After 24 hours of travelling on the Anapu river, located in northern Brazil in the Ilha de Marajo (Marajo Island), we reached our first stop, in Ipixuna, a small riverside community in the remote Portel municipality.
The main objective was to provide healthcare for people who were suspected to have COVID-19. However, our teams knew that they could find other health issues along the way and so they incorporated a strong primary health component to be able to assist patients with other diseases.
The Portel municipality has one of the worst Human Development Index (HDI) averages in Brazil, according to the Brazilian Institute of Geography and Statistics (IBGE), and the rural communities historically have been neglected from the health system, mainly because access is difficult through rivers. Given this context, we sent a comprehensive health team to these communities, composed of health promoters, logisticians, medical doctors and nurses, with the objective to reinforce messages and health services against COVID-19 but also to provide care for other diseases we might encounter.
From the first day of intervention, our teams witnessed a severe lack of access to primary health services for people. We saw that there was not enough medical staff, medicine, nor an adequate response to emergencies (such as snake bites) and very limited access to basic medical services, such a sexual and reproductive healthcare.
“Our mobile clinics were here to do COVID-19 medical activities, fortunately we didn't find cases of the disease,” says Ana Claudia Barreto, MSF nursing activity manager in the Portel project. “What we did find is a lack of a primary health system, especially for health prevention on issues such as sexual and reproductive health.”
In every consultation our team heard stories from patients that emphasised the vulnerability of people from the Anapu river, something they have to face on a day-to-day basis.
“When it's a serious health problem, either you leave and go to Portel or go straight to the cemetery. And Portel is far away. If I have 400 liters of fuel, I go there. If I don't have it, I don't. Through the forest there is the transportation that God left us: the path and our legs. We put our boots on and head through the bush. We say it's close, but it's more than 24 hours of walking,” says Maria Rosinete Monteiro, Ipixuna resident.
“During the medical activities, we realized that many people lack basic information about COVID. They have limited knowledge about its symptoms as well as on how the virus spreads and how to prevent it”, says Barreto.
Even though all the COVID-19 rapid tests conducted to symptomatic patients were negative, the risk of a case getting to the community remains a reality and is particularly dangerous for a group so excluded from basic access to health care. For this reason, the health promotion team had long sessions and talks with the population and delivered masks to reduce the risk of exposure to the virus as long as possible.
“This population would have a hard time fighting a big COVID outbreak with this lack of access. Our medical team put their efforts in caring for every patient in the best possible way, providing a wide range of primary health services, but what we witnessed needs to be rapidly addressed. The health and other basic needs among these rural communities in Portel are very high, these people are very vulnerable and the spread of the COVID virus in these conditions would be catastrophic”, said Ana.
Community leaders, mainly teachers and nurse technicians in charge of health posts, are first-hand witnesses of the lack of services in these communities.
“We live in Portel and spend periods of about 20 days here in Ipixuna because of my work. Here, access to healthcare is complicated. People often don't even have the money to buy fuel for the boat in order to get to the health post. And for me, as a nurse technician, it's also difficult because there are no commercial boat lines that come here,” says Clevenaldo Rodrigues, Ipixuna community nurse technician.
Our teams treated 390 patients in the Anapu river intervention in in Portel. The main medical diagnosis were non-covid related respiratory tract infections, skin diseases and genito-urinary tract infections. In addition, we identified a lack of health promotion information and comprehensive health services for sexual and reproductive health and sex gender-based violence.
“The population here is isolated and the houses and communities are very far apart. Health posts are often managed only by a nurse technician,” says Eduardo Rugani, MSF medical doctor. “It was important that we promoted access to healthcare for these communities. Not only in regards to COVID-19, but all their other issues, as well. People tell us they haven't seen a doctor in a long time. So, MSF was here to treat, guide, welcome and offer healthcare, in general, to these communities,” says Rugani.
During June and July 2021, our teams also offered trainings to health professionals of the municipality, where we covered subjects such as infection and prevention control protocols, patients' flux and health promotion prevention messages. After ending the medical activities in Portel, MSF delivered a report of their findings and lessons learned to the health authorities of the municipality.
© 2026 MSF
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