AMPINA GRANDE, Brazil — Every Friday, when she comes to work, Dr. Adriana Melo steels herself for the visits ahead.

“I say that sometimes when I come down this hallway, it feels like death row, because you arrive and there’s all that anguish, everyone coming in to know my opinion,” said Melo, an obstetrician in Brazil’s Paraíba state.

At the end of each week, Melo provides prenatal care to women who have shown symptoms of Zika virus during their pregnancy. They wait for her in a long, white corridor, anxious to learn if their baby is developing normally. The news is not always good.


Melo has risen to prominence since she tested two patients’ amniotic fluid for the presence of the Zika virus last November and came back with positive results. It was one of the early pieces of evidence suggesting that Zika might infect fetuses in the womb. Since then, she has a led team of doctors and researchers caring for pregnant women who have shown symptoms of the mosquito-borne virus.

An increasing number of mothers, especially in Brazil’s northeastern states, are giving birth to babies whose brains haven’t fully developed in utero or whose heads are missing vital structures. Although the malformations vary widely, they are often loosely grouped under the rubric of “microcephaly.” Those who survive after birth often need intensive therapies and may require a lifetime of care.

In this drought-stricken region, the disease-carrying Aedes aegypti mosquito has proliferated in water storage tanks, open sewers, and uncollected garbage, exposing the local population to dengue fever and chikungunya, as well as to Zika.

Health care workers in Campina Grande treat women from towns and cities around the region, many of whom travel for hours to consult Melo. She sees patients in public hospitals, often supplementing her initial exams with visits to her private practice, where she has access to higher quality diagnostic tools.

Much of her research is self-funded, conducted on nights and weekends after she sees patients.

“We do research out of love, because we’re addicted to it,” she said, but institutional support for sustained research is lacking.

Since the surge of microcephaly cases in Brazil last year, doctors in Campina Grande have developed a protocol of care for mothers and babies. The babies begin physical therapy as early as possible, to increase the chances that they will meet milestones like walking and talking. The mothers network with one another and attend support groups led by a psychologist. Neighborhood health clinics make house visits and help coordinate scheduling and care.

“Everyone can see that it’s almost like a family,” Melo said. “Our system is very simple. We don’t have a big physical therapy operation, for example, though we’d like to set one up now. But you must have noticed the caring atmosphere there, that everyone is well received. It’s the least that we can do.”

Zika virus, which can be transmitted by mosquitoes, has exploded onto the world stage. Alex Hogan/STAT

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