Antonio posts pictures with a celebrated American physician on his Facebook. Adelia sells leather bags to sustain her two-year-old baby in Panama. José fights the prejudices of elitist surgeons in Bogotá. They all have one thing in common: they’re Venezuelan, recently graduated doctors, who left the country as opportunities (and the health system) withered away.

They’re not unique; migration is an obsession in Venezuela, with doctors and med students on top of the list. Their objectives are pretty straightforward: enroll in med school, graduate and right after that, leave the country.

Just from our circle of friends in Mérida, we know more than 20 doctors who left the country for good, most of them graduated in April. Some can’t even wait: Activities at ULA’s Medical School resumed last week after a four-month break, but many students didn’t come back.

Contrary to popular belief, becoming a doctor is not that hard: you have to read a lot and see bodily fluids on a daily basis, but once you get used to it, all you need is a couple of functioning neurons, some dedication, and patience. Now, working and actually saving people is entirely different. You need knowledge and experience, theory and practice, a balance quite hard to obtain.

That’s why doctors have it particularly hard when leaving.

If you’re a health officer planning to let some unknown guy from another country take care of your people’s health, you better make sure he knows what he’s doing. The process to validate medical diplomas from Venezuela abroad is usually a long, tiring and sometimes very expensive one.

Now, if you don’t have the time, will or money to embark on such an adventure, you can always forget about medicine.

Antonio can tell. He’s the definition of success for many Venezuelan doctors, currently taking the United States Medical Licensing Examination (USMLE) three-step test, through which everyone intending to work as a physician in the United States must get through one of the toughest (and most expensive) revalidation processes in the world. He graduated with honors in 2015, left Venezuela one year ago and has already taken two of the three exams, outperforming most candidates in both. This allowed him to start an internship in the prestigious Massachusetts General Hospital in Boston, where one day, he hopes to become an oncologist.

“Many things influenced my choice to leave. The lack of supplies to work properly, the terrible state in which Venezuelan hospitals are and, especially, what I saw as a lack of professionalism in most hospitals. People in charge of the health system simply don’t give a shit if there’s not something as basic as an intravenous rehydration solution. I felt people weren’t interested in improving things. And most of the time, when you tried, they would criticize you.”

His family has made huge sacrifices to finance his revalidation, but since this was always the plan, they were prepared. For him, the biggest problem is not money, but solitude.

“Loneliness is a terrible thing. You yearn and yearn. Sometimes it feels like dying and being reborn with memories of a past life. Some people never get over that, it takes a lot of discipline.”

José was also able to validate his title, not in the US, but in Colombia. He graduated as a General Surgeon in 2015 and moved a year ago only to find out that not even specialists have it easy when practicing in another country. He’s currently operating in Bogotá, but even after getting the paperwork done, he feels the burden of being a foreigner in the orthodox Colombian medical world.

“It took me five months to validate my title as a general medical officer, and eight more to do so as a Surgeon. The process is tiresome, but I was lucky: I have a Colombian passport.”

José tells us he knows several doctors with credentials like his who overcame increasingly difficult obstacles, only to be rejected in the end. In his view, discrimination against foreigners is to blame.

“One of the officers in charge of my process told me the only reason they were accepting my papers was because I was a Colombian citizen. I’ve felt underestimated, but our formation back home is very similar to what doctors get here. That allowed me to prove myself.”

The contrast he found between Venezuela and Colombia was also shocking, and highlights the disaster we’ve been living during these years.

“The only similar thing is that we both speak Spanish. In Colombia, you have state of the art technology to diagnose and treat patients, everything is protocolized and heavily supervised. The Colombian health system is extremely well organized.”

José finds it a bit unnerving: just 20 minutes with each patient, the less you speak, the better. Yet, at the end of the day, he feels that, for the first time ever, he’s getting paid what he deserves, and admits Colombia has given him an opportunity to grow both personally and professionally, in a way he would’ve never found in Venezuela.

Now, if you don’t have the time, will or money to embark on such an adventure, you can always forget about medicine.

This happened to Adelia, a 24-year-old physician from Apure. She finished her med school classes last October and, less than a month later, she was in Panama. Adelia’s husband left six months earlier, hoping to find a job to help her sustain their two-year-old kid. For her, money was definitely the issue.

“It was a tragedy every time my baby got sick. Finding antibiotics was a monumental task, and when I found them, I couldn’t afford them. The only reason I bought food was because my husband sent me money.”

Adelia found a job a few weeks after leaving, but not as a doctor. Working as a foreign physician in Panama is practically impossible; due to the country’s extremely closed migratory policies for healthcare workers, job opportunities are limited to highly specialized physicians who are only allowed to work in the interior. Jobs in the capital are limited to Panamanians.

“It took me a month to find a job managing the distribution of products for a local store. I can’t complain, but this is not my thing. I tried to find a job in my field, but it’s impossible. I talked to several physicians and they all told me I needed to become a Panamanian national: I could have a Panamanian-born kid and then wait five years to get my papers done, or if I was in a hurry, I could marry a Panamanian man. I can’t have another kid right now, and I don’t think my husband approves the second option.”

So Adelia adapted.

“I don’t want to stay here forever, I’d like to move to Canada. But right now, I’m intending to get a Masters degree in Health Services Administration. It’s the closest I can get to being a doctor in Panama.”

There are other options too. Some lucky and really talented people decided to skip the validation process, sacrifice clinical practice and start an entirely new career, currently developing research that no one financed in Venezuela, at top-level institutions around the world. Such is the case of Dr. Lisbeth Berrueta, one of our former immunology professors at ULA’s medical school, whose research at Harvard was recently acknowledged.

According to estimates, up to 15,000 doctors have left the country in the last decade, and training each one of them could have cost the Venezuelan State up to $60,000. The government chose to create a parallel, academically-flawed and ideologically-committed career, rather than planting the seeds; so recently graduated doctors aren’t forced to exploit their talent abroad.

With no prospective changes on the horizon, doctors will keep fleeing… And people here will keep dying.

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