Amy Schumer Had ‘Chocolate Cysts,' ‘Choked' Appendix From Endometriosis: ‘Miracle That I Was Able to Carry a Child'

The world nearly beat polio. But fake records, an imperfect vaccine and missteps aided its comeback

Yahoo

21 minutes ago

Yahoo

The world nearly beat polio. But fake records, an imperfect vaccine and missteps aided its comeback

KARACHI, Pakistan (AP) — For the past decade, Sughra Ayaz has traveled door to door in southeastern Pakistan, pleading with parents to allow children to be vaccinated against polio as part of a global campaign to wipe out the paralytic disease. She hears their demands and fears. Some are practical – families need basics like food and water more than vaccines. Others are simply unfounded – the oral doses are meant to sterilize their kids. Amid rampant misinformation and immense pressure for the campaign to succeed, Ayaz said, some managers have instructed workers to falsely mark children as immunized. And the vaccines, which must be kept cold, aren't always stored correctly, she added. 'In many places, our work is not done with honesty,' Ayaz said. The World Health Organization and partners embarked on their polio campaign in 1988 with the bold goal of eradication — a feat seen only once for human diseases, with smallpox in 1980. They came close several times, including in 2021, when just five cases of the natural virus were reported in Pakistanand Afghanistan. But since then, cases rebounded, hitting 99 last year, and officials have missed at least six self-imposed eradication deadlines. Afghanistan and Pakistan remain the only countries where transmission of polio — which is highly infectious, affects mainly children under 5, and can cause irreversible paralysis within hours -- has never been interrupted. The worldwide campaign has focused most of its attention and funding there for the past decade. But in its quest to eliminate the disease, the Global Polio Eradication Initiative has been derailed by mismanagement and what insiders describe as blind allegiance to an outdated strategy and a problematic oral vaccine, according to workers, polio experts and internal materials obtained by The Associated Press. Officials have falsified vaccination records, selected unqualified people to dole out drops, failed to send out teams during mass campaigns, and dismissed concerns about the oral vaccinesparking outbreaks, according to documents shared with AP by staffers from GPEI – one of the largest and most expensive public health campaigns in history, with over $20 billion spent and nearly every country in the world involved. In Afghanistan and Pakistan – which share a border, harbor widespread mistrust of vaccines, and have weakened healthcare systems and infrastructure – local staffers like Ayaz have for years flagged problems to senior managers. But those issues, along with concerns by staffers and outside health officials, have long gone unaddressed, insiders say. Officials tout the successes – 3 billion children vaccinated, an estimated 20 million people who would have been paralyzed spared – while acknowledging challenges in Pakistan and Afghanistan. Remote villages are hard to reach, some cultural and religious authorities instruct against vaccination, and hundreds of polio workers and security staff have been killed because of their alignment with a Western-led initiative. Dr. Jamal Ahmed, WHO's polio director, defended progress in those two countries, citing workers' tailored response in resistant pockets. 'There's so many children being protected today because of the work that was done over the past 40 years,' he said. 'Let's not overdramatize the challenges, because that leads to children getting paralyzed.' Ahmed said he believes authorities will end the spread of polio in the next 12 to 18 months. Its latest goal for eradication is 2029. The campaign says about 45 million children in Pakistan and 11 million in Afghanistan must be vaccinated this year. Children typically need four doses of two drops each to be considered fully immunized. Dr. Zulfiqar Bhutta, who has served on advisory groups for WHO, the Gates Foundation and others, said campaign officials should listen to the criticism of its tactics. 