When Brazilians began presenting with an “allergic” rash in early 2015, bedside clinicians in the rural northeastern states of Alagoas, Bahia, Paraíba, Pernambuco, and Rio Grande do Norte took notice. Brazil was already experiencing epidemics of Dengue and Chikungunya, viruses that cause high fevers, muscle aches, and fatigue. But practicing physicians were confused why their patients presented rashes that mimicked some of these symptoms without the accompanying fever. As these clinicians began conversing over phone, text, and email, they realized a new virus was circulating in the country. Some suspected that it was Zika.

The first laboratory scientists in Bahia soon isolated the Zika virus in the blood of patients, something confirmed by tests done in the Fundação Oswaldo Cruz (Fiocruz, the Brazilian equivalent of the NIH and CDC combined). When the Minister of Health gave his first press conference on May 14, 2015, he assured the public there was nothing to worry: “…Zika does not worry us. It is a benign disease, which can be cured.”2 How wrong they would be.

Bedside clinicians in Pernambuco and Paraíba made the connection between Zika and microcephaly (the more scientific term is congenital Zika syndrome, which includes various symptoms, one of which is microcephaly). Female obstetricians hypothesized that their pregnant patients, who had all contracted Zika during their first trimester, presented with fetal abnormalities because of vertical transmission (mother to fetus). Their bedside research was crucial in isolating the Zika virus in the amniotic fluid of their pregnant patients. Again, it was physicians from the country’s poorest region — and not scientists in the wealthier and better-funded institutions of Rio de Janeiro and São Paulo — that provided the crucial research in identifying the cause of microcephaly.

Brazilian government information session on Zika virus prevention. (Prefeitura de Paulínia/Flickr)

The third chapter in the Zika story is one that is still unfolding: the government response and the real implications for women’s health and reproductive rights in Brazil — and across the globe. As Diniz argues, “There would be no epidemic like the one in Brazil had the land not been hospitable to the explosive spread of the disease thanks to its mosquito populations, poor sanitation, and feeble public health policies for addressing new diseases.”3

It is the poorest women — those who lack proper sanitation, that have to travel hours by precarious public transit hours just to visit a doctor, that often fall through the cracks of a strained social safety net — who are most affected by the disease. But so are all women of reproductive age. While the outbreak was most prominent in the northeast, Rio de Janeiro also had a serious one. And Zika is circulating in many other countries that lack effective public health services and social safety nets.

Government responses in Brazil have focused on eliminating the Aedes Aegypti mosquito that carries Zika (as well as Dengue and Chikungunya). Diniz demonstrates that this misses the larger point: Zika is not just about mosquitos; it’s about women’s health. As Diniz argues, “A third chapter is waiting to be added to the story of Zika in Brazil, a chapter in which addressing women’s reproductive health needs becomes tantamount to addressing public health needs.”4

Diniz is part of a group pushing for the decriminalization of abortion in relation to Zika. Currently, if a woman contracts Zika during her pregnancy, she has to carry it to term or undergo an illegal procedure. Clearly, public health policy needs to center women.

Zika by Debora Diniz. (©University of Chicago Press)

The book is a translated version of Diniz’s 2016 Portuguese version of the same name (Zika: do sertão nordestino à ameaça Global) (Civilisação Brasileira), which has a near-similar structure. The translator Diane Grosklaus Whitty does an excellent job infusing the English-language text with its Brazilian spirit. At times, however, I felt that the translation glossed over aspects of Brazilian culture not evident to North American or European readers.

When another woman, Maria da Conceição Alcantara Oliveira Matias, contracted Zika during her first trimester in June of 2015, for example, Diniz writes that Conceição became sick on the eve of the Feast of St. John, which in the rural northeastern state of Paraíba, “is more than a holy day … the year is divided into before and after June 24.”5 Diniz tells us that Conceição felt so ill she missed the festivities. The text then quickly moves on to the subsequent tests Conceição underwent and the devastating results: fetal microcephaly.

Reading this section may come across as jarring to those unfamiliar with the importance of the holy day. As a person familiar with the festas juninas, as these June parties are called, I could imagine the sights and smells: the sweet cornbread (bolo de milho), canjica (a porridge made from white corn, milk, sugar, and cinnamon), and pé de moleque (literally “boy’s foot”), a peanut brittle. The festive flags, caipira (“rural folk”) costumes, and “square-dancing” (quadrilha).

Without this knowledge, this sentence comes across as out-of-place. Why does it matter if Conceição missed the party? She had Zika! Diniz hints at the importance of the event — something Brazilians would understand in just a sentence. But the passage doesn’t show non-Brazilians the important cultural role of these festivities — you have to be really sick to miss one.

I also wanted more about the individual women who contracted Zika. Diniz highlights three women: Géssica, Conceição, and an Italian woman named Sofia Tezza who became pregnant while living in Recife, another northeastern city. But she interviewed and engaged in ethnographic research with many, many more women whose stories don’t appear in the book. This is partly because Diniz highlights how bedside clinicians from one of the country’s poorest regions — and not fancy laboratory scientists in the richer southeast — discovered and diagnosed the problem.

She also includes much-needed analysis on the global implications of Zika — especially for women of reproductive age. Yet I was still left wanting a little more about the women themselves. Diniz also has a documentary on Zika out, which focuses on these women’s lives. Reading the book in conjunction with the documentary will give a fuller picture of these women’s lives.

And we need to keep that in mind going forward. The Zika outbreak might have died down in Brazil, but it will rear its head elsewhere. And there are still thousands of Brazilian women who are struggling to raise children with congenital Zika syndrome. We can’t forget them.

Notes

  1. Quoted in Debora Diniz, Zika: From the Brazilian Backlands to Global Threat, translated by Diane Grosklaus Whitty (London: Zed Books, 2017), 49–50. Return to text.
  2. Quoted in Diniz, 40. Return to text.
  3. Diniz, 19–20. Return to text.
  4. Diniz, 108. Return to text.
  5. Diniz, 50. Return to text.

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