September 20, 2016

A man walks past a huge Zika-prevention billboard in San Juan, Puerto Rico. Video screen grab ©Ed Kashi/VII.

I just returned from an intense whirlwind trip to Puerto Rico, where I worked on a short documentary film about the Zika virus. I was working with an amazing director, Beth Murphy, who runs Principle Pictures, on a project for GroundTruth Films.

We interviewed more than a dozen doctors and experts, including the head of the CDC (Centers for Disease Control) in Puerto Rico, to learn more about this impending public health epidemic. There has been a relative explosion of Zika-related stories in the news media of late, yet very few people are feeling sick in Puerto Rico and thus far, thankfully, few babies have been born with microcephaly – the devastating condition in which a baby’s head is much smaller than normal because of abnormal brain development. Despite this: the situation in Puerto Rico is in danger of spiraling out of control. As of now Zika is an ‘invisible disease’ that could be incubating in the thousands of pregnant women in Puerto Rico who have tested positive for the virus as well as many other pregnant women who have not been tested or are awaiting their results.

The WIC office in San Juan, Puerto Rico on Sept. 14, 2016.

Pregnant women sit in the waiting room at the WIC office, where pregnant women can come to get care and check-ups, in a mall in San Juan, Puerto Rico on Sept. 14, 2016. Photo ©Ed Kashi/VII.

One thing we heard repeatedly was that getting test results back in a timely manner was proving frustrating and raising stress levels for many pregnant women in Puerto Rico. There is also a stigma attached to having Zika. This stigma makes it nearly impossible for journalists to gain access to Zika infected pregnant women: virtually none of the doctors we interviewed were willing to introduce us or give us access to their patients. However one fearless nurse-midwife in San Juan put us in contact with a subject, a 30-year-old upper middle class professional, who agreed to speak to us but would not allow us to film her or use her name. She has family in Miami who don’t know she has Zika and wants to wait until she gets her test results and passes the 21 week mark of her pregnancy. While abortion is legal in Puerto Rico, many doctors do not believe in them on religious or cultural grounds, so their counsel to many pregnant women with Zika does not include abortion as an option. This is another source of anxiety for these women who might be facing positive test results in the coming weeks and months. If their test results show that their unborn children have serious birth defects because of Zika, they are potentially in for a lifetime’s worth of financial and psychological stress. Because abortions are not widely accepted and many doctors are openly against them, a positive Zika diagnosis in a pregnant woman is potentially devastating.

Another effect of the stigma against Zika is that people are unwilling to get checked for the virus lest they test positive. There are many who fear learning that they might be infected, so there is a public service element to doing this kind of documentary work. The public must know and officials must be forthright so that their society can adjust its thinking and behavior. Better to work together when it comes to public health epidemics that cost us all so much in both personal and broader economic, political and social terms.


Dahiana Alcala holds up her phone to show an ultrasound picture of her unborn child in San Juan, Puertor Rico. Dahiana has the Zika virus and is three months pregnant. Video screen grab ©Ed Kashi/VII.

The most urgent concern in the medical community is that Zika can be transmitted sexually.  An infected man could pass it along to a woman, pregnant or not, without knowing it. This is a problem in Puerto Rico  because of the dearth of desire to use condoms in a staunchly Catholic society. The easiest way to prevent the spread of the Zika virus between people who already have it is to get people to practice safe sex, but in Puerto Rico’s case  that is very difficult to do. The result is that other precautions must be taken that are much more difficult to implement. These include generous use of mosquito repellent, putting screens on all windows and doors and staying in air conditioned rooms as much as possible. There are, of course, many people on the island who do not have screens: in fact most of the homes we visited did not have any, while none had air conditioning. As is frustratingly often the case, this virus is affecting the folks who can least afford the costs. The poor will most likely bear the brunt of Zika’s price tag both in terms of their health and pocket books.

It is projected that a quarter of the island’s 3.5 million inhabitants will eventually become infected. This means thousands of babies, if not tens of thousands, could be born with birth defects. Which also means thousands of pregnant women, some for the first time, are living with extra stress and worry. They are living in the unknown. We eventually met a few pregnant women infected with Zika through the dogged work of our local assistant, journalist Mildred Rivera, and Beth’s single minded pursuit of the truth. Only one of the women, Leslie Ortiz who is pregnant at age 21, agreed to be filmed and give her name. We are indebted to her and hope her story will help raise awareness and give people the strength to find out about their own conditions and take precautions. Spreading awareness often relies on the bravery of people like her who are willing to speak out in the face of stigma. The economic pressures of having babies with such severe disabilities could be profound, both on families and on the island’s government. Given that there is already an economic crisis in Puerto Rico, there is concern that public funds from congress and the federal government are not coming in a timely-enough manner when such funds could help to stem or possibly prevent a widespread outbreak.

Leslie Ortiz, who is pregnant and has Zika virus, in her apartment in Ponce, Puerto Rico on Sept. 15, 2016.

Leslie Ortiz, who is pregnant and has Zika virus, poses for a picture in her apartment in Ponce, Puerto Rico on Sept. 15, 2016. Photo ©Ed Kashi/VII.

It’s hard to overstate how much of a concern it is among researchers and doctors that Zika can be transmitted sexually. People are not taking it seriously enough nor are they taking precautions. In fact there seemed to be a sense of fatalism among many folks, whether it was putting their faith in God or just being nonchalant about it as a real concern. We interviewed an inspiring doctor, Dr. Carmen Zorilla, who talked poignantly about being on the front lines of the HIV/AIDS epidemic that swept Puerto Rico in the 1980s and 90s. To her,  Zika represents a possible replay of this epidemic, particularly given it can be passed on through sexual contact.

Much will be told in the next 3-9 months, as babies are born out of the prime Zika infection period. We were very impressed with the intelligence, hard work and dedication of the healthcare professionals we met, and the CDC is clearly deploying assets on the ground to help oversee and get this situation under control. In the end, there is still hope that it’s much ado about nothing, but only time will tell. The most important thing at the moment is for congress to hurry up and approve the necessary funds so that an explosion of Zika-related cases can be avoided.

Scenes in San Juan, Puerto Rico on Sept. 10, 2016.

A woman in yellow curlers sits in a housing complex in San Juan, Puerto Rico on Sept. 10, 2016. Like the thousands of other tenants of housing projects like these in Puerto Rico’s cities, there are no screens on the windows nor is their air conditioning, so these folks are prime targets for the Zika virus. Photo ©Ed Kashi/VII.


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Categories: General News, Notes From Ed