AP PHOTOS: A river route for food and crime: The dual nature of a major South American waterway

VILLA GOBERNADOR GALVEZ, Argentina (AP) — From its headwaters in Brazil, the Paraguay River flows hundreds of miles (kilometers) south to where it joins the Parana River to form a single 2,100-mile (3,400-kilometer) waterway that carries much of the agricultural and mineral wealth of South America to the Atlantic.

The riverine waterway connects Argentina, Bolivia, Brazil, Paraguay and Uruguay and carries much of the world’s soybeans, ore and minerals.

While the Amazon River is longer and bigger, the Parana-Paraguay waterway carries almost as much freight. In a sense, it is the Mississippi River for the nations of South America’s southern cone.

Given the nature of the freight — bulk cargos — most of the thousands of ships that ply this waterway are huge, hulking transports carrying loads for international food conglomerates like Cargill. They tower above the low-lying port towns that dot the length of the Paraguay-Parana.

Into the bowels of the ships are fed unimaginably large quantities of soy beans from warehouses holding equally gargantuan piles of soy, the basic foodstuff for millions of farm animals around the globe.

But like the Mississippi, the waterway known locally as the “hidrovía” also conserves traces of its past.

Fisherman Dante Andino rises at dawn, around 5 a.m. His son Pablo, 14, accompanies him, learning the trade.

The elder Andino puts on his rubber boots and once on the water carefully uncoils the net he will cast by hand four or five times in a day from the prow of his tiny row boat.

On average, that will earn him around $20 per day. His net is the most valuable tool he owns, and the one that is most at risk from the huge freighters. “If we are not careful, they run over our nets and cut them.”

“This waterway has made it very difficult for us fisherman, because for these big ships to pass, they have to dredge out (the river bottom) very deep,” said Andino, as he prepared his net. “They tell us that the river is for agricultural exports, not for fishermen.”

“But we have families, daily expenses, we can't stop,” he said. “I am 35 years old, and stopping fishing now and looking for other work would be difficult.”

Gustavo Idígoras, the head of Argentina's oil and seed business chamber, said the freight traffic on the waterway cannot stop. It's a question of “world food security,” he says.

“It is truly a highway that connects our country with 120 overseas markets,” said Idígoras.

But the waterway also carries violence and drug trafficking. And the drug cartels, among them, Brazil’s First Capital Command, have found devious and complex ways to use the waterway to ship cocaine as far away as Belgium and Holland.

In the last two years, more than 50 tons of cocaine that traveled this route through South America were seized from the European ports of Antwerp, Belgium and Rotterdam in the Netherlands. Much of it was controlled by the First Capital Command.

The trafficking is so large-scale that it can sometimes be downright brazen.

In July, authorities at a river port on the outskirts of Asuncion, Paraguay seized four tons of cocaine that had been packed into sugar sacks in a container bound for Antwerp, Belgium. The traffickers apparently hoped that one sack of white crystals would look much like any other.

According to a 2019 investigation by Paraguay’s anti-drug agency, Senad, huge loads of cocaine were produced in Bolivia. From there, traffickers loaded it aboard small airplanes and landed in Paraguay’s Chaco region, which borders Bolivia.

It’s the perfect geography for drug trafficking, said Francisco Ayala, a spokesman for Senad.

“It is an ideal terrain for trafficking all kinds of products, it is ideal,” said Ayala. “It is a sparsely populated area with rough terrain, directly on the border with Bolivia.”

“Paraguay’s Chaco (region) has, and lends itself to, setting up clandestine airstrips” for drug flights mainly from Bolivia, he said.

Once in Paraguay, the drugs in the 2019 case were taken by land to Seguro de Villeta, a shipping port on the upper Paraguay River. There, the cocaine was hidden in freight containers bound for Belgium and Holland.

Farther down the river is Rosario, Argentina, the picturesque hometown of soccer star Lionel Messi and revolutionary Ernesto “Che” Guevara. It lies just 180 miles (300 kilometers) from where the vast river enters the sea. Here, the trafficking and violence intensifies as the shipments get closer to the sea and drug gangs vie to protect their shipments. Homicide numbers in Rosario are five times the national average for Argentina.

