CARTAGENA, Colombia — Everywhere she goes, Ana Guardo Acevedo, 17 and seven months pregnant, has a worried look on her face and a folder full of medical tests in her hands.
Three months ago, when her baby bump was still barely noticeable, the rims of Ana’s eyes turned red and a rash crept across her stomach, down her arms, over her face. Doctors in the emergency room first suspected chickenpox but then told her she was infected with a virus she had never heard of before, Zika.
And, suddenly Zika was everywhere. On TV, Ana saw babies in Brazil with deformed heads born to mothers with Zika. She read about brain damage, blindness, paralysis — all linked to Zika. The Colombian government started sending fumigation trucks through neighborhoods to kill mosquitoes carrying Zika, and health officials warned women not to get pregnant.
For tens of thousands of women in three dozen countries it was too late. Just in Colombia, there are more than 8,000 pregnant women infected with Zika. Ana is one of those waiting to see what damage Zika has done.
“Is my baby okay?” That question has taken over her mind.
Doctors keep telling her it’s too early to know, that chances are her baby will be fine, but those thin assurances don’t chase away her fear. She saw what it did to her eyes and skin. What was it doing inside of her?
Unable to control Zika, she tries to organize it by stuffing every piece of paper related to the virus and her baby into the plastic folder.
Protein and blood in urine: Traces. Glucose: Negative. And the result she looks at again and again:
Sonogram: Repeat later in term.
Now on a Wednesday morning, she carries her folder on a crowded bus to JuanFe, a two-story oasis on the outskirts of town that provides health services and job skills to low-income teenage mothers. A high school graduate, she is taking cooking and computer lessons and hopes to get a job as a hotel chef.
“How many of you have had Zika?” a volunteer asks a classroom of 33 young women. Seven hands shoot up.
Ana notices one of them is carrying a baby.
“How old is your baby?” she asks her after class.
“Just 15 days,” the new mother says, rocking her sleeping son under a soft blanket with little red stars.
“Can I look?”
Ana gently pulls back the blanket. It’s not the boy’s black hair or fat cheeks that grab her attention, but the size and shape of his head: perfectly normal.
“He’s so healthy!” she says. “I can’t wait for the moment I find out if my baby is okay, too.”
In her Zika folder on her lap is a handwritten note with the time and date of her next sonogram. She would be nearly 30 weeks pregnant, and doctors would have a better look at any sign of microcephaly — a condition that results in an abnormally small head and, very often, brain damage. A scan could ease her mind, or devastate her.
It’s scheduled for 12:30 Friday. Just two days away.
Later Wednesday, Ana walks into her parents’ home, where her worries all started when a mosquito with whitish legs bit her on her arm. That was the one, she thinks, that caused her to boil with fever and ache in her bones.
“No! A mosquito,” Ana shouts, smacking a bug on her mother’s leg.
Their concrete-block house has no air conditioning, no screens on the windows, no way to keep out the insects spreading Zika.
“I want my baby to be fine,” she tells her mom. “I am not the only one dealing with this. But sometimes at night when I can’t sleep, it feels like that.”
“The baby can withstand this,” her mother says.
“I hope,” Ana says, taking a liter of Pepsi out of the refrigerator and then, reconsidering, opting to drink water.
Zika zeroes in on young, poor women. Across Latin America, where the epidemic is centered, women often have babies in their teens. And, while insect repellant and air conditioning keep mosquitoes away from the wealthier, millions cannot afford those protections.
In an unusually pronounced class system, the Colombian government categorizes neighborhoods into six “strata”: 1 is the poorest, 6 is the richest. That ranking determines the price people pay for electricity and water. The vast majority of Colombians live in the three lowest classes.
Ana grew up in Strata 1, in a house painted bright green with a row of flowerpots outside. Her mother, Berleys Acevedo, sells detergent, diapers, aspirin and other basics from her front porch. She stocks no bug repellant, which costs about $4 — a sum that buys many people their food for days.
“But it’s much better now since the truck came through,” said Ana’s mother, describing how it drove slowly down her rutted street two weeks ago showering pesticide.