'Continuing blindly with the same strategies that we have relied on since eradication began is unlikely to lead to a different result,' he said. Documents show yearslong problems on polio vaccination teams Internal WHO reports reviewing vaccination drives in Afghanistan and Pakistan over the past decade – given to AP by current and former staffers – show that as early as 2017, local workers were alerting significant problems to senior managers. The documents flagged multiple cases of falsified vaccination records, health workers being replaced by untrained relatives and workers improperly administering vaccines. On numerous occasions, WHO officials noted, 'vaccinators did not know about vaccine management,' citing failure to keep doses properly cold. They also found sloppy or falsified reporting, with workers noting 'more used vaccine vials than were actually supplied.' According to an August 2017 report from Kandahar, Afghanistan, local government authorities and others interfered in choosing vaccinators, 'resulting in the selection of underage and illiterate volunteers.' Vaccination teams worked 'in a hurried manner,' reports said, with 'no plan for monitoring or supervision.' A team in Nawzad, Afghanistan, covered just half of the intended area in 2017, with 250 households missed entirely. Village elders said no one visited for at least two years. Vaccine workers and health officials in Afghanistan and Pakistan confirmed the issues in the documents and told AP it's hard for campaign leadership to grasp the difficulties in the field. Door-to-door efforts are stymied by cultural barriers, unfounded stories about vaccines, and the region's poverty and transience. 'Most of the time when we go to vaccinate and knock on the door, the head of the house or the man is not at home,' said one worker, speaking on condition of anonymity because they weren't authorized to talk to the press. 'Many people find it offensive that a stranger knocks on the door and talks to a woman.' Some workers find families have moved. Occasionally, they say, the encounter abuse. 'We have shared these problems with our senior officials,' the worker told AP. 'They know about it.' In an email response to AP's questions about officials' knowledge of the issues, WHO polio director Ahmed noted 'operational challenges' in Afghanistan and Pakistan and said the program has 'robust monitoring and evaluation processes.' Worker Ayaz described 'fake finger marking' — placing the ink used to show a child is vaccinated on their pinky even when no vaccine has been given. 'There is so much pressure,' Ayaz said. Critics point to continued use of the oral polio vaccine Before the first polio vaccine was developed in 1955, the disease — spread mostly from person to person, through contaminated water and via fecal particles — was among the world's most feared, paralyzing hundreds of thousands of children annually. People avoided crowded places during epidemics, and hospital wards filled with children encased in iron lungs after the virus immobilized their breathing muscles. Polio is mainly spread when people are exposed to water infected with the virus. In countries with poor sanitation, children often become infected when they come into contact with contaminated waste. WHO says that as long as a single child remains infected, kids everywhere are at risk. Eradication demands near-perfection – zero polio cases and immunizing more than 95% of children. But public health leaders and former WHO staffers say campaign efforts are far from perfect, and many question the oral vaccine. The oral vaccine – proven to be safe and effective — has been given to more than 3 billion children. But there are some extremely rare side effects: Scientists estimate that for every 2.7 million first doses given, one child will be paralyzed by the live polio virus in the vaccine. In even rarer instances, the live virus can mutate into a form capable of starting new outbreaks among unimmunized people where vaccination rates are low. Worldwide, several hundred vaccine-derived cases have been reported annually since at least 2021, with at least 98 this year. Most public health experts agree the oral vaccine should be pulled as soon as possible. But they acknowledge there simply isn't enough injectable vaccine — which uses no live virus and doesn't come with the risks of the oral vaccine — to wipe out polio alone. The injectable vaccine also is more expensive and requires more training to administer. More than two dozen current and former senior polio officials told AP the agencies involved haven't been willing to even consider revising their strategy to account for some of the campaign's problems. Dr. Tom Frieden, a former director of the U.S. Centers for Disease Control and Prevention who sits on an independent board reviewing polio eradication, said it would be impossible to eliminate polio without the oral vaccine. But he's urged authorities to find ways to adapt, such as adopting new methods to identify polio cases more quickly. Since 2011, he and colleagues have issued regular reports about overall program failures. 