In the Amazon, an indigenous nurse volunteers in coronavirus fight

Vanderlecia Ortega dos Santos, 32, a nurse from the Witoto tribe, an indigenous ethnic group, who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, and language teacher and artisan Natalina Martins Ricardo, 42, from the Bare Tribe, wear protective masks that read "Indigenous lives matter", as walk along a road in Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district, Manaus, Brazil, April 26, 2020. "Because we were so devoid of public assistance, I took the initiative to start a campaign on social media to receive donations of food and hygiene kits," said Santos. REUTERS/Bruno Kelly

Vicente Piratapuia, 69, of the Piratapuia tribe had a high fever and could hardly breathe, but he refused to leave his home on the outskirts of the Amazon rainforest's biggest city.

It took a stern word from a trained nurse in his community to convince him he would die if he refused a ride with her to the emergency room.

Vanderlecia Ortega dos Santos, 32, a nurse from the Witoto tribe, an indigenous ethnic group, who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, examines her patient Vicente Piratapuia, 69, from the Piratapuia tribe, who is suspected to have been infected with COVID-19 after he came down with a high fever and could hardly breathe, as his wife Apolonia Antonia Martins Bare, looks on, at their home in Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district, Manaus, Brazil, April 30, 2020. REUTERS/Bruno Kelly

Vanderlecia Ortega dos Santos, or Vanda to her neighbors, has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak ravaging the Brazilian city of Manaus.

It is an uphill battle. The ramshackle settlement of descendants from 35 different tribes, called Parque das Tribos, lacks plumbing and electricity in most homes.

Ambulances regularly refuse to pick up the seriously ill because there is no public health clinic nearby.

Vanderlecia Ortega dos Santos, 32, a nurse from the Witoto tribe, an indigenous ethnic group, who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, wears a protective face mask that reads "Indigenous lives matter", as she drives to work, during the coronavirus disease (COVID-19) outbreak, in the Taruma district in Manaus, Brazil, April 30, 2020. REUTERS/Bruno Kelly

As the coronavirus pandemic has begun spreading across Brazil, indigenous people who live in and around cities have been caught in a dangerous limbo. The country's indigenous health service, Sesai, focuses its resources on those living on tribal reservations.

Sesai has reported 10 indigenous deaths from the pandemic on native lands, but indigenous umbrella organization APIB estimated this week it has taken the life of at least 18 indigenous Brazilians if fatalities in urban areas are counted. The real number of cases in often remote villages across Brazil's vast hinterland is difficult to ascertain.

"Our people are dying from this disease here and they are not being recognized as indigenous people by the state and Sesai," said Vanda, a member of the Witoto tribe from the upper reaches of the Amazon river on the border with Colombia.

Makeshift homes stand in Parque das Trios, where Vanderlecia Ortega dos Santos, a nurse from the Witoto tribe, an indigenous ethnic group, who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, lives with her husband, during the coronavirus disease (COVID-19) outbreak, in the Taruma district, Manaus, Brazil, May 4, 2020. REUTERS/Bruno Kelly

Sesai has said indigenous people living in cities should use Brazil's public health service.

A spokeswoman for the mayor of Manaus said indigenous health was a federal issue and not the responsibility of city hall.

Manaus, the state capital of Amazonas, which is suffering Brazil's most deadly COVID-19 outbreak per capita, has seen the disease overwhelm hospitals, cemeteries, and officials' ability to tally the dead.

Vanderlecia Ortega dos Santos, 32, a nurse from the Witoto tribe, an indigenous ethnic group, who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, examines her patient Apolonia Antonia Martins Bare, who is from the Bare tribe, in Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district in Manaus, Brazil, April 30, 2020. REUTERS/Bruno Kelly

Vanda, 32, was born in the river village of Amatura and moved down river 10 years ago to Manaus, where she trained as a nurse technician. She works treating skin cancer patients at a clinic in the city.

But since the outbreak started she is using her free time to make house calls in her community, tracking potential COVID-19 symptoms through a WhatsApp group she set up.

This week she has been monitoring some 40 suspected coronavirus cases. She referred five people in serious condition to emergency services, including an old woman who had to be taken by car for lack of an ambulance.

