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ByFabiolaSanchez TheAssociatedPress CARACAS, VENEZUELA This is what the Zika out- break looks like in Venezu- ela, a country whose medi- cal system has teetered for months on the brink of col- lapse: There's a lack of bug spray to prevent mosquito bites, scant contraceptives to avert pregnancies, lit- tle medicine to treat Zika- linked maladies. There has been no effective public health campaign to inform the public about the disease — and nobody really knows how many infections there have been. "It's just terrible what we are living," said Carla Natera, a 50-year-old local government worker who contracted Zika and spent three days searching phar- macies for an ointment to calm the angry rash that broke out on her face and body. William Barrientos, a doctor and opposition law- maker, says the socialist government is not equipped to confront a health crisis in a country where food and medicine shortages are acute, the economy is a shambles and a political cri- sis deepens by the day. "There is no education and information campaign among the population here," and no tracking of the mosquitoes that carry the virus, he said. The scale of what Ven- ezuela is going through is unclear. Officials alerted the World Health Organi- zation to the first case of Zika here in November but did not release statistics or reach out to the public un- til two months later. The Health Ministry is now reporting more than 5,000 suspected Zika cases and three related deaths. But a network of indepen- dent physicians allied with the opposition — the Ven- ezuelan Society of Public Health — says that's likely a dramatic underestimate. It says a polling of local health officials found a rise in acute fevers that could correspond to 400,000 Zika cases, and the outbreak will likely reach its peak around the end of March. Neighboring Colombia, by contrast, has reported more than 30,000 cases. It's been a year since the government published up-to-date epidemiologi- cal data and reaching the Health Ministry for infor- mation is frustrating. The main line for hits "Zika sit- uation room" was out of or- der Tuesday and the person answering another number for the room hung up twice on a reporter. To compensate for the lack of official figures, doc- tors have been turning to informal surveys, social me- dia and even Google analyt- ics to try to get a handle on the scope of the outbreak. The virus has been linked to a spike in Guillain-Barre, a rare disorder in which the immune system attacks the nervous system, causing temporary paralysis that can be fatal. Health officials say the country has seen 255 cases of the Guillain- Barre syndrome since the Zika outbreak began — a much higher incidence than reported in other countries grappling with the virus. "Normally, we'd expect 30 or 40 cases of Guillain- Barre a month," said former health minister José Félix Oletta. "What this shows is that the minister has the total number of Zika cases wrong. It's much higher." Venezuela's medical shortages could easily boost the mortality rate for Guil- lia-Barre, which is about 5 percent in developed coun- tries. Nancy Pino, a 68-year- old retired school adminis- trator, died last month of Guillain-Barre that devel- oped after she fell ill over Christmas with symptoms of Zika. Doctors said the woman from the lowland state of Anzoategui needed intrave- nous immunoglobulin ther- apy, and sent her three chil- dren on a frantic two-week search for the medicine af- ter they rushed her to Ca- racas. As the family begged for immunoglobulin at state agencies, on local televi- sion channels and even at the presidential palace, their mother lost the abil- ity to walk, speak, open her eyes and, finally, to breathe. "They shut the doors on us. There's just not medi- cine here," daughter Nehara Ramos said. The country's private, op- position-leaning pharma- ceutical association says Venezuela only has 20 per- cent of the medications it requires, a result of cur- rency and price controls. The government blames the shortages on "economic war" waged by its right- wing opponents. Earlier this month, Health Minister Luisana Melo invited sick Venezu- elans to email requests for medicine to a state-run Gmail account. Last week, President Nicolas Maduro said the country had re- ceived a special shipment of drugs that will be sufficient to combat Zika, but did not specify what the shipment included. The Health Ministry is advising the public to use bug spray, an item all but impossible to come by in Venezuela these days, and to clean out their tubs of standing water once a week. That is a lot to ask, however, of the many Ven- ezuelans keep tubs in their homes full of water to deal with chronic shortages. Meanwhile, state media have been broadcasting a steady stream of footage of health officials accompany- ing workers on mosquito fu- migation and immunoglob- ulin distribution missions. What they haven't been doing with any regularity is offering the public advice on how to behave. Venezuelan officials say the country has not yet seen any cases of birth de- fects associated with Zika, as have been reported in Brazil. Other countries have advised women to post- pone pregnancy until the Zika epidemic has slowed. But in Venezuela, condoms and birth control pills are in extremely short supply, making it complicated for women to avoid pregnancy. In the western state of Zulia, a focal point of the epidemic, local health au- thorities say 25 pregnant women have contracted Zika and are under medi- cal observation. Doctors are also com- plaining that laboratories have been unable to obtain the chemical needed to di- agnose Zika by identifying the DNA of the virus. Doc- tors have to rely on a clini- cal diagnosis based only on symptoms. "It's like flying by instru- ments," pediatrician Caro- lina Mirabal said. Associated Press writer Hannah Dreier contributed to this report. OUTBREAK VenezuelafightsZikaamidshortages,informationblackout THEASSOCIATEDPRESS A municipal worker fumigates against the Aedes aegypti mosquito that transmits the Zika virus in the Petare neighborhood of Caracas, Venezuela. Preventing