MANAUS, Brazil (AP) — They left their tribal lands in the Amazon for the city, many seeking a better life. But in the midst of the coronavirus pandemic they have neither the protective isolation of their homelands, nor the government care that drew them to the city of Manaus in the first place.

More than 30,000 indigenous people live in the Brazilian state capital hardest hit by the global pandemic. Many among them are sick with fever, straining for air and dying, but just how many no one knows.

The indigenous people of Manaus live together in poor neighborhoods where they struggle to maintain their native languages, culture and identity on the fringes of Brazilian society.

In April, Brazil’s minister of education said during a Cabinet meeting: “I hate the term ‘indigenous peoples’” because in his opinion the indigenous should just be called Brazilians. The comments were roundly denounced in Brazil and abroad by those who believed he meant to erase the identity they are trying to preserve.

For decades, they have fought racism and discrimination with the worst health indicators in the country, including the highest infant mortality rate. The pandemic only highlights this.

The AP interviewed and photographed more than a dozen indigenous people in and around Manaus who wore the traditional dress of their tribes, and the masks they are making to protect themselves against the deadly virus.

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This story was produced with the support of the Pulitzer Center on Crisis Reporting.

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VANDA ORTEGA, 33, WITOTO ETHNICITY

“If I don’t walk with my body painted and with my feathers I am an invisible citizen,” said Vanda Ortega who lives in the Park of the Tribes, a community that is home to more than 2,500 indigenous from 35 ethnic groups in the outskirts of Manaus.

In the absence of medical services in her community, Ortega volunteers as a nurse, treating sick neighbors suspected of having the new coronavirus. She has become one of the symbols of the indigenous fight against the pandemic after raising her voice to denounce government neglect, including the undercounting of indigenous patients who were, instead, registered as multiracial in the public health system.

Ortega’s outrage came after she was denied an ambulance to take her coughing and feverish 46-year-old neighbor to a hospital in April. The attendant suggested Ortega take the patient to an indigenous field hospital that had been promised by the health minister, unaware that it didn’t yet exist.

“If you have the address, please send it to me,” Ortega told the attendant sarcastically. She hung up and drove the sick woman to the nearest hospital herself. She would have to do the same for another six residents as dozens fell ill in her community, including the leader who eventually passed away.

When federal authorities visited a Manaus hospital, Ortega stood outside holding up signs that read “Indigenous Lives Matter.” The health minister didn’t stop to speak to her, but she grabbed the media’s attention and her protest eventually paid off.

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On May 20, nearly two months after the slum’s first suspected COVID-19 case, municipal authorities finally set up a basic field clinic inside the Park of the Tribes and began testing residents.

A week later, state and federal authorities inaugurated a wing of a Manaus hospital with 53 beds and hammocks in the rooms for indigenous patients — a small victory for Ortega who attended its inauguration.

She hopes that both the clinic and the indigenous wing of the hospital will continue after the pandemic.

“For 520 years we have been fighting for education and healthcare that respects our culture and values our ancestral knowledge,” Ortega said.

SÔNIA VILACIO, 46, SATERÉ MAWÉ ETHNICITY

The new coronavirus has hit Sônia Vilacio twice. The first time was when tourists disappeared from Manaus. Like the rest of the artisans in the Sateré Mawé Women’s Association who earn a living selling their arts and crafts, she was left without an income. Soon after, she fell ill with a fever, shortness of breath and a cough, telltale signs of COVID-19.

“We didn’t have painkillers and no money to buy any,” said Vilacio who lives in a working-class neighborhood in Manaus with her four children, husband and extended family.

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Fearing the city’s overrun hospitals, she decided to stay home and treat her illness with natural remedies that she had learned to make from her grandmother, who first moved to the city in the 1970s as a widow with seven daughters.

Vilacio and the two generations of women before her were never able to finish their studies. Instead they worked as housemaids, where they were not allowed to wear traditional dress and body paint. “We couldn’t use our feathers,” said Vilacio whose indigenous headdress symbolizes protection.

With the help of donations, Vilacio and the rest of her family were able to buy sewing machines and cloth to make masks and sell them through social media. Unlike the rest of poor and unemployed Brazilians, Vilacio said she was unable to receive the federal governments’ emergency cash benefit and is surviving from the sale of masks for now.

Other members of her family have since fallen ill with symptoms of COVID-19, but their cases will not be included in the indigenous tally of virus cases since they have yet to see a doctor or to be tested.

PEDRO DOS SANTOS, 70, MURA ETHNICITY

Pedro dos Santos is one of two leaders of the Park of Indigenous Nations community, a slum in Manaus where 300 families from 13 tribes live in unfinished brick houses. Children there run along unpaved streets next to open sewers and water only runs three times a week from faucets.

Dos Santos moved to Manaus with his family over a decade ago so his wife who suffered chronic stomach problems could be closer to hospitals. What they found, however, was a bureaucratic and skeletal public health system where it took months to book an appointment with a specialist.

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In April, dos Santos, his wife, children and grandchildren all fell ill with COVID-19 symptoms. After days of fever the 70-year-old chief sought treatment in a public clinic, but the nurse said he’d be better off staying at home, so he returned without ever being tested for the new coronavirus. Soon, one by one, the rest of his neighbors also fell into their hammocks with fever.

Like many in his community Dos Santos relied on medicinal plants, drinking tea made of chicory root, garlic and lime, and prayed for the virus to pass.

“The few that went to the hospital didn’t return,” dos Santos said referring to one of his neighbors who died shortly after being intubated. “So we got scared.”

TEREZINHA DE SOUZA, 45, SATERÉ MAWÉ ETHNICITY

A 15-minute boat ride away, just beyond Manaus’ edge on the other side of the Taruma Acu river, 150 indigenous men, women and children from five ethnicities feel equally neglected.

Unlike the Park of the Tribes and the Park of Indigenous Nations, the communities on the bank of the Taruma Acu river fall under the responsibility of federal indigenous health care provider SESAI. But even they complained they weren’t getting the on-the-ground primary care SESAI said publicly that it was providing.

Terezinha de Souza, who is part of the Sateré Mawé ethnic group, looks after the local health clinic: a wooden shack equipped with a scale and a stash of basic medications including antibiotics and paracetamol. Like most in her community she fell ill with fever, body aches and a dry cough at the end of May. She said she asked for help through a WhatsApp chat created for the pandemic that includes SESAI health workers.

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“I told the group: I need help, I’m weak, I can’t speak, I can’t get up and my people are coming to me asking for medication. I can’t even give them medication,” she said as she stood in the empty clinic a few days later. “Where are the people who are paid to be here?”

De Souza’s health deteriorated. On June 2 she crossed the river hoping to be admitted at the indigenous wing of the Manaus hospital inaugurated just a few days earlier. She was initially turned away and sent to a different public hospital where, after eight hours, she was finally transferred back and admitted to the indigenous wing. The delay in her hospital admittance sparked a small protest by other Sateré Mawé indigenous outside the hospital.

The next day four more residents of the Taruma Acu communities were transferred to Manaus suspected of having COVID-19.

In de Souza’s opinion the hospitalizations could have been avoided had a nurse or doctor visited them at earlier stages of the pandemic.

“I ask for more compassion with us” she said. “More care.”