Vanderlecia Ortega dos Santos, 32, a nurse from the Witoto tribe, an indigenous ethnic group, who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, talks to one of her colleagues, who is a doctor, at The Alfredo da Mata Foundation of Tropical Dermatology and Venereology, where Santos works, during the coronavirus disease (COVID-19) outbreak, in Cachoeirinha, Manaus, Brazil, April 30, 2020. REUTERS/Bruno Kelly

Vanda gives her patients painkillers and other basic medicines, while offering guidance on limiting contagion. She makes house calls wearing a protective apron, gloves and mask – sometimes under a traditional Witoto headdress of macaw feathers.

Hunger arrived in the community before the virus, she said. Social distancing measures imposed to slow the outbreak have hammered the local economy and wiped out incomes for both the women who make crafts or work as maids in Manaus homes, and the men who labor on building sites.

"Because we were so devoid of public assistance, I took the initiative to start a campaign on social media to receive donations of food and hygiene kits," Vanda said.

Vanderlecia Ortega dos Santos, 32, a nurse who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, plays with her nephew Davi Ortega Vasques, 4, both of whom are from the Witoto tribe, an indigenous ethnic group, at Santos's home in Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district in Manaus, Brazil, May 4, 2020. REUTERS/Bruno Kelly

She also started a workshop at her mother's house where women sew cloth masks for the community, turning out 30 a day on one sewing machine.

When Brazil's health minister visited Manaus this week, Vanda and two of her friends greeted him with a protest outside the city's main hospital, demanding medical attention for indigenous people.

She and two other women wore masks made by her mother, emblazoned with the phrase "Indigenous Lives Matter."

Davi Ortega Vasques, 4, the nephew of Vanderlecia Ortega dos Santos, 32, both of whom are from the Witoto tribe, an indigenous ethnic group, sits on a chair outside Santos's home in Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district, Manaus, Brazil, May 3, 2020. REUTERS/Bruno Kelly

The demonstration prompted a meeting with Sesai head Robson Santos da Silva, who said a field hospital in Manaus promised by the federal government would have a wing for indigenous patients with the coronavirus.

However, a ministry spokesman said construction of the field hospital would have to wait while the government focuses first on expanding existing facilities in Manaus.

Photo essay: https://reut.rs/35F183o

Vanderlecia Ortega dos Santos, 32, a nurse who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, sits with her niece Maria Eduarda Ribeiro Ortega, 4, and nephew Davi Ortega Vasques, 4, as Santos's mother Brazileia Martimiano Barrozo, 52, looks on, all of whom are from the Witoto tribe, an indigenous ethnic group, at Barrozo's home in Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district, Manaus, Brazil, May 4, 2020. REUTERS/Bruno Kelly

(Reporting by Bruno Kelly; Writing and additional reporting by Anthony Boadle; Editing by Brad Haynes and Rosalba O'Brien)

Vanderlecia Ortega dos Santos, 32, a nurse who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, watches her nephew Davi Ortega Vasques, 4, both of whom are from the Witoto tribe, an indigenous ethnic group, play on hammock next to Santos's husband Sidnei dos Santos, 34, at their home in Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district, Manaus, Brazil, May 3, 2020. REUTERS/Bruno Kelly

Vanderlecia Ortega dos Santos, 32, a nurse who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, and Santos's mother Brazileia Martimiano Barrozo, 52, who are from the Witoto tribe, an indigenous ethnic group, cook a fish together in the kitchen of Barrozo's home, in Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district, Manaus, Brazil, May 3, 2020. REUTERS/Bruno Kelly

Vanderlecia Ortega dos Santos, 32, a nurse who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, looks at her mother Brazileia Martimiano Barrozo, 52, as Barrozo feeds Santos's niece Maria Eduarda Ribeiro Ortega, 4, all of whom are from the Witoto tribe, an indigenous ethnic group, at Barrozo's home in Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district in Manaus, Brazil, April 30, 2020. REUTERS/Bruno Kelly

Davi Ortega Vasques, 4, and Maria Eduarda Ribeiro Ortega, 4, from the Witoto tribe, an indigenous ethnic group, who are the nephew and niece of Vanderlecia Ortega dos Santos, a nurse who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, play together outside in Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district in Manaus, Brazil, May 3, 2020. REUTERS/Bruno Kelly

Vanderlecia Ortega dos Santos, 32, a nurse from the Witoto tribe, an indigenous ethnic group, who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, tends to medicinal plants that she is growing in her garden, as she talks to her niece Maria Eduarda Ribeiro Ortega, 4, at Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district, Manaus, Brazil, April 30, 2020. REUTERS/Bruno Kelly

