PORTO ALEGRE, Brazil – Artur has trouble sleeping.
Artur grows restless as he begins shaking and convulsing, becoming so uncontrollable he needs a sedative.
Artur can’t understand why he’s in such agony.
Artur is less than a month old – and his body craves crack.
Artur is among thousands of babies born to crack addicts in Brazil annually.
No official statistics of pregnant addicts are kept in the country, but the Brazilian Institute of Geography and Statistics (IBGE) estimates the nation is home to more than 1.2 million crack addicts.
With no official data, alarming scenes at hospitals are drawing officials’ attention to a new public health crisis, as what was once rare has become routine.
At Presidente Vargas Hospital, a public-health institution in Porto Alegre, the capital of Rio Grande do Sul state, about 150 children born to addicted mothers are cared for by the Materno Infantil Hospital program.
At the Conceição Hospital Group (GHC) in Port Alegre, at least one crack baby is born every day.
“I can’t speak right now because I have another delivery to attend to...the mother’s a crack user,” says Dr. Paulo Sérgio da Silva Mário, GHC’s Neonatal Unit director, as he is about to give an exclusive interview to Infosurhoy.com.
It’s become common for Mario to deliver babies to mothers who arrive at the hospital very agitated and often high, as many smoke crack – one of the world’s most addictive drugs – on their way to the hospital.
And sometimes, mothers smoke crack while in labor on the street.
Newborns suffer the drug’s effects immediately.
“Crack can be found in the mother’s milk for up to 70 hours after her last use,” Mário says. “This is why we have to suspend that contact for 72 hours, which harms both the baby and the mother, since it delays the production of milk and hampers the child’s capacity to suckle.”
The infants may exhibit irritability, sweating, increased muscular tension, which stiffens the baby’s body and difficulties establishing a consistent sleeping pattern.
The medical community contends that Brazil needs to adopt programs designed especially for treating mothers who use drugs and children already requiring special care at birth, says Paulo de Argollo Mendes, president of Rio Grande do Sul’s Medical Union (SIMERS).
Doctors can’t predict the possible fallout from drug use during infancy or adolescence. They also can’t tell if early addiction will increase their chances of abusing drugs later in life.
Abandonment follows withdrawal
The treatment of children born to crack users often is followed by another complication: abandonment.
In many cases, crack addict mothers choose to give their babies up for adoption, says Maria do Carmo Fay, a social worker at Residential Shelter Nucleus (NAR), part of the Special Protection Foundation (FPE) run by the government of Rio Grande do Sul.
All of the children sent to NAR’s shelter homes in northern Porto Alegre were born to mothers who used crack.
NAR has sheltered 12 newborns, including Artur, in the past months, Fay says.
The new cases required efforts of the entire team of nurses, psychologists, physicians, social workers and supervisors.
“We took a course with a psychiatrist to learn how to help these young ones,” Fay says.
The first month is the most challenging – both for the newborns and the caregivers. Once past it, the infants overcome their withdrawal symptoms and start developing normally.
“To avoid these scenarios, the most important thing is to treat the mother,” Mendes says.
But a crack user requires at least 30 days of rehabilitation to break the addiction, a major step in a never-ending recovery process.
“A shorter period does not work, because it isn’t possible to overcome the physical dependency,” Mendes says.
But there aren’t enough hospital beds to keep up with the increasing demand of what Mendes calls a “crack pandemic.”
“We’re talking about a more serious surge than what we saw last year with the A flu, but we’re unable to open up new beds to treat these people,” Mendes says, referring to the inadequacy of psychiatric facilities for treatment.
SIMERS says the psychiatric support structure was dismantled after 1993, a consequence of the so-called psychiatric reform for psychiatric clinics and hospitals in Brazil.
But the measure ultimately targeted only public health services or private institutions that provide care through the Brazilian public health system (SUS).
SIMERS says treating the children implies treating the mothers.
The Ministry of Health said the psychiatric reform meant replacing the mental asylum model, which focused on hospital care treatment. The new model, however, offers individual attention for those suffering from mental problems and drug addiction.
But the substitution is gradual, according to the Ministry of Health.
From 2002 to June 2010, the number of Brazil’s Centers for Psycho-social Attention (CAPS) grew from 424 to 1,541.
The numbers don’t tell the entire story
SIMERS says the CAPS didn’t do away with the need of hospitalizations since the institutions work only during daytime hours and don’t have the physicians needed to keep up with the influx of patients.
The country also is lacking an adequate amount of facilities specialized in treating alcohol and drug abuse, which are crucial in combating crack, SIMERS says. The government has not been able to provide hospitals with enough resources to keep up with the rapidly growing number of patients, according to the Ministry of Health.
It says the process of reducing the number of beds in psychiatric clinics — there are now 35,426 compared with 52,962 in 2001— can be attributed to the closing of institutions that didn’t abide by state guidelines by offering low-quality services.
Mendes says this “adamant” opposition against psychiatric hospitals not only jeopardizes patients’ lives, including those of chemically dependent mothers and their children but also reveals an underlying prejudice.
“You can have a cardiology hospital. Brazil’s record in that area is world-class,” says Mendes. “But you cannot have a hospital to treat mental illness. Why?”
Investments in prevention reach US$235 million
The Ministry of Health’s main strategy in combating crack addictions is prevention.
The number of pre-natal exams under SUS increased by 125% from 2003 to 2009.
Making prenatal care more widely available is crucial to informing expectant mothers the damage they are doing to their babies by consuming drugs.
Women in need of help, especially those addicted to drugs or alcohol, are referred to CAPS for treatment.
The Ministry of Health’s treatment plan for drug users includes health professionals, but also officials from the justice system, human rights and social welfare. The ministry also is funding the building of 70 halfway houses to shelter at-risk mothers or those in a fragile mental state.
Local social service centers also provide specific types of assistance to the families of drug addicts.
The Ministry of Health has earmarked R$14.3 million (US$8 million) to create shelters for drug users — mostly children and adolescents — and already has implemented 14 projects for mobile clinics, manned by teams who visit the so-called “crack-lands” to offer help where users congregate to get high.
The Ministry of Health also expects to double the number of general hospital beds available for the chemically dependent by the end of the year.
The federal government expects to have invested R$410 million (US$235 million) to fund its Integrated Plan to Combat Crack and other drugs, expected to act on several fronts to prevent, fight and treat the pandemic.