Rosario’s link to soccer goes beyond Messi; in November, authorities said they were investigating the killings of two leaders of the fan club for the city’s soccer team, Rosario Central, as a possible hit by rivals or drug gangs.

Things got so bad that President Javier Milei instituted a crackdown on crime. Known as “Plan Bandera (the Flag Plan)," police were sent into the city’s roughest neighborhoods and tightened control on gang leaders running their operations from inside prisons.

Milo Lautaro Sandoval gets his slingshot ready to hunt pigeons after assisting his neighbor Carlos Andino to fish in the Parana River in Villa Gobernador Galvez, Argentina, Wednesday, Dec. 11, 2024. (AP Photo/Rodrigo Abd)

Briceno Medina and his grandfather Gerardo Medina relax on the banks of the Parana River in Villa Gobernador Galvez, Argentina, Wednesday, Dec. 4, 2024. (AP Photo/Rodrigo Abd)

Workers walk at the Molinos Agro on the banks of the Parana River in San Lorenzo, Argentina, Tuesday, Dec. 3, 2024. (AP Photo/Rodrigo Abd)

A worker stands in a soybean warehouse at the Molinos Agro agroindustrial complex on the banks of the Parana River in San Lorenzo, Argentina, Tuesday, Dec. 3, 2024. (AP Photo/Rodrigo Abd)

A couple watches the sun set outside an agricultural export port on the banks of the Parana River in Puerto General San Martin, Argentina, Monday, Dec. 2, 2024. (AP Photo/Rodrigo Abd)

A first responder from a Rosario based company CCREP, patrols the Parana River in a boat in Puerto General San Martin, Argentina, Wednesday, Dec. 4, 2024. (AP Photo/Rodrigo Abd)

Relatives grieve over the body of 21-year-old Silvano Caballero, who was shot dead in the Villa Banana neighborhood of Rosario, Argentina, early Wednesday, Nov. 13, 2024. (AP Photo/Rodrigo Abd)

Police officers talk to a woman during an anti-gang operation in the 7 de Septiembre neighborhood of Rosario, Argentina, Tuesday, Nov. 12, 2024. (AP Photo/Rodrigo Abd)

The keys used by penitentiary agents hang inside their office at the Pinero prison in Rosario, Argentina, Saturday, Sept. 28, 2024. (AP Photo/Rodrigo Abd)

A prisoner peers from his cell as penitentiary agents search the pavilion where the most dangerous gang members are held at the Pinero prison, Rosario, Argentina, Saturday, Sept. 28, 2024. (AP Photo/Rodrigo Abd)

Control towers are seen through a window of a pavilion where drug trafficking gang members are held in the Pinero prison, during a security operation carried out by prison guards in Rosario, Argentina, Saturday, Sept. 28, 2024. (AP Photo/Rodrigo Abd)

Penitentiary agents search inmates in the pavilions where the most dangerous drug gang members are held at Pinero prison in Rosario, Argentina, Saturday, Sept. 28, 2024. (AP Photo/Rodrigo Abd)

Manjui Indigenous women play volleyball in the Abisai community of Mariscal Estigarribia, in the western region of Paraguay known as the Paraguayan Chaco, Wednesday, Aug. 28, 2024. (AP Photo/Rodrigo Abd)

The luggage of passengers coming from Santa Cruz de la Sierra, Bolivia, are inspected by agents of Paraguay's National Anti Drug secretary (SENAD) in Mariscal Estigarribia, the western region of Paraguay known as the Paraguayan Chaco, Wednesday, Aug. 28, 2024. (AP Photo/Rodrigo Abd)

A private aircraft sits parked on the tarmac of the Dr. Luis María Argaña Airport in Mariscal Estigarribia, inthe western region of Paraguay known as the Paraguayan Chaco, Wednesday, Aug. 28, 2024. (AP Photo/Rodrigo Abd)

Agents from Paraguay's National Anti Drug Secretary (SENAD) stand guard at a check point in Filadelfia, the western region of Paraguay known as the Paraguayan Chaco, Tuesday, Aug. 27, 2024. (AP Photo/Rodrigo Abd)