Ana’s father fumigated inside the house, too, with a spray a government worker left at their door.
“It’s soooo hot. I’m so hot,” Ana says, picking up a few sweets for friends from her mother’s little store, as she heads back to class at JuanFe.
She glistens with sweat and struggles with short breaths in the humidity, a short-sleeve top stretched over her growing belly. “Oh, the baby just moved,” she says, suddenly smiling.
The sonogram from months ago in her folder is fuzzy and tiny, and her baby has grown so much. Just two more days and she gets another look.
Early Thursday, Ana wakes in so much abdominal pain, her aunt takes her by taxi to the hospital. She signs in at 6 a.m., the 13th woman to arrive since 3 a.m. at the Rafael Calvo Maternity Clinic.
Now, she sits in the busy emergency room, perched awkwardly on a plastic chair, her head against the wall. Her pain sharpens.
She listens to the nurses talking to other pregnant women about preeclampsia and bladder infections. She hears them asking another pregnant woman if she knows whether she has Zika. Down the hall, doctors have been huddling after delivering a baby with microcephaly.
“It hurts!” Ana keeps saying, tears streaming down her face.
A nurse tells her to breathe, calm down.
Early labor is not that uncommon, she tells Ana, as she wheels her into a windowless second-floor hospital room and moves her into the fourth, and last, bed shoved up against the wall.
She lies there in pain. All day. All night.
Friday morning, Ana curls left, then right, still seeking comfort on the blue, plastic mattress.
“I can’t take this anymore! I can’t! I can’t!”
“You need to hold on to the baby — it’s too early to deliver,” a nurse warns her. She adjusts the IV line in Ana’s vein, telling her the medicine will strengthen her baby’s lungs. “If the baby comes now, he will be put in an incubator.”
Ana bursts into tears.
“Why is all this happening?”
Ana’s blood pressure is rising and the nurse returns with two pills that Ana swallows.
“I want to give myself a Caesarean!” she yells, exhausted and desperate. Her aunt, Alba Luisa Acevedo, who has been sitting beside her nonstop, has run out of ways to try to distract her.
A nurse carries in a lunch tray and Ana sees what time it is: Friday, almost 12:30. The time her sonogram is scheduled at the JuanFe clinic a few miles away. In this crowded public hospital, with more need than money, ultrasounds are not routine.
With a sinking feeling, she realizes she is going to miss it.
“I want to get out of this hospital. But I am too scared to leave,” she tells her aunt, who keeps stroking her forehead.
Ana closes her eyes, upset that she won’t have a new black-and-white outline of her baby to add to her folder, to ease her worry. Or to help her prepare for a baby with a birth defect.
She rests her head on a rolled-up towel. In her rush to the emergency room, she forgot her pillow. Patients are supposed to bring their own.
Friday evening, Ana’s fiance, Damian Ferriera Angel, 22, arrives and leans over her hospital bed, wraps her in his arms and tells her how sorry he is that she’s in pain. “Everything will be okay,” he whispers.
For a minute, Ana stops crying.
It’s not visiting hours, but Damian persuaded a security guard to give him 10 minutes; he had to work all day. He tried to get in yesterday with no luck, but now he hands Ana the baby wipes she asked for on the phone.
She wants to be ready in case the baby comes early and puts the wipes with diapers and baby outfits on top of her Zika folder at the foot of her bed.
Only last year Ana and Damian, like so many couples, would spend romantic nights walking along Cartagena’s old fortress walls. They were excited when they found out they would have their first baby, never thinking love and hope would feel so different a few months later.
A busy nurse walks in and shoots Damian a stern look. There are no men anywhere on the floor. He feels he should go.
“Being in here makes me feel sick,” Ana tells him. “I don’t know what is going to happen next.”
“You can do this,” he says. “It’s all going to be fine.”
As Damian walks out, he sees a Zika flier that warns staffers to seal all containers that hold water — even toilet tanks — to stop mosquitoes from laying eggs. He says aloud in the quiet hallway, “One more worry to add to all the other worries.”
Three days later, Ana’s still in the hospital, still no baby, still no sonogram, and Damian is back at the job that will pay for their wedding and baby.
