Why you should care
Because epidemics are always political.
On a summer evening, hunched over a laptop in a small examination room in Caracas’ Polyclinic Hospital, Doctor Julio Castro Méndez examines a leaked government document he received earlier that day. A graph highlights Venezuela’s excessive and undiagnosed febrile cases, from which Castro concludes there are roughly 8,000 weekly Zika infections. The document might be a revelation in most scientists’ hands, at a time when many allege the government has been censoring its official medical statistics for over a year. But for Castro? It’s hardly surprising. He retrieves another document nearby, showing a similarly shaped bell curve. “This is my research from March,” he says. “It’s roughly an 85 percent match.”
Castro, an epidemiology-trained infectious-disease physician with 26 years of experience, has become frighteningly relevant in Latin America this year — his expertise in combining social-media data and mathematical models to map, track and publicize looming public health or pandemic concerns has allowed him to “go further” than most others in his field, explains Jaime Torres, head of the infectious diseases section at Central University of Venezuela’s Tropical Medicine Institute. Without official statistics, Castro’s algorithms have prognosticated dengue and chikungunya outbreaks and, finally, the mosquito-borne Zika virus, dubbed a public health emergency by the World Health Organization. Zika had many worried about the state of the 2016 Rio Olympics.
In Rio, suspected new outbreaks are down to a few hundred a week. Not so for its cousin to the north, Venezuela, where over three million cases remain nationwide. “By denying the occurrence of the problem,” adds Torres, “health authorities are also denying the possibility of minimizing Zika in large sectors of the population.”
What’s scarier is that, by all accounts, the government should have been able to make the same prediction. Castro relies on open data sources like Google Trends, social media and search queries, which are used to predict everything from the 2015 MERS outbreak in South Korea to foodborne illnesses in Chicago, explains Chi Bahk, vice president of operations at Epidemico, a public health informatics company based in Boston. What makes Castro different is that he’s turned this standard practice — performed everywhere else in the world — in his field into a quiet political cause. He and others claim the government “knew Zika was circulating since September last year and did nothing,” says Castro. So in the face of that, he’s done what Ph.D.s do: published academic papers, briefed the U.S. state department and served as a key member in Medico de Salud, an underground network of medical professionals who share information about patients, medications and equipment.
He practically rebuilt the system.
“This foolishness is common ground, it’s everyday,” says Jorge Juan Olavarria, a social communications professor at Andrés Bello Catholic University, of the government’s behavior. The government, he says, has “ransacked” the economy and cannot provide health solutions, whether for patients dying of cancer, AIDS or Zika. OZY contacted the government’s health ministry by phone, email and in person but was not provided with a response. The story of government colliding with public health researchers is nothing new in Venezuela: The Chavez administration periodically blocked weekly health reports and hid information on yellow fever and measles outbreaks for months, says Castro.
And why? National reputation, people say from the outside, though it’s hard to know without word from within the ministry. “The government wants to give the sensation that everything is normal when it’s not,” Castro says. He argues we can see the same trend in the response to the food crisis that emerged in recent months; the Guardian reported critics blamed the troubles on everything from price-control measures to government seizures of private property. In 2014, the government refused to recognize a chikungunya outbreak; Castro networked with doctors across the country and proved its existence through PCR tests. After publicizing his findings at a press conference in September, he says the police blocked local media from publishing the story and he went into hiding. A week later, the government began to publish “scarce information” of the disease, says Castro. He got back to work.
Long before he was cast as his country’s unofficial medical spokesperson, Castro was an infectious disease specialist at Vargas Hospital in Caracas with an aptitude for data mining. His interest in math modeling — not part of Venezuela’s epidemiological training, he says — perplexed his colleagues. But while at Boston’s Beth Israel Medical Center in 1998, he met math-geek doctors, and in his free time he audited math classes at Harvard’s School of Public Health.
When he returned to Venezuela, Castro spent a year teaching at Vargas pro bono before taking a tenured position at the Tropical Medicine Unit. But that appointment was interrupted when he was asked to act as health director for Sucre, Venezuela’s densest municipality. Over 12 years, Castro set up Sucre’s — and the country’s — first digital medical records and reestablished hospital and ambulatory services. “He practically rebuilt the system,” says Rafael Sierra, Sucre’s former budget and planning director. Impressed by Castro’s performance, Sucre’s mayor, Carlos Ocariz, asked Castro to join his 2012 reelection campaign, and Castro began combing social media, census data and surveys to catch the electorate’s pulse. Later, Castro would offer the same services to presidential candidate Henrique Capriles but in losing efforts—first to Hugo Chavez in 2012 and then to current Venezuelan president Nicolás Maduro in 2013.
Nowadays, Castro is back to research, teaching and clinical work. He worries that the Venezuelan government can use “its powerful tools to shut us down.” Although Castro would prefer to dedicate his limited free time to his wife and three children, the situation demands more of him. “He’s more comfortable as a technocrat than politician,” says Ocariz. “But I do think he’ll be part of the next government.”