By now you’ve probably heard the stories about the magnitude of our health crisis: people dying in hospitals from not getting the drugs they need; operating rooms (OR) closed for not having sutures, masks or even water for the surgeons to wash their hands… In the meantime our Health Minister denies that such a crisis exists while blaming capitalism for causing disease. We knew things were looking grim, but only this week we got an objective, quantified glimpse of how bad the situation actually is.

The National Assembly through its Health Subcommission, along with NGO Medicos por la Salud, issued its fourth National Hospital Poll, a valuable instrument that probed the current status of 92 public hospitals in 42 cities around a country where statistics are a state secret. The pollsters, as expected, had no access to the health centers’ records (there might not be any records left for all we know) so the information is entirely based on the testimony of doctors from several areas which answered a series of questions via electronic questionnaires.

The results are as scary as you could imagine.

The health sector, for years one of the banners of the Bolivarian Revolution, has been hit particularly hard during the last few years. Medicines and medical supplies disappeared along with the petrodollars, not only from pharmacies but also from public and —to a lesser extent— private hospitals.

Keep in mind that this poll doesn’t cover type I (small) hospitals, nor ambulatorios (centers that don’t have inpatient care), in which resources are even harder to find than in bigger hospitals, where the media usually focuses. So, as bad as the numbers are, they might be even worse.

Diagnostic Services

Every “big” hospital (type II-IV) is supposed to treat patients with diseases too complex to be dealt with in the smaller ones. In order to do that, first they must have the means required to confirm or discard the patient’s diagnosis: from relatively high-tech machines like those used for computer axial tomography (CAT or TAC for its spanish acronym) or magnetic resonance images (MRI) to much simpler methods like x-ray, echosonography or even a simple blood test. These areas showed an alarming deterioration over the last year.

As you can see in the graphic above, almost all hospitals have had problems keeping these services operational. It has been like that for several years, but the degree of deterioration seen lately is simply stunning. Broken or intermittently-working x-ray or echography machines, for example, rocketed from 37,5% and 29,3 to 89% and 71%, respectively, in 2017. This is particularly worrying since these tests, though simple and relatively inexpensive, are absolutely necessary, not only to begin a certain treatment, but also to keep an adequate routine control of healthy patients.

To put things in perspective, while I was attending the trauma and orthopedics service at Merida’s Hospital, we could order up to 30 x-rays in a single day, and we were only one of five different teams.  More expensive tests like a CAT-scan have been halted for much longer; in my particular case, I’ve never seen a single tomography made at my hospital during the 6 years I’ve been in med school, even though the required machines are in there, damaged and forgotten. MRI machines are so scarce in the public sector that they don’t even appear in the poll, so needing one of these usually means kissing good bye most of your monthly wage (130,000 Bs for the simplest type the last time I checked).

The labs aren’t doing any better, with 97% being inoperative or working irregularly. Practically every single patient attending a public hospital will be forced to go to a private lab to get tests as simple as an hematology, also part of every routine examination. And that’s not to mention more complex  tests, i.e: those required to detect viral or tumoral antibodies, the costs of which can range from 20,000 to 100,000 BsF, since the required reactives must be bought with black-market dollars.

Drugs and Supplies

This has been the main reason why so many people have asked the government to open an humanitarian channel through which the so much needed supplies could quickly get to the country.

Antibiotics, analgesics, antihypertensives, sutures, gloves, masks, catheters… It doesn’t matter, they are all hard to find in over 75% of public hospitals; and so, in most cases, patients must buy pretty much everything they need in order to be treated. If they can’t find it by themselves or simply don’t have the money, they will remain sick, and possibly die. I’ve seen it myself: Last week I had to witness three patients deteriorate to the brink of death because the antibiotic required to treat the multi-resistant bacteria causing them pneumonia had disappeared from every hospital in the state. It’s a high-cost drug, directly imported and distributed by the government, which means it isn’t even sold at regular pharmacies.