A worker repairs a wall on a ship at La Barca del Pescador shipyard on the banks of the Paraguay River in the port of Villeta on the outskirts of Asuncion, Paraguay, Thursday, July 11, 2024. (AP Photo/Rodrigo Abd)

The captain of a cargo ship from the Paraguayan company Paranave works with his crew as they navigate the Paraguay River after leaving the port of Villeta on the outskirts of Asuncion, Paraguay, Thursday, July 11, 2024. (AP Photo/Rodrigo Abd)

A crew works to release their cargo ship as they leave the port of Villeta, on the outskirts of Asuncion, Paraguay, Thursday, July 11, 2024. (AP Photo/Rodrigo Abd)

A container ship navigates the Paraguay River near the port of Villeta on the outskirts of Asuncion, Paraguay, Wednesday, July 10, 2024. (AP Photo/Rodrigo Abd)

Caacupemi port workers take a break on the Paraguay River in Asuncion, Paraguay, Tuesday, July 9, 2024. (AP Photo/Rodrigo Abd)

The Caacupemi port stands on the banks of the Paraguay River in Asuncion, Paraguay, Tuesday, July 9, 2024. (AP Photo/Rodrigo Abd)

Artisanal fisherman Marcelo Munoz nap inside a container used as a base by fishermen before fishing overnight in the Parana River in Villa Gobernador Galvez, Argentina, Wednesday, Dec. 11, 2024. (AP Photo/Rodrigo Abd

The bones of fish caught in the Parana River lay on the table after being eaten for lunch in Villa Gobernador Galvez, Argentina, Wednesday, Dec. 11, 2024. (AP Photo/Rodrigo Abd)

Dante Andino prepares to plunge a dead pig into boiling water in Villa Gobernador Galvez, Argentina, Tuesday, Dec. 10, 2024. (AP Photo/Rodrigo Abd)

Dante Andino fishes in the Parana River in Villa Gobernador Galvez, Argentina, Tuesday, Dec. 10, 2024. (AP Photo/Rodrigo Abd)

WASHINGTON (AP) — President Donald Trump had another medical exam on Tuesday, putting his health under renewed public scrutiny as he has worked to dismiss concerns over his age and stamina.

The 79-year-old president spent more than three hours at Walter Reed National Military Medical Center for what the White House described as preventive medical and dental checkups. It was Trump's fourth publicly disclosed medical exam since he returned to office for a second term, and it comes as he tries to project strength ahead of midterm elections that will test his sway with voters.

In a social media post after the visit, Trump said that he had just finished his “6 month physical” and that “Everything checked out PERFECTLY.”

For decades, administrations have released selected results from presidential physicals, offering the public a glimpse at the commander-in-chief’s health. But the results are filtered through the White House and must be approved by the president, raising questions about what the public does and doesn't get to see.

Trump, a Republican, turns 80 next month and was the oldest person elected U.S. president. His immediate predecessor, President Joe Biden, a Democrat, was 82 when he left office, dropping out of the 2024 presidential race because of widespread concerns he was too old for the job.

A Washington Post/ABC News/Ipsos poll conducted in April found that less than half of U.S. adults think Trump has the mental sharpness or physical health to serve effectively as president.

“I think concern for the president’s physical health is probably at an all-time high, and I think advanced physical age is the No. 1 concern,” said Dr. Jeffrey Kuhlman, who served as a White House physician for more than a decade under Presidents Barack Obama, George W. Bush and Bill Clinton.

For a president of Trump’s age, a complete physical would be expected to include advanced heart testing, screening for common cancers and a cognitive assessment, along with basics like height, weight and blood pressure, Kuhlman said.

The White House has not disclosed what the visit entailed but expressed confidence in what it will show.

“President Trump is the sharpest and most accessible President in American history who is working nonstop to solve problems and deliver on his promises, and he remains in excellent health,” White House spokesperson Davis Ingle said in a statement.

