In Drogaria Tefé, a pharmacy in the small city in of Tefé in the Brazilian Amazon, the powerful antibiotic Clindamycin is as easy to access as a chocolate bar. The clerk will sell you either without a prescription.
The casual sale of prescription-based medication is common in many parts of the developing world. This situation is due in part to the paucity of trained pharmacists, and sometimes lax enforcement. In the Amazon jungle, the phenomena of increased bacterial resistance is surfacing.
Dr. Ricardo Barbuti, a gastroenterologist and expert in the field of antibiotic resistance in Brazil, attributes the trend to partially to rampant self-medication, but he says physicians are also to blame. “In the smaller hospitals, there’s no control [over] it,” says Barbuti. “So you can prescribe any kind of antibiotic you want in the great majority of hospitals in Brazil.” Physicians in the rural Amazon can see more than 300 patients a day with health concerns ranging from the common cold, to postpartum depression, to Chagas disease. Dr. Barbuti says overworked and underqualified doctors here tend to hand out antibiotics as a cure-all.
The countryside of Amazonas State, whose massive boundaries encompass some of the largest tracts of Brazil’s rainforests, is not densely populated. But in tightly packed Amazonian towns, or in far-flung but often equally compact riverine villages, microbes move through the environment at high speeds.
One common vector is the urinary tract. Dr. Camilo de Oliveira, an immunologist at the general hospital in Tefé, says urinary tract infections are the main worry here. “The biggest factor is the heat; it really favors this kind of infection,” Oliveria explains through a translator. “And this is the case with women far, far more than with men.” Like women everywhere, Amazonian women are more likely to contract urinary tract infections than men because of anatomical differences. In addition, Oliveria says local customs encourage women to hold in their urine for longer periods, leading to infection. “From a young age little boys are told to take off your clothes, pee where you are, whereas little girls might be spanked for peeing on the side of the road. There’s also a lack of public bathrooms and basic sanitation, so women hold it all day until they get home. Men? They just go to the next tree!” says Oliveria.
Talismã, a 22-year-old who lives in an informal settlement in Tefé, purchased antibiotics over-the-counter for a reoccurring urinary tract infection. But she says the medication made the infection worse. “I was interned in the hospital for four days to treat this infection, but …as soon as I left the hospital it got worse,” she explains through a translator. “I went to the hospital again and stayed there for another two days, and the medicine wasn’t working. When I was examined at the clinic another doctor gave me …another antibiotic, that right now is working. It’s not completely cured, but compared to the way it was before, it’s much better,” says Talismã.
There are no single culprits for increased antibiotic resistance in the Amazon. It’s easy to think that rural, loosely populated parts of the world are the best protected against antibiotic resistant diseases. But it’s precisely because the Wild North of Brazil, not unlike the Wild West of American yore, is so expansive and disconnected, that this public health problem is alarming.