'There's no management,' he said, citing a lack of accountability. Last year, former WHO scientist Dr. T. Jacob John twice emailed WHO Director-General Tedros Adhanom Ghebreyesus calling for a 'major course correction.' John shared the emails with AP and said he's received no response. 'WHO is persisting with polio control and creating polio with one hand and attempting to control it by the other,' John wrote. In his response to AP, WHO polio director Ahmed said the oral vaccine is a 'core pillar' of eradication strategy and that 'almost every country that is polio-free today used (it) to achieve that milestone.' 'We need to step back and really care for the people,' he said. 'The only way we can do that in large parts of the world is with oral polio vaccine.' Ahmed also pointed to the success WHO and partners had eliminating polio from India, once considered a nearly impossible task. In the four years before polio was wiped out there, health workers delivered about 1 billion doses of the oral vaccine to more than 170 million children. Today, nearly all of the world's polio cases -- mostly in Africa and the Middle East -- are mutated viruses from the oral vaccine, except for Afghanistan and Pakistan. Scott Barrett, a Columbia University professor, called for an inquiry into how things went so wrong – particularly with a failed effort in 2016, when authorities removed a strain from the oral vaccine. They miscalculated, leading to outbreaks in more than 40 countries that paralyzed more than 3,000 children, according to an expert report commissioned by WHO. Last year, a mutated virus traced to that effort paralyzed a baby in Gaza. 'Unless you have a public inquiry where all the evidence comes out and WHO makes serious changes, it will be very hard to trust them,' he said. Mistrust of the polio eradication effort persists With an annual budget of about $1 billion, the polio initiative is among the most expensive in all of public health. This year, the U.S. withdrew from WHO, and President Donald Trump has cut foreign aid. WHO officials have privately admitted that sustaining funding would be difficult without success. Some say the money would be better spent on other health needs. 'We have spent more than $1 billion (in external polio funding) in the last five years in Pakistan alone, and it didn't buy us any progress,' said Roland Sutter, who formerly led polio research at WHO. 'If this was a private company, we would demand results.' Villagers, too, have protested the cost, staging hundreds of boycotts of immunization campaigns since 2023. Instead of polio vaccines, they ask for medicine, food and electricity. In Karachi, locals told AP they didn't understand the government's fixation on polio and complained of other issues — dirty water, heroin addiction. Workers are accompanied by armed guards; Pakistani authorities say more than 200 workers and police assigned to protect them have been killed since the 1990s, mostly by militants. The campaign also is up against a wave of misinformation, including that the vaccine is made from pig urine or will make children reach puberty early. Some blame an anti-vaccine sentiment growing in the U.S. and other countries that have largely funded eradication efforts and say it's reaching even remote areas of Afghanistan and Pakistan. In suburban southwest Pakistan, Saleem Khan, 58, said two grandchildren under 5 were vaccinated over his family's objections. 'It results in disability,' said Khan, without citing evidence for his belief. 'They are vaccinated because officials reported our refusal to authorities and the police.' Svea Closser, professor of international health at Johns Hopkins University, said Pakistan and Afghanistan were less resistant to immunization decades ago. Now, people are angry about the focus on polio and lack of help for diseases like measles or tuberculosis, she said, spurring conspiracy theories. 'Polio eradication has created a monster,' Closser said. It doesn't help, she added, that in this region, public trust in vaccine campaigns was undermined when the CIA organized a fake hepatitis drive in 2011 in an attempt to get DNA and confirm the presence of Osama bin Laden or his family. Workers see that continued mistrust every day. In a mountainous region of southeastern Afghanistan where most people survive by growing wheat and raising cows and chickens, a mother of five said she'd prefer that her children be vaccinated against polio, but her husband and other male relatives have instructed their families to reject it. They believe the false rumors that it will compromise their children's fertility. 'If I allow it,' the woman said, declining to be named over fears of family retribution, 'I will be beaten and thrown out.' _____ Cheng reported from London. The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content. Solve the daily Crossword