In the weeks leading up to his visit, Trump has been saying he feels as good as he did five decades ago — even as he jokes about his fondness for fast food and his minimal exercise regimen. Yet he’s also sensitive to perceptions about his age, noting that he takes extra caution descending the steps from Air Force One to avoid headlines about a stumble.

There is no law requiring presidents to publicize their health records, and the degree of transparency has varied by administration. Trump’s past reports have been criticized for offering scant detail and providing statistics that some medical experts eyed with skepticism.

At public appearances, Trump is often seen wearing makeup to conceal bruising on his hands, which the White House attributes to handshaking and regular aspirin use. He has sometimes appeared drowsy during meetings and closed his eyes for long stretches, though he denies having fallen asleep.

Trump often boasts of having “aced” cognitive tests while frequently deriding Biden, who faced questions about his mental acuity. Biden and his aides pushed back aggressively against doubts raised about his fitness for office.

Some of Trump’s previous physicals have included the Montreal Cognitive Assessment, used to screen for dementia and cognitive impairment. His physicians reported a score of 30 out of 30 for him at 2018 and 2025 checkups.

Yet critics have pointed to Trump’s meandering speeches and sometimes bellicose rhetoric as evidence of cognitive decline.

Last month, a statement from more than 30 neurologists, psychiatrists and other medical experts — who acknowledged they’ve never examined him — said Trump was mentally unfit to serve and warned of an “increasingly dangerous decline” in his behavior based on what they called “objectively observable signs of serious medical concern.″

“Any so-called medical professionals engaging in armchair diagnosis or false speculation for political purposes are clearly breaking the Hippocratic Oath they’ve sworn to,” Ingle said.

Just like any other patient, presidents get to choose what’s disclosed about their health, said Sara Rosenthal, a bioethicist at the University of Kentucky who studies presidential health. Questions about transparency have become more acute as America elects aging presidents like Trump and Biden, she said.

“I think we can expect very little disclosure about the true health status of any president unless they’re in perfect health,” said Rosenthal, who has suggested an independent medical organization to review and report on the health of the president and those in the line of succession.

Trump's first medical report in his second term was released last April. In July, he was diagnosed with chronic venous insufficiency, a common condition in older adults that causes blood to pool in his veins. Photographs have shown the president with swollen feet, ankles and calves, described by the White House as a symptom of chronic venous insufficiency leading to “mild swelling” in his lower legs.

Following his last publicly disclosed exam, described as a routine follow-up last October, Trump’s physician issued a one-page summary saying the president was in “exceptional health” without divulging many specific results.

The frequency of Trump's medical checkups is not uncommon for someone his age, according to S. Jay Olshansky of the University of Illinois-Chicago, who has studied the health of past presidents. It's part of a strategy to catch problems while they’re still treatable, Olshansky said.

Olshansky says the public deserves to see more than White House medical summaries that “may be subject to editorial discretion.” Full, unredacted medical records should be made public, he said: “Nothing should be hidden.”

President Donald Trump departs Walter Reed National Military Medical Center, Tuesday, May 26, 2026, in Bethesda, Md. (AP Photo/Alex Brandon)

FILE - The left foot and swollen ankle of President Donald Trump are pictured as he sits with Bahrain's Crown Prince Salman bin Hamad Al Khalifa in the Oval Office of the White House, July 16, 2025, in Washington. (AP Photo/Alex Brandon, File)

President Donald Trump boards Air Force One, Friday, May 15, 2026, at Beijing Capital International Airport in Beijing. (AP Photo/Mark Schiefelbein)

President Donald Trump's right hand is seen as he speaks to the press after returning and stepping off Air Force One, Wednesday, May 20, 2026, at Joint Base Andrews, Md., after speaking at the U.S. Coast Guard Academy commencement. (AP Photo/Jacquelyn Martin)

President Donald Trump walks down the stairs of Air Force One upon his arrival at Joint Base Andrews, Md., Friday, Nov. 15, 2026. (AP Photo/Luis M. Alvarez)

CORRECTS DATE - President Donald Trump sits at the back of the presidential limousine as it drives outside the Walter Reed National Military Medical Center from the White House, Tuesday, May 26, 2026 in Bethesda, Md. (AP Photo/Manuel Balce Ceneta)