EPIDEMIOLOGICAL BULLETIN (01/06/2020)
On June 21, 2020, Maranhão exceeded the number of 70 thousand confirmed cases of Covid-19 (MARANHÃO, 2020). Despite the easing of isolation rules and the gradual reopening of trade in many municipalities, the number of registrations is still growing, especially in municipalities on the continent. Consequently, when we look at the municipalities that affect Indigenous Lands in the state, we observe that the cases of Covid-19 continue to increase, as shown in the map below.
The increase in confirmed cases of Covid-19 in the municipalities of the State directly affects the spread of contagion among indigenous peoples, given the permanent communication between municipalities and villages, despite the social isolation and the adoption of health care that the indigenous people have been adopting as a protocol. of security. However, going to the headquarters of the municipalities is necessary, albeit in a much smaller proportion of exits from the villages, to reproduce their own physical subsistence through the purchase of food products, clothing, etc. that are not found in the villages, as well as access to emergency aid from the federal government. On the other hand, the entry of non-Indians into the territories of the villages, despite the vigilance of the indigenous people, did not stop happening due to the pandemic. So, contamination ends up becoming a two-way street.
The data presented below by the epidemiological bulletins of the DSEI - Maranhão / SESAI and the State Health Secretariats of the municipalities record this growth in cases of Covid -19 among the indigenous people.
In reading the table above, it should be noted that the first case of registration of confirmation of cases of Covid-19 among indigenous people in Maranhão, dated May 13, because prior to this period there would be suspicious cases registered in the DSEI-MA bulletins. / SESAI and continuously discarded. And, even when confirmed cases appear in the bulletins, the cases discarded are also significant, with a very low number of indigenous people with signs of active infection of the virus.
This change in proportion will happen when the number of confirmed persons increases 140% (these data can be observed in the bulletins between the 20th and the 21st of May), with active cases that exceed the number of discarded. From that date on, the evolutionary picture of the new coronavirus among indigenous people gradually increases. In eight consecutive days after this peak of evolution, a new evolutionary picture appears, that is, it goes from twenty-one (21) confirmed cases on the date of May 21, to 76 cases on the date of May 29. In other words, an increase of 261.9%, with a high degree of cases with active virus (73) and one (01) clinical cure. Based on this evolutionary picture of the incidence of confirmed cases with very low clinical cure, the first case of death among indigenous people occurs, registered by DSEI-MA / SESAI on June 4th. This number rises to seven (07) deaths on the date of the last collection made by the Mururu collective on June 20, 2020.
Below, the graph of the data from the SESAI / DSEI-MA table analyzed above.
SESAI's epidemiological bulletins are consistent with the invisibility of indigenous peoples as well as the bulletins of municipalities, with an aggravating factor with regard to the first. The SESAI publication cites gross numbers, following a structure of dialogue between epidemiological variables and the number of cases for each variable. For example, looking at the table and graphs above, it is not possible to say the name of the people, which Indigenous Land they belong to, the village, etc.
In contrast, the cases registered by the municipalities, if they do not follow the ethno-linguistic principles of the indigenous peoples existing in Maranhão, at least present indications of where to search for this data by peoples, as it allows us to trace from the given “village” and “TIs ”, Which are the people that are being affected by Covid-19. However, they do not mention deaths. The only reading that can be obtained in the bulletins of some municipalities is the registration of confirmed cases. But it is not possible to follow the evolution of the disease.
Our intention, as a collective that intends to be a partner in this endeavor to give visibility to the health situation of indigenous peoples, is to build qualitative data about these diverse peoples located in Maranhão. In this context, the following table was constructed, discriminating the peoples in which these municipalities are involved, as well as to which base they are administratively linked.
As mentioned above, based on research by Coletivo Mururu, it was possible to identify peoples in relation to the municipalities that refer to health care. When viewing this table, it is clear that the indigenous people most affected by Covid-19 are the tryhar / Guajajara. It is perceived that the indigenous people most affected by the pandemic is tryhar / Guajajara since they have the largest indigenous population in the state and also because they are distributed in 10 demarcated indigenous lands (in addition to residing in other peoples' lands). Thus, outside the municipality of Fernando Falcão, where the Apaniekra / Canela and Ramkokamekra / Canela are located, the tryhar / Guajajara are located in the various municipalities that register cases of Covid -19.