An indigenous child stands outside in Parque das Trios, where Vanderlecia Ortega dos Santos, a nurse from the Witoto tribe, an indigenous ethnic group, lives, during the coronavirus disease (COVID-19) outbreak, in the Taruma district, Manaus, Brazil, May 4, 2020. REUTERS/Bruno Kelly

Indigenous children play on a road, at Parque das Trios, where Vanderlecia Ortega dos Santos, 32, a nurse from the Witoto tribe, an indigenous ethnic group, lives, during the coronavirus disease (COVID-19) outbreak, in the Taruma district in Manaus, Brazil, May 4, 2020. REUTERS/Bruno Kelly

Make shift homes stand in Parque das Trios, where Vanderlecia Ortega dos Santos, 32, a nurse from the Witoto tribe, an indigenous ethnic group, who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, lives with her husband, during the coronavirus disease (COVID-19) outbreak, in the Taruma district, Manaus, Brazil, April 26, 2020. REUTERS/Bruno Kelly

An indigenous child looks outside the window of her home, in Parque das Trios, where Vanderlecia Ortega dos Santos, a nurse from the Witoto tribe, an indigenous ethnic group, lives, during the coronavirus disease (COVID-19) outbreak, in the Taruma district, Manaus, Brazil, April 26, 2020. REUTERS/Bruno Kelly

Vanderlecia Ortega dos Santos, 32, a nurse from the Witoto tribe, an indigenous ethnic group, who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, sits in a hammock with her husband Sidnei dos Santos, 34, at their home in Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district, Manaus, Brazil, May 3, 2020. REUTERS/Bruno Kelly

Vanderlecia Ortega dos Santos, 32, a nurse who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, embraces her niece Maria Eduarda Ribeiro Ortega, 4, both of whom are from the Witoto tribe, an indigenous ethnic group, at Santos's home in Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district, Manaus, Brazil, May 3, 2020. REUTERS/Bruno Kelly

Vanderlecia Ortega dos Santos, 32, a nurse from the Witoto tribe, an indigenous ethnic group, who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, reads a book as her husband Sidnei dos Santos, 34, lies in a hammock, at their home in Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district, Manaus, Brazil, May 3, 2020. REUTERS/Bruno Kelly

Vanderlecia Ortega dos Santos, 32, a nurse from the Witoto tribe, an indigenous ethnic group, who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, talks with her husband Sidnei dos Santos, 34, outside their home in Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district in Manaus, Brazil, May 3, 2020. REUTERS/Bruno Kelly

Vanderlecia Ortega dos Santos, 32, a nurse from the Witoto tribe, an indigenous ethnic group, who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, wears a face mask that reads "Indigenous lives matter" as she puts on personal protective equipment (PPE), before leaving her home in Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district, Manaus, Brazil, April 26, 2020. "Our people are dying from this disease here and they are not being recognized as indigenous people by the state and Sesai," said Santos. REUTERS/Bruno Kelly

Vanderlecia Ortega dos Santos, 32, a nurse from the Witoto tribe, an indigenous ethnic group, who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, talks to Robson Santos da Silva, the head of SESAI (Secretary for Indigenous Health), as she takes part in a protest during Health Minister Nelson Teich's official visit to the city's main hospital Delphina Rinaldi Abdel Aziz, during the coronavirus disease (COVID-19) outbreak, in Manaus, Brazil, May 4, 2020. Picture taken May 4, 2020.REUTERS/Bruno Kelly

Vanderlecia Ortega dos Santos, 32, a nurse from the Witoto tribe, an indigenous ethnic group, who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, adjusts a light in an examining room, at The Alfredo da Mata Foundation of Tropical Dermatology and Venereology, where Santos works, during the coronavirus disease (COVID-19) outbreak, in Cachoeirinha, Manaus, Brazil, April 30, 2020. REUTERS/Bruno Kelly

Vanderlecia Ortega dos Santos, 32, a nurse from the Witoto tribe, an indigenous ethnic group, who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, visits a patient's home, in Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district, Manaus, Brazil, May 3, 2020. REUTERS/Bruno Kelly

Vanderlecia Ortega dos Santos, 32, a nurse from the Witoto tribe, an indigenous ethnic group, who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, sits outside with her husband Sidnei dos Santos, 34, and their friend Luiz Tukano from the Tukano tribe, at Santos's home in Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district in Manaus, Brazil, May 3, 2020. REUTERS/Bruno Kelly

