Rosa Morales chokes up as she tries to explain how her 11-year-old daughter died.
She believes Fer María Jimena caught dengue at school in Peru’s northern city of Piura in June. One night Fer María began to vomit and complained of terrible pains all over her body. The next day, her eyes started to bleed.
After an emergency flight to the capital Lima, even the country’s best specialists couldn’t save her. Within a week, the joyful girl who loved to dance was gone.
“It all happened so fast, I’m in shock,” says Morales, who weeps uncontrollably after laying a bright bouquet of flowers at her daughter’s grave in Cementerio San José, on the outskirts of Piura. “I feel alone. I feel empty without her.”
Piura is the epicentre of what is by far Latin America’s worst-ever outbreak of dengue fever – a mosquito-borne disease also known as “break-bone fever” because of the severe muscle spasms and joint pain it causes – that has led to hundreds of thousands of infections, overwhelming hospitals across the region.
According to Peru’s Centre for Disease Control, there have been 250,000 confirmed and probable cases of dengue, and 419 deaths in total nationwide. Some 75,000 of those cases and more than a quarter of the deaths have come in Piura, a sweltering city of around half a million people near the border with Ecuador.
Top doctors warn the country’s already-fragile health system has been pushed to the brink of collapse as the deadly epidemic has raged for months, fuelled by a perfect storm of extreme weather, vastly inadequate resources and infrastructure, and a political crisis that forced the health minister to resign under a barrage of criticism.
“We risk a total catastrophe, a collapse of the system,” says María Lupu Girón, president of the Medical Federation of Piura. According to the federation, 90 per cent of the health facilities in Piura are inadequately stocked and staffed. “It’s very, very bad,” adds Girón. “Some places have been practically abandoned.”
Marcos Alban Albornoz, a doctor at the San Pedro health centre in Piura, says that his team of nine doctors covering a catchment area of 25,000 people have treated as many as 80 patients per day – overwhelming the capacity of 30 beds. During the peak, it took 20 days for authorities in Lima to process test results, he adds.
‘Urbanisation leading to larger outbreaks’
“We must reinforce our human resources and hospitals,” says Albornoz.
In February, the government declared a health emergency in several regions after recording a 72 per cent increase in dengue cases compared with the same period last year. The following months saw Cyclone Yaku batter northern Peru with torrential rains and floods that provided the ideal breeding grounds for mosquitos.
Dengue outbreaks are common in Peru when mosquitoes breed in masses during its rainy season, which in coastal areas like Piura is from December to March, but experts point to a range of other factors that are driving the surge in cases.
“Urbanisation is leading to larger outbreaks,” says Martin Hibberd, a professor of emerging infectious disease at the London School of Hygiene and Tropical Medicine.
Rapid urban growth in the tropics combined with increasing population density has brought man and mosquito into closer contact than ever before, adds Hibberd.
He also points to recent lapses in mosquito control and the role of climate change, which is increasing the lifespan of mosquitoes and shifting transmission zones.
Some 8.5 billion people could be at risk of dengue by the end of the century if carbon emissions keep rising at current levels, as hotter conditions allow mosquitos to thrive across the globe, a 2021 study published in The Lancet Planetary Health found. That would see 4.7 billion more people in affected areas than the 1970-1999 average.
Many cases of dengue, which has no cure, are asymptomatic or produce only mild symptoms, but it can be fatal in some patients. Two vaccines have been approved for use in the European Union in recent years, but none have been green lit in Peru.
Government measures to tackle the outbreak have included fumigation to kill larvae of the Aedes aegypti mosquito, which spreads the four viruses that cause dengue, and campaigns to encourage residents to use mosquito nets and to avoid having open water receptacles, where mosquitoes can lay eggs.
Yet critics say the impact of the epidemic has been compounded by an incompetent response from the Peruvian government, which has failed to learn from suffering the world’s highest rate of Covid-19 mortality.
“We have learned absolutely nothing,” says Claudia Quezada, an epidemiologist from Piura. Community outreach teams could nip outbreaks in the bud via early detection, she adds, but not enough funding has not been provided for epidemic surveillance.
Last week, hundreds of health workers in Piura took the streets to protest the low wages and insufficient funding. Last week it was revealed that the region would be receiving three million soles – roughly 1.50 soles (£0.33) per person – from the central government to fight dengue, despite the fact it requested 76 million soles.
“How do they expect us to fight this epidemic when we are given scraps?,” says Víctor Raúl Guerra Bazán, general secretary of the medical workers’ union in Piura.
Peru’s Ministry of Health did not respond to multiple requests for comment.
For now, despite the high risk in places like Piura, where poverty rates are high and where many are not serviced by the municipal water network, residents say nothing is being done to help protect them from the epidemic.
“There are so many mosquitos, we’re swarmed at night,” says Maria Griselda Galan Castillo, who lives in a ramshackle home in a settlement of 3,000 people on the edge of the city.
The 47-year-old, who caught dengue last month and was bedridden for weeks, says water is delivered by trucks just two or three times a week, meaning it must be stored in tankards that draw mosquitos. Two neighbours died of dengue last month.
Authorities refused to fumigate the community despite their requests, adds Castillo, who has no mosquito nets and just one bottle of repellent to protect her three children. With the rainy season set to return in a couple of months, she fears that another, even more devastating wave of dengue could soon strike.
“We have been abandoned,” says Castillo, clutching her son and daughter close.
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