Vicente Piratapuia, 69, of the Piratapuia tribe had a high fever and could hardly breathe, but he refused to leave his home on the outskirts of the Amazon rainforest's biggest city. It took a stern word from a trained nurse in his community to convince him he would die if he refused a ride with her to the emergency room. Vanderlecia Ortega dos Santos, or Vanda to her neighbors, has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak ravaging the Brazilian city of Manaus. It is an uphill battle. The ramshackle settlement of descendants from 35 different tribes, called Parque das Tribos, lacks plumbing and electricity in most homes. Ambulances regularly refuse to pick up the seriously ill because there is no public health clinic nearby. As the coronavirus pandemic has begun spreading across Brazil, indigenous people who live in and around cities have been caught in a dangerous limbo. The country's indigenous health service, Sesai, focuses its resources on those living on tribal reservations. Sesai has reported 10 indigenous deaths from the pandemic on native lands, but indigenous umbrella organization APIB estimated this week it has taken the life of at least 18 indigenous Brazilians if fatalities in urban areas are counted. The real number of cases in often remote villages across Brazil's vast hinterland is difficult to ascertain. REUTERS/Bruno Kelly SEARCH "CORONAVIRUS INDIGENOUS NURSE" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. TPX IMAGES OF THE DAY. Matching text: HEALTH-CORONAVIRUS/BRAZIL-INDIGENOUSNURSE

Vicente Piratapuia, 69, of the Piratapuia tribe had a high fever and could hardly breathe, but he refused to leave his home on the outskirts of the Amazon rainforest's biggest city. It took a stern word from a trained nurse in his community to convince him he would die if he refused a ride with her to the emergency room. Vanderlecia Ortega dos Santos, or Vanda to her neighbors, has volunteered to provide the only frontline care protecting her indigenous community of 700 families from the COVID-19 outbreak ravaging the Brazilian city of Manaus. It is an uphill battle. The ramshackle settlement of descendants from 35 different tribes, called Parque das Tribos, lacks plumbing and electricity in most homes. Ambulances regularly refuse to pick up the seriously ill because there is no public health clinic nearby. As the coronavirus pandemic has begun spreading across Brazil, indigenous people who live in and around cities have been caught in a dangerous limbo. The country's indigenous health service, Sesai, focuses its resources on those living on tribal reservations. Sesai has reported 10 indigenous deaths from the pandemic on native lands, but indigenous umbrella organization APIB estimated this week it has taken the life of at least 18 indigenous Brazilians if fatalities in urban areas are counted. The real number of cases in often remote villages across Brazil's vast hinterland is difficult to ascertain. REUTERS/Bruno Kelly SEARCH "CORONAVIRUS INDIGENOUS NURSE" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. TPX IMAGES OF THE DAY. Matching text: HEALTH-CORONAVIRUS/BRAZIL-INDIGENOUSNURSE

Relief worker Kim Smith (R) helps another volunteer load supplies into a pickup truck at a farm, used as a base for aid to Navajo families quarantined in their homes due to the coronavirus disease (COVID-19) in Hogback, Shiprock, New Mexico, U.S., April 7, 2020. Picture taken April 7, 2020. REUTERS/Andrew Hay

A road sign made by a local student asks residents to keep their "TtAAs" or "butts", in The Navajo language, home during the severe coronavirus disease (COVID-19) outbreak in the Navajo reservation, in Shiprock, New Mexico, U.S., April 8, 2020. Picture taken April 8, 2020. REUTERS/Andrew Hay

Relief workers pose at a farm, used as a base for aid to Navajo families quarantined in their homes due to the coronavirus disease (COVID-19) in Hogback, Shiprock, New Mexico, U.S., April 7, 2020. Picture taken April 7, 2020. REUTERS/Andrew Hay

A relief worker talks to a family as he drops off firewood at their home, as part of an effort to help Navajos stay at home to slow the coronavirus disease (COVID-19) outbreak in Shiprock, New Mexico, U.S., April 7, 2020. Picture taken April 7, 2020. REUTERS/Andrew Hay

A mural warns residents of the danger of coronavirus disease (COVID-19) outbreak on the Navajo reservation, in Shiprock, New Mexico, U.S., April 8, 2020. Picture taken April 8, 2020. REUTERS/Andrew Hay

Relief workers prepare supplies at a farm, used as a base for aid to Navajo families quarantined in their homes due to the coronavirus disease (COVID-19) in Hogback, Shiprock, New Mexico, U.S., April 7, 2020. Picture taken April 7, 2020. REUTERS/Andrew Hay

Navajo Nation Council Delegate Amber Crotty digs her vegetable patch at her house, as she stays at home during the coronavirus disease (COVID-19) outbreak in the Navajo Nation reservation, in Sheep Springs, New Mexico, U.S., April 7, 2020. Picture taken April 7, 2020. REUTERS/Andrew Hay