Vanderlecia Ortega dos Santos, 32, a nurse from the Witoto tribe, an indigenous ethnic group, who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, arrives with Vicelonia Albuquerque Martins and Vicente Piratapuia, 69, (not pictured), who are from the Piratapuia tribe, at a UPA (an emergency care unit), as Piratapuia, Santos's patient, was suspected to have been infected with COVID-19 after he came down with a high fever and could hardly breathe, during the coronavirus disease (COVID-19) outbreak, in the Campos Salles district, Manaus, Brazil, April 30, 2020. REUTERS/Bruno Kelly

Vanderlecia Ortega dos Santos, 32, a nurse from the Witoto tribe, an indigenous ethnic group, who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, and language teacher and artisan Natalina Martins Ricardo, 42, from the Bare Tribe, wear protective masks that read "Indigenous lives matter", as they talk to a neighbour outside of his home, in Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district, Manaus, Brazil, April 26, 2020. REUTERS/Bruno Kelly

Davi Ortega Vasques, 4, and Maria Eduarda Ribeiro Ortega, 4, the nephew and niece of Vanderlecia Ortega dos Santos, 32, a nurse, all of whom are from the Witoto tribe, an indigenous ethnic group, climb a tree together in Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district in Manaus, Brazil, April 30, 2020. REUTERS/Bruno Kelly

Vanderlecia Ortega dos Santos, 32, a nurse from the Witoto tribe, an indigenous ethnic group, who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, talks with her patient Sabrina de Sales Benzaquem, 34, a beautician, who is suspected to have been infected with COVID-19 when she came down with a fever, at Benzaquem's home in Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district, Manaus, Brazil, May 3, 2020. REUTERS/Bruno Kelly

Vanderlecia Ortega dos Santos, 32, a nurse from the Witoto tribe, an indigenous ethnic group, who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, wears a face mask that reads "Indigenous lives matter" as she poses for a photo outside, near her home in Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district, Manaus, Brazil, May 3, 2020. "Our people are dying from this disease here and they are not being recognized as indigenous people by the state and Sesai," said Santos. REUTERS/Bruno Kelly

Vanderlecia Ortega dos Santos, 32, a nurse from the Witoto tribe, an indigenous ethnic group, who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, does some gardening at her home, in Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district in Manaus, Brazil, May 3, 2020. REUTERS/Bruno Kelly

Vanderlecia Ortega dos Santos, 32, a nurse from the Witoto tribe, an indigenous ethnic group, who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, works on her computer as her niece Maria Eduarda Ribeiro Ortega, 4, and nephew Davi Ortega Vasques, 4, watch TV in the same room, at Santos's home in Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district, Manaus, Brazil, April 30, 2020. "Because we were so devoid of public assistance, I took the initiative to start a campaign on social media to receive donations of food and hygiene kits," said Santos. REUTERS/Bruno Kelly

Vanderlecia Ortega dos Santos, 32, a nurse from the Witoto tribe, an indigenous ethnic group, who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, injects dipyrone into her patient Sabrina de Sales Benzaquem, 34, a beautician, who came down with a fever and is suspected to have been infected with covid-19, at Benzaquem's home in Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district, Manaus, Brazil, May 3, 2020. REUTERS/Bruno Kelly

Vanderlecia Ortega dos Santos, 32, a nurse from the Witoto tribe, an indigenous ethnic group, who has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, wears a face mask that reads "Indigenous lives matter" as she prepares to go to work, at her home in Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district in Manaus, Brazil, April 30, 2020. REUTERS/Bruno Kelly

A doll which Maria Eduarda Ribeiro Ortega, 4, the niece of Vanderlecia Ortega dos Santos, both of whom are from the Witoto tribe, an indigenous ethnic group, drew indigenous graphics on the face off, is pictured at Ortega's grandmother's house at Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district in Manaus, Brazil, May 3, 2020. REUTERS/Bruno Kelly

Brazileia Martimiano Barrozo, 52, from the Witoto tribe, an indigenous ethnic group and the mother of Vanderlecia Ortega dos Santos, a nurse that has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak, bathes her grandchildren Davi Ortega Vasques, 4, and Maria Eduarda Ribeiro Ortega, 4, outside her home at Parque das Trios, during the coronavirus disease (COVID-19) outbreak, in the Taruma district in Manaus, Brazil, May 3, 2020. REUTERS/Bruno Kelly