The Maternity Hospital where I was doing part of my Obstetrics internship last week is located in Ejido, a small bedroom city 9 km west of Mérida. It’s a small place, with capacity for eight patients only, a tiny Delivery Room, and an even smaller Operation Room where only carefully planned c-sections are performed. It’s not designed to deal with emergencies, so you usually have time to spare during the night. During one of those calmed shifts, I found something I wasn’t expecting at all: a souvenir from El Difunto himself.

Standing on the Evaluation Room desk there was a big, old book. The thin layer of protective plastic wrapping it was falling apart and what had once been a blue cover had lost much of its flair. Still, the title was clearly visible: Guía Spilva de las especialidades farmacéuticas, 1999. The Guía Spilva is a classic in any Venezuelan doctor’s bookshelf. First printed in 1954, this book has a list of all drugs commercialized in Venezuela, along with its presentations, doses, commercial names and a list of pharmaceutical companies producing them. It’s published  every two years, to keep it updated with changes in a once dynamic market.

Hugo Chávez, the man responsible of the worst economic crisis this country has ever witnessed, had signed a book listing all the medicines available in 1999’s Venezuela.

I didn’t get why someone would keep an old, outdated pharmacological guide out of the trash, until I saw the first page. Covered with a foil of the same transparent plastic protecting the cover, there was a big scribble in black ink. Hugo Chávez’ unmistakable signature was written in the middle of the page, dedicating the book to its former owner, some random doctor who I guess worked here once.

It was weird to touch something the man responsible of my many years of piled up anger held in his own hands two decades ago. I was Harry Potter facing Tom Riddle’s diary, it felt almost like touching a book that could spark some dark magic that’d bring El Comandante back. I then realised how appropriate the scene was: Hugo Chávez, the man responsible of the worst economic crisis this country has ever witnessed, had signed a book listing all the medicines available in 1999’s Venezuela, medicines impossible to find 18 years later due to the corrupt, nonsensical model he unleashed upon us.

Irony is a magnificently sad thing.

Take, for example, Buscapina, page 431: an antispasmodic commonly used for stomachache and as part of the protocol to prevent preterm labor, a condition where babies are born too early. You’d expect this drug to be easily available in a hospital that only treats pregnant women, right? Well, it’s nowhere to be seen. Buscapina simply disappeared from the country after Boehringer-Ingelheim, the company producing it, ceased its activities in Venezuela, two years ago.

You won’t find antibiotics like Cefazolin, Cefalotin or Cefadroxil anywhere at Ejido’s Hospital but in pages 15, 20 and 17 of that old Guía Spilva, even though every single woman giving birth at the place should receive them to prevent postpartum infections.

Other drugs didn’t appear in the guide, since the Health Ministry never considered them necessary enough to be imported. That’s the case with Atosiban or Hydralazine, first choices to treat preterm labor and gestational hypertension, respectively. We were taught in med school that in case you can’t stop preterm labor, at least you should be able to speed up the maturation of the fetus’ lungs by using steroids. Betametasone, the intramuscular steroid used in these cases is listed three hundred and nineteen pages after Chávez’ rabo e’ cochino, yet the Maternity Hospital stock ran out of it last weekend.

Chávez’ signature isn’t only present in that eighteen year-old book. I can see it printed in the brand-new Chinese ambulance parked in front of the building, whose brakes broke a couple weeks ago, or in the face of that skinny 17 year-old girl who came in a few days ago, whose father was killed before she met him, currently pregnant with her second son; it’s indelibly written in the tearful eyes of the old nurse whose salary can’t buy her enough food for three daily meals and in the young, recently graduated doctor supervising us, who plans to leave the country as soon as possible… Chávez’ signature is present all over the place, all over the country and all over our lives.

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  1. My woman and I are currently brainstorming ideas on how to manage our business in order to survive 2018’s hyper-inflation. We’re planning to cut way back on purchases of some products and concentrate on trying to increase supplies of others.

    Pharmaceuticals are on the latter list since the town’s pharmacy has all but shut down and the local medicutura now sends most of their patients here first. We can hardly find enough antibiotics to fill our own needs in the event of an emergency so that’s one of the highest on our list. I recall handling buscapina in the distant past but haven’t seen it in longer than I can remember. Syringes, sutures, and other first aid supplies are also high on our list.

    As things stand today, we handle mostly generic medicines for common aches and pains, colds and flu, and some medicines for children. All of it though is getting more and more difficult to find. It’s absolutely criminal that a regime would allow its citizens to suffer from the lack of medicines that otherwise cost no more than a few cents per dose for them to import.

    • MR
      I sent you an e-mail yesterday with an idea about how to access prescription drugs. I am going to make some calls tomorrow and see if I can make it work. I explained it to Vicky and she believes that she can get a doctor to cooperate. Do you have a good enough relationship with the local doctor to ask him to assist us without it bringing any unwanted attention to you?

      • John, we’re rural, there are no doctors within an hour’s drive of here. Having said that, one of my step-daughters has a child with significant congenital health problems. Fortunately, they’re seeing specialists in Carcas who fly in from the States monthly. Perhaps one of them will be an option. Alternately, my woman’s first cousin is a physican in Caracas.

        I’ll check out your email and we’ll see what we can do. Simple antibiotics would be number one on my wish list.

  2. Your anger is well justified, and you are one of the bravest: The article in the PanAm post states that 13,000 doctors emigrated prior to 2015, and describes a landscape of doctors both young and old who have elected to abandon their lives in the country in search of better conditions. Many of those say they would return if conditions improved. The idea that they think conditions might possibly improve gives some hope. They are not unintelligent people, doctors.

    The anger you express is similar to mine – in a different field of economics – when I look at the socialists who would like to destroy the United States. Pure idiocy. One wonders how anyone can be so egocentric and hateful, disregarding all facts, following Marx without a rational thought or decision of their own.


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