RIO DE JANEIRO — The first to die was his aunt. Then his cousin. Then another cousin, and his uncle, and his 83-year-old grandfather, who lived his final hours waiting for a ventilator. And then the virus came for his father, whom Edney Samias could coax from the Amazon forest only by telling him it would kill him, too, if he didn’t get to the city in time.

Oxygen plummeting, cough worsening, Guilherme Samias rode four hours down dirt roads to the Brazilian river town of Tabatinga. Edney, 38, raced him to the only hospital, a hopelessly overrun institution equipped with just 10 ventilators to serve the city’s 66,000 residents. Guilherme always said positive thinking would seed positive outcomes, so Edney chanted those same words, watching his father wheeled away: “Positive thoughts, dad! Positive thoughts!”

But Edney, leader of 14,000 indigenous Kokama people in Brazil’s Alto Solimões region, felt little cause for optimism. What he felt was anger. For weeks, he’d written letters to officials warning that the fears expressed before the virus had reached South America — that it could decimate the Amazon’s vulnerable indigenous people — were coming true. Dozens of Kokama were dying in what had become Brazil’s worst indigenous outbreak. But rather than alleviate the suffering, the government seemed to be making things worse.

The first indigenous person in Alto Solimões to test positive for the novel coronavirus was infected by a government doctor who’d carried the disease back with him from vacation. Officials then ignored indigenous requests that pandemic aid be delivered to them, leaving people no alternative than to leave the isolation of the forest to travel to cities and wait in lines to collect the $120 stipend. Dozens, including Guilherme, returned to their villages coughing and feverish. The coronavirus soon ripped through the population. “The $120 of death,” people now call the aid.

But the government didn’t flood the villages with medical equipment, meal rations, coronavirus tests and health professionals. Instead, it all but abandoned them, according to nine indigenous leaders, a review of official complaints and government officials who spoke on the condition of anonymity. With little guidance on how to proceed, and less medical equipment, the communities have been left to treat their sick and dying with herbal teas, lemon syrups and other traditional medicines.

“Help from the government? We’ve received nothing, nothing, nothing,” said Sinésio Tikuna Trovão, leader of the Tikuna people. “We need oxygen. We need equipment. Our medicinal plants cure only some of the symptoms. . . . We need more doctors to teach us. It isn’t easy. We need rapid tests.”

Officials defended their responses — and blamed other agencies for any failings.

Cassio Espirito Santo, a senior official with the Amazonas state health-care system, said the state is responsible only for people in hospitals — not in the villages, where a federal agency provides health care. “They have their own health agents, and the agents take care of their own people,” he said.

But the federal agency, the Special Secretary for Indigenous Health, said its function is primary care; it doesn’t have the resources or training to treat severe coronavirus infections. “The city and state are washing their hands of this,” said Francisco Macedo Moçambique, the agency’s executive secretary in Alto Solimões. “They think the indigenous have their own resources, so they’re not helping these people.”

The confusion and infighting underscore the extraordinary challenges confronting Brazil as the world’s second-worst outbreak moves deeper into the country. Most of Brazil’s 850,514 cases and 42,720 dead have been concentrated in the cities. But now the disease is reaching communities hours from the nearest intensive care unit. Indigenous leaders say nearly 230 indigenous people have already died, many in Brazil’s most isolated reaches, and they expect that number to rise.

In Alto Solimões, the only hope for advanced care is a plane ride to the faraway state capital of Manaus — itself overwhelmed by patients. When Guilherme’s kidneys began to fail, and the Taba­tinga hospital said it had done all it could, Edney begged for his airlift. “URGENT: NEEDS TO BE REMOVED TO MANAUS; HIS KIDNEYS AREN’T WORKING,” he wrote to the state’s public ministry. But a flight never came, his father’s kidneys never recuperated, and he was dead within days.

The family buried their patriarch deep in the forest, among the macauba trees. Edney took a photograph of himself in front of the grave. Resignation and anger were in his eyes. The coronavirus was here, and they were on their own.

‘Why do these people always pay the highest cost?’

The Amazon spreads across nine South American nations, but the great majority of its indigenous people live within Brazil’s borders. Recognizing a global responsibility, the Brazilian government has made the preservation and service of the remote communities one of its primary functions. It enshrined their rights in the constitution, demarcated vast lands — more than 13 percent of Brazil’s territory — as indigenous reserves and founded sprawling agencies to tend to them. Brazil became a global standard bearer in the defense of indigenous rights.