Associated Press

24 minutes ago

Associated Press

The world nearly beat polio. But fake records, an imperfect vaccine and missteps aided its comeback

KARACHI, Pakistan (AP) — For the past decade, Sughra Ayaz has traveled door to door in southeastern Pakistan, pleading with parents to allow children to be vaccinated against polio as part of a global campaign to wipe out the paralytic disease. She hears their demands and fears. Some are practical – families need basics like food and water more than vaccines. Others are simply unfounded – the oral doses are meant to sterilize their kids. Amid rampant misinformation and immense pressure for the campaign to succeed, Ayaz said, some managers have instructed workers to falsely mark children as immunized. And the vaccines, which must be kept cold, aren't always stored correctly, she added. 'In many places, our work is not done with honesty,' Ayaz said. The World Health Organization and partners embarked on their polio campaign in 1988 with the bold goal of eradication — a feat seen only once for human diseases, with smallpox in 1980. They came close several times, including in 2021, when just five cases of the natural virus were reported in Pakistanand Afghanistan. But since then, cases rebounded, hitting 99 last year, and officials have missed at least six self-imposed eradication deadlines. Afghanistan and Pakistan remain the only countries where transmission of polio — which is highly infectious, affects mainly children under 5, and can cause irreversible paralysis within hours -- has never been interrupted. The worldwide campaign has focused most of its attention and funding there for the past decade. But in its quest to eliminate the disease, the Global Polio Eradication Initiative has been derailed by mismanagement and what insiders describe as blind allegiance to an outdated strategy and a problematic oral vaccine, according to workers, polio experts and internal materials obtained by The Associated Press. Officials have falsified vaccination records, selected unqualified people to dole out drops, failed to send out teams during mass campaigns, and dismissed concerns about the oral vaccinesparking outbreaks, according to documents shared with AP by staffers from GPEI – one of the largest and most expensive public health campaigns in history, with over $20 billion spent and nearly every country in the world involved. In Afghanistan and Pakistan – which share a border, harbor widespread mistrust of vaccines, and have weakened healthcare systems and infrastructure – local staffers like Ayaz have for years flagged problems to senior managers. But those issues, along with concerns by staffers and outside health officials, have long gone unaddressed, insiders say. Officials tout the successes – 3 billion children vaccinated, an estimated 20 million people who would have been paralyzed spared – while acknowledging challenges in Pakistan and Afghanistan. Remote villages are hard to reach, some cultural and religious authorities instruct against vaccination, and hundreds of polio workers and security staff have been killed because of their alignment with a Western-led initiative. Dr. Jamal Ahmed, WHO's polio director, defended progress in those two countries, citing workers' tailored response in resistant pockets. 'There's so many children being protected today because of the work that was done over the past 40 years,' he said. 'Let's not overdramatize the challenges, because that leads to children getting paralyzed.' Ahmed said he believes authorities will end the spread of polio in the next 12 to 18 months. Its latest goal for eradication is 2029. The campaign says about 45 million children in Pakistan and 11 million in Afghanistan must be vaccinated this year. Children typically need four doses of two drops each to be considered fully immunized. Dr. Zulfiqar Bhutta, who has served on advisory groups for WHO, the Gates Foundation and others, said campaign officials should listen to the criticism of its tactics. 'Continuing blindly with the same strategies that we have relied on since eradication began is unlikely to lead to a different result,' he said. Documents show yearslong problems on polio vaccination teams Internal WHO reports reviewing vaccination drives in Afghanistan and Pakistan over the past decade – given to AP by current and former staffers – show that as early as 2017, local workers were alerting significant problems to senior managers. The documents flagged multiple cases of falsified vaccination records, health workers being replaced by untrained relatives and workers improperly administering vaccines. On numerous occasions, WHO officials noted, 'vaccinators did not know about vaccine management,' citing failure to keep doses properly cold. They also found sloppy or falsified reporting, with workers noting 'more used vaccine vials than were actually supplied.' According to an August 2017 report from Kandahar, Afghanistan, local government authorities and others interfered in choosing vaccinators, 'resulting in the selection of underage and illiterate volunteers.' Vaccination teams worked 'in a hurried manner,' reports said, with 'no plan for monitoring or supervision.' A team in Nawzad, Afghanistan, covered just half of the intended area in 2017, with 250 households missed entirely. Village elders said no one visited for at least two years. Vaccine workers and health officials in Afghanistan and Pakistan confirmed the issues in the documents and told AP it's hard for campaign leadership to grasp the difficulties in the field. Door-to-door efforts are stymied by cultural barriers, unfounded stories about vaccines, and the region's poverty and transience. 'Most of the time when we go to vaccinate and knock on the door, the head of the house or the man is not at home,' said one worker, speaking on condition of anonymity because they weren't authorized to talk to the press. 'Many people find it offensive that a stranger knocks on the door and talks to a woman.' Some workers find families have moved. Occasionally, they say, the encounter abuse. 'We have shared these problems with our senior officials,' the worker told AP. 'They know about it.' In an email response to AP's questions about officials' knowledge of the issues, WHO polio director Ahmed noted 'operational challenges' in Afghanistan and Pakistan and said the program has 'robust monitoring and evaluation processes.' Worker Ayaz described 'fake finger marking' — placing the ink used to show a child is vaccinated on their pinky even when no vaccine has been given. 