The Crisis Through Diabetic Eyes

Pedro is 47 years old. He manages a butchery in Caracas, and struggles with the day-to-day of living in Venezuela like anyone else. Oh, and he has type 1 diabetes.

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Pedro has to be extra careful in order to remain healthy. He’s a type-1 diabetic, so he has to inject himself with insulin multiple times a day in order to keep his blood sugar at bay.

It’s quite the challenge.

Every day, after he wakes up, Pedro has to use a glucometer, a little device that reads the the concentration of sugar in his blood. Pedro grabs a cotton ball, soaks it in isopropyl alcohol, cleans his thumb and then pricks his finger with a lancet, placing a drop of blood into a strip that he inserts into the device. The device tells him his blood glucose level. He writes the number down in a notebook to help him, and his doctor, track his diabetes.

But Pedro lives in Venezuela, and blood glucose test strips are hard to find. They’re supposed to be imported using a preferential exchange rate, but like most things that depend on cut-rate foreign exchange, they’re in short supply. When you do find them, they are terribly costly by Venezuelan standards.

Once upon a time, the Venezuelan Institute of Social Security provided diabetics with a Johnson & Johnson brand glucometer along with the strips, but the powers-that-be felt that giving high-quality medical devices to those in need was benefitting the evil capitalist corporations of the North American empire, so that program was shut down.

“Damn it, I only have five strips left.”

As Pedro curses his disease, he grabs his bag and notices that he has only 7 insulin needles left.

Pedro needs insulin, several times a day. He has recently been switched to a different insulin scheme by his doctor because pen-shaped insulin preparations have disappeared from the Venezuelan market. These pen-shaped insulins are -in the opinion of the medical community- safer, because they deliver different types of long lasting and short acting insulin, thus reducing the number of injections needed in a day. But now, Pedro has to buy a different insulin preparation, and the long lasting one is nowhere to be found, even in the shelves of the Social Security Pharmacy.

Pedro has his Social Security Pharmacy on speed dial. He calls every day to check if some of the insulin he needs has arrived. Oftentimes he gets a negative answer, but when he hears from the other side of the telephone that the insulin he needs is in stock, a rush of blood to the head full of joy comes inside him, only to be quickly mitigated by what he hears next.

“You have to get here before 11:00 a.m., it’s flying off our shelves”.

Coño, it’s a quarter past ten, and I’m on the other side of town”.

Pedro has made the Mototaxi his best friend. Today, he rushes to the pharmacy only to receive two vials of the prized medicine, less than half of what he needs for what’s left of the month.

On his last trip to the pharmacy, he was frustrated by finding no needles. This one haunts him like a ghost. The last time Pedro ran out of needles, he developed a life-threatening complication of type one diabetes mellitus called “diabetic ketoacidosis”, which had him hospitalised in the intensive care unit for six days.

Ni de vaina paso por eso de nuevo.”

Pedro grabs the vial of insulin, injects himself, and goes to work.

As a diabetic, he’s aware that he cannot eat whatever he wants. Buying food and sticking to a strict diet means having to stand in endless queues under the scorching sun and pay hefty prices.

Even in the best of cases, diabetics have to make huge sacrifices in their diet to stay healthy. The ones that cannot afford to do so often end up in the emergency room with a possible life-threatening complication of their disease. This also causes the health system to be even more collapsed by hospital admissions that could be perfectly avoided if patients stuck to a healthy lifestyle and appropriate medication.

Pedro often feels tempted to eat like anyone else, but he adheres to the diet strictly.

He has developed what he calls “tolerance” for the diabetic supplements like Enterex or Glucerna, which he considers to be awful tasting, but he knows that help him handle his food cravings as these products reduce hunger without causing a rapid increase in the amount of sugar in the bloodstream. Finding these products is yet another frustration for Pedro, for the Orwellian Superintendencia de Costos y Precios has regulated the number of cans you can buy each week. “If I have to buy them bachaqueadas, I will, because they prevent me from being hospitalised”, he says.

The shortage of medicines is a new therapeutic challenge for new doctors and veterans alike, for the prescriptions we write and give to our patients are accompanied by the “y ese remedio se consigue?” Often, people ask us to prescribe stuff they can find. This is a challenge to both your knowledge as a physician and your skills dealing with difficult patients because you have to be in constant contact with the pharmacist, use smartphone apps to learn of the availability of certain drugs and make use of social networking/engineering to prescribe your patients.

Diabetes is a disease whose complications can be avoided if treated properly. But if the government continues neglecting health policy, the consequences can be as tragic as the drama that cancer patients, epileptic patients, and mental health patients face: all lack access to the medicines that they need in order to remain healthy.
Pedro lives with this knowledge every day.

15 COMMENTS

  1. We are arriving at lifeboat ethics territory. The weak and infirm are being thrown overboard, and every time it happens, we all lose a little piece of our humanity.

    • yes! & while the weak and infirm are going into the stormy waters first, we are all soon following them as well

      these tragic times are making us less human, you are so right
      lack of empathy, magnified survival instincts, soaring crime rates, you name it!

  2. Terrifying thought, to be in Pedro’s situation. Hanging by a thread while a bunch of assholes just put a perimeter of guns and gas around themselves so they can keep the party going….

  3. I am reminded of stories like this during WWII in the Jewish ghettos. Those with any special needs were the first to go. Those that hid people like this eventually had to turn a blind eye until it was their turn to head into the gas chambers.

    What is so frustrating for me, as an American, is that I am completely incapable of helping the person in the story. If I sent funds, they would never make it to the person who needs the help the most. Sending any form of a supply or such to them would be confiscated and/or heavily taxed/tariffed… or most likely “lost” in customs. (ending up on the black market)

    I can’t travel there with a suite case as I can’t get a visa to enter.

    So you see the problem myself and others have when we read this? I pray for those souls who are in harms way, but, the reality is that Venezuelans voted and got the government they wanted. Whether they deserve it or not is completely beside the point. And there is precious little that foreigners can assist with since Maduro is quickly turning his country into another North Korea (“Hermit Kingdom”).

    • You’re right all those direct methods of help won’t work in our case.

      Even if you try to go to some multilateral organization they’ll fail to help for the same reasons and mainly because the government simply doesn’t acknowledge this as a problem at all.

      But you can help in some other way, you can show this post to all the people you know and you can help your propagating this horror story between your friends and family, and then all the people that feel bad for this story can write to your local congressman, to your local newspaper, to your local radio / tv show, and they (maybe) could spread the news even more and so on…

      I know international pressure is pretty much overrated this days, specially since all the countries are minding their own business (just look at Macri in Argentina turning back from Venezuela just for a seat in the OAS), however enough pressure could make at least people interested in our country.

      • I would send bitcoin, but the market for it there is immature, or so I have been told.

        Getting relief to those in need is what is most depressing.

  4. Hermit kingdoms seem very distant to the average american, unbeknownst to them, they are only miles from Florida, and a three and a half hours flight… (Cuba and Venezuela)
    The crisis in Venezuela is far worse than you’d might think. The deaths because of medicine scarcity are in the thousands..

    • That’s what I was thinking about reading your piece. I’m a type 1-diabetic myself and thankfully I live in the Netherlands, because I know I wouldn’t last very long under the horrible circumstances that you’ve described. My heart goes out to the diabetics trying to survive in Venezuela.

  5. The food and medicines that are so desperately needed would flood into venezuela if the government would allow it.
    Maduro and his cadre have the blood of thousands of Venezuelans on their hands.

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