Seth Kugel's Notebook:

Brazil outlaws tanning machines

There's no real need to write a story here. The headline says it all.

But because convention must be followed, here goes: On Wednesday, Anvisa, the Brazilian equivalent of the FDA, prohibited the sale and use of tanning machines for aesthetic purposes. The ban is effective immediately, and the Brazilian press reported law-abiding spa owners calling clients to cancel appoints...and non-law-abiding spa owners not calling clients to cancel appointments.

Violating the regulation can lead to fines from 2,000 reais to 1.5 million reais ($1150 to $860,000). The Brazilian Association of Tanning Professionals said the prohibition has no scientific basis, according to G1 news. They had previously circulated a petition urging ANVISA not to enact the ban, and now will be seeking a court injunction.

The head of Anvisa, Dirceu Barbano (who last appeared in GlobalPost when his agency required pharmacists to pull most non-prescription medication from the shelves and require customers to ask for it from staff members) said Brazil was the first country in the world to institute such a ban, and that he would be sharing its experience with the World Health Organization.

Meanwhile, the forecast for Saturday in Rio de Janeiro is 88 degrees and sunny.

Shrinking the Amazon?

There are some people you look at and think: this guy has a story to tell. That’s the impression I got from the bushily grey-bearded guy in the straw hat taking in the breeze on the commuter boat back from Novo Aripuana to Manaus. It may actually be illegal to have a beard like that and be boring.

And wouldn’t you know, he’s Wilson Gonzaga, a psychiatrist from Sao Paulo who is trying to get a boat and equipment funded so he can roam the rivers providing mental health care in cities like Manicore (pop. 47,000) and Novo Aripuana (pop. 19,000) that have very high population to psychiatrist ratios. As in 47,000:0 and 19,000:0.

In fact, Gonzaga said, as far as he knows, there is just one psychiatrist in Amazonas state outside the capital, Manaus, and she’s the wife of a military officer stationed in Tefe who could be transferred out at any time.  Whether there are a few more out there or not, it’s still pretty obvious that there is a huge lack of psychiatric care for the bigger Amazonian cities, not to mention the small, isolated villages.

He cited psychoses and mental deficiencies as major issues that were going untreated, but also noted that “neuroses that exist in the big city also exist here: anxiety, mood disorders, depression.” The lack of care leads to great suffering, and elevated suicide rates, he said, especially among indigenous peoples “on the margin of white culture.”

His idea is called Saude Navegante, which means something like “Health Navigator” or perhaps even “Floating Health.” It would be staffed by him, his wife and a crew that he hopes will be supplied by the state government along with the boat. (So far, no luck there, but he’s also hitting up private businesses.) In addition to providing mental health services, there would have a pharmacy on board, and Gonzaga would provide basic medical care as well. (He recently went back to school to bone up on clinical practice.) He and his wife would also conduct health, drug-prevention and environmental education sessions.

Last week, in Manicore, he saw a case that showed the severe need for help. In Manicore, a father had begun tying up his out-of-control, drug-addicted, 11-year-old daughter with a chain because he didn’t know how to control her. I asked him what how you handle a case like that, but I pretty much knew what was coming.

“First, you treat the father,” he said.

The Amazon with back pain, Part II

I’m now back in Novo Aripuana (pictured), where the perfectly decent Hotel Tio Ze does not have perfectly decent beds for back pain sufferers. So, yesterday, with a nap aborted, I decided to take advantage of the two things the town seemed to offer me: a pharmacy, and a massage therapist.

Pharmacists take on extreme power over foreigners in small towns like this, presiding as they do over a limited stock of drugs with totally unfamiliar names. Sao Paulo has Advil and Tylenol. The pharmacy in Novo Aripuana had nothing of the sort. So I told the pharmacist my back was killing me, and she gave me something called Torsilax, which had no ingredients I recognized beyond caffeine, but sounded like something that might make my torso relax, which was vaguely reassuring. She told me to take one every eight hours, on a full stomach.

I figured I wouldn’t take one until after my trip to the massage therapist, whom the folks at Tio Ze told me about. The sign on the cute orange house read “English and Massage Therapy,” which showed that the family was somewhat sophisticated, maybe even a bit too much for this one horse town. (By one horse town, I mean 1,000-motorcycle town.) Turns out the therapist is from Goiania, a city I usually think of as a hick regional capital, but compared to here seems the center of the universe. She didn’t really give much of an explanation as to why she had moved here, but it struck me that if Brazil has a witness protection program, this would be exactly the kind of place it would send people.