Although the poll affirms that shortages of supplies have improved slightly since last year, earlier this week, my local hospital Directorate issued an order forbidding medical students to use masks, gloves and other disposable materials because they had become extremely scarce; the order was eventually revoked after an active protest inside the hospital took place. It was the first time in my 23 years of life that I actually got something tangible from a protest (hooray!).

Like pretty much everything else in the country, these items have recently widened the inventories of bachaqueros. If patients need a suture,  they shouldn’t waste their time in pharmacies; any of the dozen buhoneros that roam around hospitals will have them for sale, at about 15 times their real cost, of course. But hey, el Venezolano es pana, you know.

You could hardly say healthcare in Venezuela is free, even though physicians won’t charge. Literally: graduate students, residentes de postgrado as they’re known here, do most of the hard work in hospitals. From running the emergency area, to doing most of the surgeries, depending on which area they  specialize in: internal medicine, surgery, pediatrics, whatevertology… They all have their own tasks and they get paid for them. Actually Venezuela is one of not-that-many countries where graduate students get paid while studying. The problem is that their salary is simply ridiculous: about  Bs.30k a month, plus a Bs 68k bonus that can only be used to buy food (not including night-shift bonus). If you add both you have an “integral wage” of about Bs 100k… 4.7 dollars a day at the DICOM exchange rate; only 1.1  at the black-market one.  The World Bank’s poverty threshold is currently USD 1.9 per day, in case you are wondering.

Residentes can’t work in private practice while studying, due to their exclusive contract . So that income is the only one they’ll see until they graduate.

As if salaries weren’t bad enough already, in Mérida’s Hospital and several other public health centers around the country, residentes have not been paid a single bolívar since the year began, and the situation might continue until May, to be optimistic. Today, they announced residentes are going on a strike that will basically paralyze the entire hospital (with the exception of emergency areas and surgeries). The Directorate’s response? To offer them CLAP bags to tide them over..

It makes perfect sense. That’s the whole point of those bags anyway: they are instruments of control; so why not use them to try to control uncomfortable situations like a hospital strike?

Food and Nutrition

Speaking of food, this is a particularly scary point. Sick people not only need to eat, they must have special diets, usually vital for their full recovery.

In a country now famous for not having any food, special diets are simply impossible for any institution to do, but the fact that up to 64% of hospitals nation-wide don’t have active clinical nutrition services is extremely alarming, especially when compared to the 14.52% without those programs that were reported last year. In addition, with no signs of improvement in the food distribution chain, it’s clear that the 21% still working with failures will likely shut down completely sooner rather than later.

Patients aren’t the only ones affected by the food crisis. Walk around the hospital wards of any public hospital in the country and you’ll find their relatives, some of whom themselves haven’t eaten more than crackers in days, taking care of them. It’s all they can afford. In the case of Mérida, where the hospital receives people from three different states, the situation is often much more dramatic.

Babies don’t escape this reality, as the poll also indicates that 64% of hospitals lack infant formulas. This isn’t such a big problem if babies are being taken care of by mothers who don’t have any contraindication to lactate; but it’s quite bad when the mothers are taking drugs that can be secreted into milk, or they’re ill with infectious diseases that can be transmitted by mother’s milk, like HIV.

The poll also reported that only 51% of all operating rooms in the country remain active. Reasons for this are widely varied, from broken or contaminated air conditioners to water cuts, floods or lack of materials required to operate. These limitations mean that even when working, ORs can only be used to do quite simple surgeries, which means that more complex surgeries are usually done only in private health centers.

These private centers, according to lawmaker José Manuel Olivares (who presented the poll), end up attending up to 55% of the population, but their prices (that already highlighted in Olivares’  unfortunate declarations last week) make them completely unattainable for an enormous part of an impoverished country.

