Caracas Chronicles

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.