Caracas Chronicles

If you got the money, honey,

we got your disease

Guns n’ Roses, “Welcome to the jungle”

Whether you have a sinus infection, an allergy, hypertension, diabetes, epilepsy, or cancer, you can always find a con-artist ready to part you from your money using old, outdated, cold-war-era “medical devices” already proven to be a farce.

They call themselves “alternative doctors”, “therapists”, “healers”, “homeopaths”, etc. They claim to have the cure for whatever it is that ails you. Some have a medical degree, others a pharmaceutical lab, others lack any sort of qualification or license to treat patients whatsoever. Their consultations are costly, and their waiting rooms are crammed full of desperate patients who’ve given up on a broken medical system. And they hurt people. I’ve seen it.

I have a young patient we’ll call Martina —not her real name. She’s a 23 year-old student at Universidad Central de Venezuela and, like any other student, she loves going to the beach, climbing Él Ávila with her friends, and enjoys her romantic life with her boyfriend.

Alas, Martina has a history of atopic dermatitis, an allergic disease in which patches of skin become rough and inflamed, with blisters that cause itching and bleeding, sometimes resulting from a reaction to irritation. It’s a condition than can be easily treated and controlled with a very specific set of medicines called “inmmunomodulators”, basically drugs that change the way your body responds to the allergy. These drugs used to be available, they were costly (a small tube went on for about 7,000 bolivars) and lasted a couple of days. Now, with CADIVI and SUNDDE’s price controls, they’re just nowhere to be found, even the best-stocked pharmacies.

Since Martina was very little her pediatrician told her mother that she was allergic to certain types of soaps and fabrics, she even had an immunologist at Universidad Central’s Institute of Immunology test her blood and skin to determine which substances set off her allergy and had it under control for a long time.

Until the crisis came and the scarcity of medicines spread everywhere.

First, came the trouble finding hypoallergenic soap, a basic toiletry that you could find at every single supermarket anywhere else in the world. Martina had to change soap brands or even try homemade soap made out of animal fat. When those alternatives ran out, she had to use industrial-detergent to shower, and Martina’s skin started to itch and bloat, the creams and products that she needs to keep her delicate skin moisturized have disappeared from the shelves, the red itchy patches on her arms, breasts, and legs became more evident and she started to cover herself with long sleeves and turtlenecks under scorching mid-year Caracas heat. She felt terrible about herself and put her years-long relationship with her boyfriend on hold.

When the patches moved up to her face and scalp, her hair started to fall and she became desperate. She called her immunologist, and found out that she had left the country, and there’s a two-month wait for emergency consultations at Universidad Central. She doesn’t have the money to pay for a private consultation with a new doctor.

She had heard from “una amiga que tuvo una comadre que le dijo” about a guy they called “el brujo del Cafetal” a “doctor with a PhD from a East German University in Homeopathy”. She heard he’d treated several people with a machine, prescribed them them some sort of natural, herbal products and they got better. What choice did Martina have?

So she and her mother set up an appointment to meet this guy in El Cafetal, a middle class neighborhood in the East of Caracas. El Brujo charges upfront. He uses a quack device called “Dermatron” and pricks the fingertips of Martina with a brass needle connected to an old looking machine with a moving needle gauge, he looks at her skin and says she has a “problem with her immune system”, he recommended that she suspends all treatments she previously had, and ordered her to take “foot baths”, including a drop of a mixture he prepared from a box of amber vials. And six weekly courses of an intravenous ‘vitamin serum’. He even recommended Martina that she uses the synthetic fibers that cause her skin allergies and the foods that her old immunologist told her not eat, all for the price of Bs.45,000.

Martina only got worse.

She came to my office with a broken heart, with little hope and this story. I prescribed other medications, the second-line treatment for these kinds of episodes: steroids, prednisone. Hemmed in by shortages, she was forced to buy veterinarian version of these tablets —which are not price controlled and, therefore, can be obtained at a petshop pharmacy. Later, a kind soul who traveled to Miami brought her the first line treatments, and she got better. She’s struggling to find her skin care products but at least her skin and hair have improved greatly.   

I understand why Martina did what she did, though I find it sad. Virtually every patient who comes to see me asks me if the treatment I’m prescribing them is available. I find myself repeating the same dialogue every single day. “Just, prescribe me something that I can actually find, ok?” patients tell me again and again. I get it, nobody wants to go on a wild goose chase after a drug that just isn’t around.

I take a deep breath. I explain I don’t prescribe medication based upon what’s available. I tell them, in as even a tone of voice as I can muster, that my duty is to prescribe the medicine they need, according to my medical knowledge. I give them three alternatives prescriptions for antibiotics that according to this one app, and these twitter reports, and these reports that I have from ten pharmacies in a radius of ten blocks from my practice, I think they can find.

We doctors go the extra mile when it comes to providing help for their patients. And yet shortages stalk us. It’s enormously frustrating. What are you supposed to do as a patient when, according to the Venezuelan Medical Federation, 90% of medicines are missing from any given pharmacy?

Well, we know what they’re not supposed to do: go to quacks and brujos. But we know many of them will.