But hey, I guess I shouldn’t complain too much since President Maduro just declared Merida, along with several other states, Territorio 100% Barrio Adentro last week.
Quality health for the pueblo, right?

25 COMMENTS

  1. Backing things up with facts is always great. But to get the full picture of the bleakness of the health crisis, just look at the NYT report of last year (which is full of pictures). It’s truly horrible.

        • No si siguen mandando las toneladas de cocaína de la farc y financiando la guerrilla que quiere invadir y destruir a Israel.

          Sin contar con los que van a EEUU a intentar desestabilizar su sistema capitalista.

      • Not what I meant. Like I said, facts are indeed a good thing and we must rely on them.

        But you don’t really get the true horrors of a Venezuelan hospital until you’ve seen how utterly destroyed they are, how the patients suffers, how everything just reeks of hopelessness…

        For example, numbers and facts tell us that scarcity and poverty are on the rise, but the subjective reality completely hits you when you’ve seen people eating from garbage bags.

        Not saying this to criticize the post.

  2. Sometimes the naked facts are so overwhelming that you cant really grasp what’s happening in any comprehensive way , you are just stunned to a state of befuddled confusion, is the piece describing the postrate conditions of Venezuelan health services or some pail of torments in the deepest abysses of hell …..!!

    • Bill.

      For people that have the ability to pay or have friends or relatives in the United States that desire to help, here is the website of a shipper in Miami.

      http://totalcargoexpress.com/index.php/es/

      Total Cargo Express is doing many things to get much needed supplies to the Venezuelan people. They have been immensely helpful to me. The lady in charge of the office is named Maria. The owner or manager is named Robert. Maria is easier to reach by phone. Everyone is making a good faith effort to help all that they can.

      They will go shopping, package shipments and deliver the shipments to most urban areas in Venezuela. They also have a free locker service which allows people to order merchandise and have it delivered to them and accumulate items for a shipment. The company has a Venezuelan family rate that basically is their cost. I was referred to them by a different shipping company that has ceased shipments of household goods to Venezuela due to the amount of losses while shipments await customs clearance. I have found the people at Total Cargo Express to be honest and helpful in much more ways than I ever expected. The time from shipping to delivery is 3-4 weeks by ship. They also ship by airplane but I have not used the service.

      Walmart has begun 2 day free delivery in the US in response to Amazon’s popularity. This gives people some options to access much needed supplies and having them delivered to Total Cargo Express.

      I have great empathy for the plight of the Venezuelan people. I am constantly tortured by my inability to do more than I am doing. The Torah says that if you save one person, you can save the world. It is still little consolation when their are millions of my brothers and sisters suffering.

      Keep the faith. People are slowly beginning to take notice of the dire conditions that so many Venezuelans are being forced to endure. As chaotic as the new administration is in Washington, I do believe that there is more of a focus on the plight of the Venezuelan people.

      I pray for a quick end to Maduro’s rule of terror and for Venezuela to return to its former glory.

      • John,

        I no longer have family or acquaintances in VZ, but I do want to help. How can I do that? Can I have goods shipped to a trusted entity? Can I transfer USD to a trusted account? I see that the people in your link above will shop and ship goods…but to whom?