She gave a decent massage, which relieved much of the pain. But the best part was meeting her husband — the English teacher.  And not just any ordinary English teacher: he had arrived in Novo Aripuana from India as a Catholic priest, met the massage therapist and … you can imagine the rest. (Though you may not want to.)

Walking back to the hotel, I decided it was time to pop a Torsilax, but soon felt my stomach churning and realized I had taken my Torsilax on a completely empty stomach. Bad decision. To be followed by a terrible one: a stop at the Rei do Espetinho, the "King of Kebobs," a street stand with a disco ball near my hotel.   

At the King of Kebobs, you choose your own mostly-cooked kebab, they cook it the rest of the way, and serve it to you with rice and coarse manioc flour. Could there be a worse decision than eating street food that involves fatty sausage and gristly chicken at a place with a flashing disco ball? I ate most of it, passed the rest to a surprisingly unmangy dog who was scrounging around for a bite, and went back to the hotel.  The good news … the pain has left my back entirely. The bad news … it's moved to my stomach.

The Amazon, with back pain, Part I

Somehow, woke up this morning with immense pain on the lower right side of my back. It’s the kind that when anything jolts, like you trying to get out of bed, pain shoots through your side.

It was also the day I came back from the Juma reserve, an hour down the river from the city of Novo Aripuana by small motorboat, city being a word I use only because that’s what they call it.  It was one of those times when it pays to be a journalist: an hour with nothing to do except watch the trees go by, try to spot the head of a jacare (the Amazonian alligator), or fantasize about getting home and looking up where you’ve been on the Google Maps satellite shot, knowing it will be a stark river surrounding by stunning green, the kind of place that I often look at on Google Maps and think, wow, it would be cool to be there.

But none of this is really much fun with a bad back, since the jolting of the boat kept me in pretty much constant pain. So I thought of all the other people in the world with bad backs that are not actually temporary, as I assume mine is, and I thought, how do they enjoy alligator heads?  

There was little time to ponder. A half-hour in to an hour ride, we figured out we had too many people in the boat – a bunch of teachers, adult students, and their kids from the school in the reserve I’ll be writing about were there, with their luggage – and realized there wasn’t enough gas to get us back to the city.  So we stopped on the side of the river, at a spot that didn’t look like much of anything. Some of us, including me, trudged about five minutes along a wide clearing through the woods, and came out at a lake.

A small community was perched on the other side of the lake, home to one of the people in the boat.  We whistled across, and someone came in a small motor-powered boat called a rabeta to pick her up. Her mission: to try to find 20 liters of gas in the town we could borrow.  Three of us sat around on a fallen branch, which (because of my back) did not appeal to me, so I tried to sit on the ground. I was quickly warned there was some insect that would cause some extreme itching living in said ground. 

I stood.

Maybe half an hour later, the boat chugged across the lake, with 20 liters of gasoline for us, which we brought back along  path and filled up the boat.

With a bad back, alligators may lose their charm, but running out of gas in the middle of nowhere was still pretty fun.

Back of the boat

I just started on a reporting trip in Amazonas state, so a word on the means of transportation here, which pretty much boils down to ABC: Anything but cars. Highways are few and far between here, both because historically it has been very difficult and expensive to lay down a lasting highway here, and these days, it is considered environmentally hazardous to the land it runs through. I've heard a few different slight variations quoted, but something like 52 out of 62 municipalities in the state cannot be reached by road.

I’m headed to Novo Aripuana, about 150 miles as the crow flies (and more like 300 as the fish swims) from Manaus, and there are three ways to get there by public transportation: the 36-hour slow boat, the 12-hour fast boat and $180 airplane. I suppose you could swim, too, but I don’t recommend it.

I’m on the fast boat, which costs 120 reais, almost $70 at the newly punishing exchange rates, and have an important travel tip for anyone planning any sort of trip via public transportation in the Amazon:

Sit as far forward in the boat as you can.

As I write, I'm sitting practically on top of the engine. Anyone who thinks the Amazon is a quiet place, it is. But not on top of the engine. I tried to get some sleep, and the noise was what I imagined it would be like to sleep in a foxhole with constant machine gun fire around you. Without the danger, of course.

In the short video I'm attaching, you will see one man asleep near the motor, and a couple of kids playing right on top of it. So it is possible to get used to it.

On the slow boats, which take days to go between cities that no highways link, you don’t get a seat, you hang a hammock. I was on one of those boats too, five years ago, and it was only a few days in that I ventured to the lower level where the engine was and noted that those who boarded later were stuck down there next to it. And it sounded like a machine gun as well. So a better rule: find the motor, and get as far away from it as you can.

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