A town devastated by the coronavirus pandemic is fast running out of hospital beds and scrambling each day for oxygen as it seeks to accommodate an influx of Covid patients who cannot get to the nearest big city.
The Hilda Freire hospital is the only one in Iranduba, an Amazonian town in northwest Brazil, which has no dedicated intensive care unit and has had to improvise under the onslaught of a second pandemic wave that has battered Brazil's northern Amazonas state.
"It was all very quick. Suddenly everything was full. Our structure cannot handle this," an administrative employee of the hospital, who asked not to be named, told AFP.
It comes after the South American nation reached 200,000 Covid deaths earlier this month.
Iranduba, a town of 50,000 people some 40 kilometres from the Amazonas capital Manaus, registered 15 coronavirus deaths between Monday and Wednesday this week - more than in the last four months put together.
Almost all the hospital's 30 beds are occupied, and it now has just enough oxygen left for one day.
"We have had some losses," said another hospital worker, clad in top-to-bottom, white protective gear.
Health personnel say they do not wish to give their names for fear of professional repercussions.
"We were very sad. We had no way to help them," the worker said, describing how several patients left the world gasping for breath without access to oxygen.
The hospital has since received several oxygen canisters from other Brazilian states as well as neighbouring Venezuela.
But the relief is short-lived.
"As soon as they unload the oxygen, we start worrying where the next day's supply will come from. It is a constant stress," said one hospital staffer.
One hospital for 100,000 as Covid bites
Iranduba is accessible via a road with many muddy stretches that are hard to navigate in periods of heavy rain, which are frequent.
It is this road the more seriously-ill patients must travel to Manaus -- the only of Amazonas state's 63 cities with dedicated intensive care beds.
But Manaus, too, is under strain, and has itself received emergency oxygen deliveries.
Privately, families in Manaus are scrambling to find oxygen as they set up makeshift intensive care units at home, distrustful of the state's ability to take care of loved ones.
Brazil has had more than 210,000 deaths due to the Covid-19 pandemic, second only to the United States.
Amazonas state has been particularly hard hit among Brazil's 27 states, with a death rate of 159 per 100,000 inhabitants in an area where rivers and forest terrain make the logistical challenges of confronting a health crisis even more difficult.
At the Iranduba hospital, a volunteer drops off an oxygen cylinder for an 86-year-old patient admitted two weeks ago.
She works for an NGO that delivers medicines and clothes to indigenous communities.
The patient had "spent three or four hours without oxygen, with manual ventilation, and her family asked us for help."
About 85 km west of Iranduba along a road that crisscrosses rivers and jungle, is the town of Manacapuru, which counts 223 Covid deaths among its 100,000 population -- the highest rate in Amazonas.
It has only one hospital, Lazaro Reis, where staff race up and down its dilapidated corridors to try and deal with the influx.
Devastated doctor ‘cannot tell you how many have died’ of Covid
A patient lies on a stretcher in the hall, hooked up to an oxygen cylinder.
"I cannot tell you how many died, but it has been many," said a doctor, who also did not want to be named.
A siren rings out, drawing closer, prompting someone to exclaim: "Another ambulance."
"No, it's oxygen," cries a man from outside, where he was controlling traffic access with orange cones and making way for the convoy of four vans loaded with green cylinders.
A dozen men rush in to start unloading the vans.
"It gives great joy when they arrive," said the traffic controller.
"You never know if they will come again."
On Tuesday, a delivery delay caused seven deaths in Caori, a settlement west of Manacapuru, according to authorities.
One of the men helping load empty cylinders onto a truck pauses, raises his hands to the sky in a praying gesture, and exclaims: "May the oxygen not stop again!"
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