        • J
          I get money to people through a friend that has a US account at Bank of America. He travels regularly and brings Dollars into Venezuela.
          I make a deposit, e-mail a picture of the deposit slip to the person I want to get the money. They show it to his wife and she confirms the deposit and then distributes Dollars.
          I can’t Use VZ banks because of the exchange rate. The Dollars get sold privately.
          My daughter works with a lady from VZ. She has been making regular shipments to an orphanage in Venezuela through the same shipping company.
          I don’t think it would take much to find people that are in need. The heartbreaking part is having to decide who you can help and where the line must be drawn.
          I have a few suggestions for getting the most value for your money.
          I use Aldi’s and Walmart when shopping for many items.
          Rice, beans, pasta, coffee, sugar, cooking oil, oats, tomato paste and diced tomatoes. Nido powdered milk is preferred over Carnation, protein powders, vitamins, Parmesan cheese, canned meats and fish (tuna, shrimp, oysters, clams, chicken,beef, turkey and barbecued pork), dried soup in envelopes, envelopes with rice and pasta mixes, spices, vitamins, soap, shampoo, sunblock, bandages, antibiotic ointments, bandages and toothpaste.
          I live in New York and between myself and my family members and visitors from Florida we have been able to get our shipments to Total Cargo Express.
          A local supermarket supplies me with boxes that apples come in. They are sturdy and hold the weight well.
          I mix up the supplies in the boxes in case some of the boxes disappear in customs, all of one product won’t be lost. So far our shipments have been delivered in their entirety. I think this may be due to them filling a pallet and being shrink wrapped. It might be too much work for the soldiers to steal it. Total Cargo Express is diligent about protecting the shipments.
          I pack the larger products first and then I fill in any spaces with smaller products and the envelopes of food. This makes the boxes solid.
          For items that may leak like the cooking oils, I buy the big zip-loc bags at the dollar store. They have them up to 2 gallons.
          Robert at Total Cargo Express warned about sending anything that may melt. He said that he shipping containers can get hot. Someone shipped a case of butter that melted all over a container and ruined other packages. If you have any doubts use the Zip-Locs. Aldi’s sells 2 pound bricks of a processed cheese like Velveeta. That has made the trip without melting. It is stable at room temperature and we bag it just in case.
          I also send candies, brownie mixes, baking mix like Bisquick from Aldi’s, maple syrup, trail mix, cookies and cookie mixes, chewing gum and anything else that I think would improve someone’s quality of life. I want to send varied and tasty foods rather than “survival” products.
          If you can get your family doctor, (in my case my dentist) involved it can be life saving. I have been able to get broad spectrum antibiotics, diabetes medication and blood pressure medications on a regular basis. The psoriasis cream from the dollar store is helping a lady that was dependent on a prescription cream.
          The shipments average between 250 and 300 kilos and take 10-12 boxes. They go on their own pallet and are shrink wrapped.
          I apologize for this being so long. Basically anything will be welcomed by almost anyone.
          When these people are out of power, I hope to travel to Venezuela. It is going to take a long time to undo the damage that has been done and I hope to be able to make a difference.
          I foolishly posted comments using my full name and I don’t think the narco-criminal government would be very hospitable to me. I would be surprised if I made it out of the airport.

      • thanks for your recommendation and well wishes , I do get to travel North every so often, when I do I try to send a package or box with basic necessities to people in my inmediate family. Next time Ill try to broaden the number of people I sent packages to .

        The needs are so many and so widespread that as an individual there is only so much you can do …., we need a more concerted effort if only the govt would allow it Im sure lots of people abroad would be willing to lend a helping hand….!!

