Can Our Hijacked Health System Put Humanitarian Aid to Good Use?

I'm a doctor, working in a small town. I deal with our complex humanitarian emergency every single day. Here’s why I think Venezuela's ramshackle outpatient clinic network has to have first dibs on aid… if the military and the regime allow its entry.

Photo: El Comercio retrieved

As seen from the air, the two containers and the cistern truck blocking a functional, yet never-inaugurated highway between Tachira and Colombia remind a George A. Romero movie, the last defense of mankind against an impending wave of zombies. In reality, they were placed there on the orders of Nicolás Maduro, after rumors that the highway could be used by Juan Guaidó and his Colombian allies to push humanitarian aid into Venezuelan territory from Cúcuta, rather than the always overcrowded Simon Bolivar Bridge.

The image is everywhere, reinforcing the common opinion that the Armed Forces will refuse the aid’s entry. But what if it somehow gets past the containers, what if it reaches Venezuela? Congressman Miguel Pizarro, in charge of the matter by the National Assembly, assured that the first lot of aid will be distributed across a series of type IV hospitals near the Colombian border, but how exactly, remains dubious, especially if we are facing a hostile state apparatus.

The humanitarian aid issue is getting more political, creating a rift between its more vocal defenders and the NGOs that have publicly voiced their concerns with the way the matter has been handled. A representative from one of these NGOs confirmed he received a messy survey from some opposition parties, asking if his organization was willing to help, but little details were provided.

The image is everywhere, reinforcing the common opinion that the Armed Forces will refuse the aid’s entry.

As a Venezuelan doctor currently working in a small town, I believe the outpatient clinic network is the most likely candidate to put such aid at the reach of people.

Although heavily hit by 20 years of underinvestment at the shadows of the Barrio Adentro scam, the outpatient clinic network still exists. You can find a small outpatient clinic in almost every town around the country, though not all of them have doctors and all lack the most basic of supplies. In Tabay, where I work, we were lucky enough to receive a truck from the Health Ministry in early November, a few weeks before municipal elections took place. Most of those supplies have already run out, and with a small bottle of pediatric antibiotics costing more than a whole month’s minimum wage, that means most patients stay with no treatment.

Outpatient clinics don’t require expensive, high-tech medicine to operate. With a somewhat regular supply of IV solutions, oral rehydration serum, and some basic medications such as antibiotics, analgesics, and hypertensives, we can solve most of the consults of a small town. Last December, a Canadian doctor visited Los Nevados, a small village in the middle of Merida’s Sierra Nevada where a friend works. He brought gloves, amoxicillin, ibuprofen and some other medicines he carried in his luggage. The few supplies made a huge difference in a place where the nearest drugstore is four hours—and two cable car stations—away.

These kind of low-cost/high-impact resources are exactly what we can expect from the humanitarian aid, at least in these first stages. They could prevent tragedies like the deaths of 12 children in Anzoátegui due to vomiting and diarrhea earlier this week.

Having a strongly equipped outpatient clinic network also allows more expensive medications and equipment to reach big hospitals, where highly-specialized physicians can properly use them to treat more complex conditions. Hospitals may also benefit from IV antibiotics, which will probably also arrive in the first waves.

Using the outpatient clinics to distribute the aid would decentralize its access, preventing crowds of people outside already overcrowded hospitals, and benefiting those who can’t move to state capitals, a real matter to keep in mind in a country where public transportation crumbles and gasoline shortages are getting increasingly common.

Nonetheless, this is tricky, too. The outpatient clinic network receives funding through the regional branches of the Health Ministry, state health corporations, whose authorities are named by every state’s governor. In order for this plan to work, it needs a wide collaboration with governors and/or the Health Ministry. And as long as those posts are occupied by the same guys blocking bridges with containers, you can be sure that’s not gonna happen. A chavista governor could easily use police or military forces to seize supplies from clinics, and the Health Ministry could cut all their funding, if opposition governors allow them to play a role in the humanitarian aid distribution.

There’s no way to take humanitarian aid to the places where it‘s mostly needed while chavismo remains in power.

Which brings us to the elephant in the room: there’s no way to take humanitarian aid to the places where it‘s mostly needed while chavismo remains in power. At least not in the volumes needed to make a difference.

With most NGOs unwilling to take part in the distribution schemes, opposition parties could try to use their own grassroots groups, which wouldn’t only make inspection complicated, but also expose them to attacks and sabotage from colectivos and similar groups.

Humanitarian aid is vital to quickly improve the quality of life of vulnerable groups in Venezuela, and the fact that President Guaidó is trying to bring it in against the state’s will is remarkable. But while Maduro keeps his hold on power, it may have a bigger impact as a tool to furtherly pressure the already strained Armed Forces, than in substantially improving quality of life in the country. For the latter we need resources and infrastructure that are still hijacked by the Maduro regime.

The opposition might well come up with a way to get the help to certain sectors of the population, but for now, the reaction of the military to its arrival, beyond the empty containers at that bridge in Tachira, might be more determining than its impact on the health crisis.