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The government say everything's under control --- but they give conflicting tales of what it is

Rash of child deaths in one district of the Ngobe - Bugle Comarca

by Eric Jackson

Local officials and some of the daily newspapers have reported that 42 people have died, almost all of them children, in a rash of deaths in the remote Ñurum district of Panama’s indigenous Ngobe - Bugle Comarca. The Torrijos administration is citing a much lower death toll.

By all accounts the ailment begins with a runny nose, coughing and fever, and when it gets deadly kills with symptoms that look much like bronchial pneumonia.

The latest word from Panama’s Ministry of Health is an October 5 press release that  states "[t]he problem is due to adenovirus and influenza... [and Heath Minister Rosario Turner] rejected any possibility of a deadly germ.... Officially 10 deaths have been confirmed... and 39 are hospitalized."

The document blasted those who accuse the ministry of hiding information, and apologized for expelling reporters from the hospital in Santiago where most victims were taken.

Previous annnouncements by the government were contradictory and then in some cases apparently garbled by news media. The information gap is widened by the difficulty in getting to Ñurum, which is far from any pavement, has dirt roads that become impassable to most vehicles in this, the rainy season, and a population that in many cases lives a long walk from even the dirt roads. Word of a problem first got out in mid-September when local officials contacted the Ministry of Health and then, alarmed by what they considered a lackadaisical response, took their story to the press.

On September 23 Gladys Guerrero, the ministry’s director of epidemiology, denied to a reporter for the tabloid El Siglo that there was any viral or bacterial pathogen at work, attributing the problem to complications of rainy season colds that are common in the area, especially because of its poor sanitary conditions. Guerrero also said that local claims of 10 deaths since late August were exaggerated. Within  five days, however, Ngobe officials were reporting 40 deaths and many more illnesses.

As the crisis unfolded El Panama America reported that police and health care officials begged parents to put their gravely sick kids on a police helicopter to be taken to the government hospital in Santiago, but were rebuffed because the families lacked the resources to sustain themselves in Santiago or pay for their transportation back.

The Ngobe-Bugle Comarca, the youngest of Panama’s semi-autonomous indigenous regions, comprises about nine percent of the country’s land mass and by all accounts has its biggest concentration of poverty. Many of the inhabitants leave for part of the year to pick coffee or other crops. Panama’s long-standing compulsory public education laws are mostly theoretical there. The Comarca, shared among its Ngobe majority and Bugle and other minorities, is politically fractious and its self-governing institutions are not nearly so well developed as in some of Panama’s other indigenous areas. One internal weakness that adds to this crisis is a weak system of traditional health care. The Ministry of Health maintains a relationship with traditional healers like the Kuna inatuledes and the Embera jaibanas, who in many cases serve a triage function for the standard medical services that the ministry offers in addition to dispensing their herbal medicines and other health care techniques. These traditional systems are much less developed in the Ngobe - Bugle Comarca.

If economic marginalization, political atomization, difficult access and cultural breakdown might serve to make the Ngobe - Bugle Comarca a “throw away” region to those who make the nation’s major decisions in Panama City, one factor works against that. The area is home to the largest, most persistent and most volatile swing vote in Panamanian politics. President Torrijos is consitutionally barred from seeking another term in 2009, but he has fairly high approval ratings and there is a chance that his Democratic Revolutionary Party (PRD) can hold onto power. No party has won back-to-back elections since the end of the 22-year dictatorship in 1989. Thus the president has spent a lot of time in the Ngobe - Bugle Comarca, especially on missions for his Network of Opportunities. That program, patterned after similar ones in Venezuela and Brazil, provides the mothers of minor children with stipends of $35 if they make sure that their kids get their innoculations and stay in school. Torrijos has often flown in to remote communities, passed out envelopes with $35 to local mothers, posed for press photographers and made political speeches to maintain his support in the Comarca.

Thus when the initial denials proved premature, Torrijos cut short a trip to the United States and flew into Ñurum with a team of some 60 health care workers. Government officials fanned out to visit the thousands of mothers receiving Network of Opportunities assistance, check on their kids’ health and advise the families that cooperation with health officials is mandatory and that nobody evacuated to a hospital would be left stranded.

As this report was written Ngobe officials put the death toll at 42, the national government at 10, and more than 30 children from Ñurum were being treated in various hospitals around the country. The Health Ministry said in a September 29 press release that the problem appears to be “a known acute viral respiratory situation like influenza,” but on October 1 a ministry spokesman told this reporter that no flu or other virus had yet been identified as the cause. Then in its October 5 press release Health Minister Rosario Turner declared that the deaths were "due to the adenovirus virus and influenza... that principally affects persons with nutritional problems and anemia." She advised people in Ñurum to wash their hands more often.

An influenza strain that mainly affects kids would be unusual and of great international interest in these times when there are attempts to block the spread of new, virulent flu strains. Even fear of such a thing could be very harmful to tourism. But the Torrijos administration declined offers of international help and has not specified which influenza strain or which adenovirus is involved.

Adenoviruses are much more likely to be the cause of an epidemic that mainly affects children. According to the kidshealth.org website, adenoviruses are "[a] group of viruses that infect the membranes (tissue linings) of the respiratory tract, the eyes, the intestines, and the urinary tract, [and] account for about 10% of acute respiratory infections in children and are a frequent cause of diarrhea." The rarely fatal but annoyingly contagious bane of day care centers and schools, conjunctivitis or pink eye, is one of the adenovirus infections. Life-threatening pneumonia and dehydration by diarrhea are occasional complications. The viruses are most often spread by touch, as in when someone with a runny nose from an infection touches his or her nose, then touches a doorknob or other surface, which another person then touches.

The government has not identified which adenovirus it says is involved in these deaths, but insists that it's a "known" rather than a new and more virulent strain.

So what if the ministry's word, with all the uncertainties, is taken at face value? The United Nation's Children's Fund (UNICEF) and a gathering of indigenous women did just that, and came to withering conclusions.

Kids are dying not because there's an unusually severe virus going around, but because they're malnourished and their bodies can't take a mild infection? How can that situation be called "controlled" if there are no special food shipments going into the affected area?

Within minutes of the Health Ministry's October 5 press release, a gathering of the National Indigenous Women's Coordinator passed a resolution declaring that "it is a crime that children, indigenous or non-indigenous, die of hunger as in the recent deaths of Ngobe babies." The women also accused the government of under-reporting the deaths of children from malnutrition and complained that its economic development policies are meant only to benefit "the elitist sectors of the population."

In September the Comptroller General released a report that last year 51 Panamanian children died of malnutrition. President Torrijos regularly claims in his stump speeches that his administration has reduced the amount of poverty and its severity in this country.

The UNICEF director in Panama, Fernando Carrera, concurred. "These children have likely died because of a combination of poor nutrition and the infection," he told a Reuters reporter, adding that the situation is probably not worse this year than in other years. Carrera estimated that about 1,200 kids die every year in Panama and that half of these deaths are poverty related and can be prevented.

If 51 kids died of malnutrition in all of Panama over all of 2006, and in one district of the Ngobe - Bugle Comarca some 40 kids --- or even 10, by the government's lower count --- have died of the same thing in just a few weeks, that would suggest that the government's figures on malnutrition-related deaths are lower than the true numbers and that its claims of having reduced extreme poverty are exaggerated.

Rash of deaths in Ngobe-Bugle Comarca prompts criticism of Torrijos information controls
An epidemic as photo op

Panama rejoining the Andean Community

Sucking up to Pedro Miguel González

Mark Boswell alias Rex Freeman is Winner's new columnist
Panama News Briefs