        • Bill, I would happily donate to an aid organization instead. My personal spending has gone into the tens of thousands of Dollars. I can’t take it with me and my kids don’t need it so what the hell. I do think that aid organizations could do what I am doing more efficiently. In essence they would get more “bang for the Buck”. The government refuses to admit they have failed and know that accepting aid would be an admission of failure. Empty store shelves, overflowing morgues, rampant violence and an absence of medical supplies doesn’t mean anything to them as long as they are living well.
          This has been my way of “flying under the radar”
          The people that have learned of my shipments have quickly volunteered to help.
          Pharmaceuticals have been very hard to come by. I have friends that are explaining what we are doing to their doctors and some doctors are helping. I have written to pharmaceutical companies with no success. They donate to organizations but not to individuals. I have included copies of my shipping bills and photographs with no success. I have a friend that migrated from Russia after the collapse of the Soviet Union. He is a doctor and has empathy for the plight of the VZ people. He is going to discuss this with the drug salespeople that call on the hospital where he works. I have my fingers crossed.
          Getting the word out is the challenge.
          The US Presidential election and the ensuing accusations and twitter rants, the lunatic in North Korea, Brexit, travel bans and whatever will be news tomorrow has kept the humanitarian crisis in VZ off of the front page.
          The NY Times, Reuters and the BBC have reported on it but not focused on it. Now the famine in Africa is becoming the big story. I am not down playing the plight of others, I just wish the people in the US would stop playing angry birds on their phones long enough to pull their heads out of their asses and get informed about the world.
          It is a sad irony that the internet gives people access to a trove of information and yet so many seem more ignorant about current events than ever before. Every time I hear a rant about the travel bans, I remind people that the Obama administration ceased issuing visas to Venezuelans. The normal response is a blank look.
          I am active politically. Trying to get the politicians that can make a difference interested in Venezuela is a challenge. I keep writing letters and e-mails in the hope that one may get past the staff that replies with boiler plate “Thank you for your interest.” letters.
          I have hopes that Rex Tillerson will be influential in ending the reign of terror.
          Chavez screwed him over when he was with Exxon-Mobil. At the very least he understands what he is dealing with more than many other diplomats.
          When you do travel north, setting up a US bank account can be helpful. People can put money in it and you can use the debit card to pay Total Cargo Express for shipments. The official exchange rate is so ridiculous that you can’t use VZ banks or VZ credit cards.
          Amazon still delivers in VZ but they don’t deliver food. They have Amazon Global and many items are available.
          I wish you all the best and want you to know that the people of Venezuela are in my prayers.
          John

          • John, as a Venezuelan, I would like to thank you for your help to the Venezuelan people, and for seeing beyond the ideologies or the differences between us. Sadly, with the government denying any crisis of any sort, help is limited to a number of individuals and organizations if they able to. Thank you again.

  3. What some people may not know is that Venezuela produces good doctors. But they can’t access the materials they need to do their jobs. And the regime actively prevents life saving assistance from outside the country. It is diabolical, the situation.

    • It’s called a genocide.

      And there are still some who want to coexist with those monsters with the excuse that they might get angry and “do worse stuff” if Venezuelans insist on getting the slightest hint of justice.

  4. The underlying problem is the attempted eradication of free market capitalism. What you are seeing is socialism. Do you like it?

    • Gringo
      There is no reason to rub anyone’s nose in this mess. People voted for Chavez and Maduro for varied reasons. I doubt that their supporters ever imagined that living conditions could deteriorate to the level we are now witnessing.
      When you see a homeless person that is in need of food or shelter do you ask how they got where they are, or do you try to help?
      In my mind Venezuela is the same. Economists predicted this result many years ago. Going against market forces for an extended time, especially with an economy that relies on a single export and the importation of almost all necessities, will always end in disaster.
      Rather than ask people how they like Socialism, ask yourself what you can do to ease their suffering.
      I am an American. I am now retired. I spent my entire adult career in US government service. I no longer have any influence beyond contacting my Congressional representatives. Like any other American.
      I am very frustrated by my inability to do more. Slowly the circle of people assisting me is growing. Sadly my ability to supply goods to Venezuela is not keeping up with the growing needs of the people trapped in this hell hole.
      I have posted information in this comment thread regarding an avenue to get supplies to Venezuela. With a clear conscience I can not spend money on luxuries for myself when I am aware of so many people in such dire need. I would dread standing at the pearly gates and having to explain why I bought a new car instead of spending the money on people that I knew were suffering.
      I hope and pray that this murderous regime will come to an end very soon. I do believe that targeting these narco-criminals with sanctions will need to give way to targeting them with weapons.
      The people of Venezuela have paid a terrible price to be educated on the vigilance that is required to guarantee the liberties that democracy and human rights laws bring to everyone.
      Just as history has proven that there will always be tyrants, there will always be brave men that emerge to challenge Tyranny.
      I look forward to the day in the near future when Venezuela is once again a free and vibrant democracy.