'There is so much pressure,' Ayaz said. Critics point to continued use of the oral polio vaccine Before the first polio vaccine was developed in 1955, the disease — spread mostly from person to person, through contaminated water and via fecal particles — was among the world's most feared, paralyzing hundreds of thousands of children annually. People avoided crowded places during epidemics, and hospital wards filled with children encased in iron lungs after the virus immobilized their breathing muscles. Polio is mainly spread when people are exposed to water infected with the virus. In countries with poor sanitation, children often become infected when they come into contact with contaminated waste. WHO says that as long as a single child remains infected, kids everywhere are at risk. Eradication demands near-perfection – zero polio cases and immunizing more than 95% of children. But public health leaders and former WHO staffers say campaign efforts are far from perfect, and many question the oral vaccine. The oral vaccine – proven to be safe and effective — has been given to more than 3 billion children. But there are some extremely rare side effects: Scientists estimate that for every 2.7 million first doses given, one child will be paralyzed by the live polio virus in the vaccine. In even rarer instances, the live virus can mutate into a form capable of starting new outbreaks among unimmunized people where vaccination rates are low. Worldwide, several hundred vaccine-derived cases have been reported annually since at least 2021, with at least 98 this year. Most public health experts agree the oral vaccine should be pulled as soon as possible. But they acknowledge there simply isn't enough injectable vaccine — which uses no live virus and doesn't come with the risks of the oral vaccine — to wipe out polio alone. The injectable vaccine also is more expensive and requires more training to administer. More than two dozen current and former senior polio officials told AP the agencies involved haven't been willing to even consider revising their strategy to account for some of the campaign's problems. Dr. Tom Frieden, a former director of the U.S. Centers for Disease Control and Prevention who sits on an independent board reviewing polio eradication, said it would be impossible to eliminate polio without the oral vaccine. But he's urged authorities to find ways to adapt, such as adopting new methods to identify polio cases more quickly. Since 2011, he and colleagues have issued regular reports about overall program failures. 'There's no management,' he said, citing a lack of accountability. Last year, former WHO scientist Dr. T. Jacob John twice emailed WHO Director-General Tedros Adhanom Ghebreyesus calling for a 'major course correction.' John shared the emails with AP and said he's received no response. 'WHO is persisting with polio control and creating polio with one hand and attempting to control it by the other,' John wrote. In his response to AP, WHO polio director Ahmed said the oral vaccine is a 'core pillar' of eradication strategy and that 'almost every country that is polio-free today used (it) to achieve that milestone.' 'We need to step back and really care for the people,' he said. 'The only way we can do that in large parts of the world is with oral polio vaccine.' Ahmed also pointed to the success WHO and partners had eliminating polio from India, once considered a nearly impossible task. In the four years before polio was wiped out there, health workers delivered about 1 billion doses of the oral vaccine to more than 170 million children. Today, nearly all of the world's polio cases -- mostly in Africa and the Middle East -- are mutated viruses from the oral vaccine, except for Afghanistan and Pakistan. Scott Barrett, a Columbia University professor, called for an inquiry into how things went so wrong – particularly with a failed effort in 2016, when authorities removed a strain from the oral vaccine. They miscalculated, leading to outbreaks in more than 40 countries that paralyzed more than 3,000 children, according to an expert report commissioned by WHO. Last year, a mutated virus traced to that effort paralyzed a baby in Gaza. 'Unless you have a public inquiry where all the evidence comes out and WHO makes serious changes, it will be very hard to trust them,' he said. Mistrust of the polio eradication effort persists With an annual budget of about $1 billion, the polio initiative is among the most expensive in all of public health. This year, the U.S. withdrew from WHO, and President Donald Trump has cut foreign aid. WHO officials have privately admitted that sustaining funding would be difficult without success. Some say the money would be better spent on other health needs. 'We have spent more than $1 billion (in external polio funding) in the last five years in Pakistan alone, and it didn't buy us any progress,' said Roland Sutter, who formerly led polio research at WHO. 'If this was a private company, we would demand results.' Villagers, too, have protested the cost, staging hundreds of boycotts of immunization campaigns since 2023. Instead of polio vaccines, they ask for medicine, food and electricity. In Karachi, locals told AP they didn't understand the government's fixation on polio and complained of other issues — dirty water, heroin addiction. Workers are accompanied by armed guards; Pakistani authorities say more than 200 workers and police assigned to protect them have been killed since the 1990s, mostly by militants. The campaign also is up against a wave of misinformation, including that the vaccine is made from pig urine or will make children reach puberty early. Some blame an anti-vaccine sentiment growing in the U.S. and other countries that have largely funded eradication efforts and say it's reaching even remote areas of Afghanistan and Pakistan. In suburban southwest Pakistan, Saleem Khan, 58, said two grandchildren under 5 were vaccinated over his family's objections. 'It results in disability,' said Khan, without citing evidence for his belief. 'They are vaccinated because officials reported our refusal to authorities and the police.' Svea Closser, professor of international health at Johns Hopkins University, said Pakistan and Afghanistan were less resistant to immunization decades ago. Now, people are angry about the focus on polio and lack of help for diseases like measles or tuberculosis, she said, spurring conspiracy theories. 'Polio eradication has created a monster,' Closser said. It doesn't help, she added, that in this region, public trust in vaccine campaigns was undermined when the CIA organized a fake hepatitis drive in 2011 in an attempt to get DNA and confirm the presence of Osama bin Laden or his family. Workers see that continued mistrust every day. In a mountainous region of southeastern Afghanistan where most people survive by growing wheat and raising cows and chickens, a mother of five said she'd prefer that her children be vaccinated against polio, but her husband and other male relatives have instructed their families to reject it. They believe the false rumors that it will compromise their children's fertility. 'If I allow it,' the woman said, declining to be named over fears of family retribution, 'I will be beaten and thrown out.' _____ Cheng reported from London. The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute's Department of Science Education and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