A pickup truck carrying food and towing a trailer filled with firewood pulls up to a homestead to bring supplies to a Navajo family, whose father died hours earlier from coronavirus disease (COVID-19), south of Shiprock, New Mexico, U.S., April 7, 2020. Picture taken April 7, 2020. REUTERS/Andrew Hay

A general view of Navajo Nation public housing where residents have been asked to stay at home during the coronavirus disease (COVID-19) outbreak in the Navajo Nation reservation, in Shiprock, New Mexico, U.S., April 8, 2020. Picture taken April 8, 2020. REUTERS/Andrew Hay

Relief workers drop off supplies at a house, as part of an effort to help Navajos stay at home to slow the coronavirus disease (COVID-19) outbreak in Two Grey Hills, Shiprock, New Mexico, U.S., April 7, 2020. Picture taken April 7, 2020. REUTERS/Andrew Hay

A road sign outside Bloomfield warns Navajos to stay home during their nation's 8pm to 5am curfew to slow the spread of the coronavirus disease (COVID-19), New Mexico, U.S., April 7, 2020. Picture taken April 7, 2020. REUTERS/Andrew Hay

Elephant Rock, a rock formation, stands off the coast on the Quinault Indian Reservation in Taholah, Washington, U.S., March 2, 2020. Several years ago ''the trunk'' of Elephant Rock succumbed to coastal erosion. The damage to the iconic Quinault landmark has made tribal members more aware of the impacts of climate change. REUTERS/Stephanie Keith SEARCH ''QUINAULT CLIMATE CHANGE'' FOR THIS STORY. SEARCH ''WIDER IMAGE'' FOR ALL STORIES.

A Quinault tribal member digs for clams on Pacific Beach, Washington, U.S. March 5, 2020. REUTERS/Stephanie Keith SEARCH ''QUINAULT CLIMATE CHANGE'' FOR THIS STORY. SEARCH ''WIDER IMAGE'' FOR ALL STORIES. TPX IMAGES OF THE DAY

Aliza Brown, the health and wellness director for the Quinault Indian Nation, wears a traditional Quinault hat on the Quinault Indian Reservation in Taholah, Washington, U.S., March 2, 2020. ''The hat was a gift from my husband and father. It was woven by my relative Vickie Trudeau. There is so much detail and story in the hat that I primarily wear it during potlatch or tribal journeys when the Quinault?s take the floor (singing, dancing and sharing gifts) ... It?s a special piece to me and something I will pass down to my daughter and granddaughters'' said Brown. REUTERS/Stephanie Keith SEARCH ''QUINAULT CLIMATE CHANGE'' FOR THIS STORY. SEARCH ''WIDER IMAGE'' FOR ALL STORIES.

Celina Markishtum, a fisherwoman, who is clam digging during the clam season, smokes a cigarette as she lies on her bed at her home in Quinault Indian Nation's main village, on the Quinault Indian Reservation in Taholah, Washington, U.S. March 6, 2020. ''Clam digging is just for Quinault tribal members, like my husband Stan, he's Micmac and he's not allowed to dig. I mean, we only get $2.50 for a pound so that's a lot of digging. Before we used to get as much as a whole 5 gallon bucket in a day but now we are lucky to get half that. Today, I think I made $15.'' said Markishtum. REUTERS/Stephanie Keith SEARCH ''QUINAULT CLIMATE CHANGE'' FOR THIS STORY. SEARCH ''WIDER IMAGE'' FOR ALL STORIES.

A tribal man performs stunts during a protest rally against a new citizenship law in Mumbai, India, December 26, 2019. REUTERS/Francis Mascarenhas

U.S. President Donald Trump holds a gift he was given by tribal leaders, a picture of himself at an event with them, after signing an Executive Order to address the issue of missing and murdered Native Americans, in the Oval Office at the White House in Washington, U.S. November 26, 2019. REUTERS/Jonathan Ernst

Near midnight, a group of six Guajajara tribesmen with their faces painted for battle listen to the rumble of heavy trucks about 19 miles (30 km) from their village in the Amazon rainforest. They suspect a caravan of illegal loggers felling trees on their reservation. The police are not coming, but the natives have a plan to fight back. The "forest guardians," as they call themselves, hurry to a choke point in the local network of rutted dirt roads and lay in wait, armed with rifles and handguns. As the trucks approach, they ready themselves to spring an ambush, apprehend the loggers and deliver the culprits, along with their equipment, to the nearest federal police station, hundreds of miles away. The men say they are among some 180 guardians patrolling their tribal land against loggers on night missions. REUTERS/Ueslei Marcelino SEARCH "MARCELINO GUARDIANS" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. TPX IMAGES OF THE DAY Matching text: BRAZIL-ENVIRONMENT/GUARDIANS

