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Caring for mothers and babies on the Zika front line

Zika-linked microcephaly has brought professional and personal challenges for nurses in Brazil. As the world gears up for the Rio Olympics next month, Jacqui Thornton reports from the heart of the outbreak
Baby Graziella

Zika-linked microcephaly has brought professional and personal challenges for nurses in Brazil. As the world gears up for the Rio Olympics, Jacqui Thornton reports from the heart of the outbreak

Paediatric nurse Roberta Seabra quickly and quietly takes control when the mother of baby Graziella breaks down. Ushering visitors from the room, she reassures Inabela Souza about her six-month-old daughter who has been born with an abnormally small head and brain - one of 5,000 babies thought to be affected by the condition microcephaly here in Brazil.

Nurse Roberta Seabra, baby Graziella and Inabela Souza Baby Graziella. Picture: World Vision

Ms Souza has been given a room with a large window above the cot looking out onto the corridor and to the nurses station. I told her this is the right place for you to stay, close to the window, so the doctors and nurses

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Zika-linked microcephaly has brought professional and personal challenges for nurses in Brazil. As the world gears up for the Rio Olympics, Jacqui Thornton reports from the heart of the outbreak

Paediatric nurse Roberta Seabra quickly and quietly takes control when the mother of baby Graziella breaks down. Ushering visitors from the room, she reassures Inabela Souza about her six-month-old daughter who has been born with an abnormally small head and brain - one of 5,000 babies thought to be affected by the condition microcephaly here in Brazil. 


Nurse Roberta Seabra, baby Graziella and Inabela Souza Baby Graziella. Picture: World Vision

Ms Souza has been given a room with a large window above the cot looking out onto the corridor and to the nurses’ station. ‘I told her “this is the right place for you to stay, close to the window, so the doctors and nurses can see you. Don’t be afraid”.’ 

The nurse’s calming words and soothing manner work and soon Ms Souza appears happy to cradle Graziella, who is wearing trademark plastic glasses to improve the sight issues the condition commonly brings. Other complications can include epilepsy and swallowing problems. 

‘This baby is a blessing,’ Ms Souza says, as she attempts to stimulate her with a small brown toy monkey. ‘I believe that God gave this baby to our family, and we are raising her with the most love we can.’  Ms Seabra smiles. ‘Mothers prefer to be here,’ she says. ‘They feel insecure at home.’ 

She has worked at the Oswaldo Cruz hospital in Recife, in north east Brazil, for 15 years. Until last year she had only seen a handful of microcephaly cases; instead her cases were made up of measles, whooping cough and HIV. Now the hospital has 450 babies with the condition under its care and a number are hospitalised each week.

Nurses at the forefront

These newer cases are known by the new term congenital syndrome of Zika (CSZ). Doctors and scientists do not know the full extent of the new syndrome but say the complications are more random than non-Zika microcephaly. 

In the run up to the Rio Olympics next month (5-21 August), Brazil is trying to downplay Zika. Olympics bosses have estimated there will only be one case involving tourists and athletes, and said pregnant women will be safe if they take precautions, even though the World Health Organization has said they should not travel to Zika outbreak areas.  

But public health officials and doctors are concerned about the ongoing risks for poverty-stricken pregnant women in this vast country of 200 million people, the majority of whom live in poverty in cities. 

Nurses are at the forefront of the battle against the virus in this ‘at risk’ group. In Brazil, there are two levels for the profession. A university-trained nurse takes five years to qualify and earns 3,000 Brazilian Reals a month (£600). As assistant nurse takes three years to train and earns R2,000 (£400) a month.  

Primary care nurses play a leading role in identifying Zika symptoms – a tell-tale red rash, fever and pain in the joints in pregnant women, as midwives do not exist as a profession here. Instead obstetric nurses work in hospitals. In primary care, one GP works with one nurse and one assistant nurse to cover a population of 3.5-4,000 people.  

Despite difficulties accessing healthcare generally, pregnant women do have scans at public hospitals and microcephaly is usually picked up at 30 weeks.

Once the babies are born, paediatric nurses take over as part of a multi-disciplinary team. Children have to come back for hospital appointments regularly depending on the severity, which can be difficult given cost, time and distance. 

In Rio de Janeiro, many of the state’s microcephaly babies are being seen at the State Brain Institute. Here, neurologists are trying to teach mothers how to do exercises to stimulate their babies as there is not enough capacity in the local areas for them to be helped by nurses, speech therapists and physios.

Strains and emotions

Assistant nurse Simone Santiago has been dealing with some of the institute’s 61 confirmed and 271 suspected cases of microcephaly in the state. She works with a qualified nurse, two paediatricians, a psychologist, a social worker, two physios, a speech therapist and a dentist.

The mothers have three distinct sessions over the course of a month – first, a consultation lasting a day; second, clinical examinations a week later; and the third, when a dossier is given to the parents with full diagnosis and in-depth information they need going forward. Even if the children are diagnosed at birth, they are first seen by this specialist team at the optimum time, four to eight weeks old. 

Intensive care paediatrician Fernanda Fialho says: ‘Our main goal is the social assessment for these children. Nurses do half the work. We couldn’t work without them.’

Assistant nurse Ms Santiago has worked here for three years, and is training at night school to become a nurse. When asked why she wanted to join the profession, she lights up. ‘I was born to do it.’

Regarding microcephaly cases, she says although there are clinical tasks, it’s the caring and teaching roles that are key, including helping mothers to feed babies who commonly have reflux and swallowing problems. ‘I learn new things every day. Mothers are often devastated and need support and love. I give them that.’    

But not everyone has her resilience. In Recife, Ms Seabra, who works two 7am-7pm day shifts, then has a day off, reveals that four nurses out of the total 32 in her unit have quit as they found it too difficult. 

Despite the strains and emotions involved in nursing microcephaly babies, she says the new challenges have been satisfying. ‘There’s the emotional intensity of the parents, they come here thinking they are condemned. I tell them this hospital is a reference centre and that we can help them in every possible way.’ 


Baby Graziella. Photo: World Vision

She smiles, looking at Graziella, and adds: ‘And the babies are very special.’

Nurses starting a family in a Zika zone

Zika has been personally challenging for nurses of child- bearing age who want to start families. Doctors are advising women not to conceive, backed by WHO.

Insect repellent can protect against the Aedes aegypti mosquito which transmits the virus but repellents are expensive, even for nurses. ‘Often they are sold out anyway.’ In poor communities, NGO World Vision Brazil has been providing free repellent, bed nets and advice to pregnant women.          

Younger nurses have time for a family life later. But for older women, the decision becomes very difficult.  Luciana Caroline Albuquerque, 38, executive secretary for health inspection in the state government of Pernambuco, says young women have been scared of getting pregnant, including nurses. She has one child and does not know whether she should try for another

For Roberta Seabra, there is no question. She has been trying for a baby for five years and at the age of 37 knows she has no time to waste. 

Her boss, Maria Angela Rocha, says women of this age need to be pragmatic, and try to conceive in the lowest risk season for mosquitoes which starts now, in Brazil’s winter. ‘It’s a personal decision. Take care, take precautions.’ 

In Rio, Ms Albuquerque says pregnancy is the talk of the hospital for female workers. She says: ‘Everybody asks me this. I don’t have any plans to get pregnant - with or without Zika.’  

Jacqui Thornton is a health writer

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