the Zika virus' spread in the absence of a public campaign in Venezuela where the health care system is near collapse means the people most at risk, the poor, don't even know about the epidemic. By Matt O'Brien The Associated Press PROVIDENCE, R.I. Lisa So- lano-Sanchez looks at her 16-year-old son and sees a bright, healthy, musi- cally gifted teenager. A re- lief, considering she had no idea how he would turn out when she discovered he was poisoned by lead as a tod- dler. Still, she scrutinizes her son's behavior and can't help but wonder if he's been held back from his full po- tential. "Not knowing drives me crazy," she said. A decade before Flint, Michigan, there was Rhode Island, a tiny state that took a daring plunge by suing the paint industry to seek money for cleaning up a danger lurking on walls and windowsills in up to 80 percent of its homes. The landmark lawsuit re- verberates today not only in Flint, but also in California, where 10 cities and counties are fighting to hold onto a $1.1 billion victory over the same industry. Though the lawsuit re- mains influential, Rhode Island has little to show for its short-lived triumph on Feb. 22, 2006. Two years later, the state's highest court unanimously over- turned the verdict, saying the paint industry couldn't be held responsible. "My heart is still broken at the Supreme Court's de- cision that I still today can- not understand or justify," said Democratic U.S. Sen. Sheldon Whitehouse, the former Rhode Island attor- ney general who had initi- ated the case. Studies have tied lead poisoning to permanent damage to children's brains and conditions including lowered intelligence, learn- ing disabilities and behav- ioral problems. Symptoms can take years to manifest and be hard to confirm. Leaded paint, easily in- gested by children whose fingers touch contaminated dust or who pick up sweet- tasting flakes that end up in their mouth, was a known danger and outlawed in the late 1970s. Rhode Island was hardly the only place with potentially exposed children, but in a compact and old state with an el- derly housing stock, the threat was especially acute. In 1999, when Rhode Is- land first sued, more than 2,300 children under 6 years old, nearly 7 percent of all those tested in the state, were found to have dangerously elevated levels of lead , according to the federal Centers for Disease Control and Prevention. By 2014, that number had dropped to 217, just under 1 percent of all the children tested statewide — but still 40 percent above the na- tional rate. Education campaigns helped, health experts say, as did government subsi- dies for remediation and laws that put more respon- sibility on landlords. But blood tests still find more than 1,000 new cases each year of children with ele- vated levels. Few families were im- mune, especially in poorer areas populated by racial minorities — a connection also seen in Flint, where the culprit is the water supply. "Lead poisoning would have been wiped out" if the problem had been con- centrated in wealthier and whiter neighborhoods, said Roberta Hazen Aaronson, founder and director of the Childhood Lead Action Project. "It's not an equal-oppor- tunity disease," she said. But wealthier families did fall victim. Donna Lizotte thought she and her husband knew what they were doing when they bought a stately Victo- rian a decade ago in the de- sirable Edgewood district of Cranston and painted over old layers. Later, their daughter was found to have 23 mi- crograms of lead per decili- ter of blood. Federal health officials have said there is no safe level of lead in chil- dren's blood, but that any- thing above 5 micrograms is high. The family found evidence she had scratched at a wall near her crib. "I thought lead poisoning was something that hap- pened in dilapidated rental units," said Lizotte, an ed- ucator and scientist with a doctorate in molecular biol- ogy. "Honestly, I think I was just naive." Now 10, the girl has at- tention deficit disorder, something correlated with lead poisoning, and other conditions. "Here we are, 40 years later, it's still everywhere," she said. "I think the com- panies owe it to the chil- dren that are sick to fix it." Most companies began phasing out lead-based pig- ments decades before the U.S. banned them in resi- dential paint in 1978. Plain- tiffs have said the compa- nies and the now-defunct Lead Industries Association, a trade group that declared bankruptcy during Rhode Island's litigation, should havestoppedpromotingand selling the paint earlier be- cause some of lead's damag- ing effects had been known for a century. Whitehouse — whose own two children had ele- vated lead levels — sued on the state's behalf in 1999. It ended in a hung jury and mistrial, and was followed by a second trial argued by Whitehouse's successor. A jury found three companies liable: Sherwin-Williams, Millennium Holdings and NL Industries. After the industry ap- pealed, Rhode Island's highest court recognized the long-term health con- sequences but dismissed the theory that a problem in homes and apartment buildings was a public nui- sance for which paint com- panies were liable. The judges declared it land- lords' responsibility to keep homes safe. Courts and state officials elsewhere scrapped law- suits that sought to hold manufacturers responsi- ble for the windfall of cash needed to repair hazardous housing stock. STATE SUED PAINT INDUSTRY A decade before Flint's lead scare, there was Rhode Island Endsnoring Anestimated80million people in North America snore. Taking into account the snorer's spouse and children, as many as 160 million people are negatively affected by snoring. Snoring not only interrupts your sleep cycle, it can also be a symptom of a condition called sleep apnea. Fortunately, there are cost-effective oral appliances for snoring and sleep apnea that dentists can prescribe to their patients. Traditional mandibular advancement appliances, such asSilentNightSlide-Link,TAP,EMA, help reduce or eliminate snoring by moving the lower jaw forward, opening the airway to allow air to flow more freely. CALL DR. 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