Tribal fighters loyal to the Yemeni government ride on the back of a truck on a road taken by government forces during recent clashes with southern separatists west of Ataq of the Shabwa province, Yemen August 26, 2019. REUTERS/Ali Owidha

U.S. 2020 Democratic presidential candidate and U.S. Senator Elizabeth Warren sits between Wampanoag Tribe Chairwoman Cheryl Andrews-Maltais and Lumbee Tribe of North Carolina Chairman Harvey Godwin Jr. as she appears with Native American tribal leaders during an appearance at the Frank LaMere Native American Forum while campaigning in Sioux City, Iowa, U.S., August 19, 2019. REUTERS/Alex Wroblewski

U.S. 2020 Democratic presidential candidate and U.S. Senator Elizabeth Warren waves in front of tribal flags and tribal leaders as she appears at the Frank LaMere Native American Forum while campaigning in Sioux City, Iowa, U.S., August 19, 2019. REUTERS/Alex Wroblewski

U.S. 2020 Democratic presidential candidate and U.S. Senator Elizabeth Warren stands in front of Native American tribal leaders as she speaks at the Frank LaMere Native American Forum while campaigning in Sioux City, Iowa, U.S., August 19, 2019. REUTERS/Alex Wroblewski

U.S. 2020 Democratic presidential candidate and U.S. Senator Elizabeth Warren sits among Native American tribal leaders as she speaks at the Frank LaMere Native American Forum while campaigning in Sioux City, Iowa, U.S., August 19, 2019. REUTERS/Alex Wroblewski

U.S. 2020 Democratic presidential candidate and U.S. Senator Elizabeth Warren sits among Native American tribal leaders as she speaks at the Frank LaMere Native American Forum while campaigning in Sioux City, Iowa, U.S., August 19, 2019. REUTERS/Alex Wroblewski

REFILE - ADDING IDENTIFICATION INFORMATION U.S. 2020 Democratic presidential candidate and U.S. Senator Elizabeth Warren sits between Wampanoag Tribe Chairwoman Cheryl Andrews-Maltais and Lumbee Tribe of North Carolina Chairman Harvey Godwin Jr. as she appears with Native American tribal leaders during an appearance at the Frank LaMere Native American Forum while campaigning in Sioux City, Iowa, U.S., August 19, 2019. REUTERS/Alex Wroblewski

U.S. 2020 Democratic presidential candidate and U.S. Senator Elizabeth Warren waves in front of tribal flags as she speaks at the Frank LaMere Native American Forum while campaigning in Sioux City, Iowa, U.S., August 19, 2019. REUTERS/Alex Wroblewski

Supporters of India's main opposition Congress Party burn an effigy during a protest against stopping of their leader Priyanka Gandhi Vadra from visiting a village where tribal people were gunned down this week over a land dispute, in New Delhi, India, July 19, 2019. REUTERS/Danish Siddiqui

A supporter of India's main opposition Congress Party shouts slogans during a protest against stopping of their leader Priyanka Gandhi Vadra from visiting a village where tribal people were gunned down this week over a land dispute, in New Delhi, India, July 19, 2019. REUTERS/Danish Siddiqui TPX IMAGES OF THE DAY

Ray Mitsuing of Meadow Lake Tribal Council (black) races across the finish line before Todd Baptiste of Manteo with Groundswell in the eighth heat of the chuckwagon races during the Calgary Stampede in Calgary, Alberta, Canada July 8, 2019. REUTERS/Todd Korol

U.S. Attorney General William Barr on as Julie Roberts-Hyslop, a tribal leader from the Athabascan village of Tanana speaks during a Department of Justice roundtable with Alaska native leaders in Anchorage, Alaska, U.S., May 29, 2019. REUTERS/Yereth Rosen

U.S. Attorney General William Barr (C) and Senator Dan Sullivan (R-AK) looks on as Julie Roberts-Hyslop, a tribal leader from the Athabascan village of Tanana speaks during a Department of Justice roundtable with Alaska native leaders in Anchorage, Alaska, U.S., May 29, 2019. REUTERS/Yereth Rosen

A landscape, part of the indigenous Pemon tribal land, is seen from the border city of Pacaraima, Brazil April 12, 2019. Picture taken April 12, 2019. REUTERS/Pilar Olivares

Men stand next to a statue of the Kurdish tribal leader Seyit Riza in Tunceli, Turkey April 16, 2019. Picture taken April 16, 2019. REUTERS/Murad Sezer

Men stand next to a statue of the Kurdish tribal leader Seyit Riza in Tunceli, Turkey April 16, 2019. Picture taken April 16, 2019. REUTERS/Murad Sezer

U.S. President Donald Trump speaks during an "Opportunity Zone" conference with state, local, tribal, and community leaders at the White House in Washington, U.S., April 17, 2019. REUTERS/Carlos Barria