Their children can't eat, speak or walk - so forgotten Zika mothers raise them together

Yahoo

15 hours ago

Yahoo

Their children can't eat, speak or walk - so forgotten Zika mothers raise them together

When Rute Freires was told by a doctor that her newborn daughter Tamara wouldn't live long, she started crying uncontrollably. Tamara had microcephaly - an abnormally small head - one of many conditions resulting from her mother being infected with the Zika virus while pregnant. Now nine-years-old, Tamara eats through a stomach tube. Her hands are increasingly stiff and contracted and she has a hard time holding her head still. "I was told early on that she wouldn't walk, she wouldn't speak nor smile," says Rute. "And yet I would ask every doctor I visited: 'My kid is going to walk, right?'" Rute's daughter is one of the nearly 2,000 babies born to women who contracted the mosquito-borne virus in Brazil between 2015 and 2016. Back then, the country was preparing to host the Olympics and the world watched with concern as the virus spread across Brazil as well as to dozens of other countries. Zika Love Stories: I went to Brazil to find out how families are coping A public health emergency was declared by the World Health Organization and Brazilian authorities, whose warning remained in place until May 2017. It's still not clear why the outbreak spontaneously ceased and it hasn't resurged over the past decade. Zika disappeared from the public eye, and families dealing with its long-lasting consequences have been largely forgotten. According to government figures, 261 children diagnosed with congenital Zika syndrome - a pattern of birth defects caused by infections during pregnancy - have died. Hundreds more have seen their health conditions deteriorate. Tamara is one of them. She lives in Maceió, a coastal city in north-eastern Brazil, where 75% of the cases of congenital Zika virus syndrome in the country were registered. Scientists still don't have a conclusive explanation of why that region was the most affected. Congenital Zika syndrome is characterised by heart problems, joint issues and difficulty co-ordinating chewing and swallowing. Most of those with it do not go through traditional development milestones like crawling, eating, walking, speaking or potty training. To deal with the challenges of raising her daughter, Rute joined forces with other affected mothers. She first met them in a support group put together by local health authorities in 2016. "There were so many kids with the same syndrome as Tamara. We started talking to each other, exchanging information… and things finally started to make sense." But life was still difficult. A year on, the women felt they weren't getting enough support from local authorities. So they formed an independent group, with bespoke yellow shirts, to help each other - and demand more. Moving in together Many of the mothers had stopped working and were living off state benefits of around $265 (£199; €230) per month - the minimum wage. They found themselves in legal battles against the healthcare system trying to secure surgeries, wheelchairs, medication and baby formula. Several had been abandoned by their husbands - some of whom have remarried and formed new families. The founder of the association, Alessandra Hora, says men rarely came to the group. "I heard from many women that their husbands felt they were putting being a mother before the role of wife," she tells the BBC. The women have found new ways of organising their lives. After making an application to public housing authorities, almost 15 were able to move into the same complex, where they've now lived for five years. "Our goal was for them to live close to one another so they could help each other - to be the support network that most don't have," says Alessandra. She started taking care of her grandson Erik, who has congenital Zika syndrome, after her son was murdered in their neighbourhood on the outskirts of Maceió. Rute moved to the Zika mothers' housing block after her divorce. She became close to her neighbours Anne Caroline da Silva Rosa and Lenice França, whose children Moisés and Enzo also have congenital Zika syndrome. Like Tamara, Moisés eats through a feeding tube that comes out of his stomach. He can no longer stand, but he manages a faint smile when his little sister Maria covers him in hugs and kisses. Enzo is one of the few children with Zika-related microcephaly who has more autonomy. After many years in and out of hospitals, the nine-year-old is now able to walk and speak. Living so close to one another means the mothers have been able to share tips on how to handle their children's complex health conditions. But there have been other benefits too. Rute started taking night classes when Anne Caroline and Lenice offered to look after Tamara - meaning she could resume her