      • John – Thank you for your thoughtful reply. The reason I posted that was to address those who still think that socialism is somehow superior to free market capitalism.

      • I read all of your comments, and as a Venezuelan still living in this mess, I don’t have enough words to thank you for all you are doing. It is hard seeing how bad things have gotten and seeing so much people who are struggling just to get by. Middle class families who are now eating less and just surviving, without taking in account people in poverty. Again what you are doing is amazing, thank you so much

  5. I suspect historically there is no pure breed of market capitalism or socialism but many versions of each , also some hybrid models that incorporate features of both systems , moreover that while market capitalism is the one proven to work best in most circumstances it can sometimes develop its own vices and excesses ….These models are also subject to periodic changes as social and political cultures evolve to the tune of circumstances that they themselves have helped create and which no one ever intended or predicted. No model is exempt from failures , those of pure socialism are chronic , those of market capitalism much less so but they do happen …..I am loath to think of any one pure system as sacred and untouchable , guess my preference is for a pragmatic approach , favour whatever will work most dependently in accordance with the ethos or peculiarities of the people that have to make it work and ALWAYS dont expect perfection , and recognizing the limitations of the human condition dont be blinded by the promise of pie in the sky utopias !! NO system can deliver that..!!.

    In Venezuela people are less afraid of Big Govt than is the case in the US (which also has a fear of big business or anything big) , the rest of the world is less afraid of govt and there are even some nations that idolize it …..which pretty dangerous !!

    This govt failures are not just the result of adopting a virulent socialist discourse but of the crude ineptness and the ferocious ideological narcissism of its leaders , other nations following a similar ideological discourse have not incurred in the atrocious failures that beset Venezuela , take the case of Bolivia , Ecuador and Nicaragua…!! Perhaps the greatest sin of our regime has been its hubris…..and its penchant for corrosive forms of corruption.!!

    The socialist and capitalist tags are often used very loosely as if they had an unequivocal pure abstract meaning which is wrong because these terms can be understood many different ways by different people in different cultural historical settings . for that reason I prefer to avoid them altogether……!!

    • Bill, the word “government” comes up very often in your post.

      The basis of socialist theory is to take over production by taxation and redistribution, with the idea that “government” is better suited and more capable of making these decisions than “free markets”. By implication, then, government is better suited and more capable of regulating the free will of individual citizens – both in terms of what to produce, and in terms of what to purchase. Do you see where this is going? The direction is to control the individual, as in, for example, you, Bill, being some “Director of Public Books” telling me, Gringo, which books I should or should not read.

      The basis of free markets is respect for the individual to make his own choices, negotiate his own purchases of materials with which to make his chosen products based on his talents, inclinations, and ambitions. Likewise, it is respect for the individual in choosing what he feels like purchasing, within his means (including books). If he prefers to save his earnings to open a business, rather than spend them or have them taxed away by the “government’s better plan”, then that is his business. In short, the free markets establish and respect the individual as a citizen, not a “collective subject”.

      If I wanted to muddy the waters, I could begin pointing out the irony that “socialists” want greater government control over the population, while free market hawks trust in the social nature of man, and see no need for any government to exercise “control” or “regulation” over free will. I am not trying to muddy waters and obfuscate. My intent is to clarify in bold the distinctions between socialism and free markets.

      Socialism seems to invite corruption, gross inefficiency, death, and misery. Had Venezuela remained free market, goodness, who can estimate how much better things would be today? Or in which ways? That would have been for the citizens to “vote” for, everyday, with their every action and speech.
      _______
      Just as a footnote: In economics I’m certain you are aware of the writings and practicalities of “natural monopolies” and these are recognized in free market economies. Electrical girds, water systems, sewage systems, and the like are regulated to prevent monopoly pricing or “price gouging”. Similarly, there are public works such as dams and highways, measures to ensure national sovereignty.

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