U.S. President Donald Trump speaks during an "Opportunity Zone" conference with state, local, tribal, and community leaders at the White House in Washington, U.S., April 17, 2019. REUTERS/Carlos Barria TPX IMAGES OF THE DAY

U.S. President Donald Trump speaks during an "Opportunity Zone" conference with state, local, tribal, and community leaders at the White House in Washington, U.S., April 17, 2019. REUTERS/Carlos Barria

U.S. President Donald Trump speaks during an "Opportunity Zone" conference with state, local, tribal, and community leaders at the White House in Washington, U.S., April 17, 2019. REUTERS/Carlos Barria

U.S. President Donald Trump speaks during an "Opportunity Zone" conference with state, local, tribal, and community leaders at the White House in Washington, U.S., April 17, 2019. REUTERS/Carlos Barria

U.S. President Donald Trump speaks during an "Opportunity Zone" conference with state, local, tribal, and community leaders at the White House in Washington, U.S., April 17, 2019. REUTERS/Carlos Barria

U.S. President Donald Trump speaks during an "Opportunity Zone" conference with state, local, tribal, and community leaders at the White House in Washington, U.S., April 17, 2019. REUTERS/Carlos Barria

U.S. President Donald Trump departs after taking part in an "Opportunity Zone" conference with state, local, tribal, and community leaders at the White House in Washington, U.S., April 17, 2019. REUTERS/Carlos Barria

U.S. President Donald Trump departs after taking part in an "Opportunity Zone" conference with state, local, tribal, and community leaders at the White House in Washington, U.S., April 17, 2019. REUTERS/Carlos Barria

U.S. President Donald Trump speaks during an "Opportunity Zone" conference with state, local, tribal, and community leaders at the White House in Washington, U.S., April 17, 2019. REUTERS/Carlos Barria

U.S. President Donald Trump departs after taking part in an "Opportunity Zone" conference with state, local, tribal, and community leaders at the White House in Washington, U.S., April 17, 1019. REUTERS/Carlos Barria

U.S. President Donald Trump speaks during an "Opportunity Zone" conference with state, local, tribal, and community leaders at the White House in Washington, U.S., April 17, 1019. REUTERS/Carlos Barria

U.S. President Donald Trump departs after taking part in an "Opportunity Zone" conference with state, local, tribal, and community leaders at the White House in Washington, U.S., April 17, 1019. REUTERS/Carlos Barria

U.S. President Donald Trump speaks during an "Opportunity Zone" conference with state, local, tribal, and community leaders at the White House in Washington, U.S., April 17, 1019. REUTERS/Carlos Barria

U.S. President Donald Trump speaks during an "Opportunity Zone" conference with state, local, tribal, and community leaders at the White House in Washington, U.S., April 17, 1019. REUTERS/Carlos Barria

U.S. President Donald Trump arrives to take part in an "Opportunity Zone" conference with state, local, tribal, and community leaders at the White House in Washington, U.S., April 17, 1019. REUTERS/Carlos Barria

Hedi Bogda, a survivor of the Cedarville Rancheria Tribal Office mass shooting, has a quiet moment during the grand opening of the Aurora Theater shooting memorial in Aurora, Colorado, U.S., July 27, 2018. REUTERS/Leah Millis SEARCH "COLUMBINE SURVIVOR" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. THE IMAGES SHOULD ONLY BE USED TOGETHER WITH THE STORY - NO STAND-ALONE USES.

An indigenous Macuxi man receives medical care by an indigenous health agent at the community of Uailan on the Raposa Serra do Sol reservation, Roraima state, Brazil February 10, 2019. REUTERS/Bruno Kelly SEARCH "BOLSONARO INDIGENOUS" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.

Indigenous Macuxi leader Orlando Pereirana da Silva, 73, weighs cattle meat at the community of Uailan on the Raposa Serra do Sol reservation, Roraima state, Brazil February 10, 2019. REUTERS/Bruno Kelly SEARCH "BOLSONARO INDIGENOUS" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.

Indigenous Macuxi people work in a manioc plantation at the community of Uailan on the Raposa Serra do Sol reservation, Roraima state, Brazil February 10, 2019. REUTERS/Bruno Kelly SEARCH "BOLSONARO INDIGENOUS" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.

Indigenous Macuxi children play in Uailan River at the community of Uailan on the Raposa Serra do Sol reservation, Roraima state, Brazil February 10, 2019. REUTERS/Bruno Kelly SEARCH "BOLSONARO INDIGENOUS" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.

Indigenous Macuxi leader Tuchaua Gilmario Pereira poses for a photograph at the community of Uailan on the Raposa Serra do Sol reservation, Roraima state, Brazil February 10, 2019. REUTERS/Bruno Kelly SEARCH "BOLSONARO INDIGENOUS" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.