“Where are the crackers that are on sale?”
“Which ones are healthy?”
Customers at this supermarket in a middle-class neighborhood — Strata 4 — keep interrupting his thoughts of Ana as he works Aisle 14.
Six days a week, eight hours a day, he restocks salty crackers and sweet cookies. He scoops saltines off the floor after a customer messed up his handiwork and counts the minutes until he can go buy a surprise for Ana.
She loves it when he plays his guitar and sings “Dueña de Mi Corazón” — “Owner of My Heart” — a song he wrote for her. But he has another idea of how to make her smile.
“Can we go buy a new bed for Ana today?” he asks his mother, Mery Angel, when his shift is over and he can use his phone. Before her trip to the hospital, Ana had begun staying close to it at her aunt’s home, bunking with a cousin or sleeping on the couch.
If Ana sleeps better, it’s good for their baby, too, he tells his mom as they board a bus that pulls up right near the almond tree in front of their home.
The windows of the old bus are covered with blue curtains to block the harsh sun. It’s stuffy and slow. Folk music is blaring from the radio, and Damian taps his leg. No news this hour, just music. Sometimes on his rides, Damian catches the latest on Zika: the rising number of cases, the U.S. doctors arriving to help investigate what they are calling a global health emergency.
They get off in front of side-by-side mattress stores, and he walks through aisles of beds, looking for one he can afford on his $10-a-day salary.
He and his mom are asking for a better price for a mattress marked at $100 when her phone rings.
“They let Ana out of the hospital!” she tells him.
“What? She’s out?”
“Yes! She’s waiting for you at her aunt’s house.”
Hurrying now, he stops haggling, waves down a taxi, helps the driver tie the mattress to the car roof and speeds off to find Ana.
Ana answers Damian by burying her head in his chest. “Yes! I’m okay!”
She looks at the mattress wrapped in plastic, a hand across her mouth. “I had no idea!” She talks excitedly about later taking it to their own place, but Damian wants to know why she was suddenly allowed home.
Her pains stopped and she felt well enough to sit up and eat, she tells him. She was actually well enough to think about happy things like “the big, big wedding dress” she wants to wear at their December wedding.
She sits back in her rocker. “The doctor said no walking around,” she says. “I can’t go to class. I can’t do anything for a while.”
Taking her folder off the table next to her, she puts it on her lap and says, “I have all the notes here.” One tells her to see a doctor in 10 days. “29.5 weeks pregnant” is typed on another.
Doctors hope she can hang on close to full term — two more months. In May and June, thousands of the babies whom doctors are watching for Zika effects are due.
Damian sits on a plastic chair inches from Ana. She kicks off her flip-flops and says she has more to tell him.
She was by herself this morning when a nurse appeared and wheeled her down the hallway into a new room. She thought it would be yet another exam by a doctor feeling her hardening belly with his hands, saying the very low position in which she was carrying the baby was causing her pain.
But instead, a doctor stared at a screen and a nurse smeared her stomach with a cold gel, preparing her for a scan of her baby.
“I was so nervous, I could barely breathe.”
“What?” Damian says. “You had an ultrasound?”
She nods, describing how she closed her eyes, afraid and praying, as the doctor’s wand glided over her belly.
“What did it show? What happened?”
“The baby is really strong,” she says. “The doctor said, ‘The baby’s heartbeat is really loud.’ He said he never heard a beat that loud, that it sounds like the heart of an older person!’”
“What else did he say?” Damian asks, leaning closer to Ana, wondering why she isn’t saying anything about the baby’s head.
She tells him she wished she had gotten a glimpse of the computer screen the doctor was looking at, or a printout of the scan, but the doctor assured her: “All looks good with the head, the brain. The baby looks normal.”
Damian repeats the word.
That’s all he wanted to hear.
“I’m calmer now,” Ana says, rocking and smiling, holding Damian’s hands in hers. “Even if something is wrong with our baby, we will take care of him forever.”
Both of them understand: One sonogram can’t detect all the problems Zika can cause. But in this moment, in this time of Zika, both of them feel less afraid.