As can be seen above, the confirmed cases of Covid-19 among the Tenthar / Guajajara already add up to more than 390 cases if we take into account that in these municipalities, where more than two indigenous peoples reside, the prevalence is of the temptation / Guajajara people, as well as in the Arariboia indigenous land, where, besides them, live the Awá (people that have groups of new contacts and others in voluntary isolation). We assume that the contaminated peoples in the TI Governador are the Gavião / Pukobyê, since they are in greater numbers in this land, where fifteen (15) cases are registered. However, the Krenyê also reside there. But the municipalities do not register who the indigenous people are.
With reference to the Canela, Apaniekra and Ramkokamekra peoples, eighty-three (83) confirmed cases have already been registered, with eighty (80) among the Ramkokamekra of the Escalvado village and the Velha village and three (03) among the Apaniekra of the Porquinhos village. With reference to the Krikati people, if we take into account that they are the majority in these municipalities, to the detriment of the Guajajara people that inhabit this TI, there are forty-seven cases (47) distributed in two municipalities, Montes Altos and Sítio Novo, respectively in São José and Nova Jerusalem villages.
Below we present the graph with the data of the cases of Covid-19 among the indigenous population of the municipalities with the intention of giving visibility to the evolution of the cases. Below is the graph and analysis from May 31, June 10 and June 21, 2020 .
Regarding the number of confirmed cases that were collected on the days referred to in the previous paragraph, it can be seen that the municipality of Amarante initially identified six (06) cases in the TI Arariboia in the first bulletin (on May 31, 2020), increasing to eleven (11) and decreasing to nine (09) cases on June 21, 2020. This implies cases of cure, although not mentioned in the bulletin, which only records confirmed cases.
Still in the same municipality, at TI Governador, which initially registered seven (07) cases, decreasing to six (06) and then increasing to fifteen (15) cases. In Arame, there are initially twenty-three (23) cases, increasing to seventy (70) and rising to ninety-two (92) cases, on June 21, 2020.
The municipality of Barra do Corda in the first bulletin did not present indigenous cases from Covid -19. In the second bulletin of 06.10.20, they reported one (01) case and on 06.21.20, fourteen (14 cases). Here, it is registered, a high percentage increase of contamination of 1,300% if we count from the first bulletin in which no case was registered.
In Bom Jardim, the epidemiological bulletin initially recorded twenty (20) indigenous cases. Already in the bulletin of the day 10.06. 20 registered cases evolved to thirty-four (34) cases and on June 21. 20 for eighty (80) cases. The municipality of Fernando Falcão, as well as Barra do Corda, in the first bulletin did not present any case of Covid-19 among indigenous people. In the second bulletin of 10.06.20, he presented thirty-one (31) cases, increasing considerably to eighty-three (83) cases in the last bulletin dated 06/21.20. We identified a high percentage of contamination at the rate of 167.74% if we count from the first bulletin in which no case was registered.
Jenipapo dos Vieiras follows the significant percentage increase identified in the other municipalities mentioned above. In the first bulletin, he did not identify any indigenous cases of contamination. The second bulletin, on May 10, 2020, records eighty-seven (87) cases and on June 21, 20, it records a number of 170 cases, which in percentage terms is equivalent to 95.4% of contaminated indigenous people in a short time.
In the Montes Altos bulletin five (05) cases are registered on 05/31/20. In the following bulletin, eleven (11) cases. The last bulletin of June 21, 20 registered twenty (20) cases in Montes Altos, which appears to be a case of stability in terms of the evolution of contamination cases, despite the existence of underreported cases in relation to the indigenous population. Finally, the municipality of Sítio Novo, which maintained the same 27 cases in the three highlighted bulletins. We hypothesize a situation of stability in the contamination of the Krikati peoples who inhabit both municipalities or underreporting of cases.
However, one of the questions that instigates us at this point concerns the health system and its functioning. If health care for indigenous peoples is part of a system that dialogues with each other (basic health units / health posts, base poles, CASAI, DSEI-MA, SESAI), at different levels (local, state, national), by that SESAI and the municipalities do not dialogue? Why are the data (quantitative and / or qualitative) unevenly presented? And the most serious, why not register the cases of Covid-19 among indigenous people based on the ethnic diversity of the peoples?
In this way, we have closed yet another Complete Epidemiological Bulletin pointing out a series of analyzes referring to the data we have been able to collect to date, raising questions, pointing out the importance of mapping networks in this process of visibility of the impacts of the pandemic among indigenous peoples in the state of Maranhão and reiterating the need for public policies that assist these peoples. We continue in the daily struggle in search of information that will help us to expand our network and we ratify the importance of dialogue with the indigenous people and supporters of this very urgent and necessary cause.