But in recent years, a chasm has opened between written promises and lived realities. Indigenous territories are frequently illegally invaded by gold miners, loggers and squatters. Deforestation has surged after years of falling. Cattle ranching in the forest has helped make Brazil the world’s largest beef exporter.

Those trends have accelerated under President Jair Bolsonaro, the far-right populist who wants to develop indigenous lands, whose size he calls “abusive,” and assimilate rather than preserve indigenous populations. “More and more the Indians are human beings like us,” Bolsonaro said this year. “So we’re going to make it so the Indian assimilates and really becomes the owner of its indigenous land.”

He froze further land demarcations and tapped a former evangelical Christian missionary who’d proselytized in the Amazon to lead an agency charged with protecting isolated and in some cases uncontacted tribes. He installed military officers throughout the National Indian Foundation, giving power to people who critics say have little understanding of indigenous life.

“This is an area that demands technical knowledge and experience with the indigenous peoples in every region,” said Márcio Meira, president of the agency between 2007 and 2012. “You can’t just put in anyone, much less military people who haven’t been trained for these types of activities.”

In December, Jorge Gerson Baruf, a naval officer criticized for having little indigenous experience, was nominated to take over the agency’s office in Alto Solimões, replacing an indigenous woman. Local tribes demanded his nomination be withdrawn. “He doesn’t have any preparation, capacity or professional training to act in the area of promoting and defending indigenous rights,” local leaders said in a public statement at the time.

Neither the indigenous agency, known as Funai, nor Baruf responded to requests for comment.

Several months later, when the coronavirus penetrated the Amazon forest, local leaders and agency officials say, that inexperience hindered the government’s response. It struggled to distribute food rations and other supplies to barely a fraction of the thousands of families in need. Then, as the disease spread, Baruf blamed the indigenous people for catching the disease while waiting in line for aid, according to two agency officials who spoke on the condition of anonymity to speak candidly.

“Until now, there has not been any concrete action taken by Funai to protect indigenous people . . . in the indigenous lands of Alto Solimões,” one said. “Why do these people always pay the highest cost? And always receive the least resources?

“Now in this time of pandemic, it’s no different, except it’s being paid with life.”

A growing reliance on traditional medicine

At the beginning of the year, Edney Samias had a frightening premonition. While participating in a spiritual ceremony involving ayahuasca, an Amazonian plant with powerful hallucinogenic properties, he saw his mother dying. He saw his father dying. He saw his people dying.

At the time, he interpreted the vision as a “spiritual plague” that would afflict the Kokama people at some point in the future. But he has since come to see it as an unheeded warning.

Raised on a village but now a physical therapist in Tabatinga, he trusted modern medicine more than many indigenous people. So when the health system offered a medical training course at the beginning of the pandemic, he signed up. Then, when family members started dying of the coronavirus, he continued to defend the system. He just had to get its attention.

“The dearth of adequate equipment, medication and necessary supplies has allowed the virus to spread,” he wrote to the local public ministry on April 30.

“WE’RE ASKING FOR HELP,” he added four days later. “THE SITUATION IS CRITICAL!”

“A new institutional genocide by the federal government,” he wrote on May 13.

When he tried to get his father to a hospital, his father replied that he didn’t trust white people. He’d experienced too much of their discrimination in his 64 years. He feared he’d end up like his own father — gone to a city hospital, never to return. But Edney eventually convinced him.

Now he feels like a fool. The state had largely ignored his requests for help. Fifty-six of his Kokama people were dead. Indigenous peoples in others states — in Pará, in Roraima — had begun complaining the government had abandoned them, too. And his father, like his grandfather, never came home.

“I feel so much guilt,” he said. “If I hadn’t made him go to the hospital, he would still be living. Everyone who goes to the hospital leaves in a coffin.”

Mistrust now permeates the indigenous communities of Alto Solimões. Edney has told people to stay home. People are treating themselves with homemade remedies rather than trek to hospitals with few resources to care for them. Edney has formed an indigenous health group that visits the infirm, performs chants, offers massages and administers herbal teas. Sometimes the treatments work, sometimes they don’t.

His mother lived. His uncles didn’t.

But he now believes that if his culture and people are to be saved — and his premonition forestalled — it must be the Kokama people who do the saving. And if they are to die, they will die in their villages. He’s done waiting on provisions that aren’t coming.

“We thought the government would take action,” he said. “Everyone was caught by surprise. We weren’t prepared. We didn’t think the virus would get here.”