studies and obtain a high-school degree. Tamara can neither walk nor speak, as doctors predicted. A few years ago, she couldn't fix her gaze on an object either - but thanks to physical therapy she can now even recognise herself in the mirror. Her eyes follow her mother everywhere she goes. They usually stare at each other when Rute is cuddling with her on the couch and stroking her long curly hair. Winning higher compensation The mothers' decade-long battle for better financial assistance has also paid off. In December, Brazil's Congress approved a bill introduced back in 2015 that would see families affected by Zika receive compensation of $8,800, and monthly payments of $1,325 - five times higher than the current allowance. But President Luiz Inácio Lula da Silva vetoed the bill, saying its financial implications were unclear. His administration had instead proposed a one-off payment of $10,500. Experts like Mardjane Lemos, the doctor who diagnosed some of the first cases of Zika-related microcephaly, said this was far from enough. She argued that state authorities had failed the families on multiple levels - failing to contain the virus and under-compensating affected children for years. Alagoas state's health department said the virus situation in the region had improved in recent years thanks to their efforts in educating citizens to clear stagnant water and training health surveillance officials. They didn't respond to questions about how the state has supported families affected by Zika syndrome. But ultimately, the mothers were victorious. President Lula's veto on the bill was overturned and they were told they would receive the full levels of compensation approved in the 2015 bill. Mysterious drop in cases Even though the number of Zika cases and births of babies with the syndrome have sharply dropped, a new outbreak is possible as the cause of the decline is still unknown, says Ms Lemos. "The boom in cases seems to have spontaneously ceased. This leads to the theory that there is some natural immunity. But is that really the case? How long does it last? We do not know," she points out. A decade on from the outbreak, a lack of research has left many questions unanswered. For example, why was north-eastern Brazil so badly hit, especially poor women there? One study suggests that it might be related to maternal malnutrition. Another proposes that water contaminated with a bacteria may have produced a nerve-damaging toxin making the effects of the virus on the babies' brains worse. Congenital brain malformation researcher Patrícia Garcez and neuroscientist Stevens Rehen, who led the two projects respectively, have told the BBC they believe the answer may be a combination of these and other factors. "We know a little more now [about] the environmental factors that may have contributed to the higher prevalence, but we don't fully understand how they have contributed," says Dr Garcez, who teaches at King's College London, highlighting the lack of research as a problem. This lack of research might have to do with the fact that those affected are predominantly poor, says Ms Lemos. Despite the uncertainty, winning the battle for compensation has given Rute a new sense of optimism for the future. "I felt such joy when I heard the news, I wanted to scream," she says. Now she's aiming to get a qualification in education and a well-paid job. She wants private health insurance for Tamara and dreams of buying a car one day, to take her to medical appointments. "Some of the mothers thought this day wouldn't come," she adds. "But I didn't give up hope." More weekend picks The mushroom killer was obsessed with true crime. Now true crime fans are obsessed with her Young US men are joining Russian churches promising 'absurd levels of manliness' How backchannels and US mediators pulled India and Pakistan back from the brink Solve the daily Crossword

Amy Schumer Had ‘Chocolate Cysts,' ‘Choked' Appendix From Endometriosis: ‘Miracle That I Was Able to Carry a Child'

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The world nearly beat polio. But fake records, an imperfect vaccine and missteps aided its comeback

The world nearly beat polio. But fake records, an imperfect vaccine and missteps aided its comeback

Their children can't eat, speak or walk - so forgotten Zika mothers raise them together

Amy Schumer Had ‘Chocolate Cysts,' ‘Choked' Appendix From Endometriosis: ‘Miracle That I Was Able to Carry a Child'

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The world nearly beat polio. But fake records, an imperfect vaccine and missteps aided its comeback

The world nearly beat polio. But fake records, an imperfect vaccine and missteps aided its comeback

Their children can't eat, speak or walk - so forgotten Zika mothers raise them together

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