Caracas Chronicles

It’s 3:00 a.m. and you walk out the door of the obstetrics emergency ward of a public hospital. It’s cold and you stand right next to the small white door, trying to stay out of the rain while you call Daisy’s relative – not her real name – the fifteen year-old girl waiting on one of the pink gurneys inside.

Daisy arrived an hour ago, after a four-hour ride, because she started having contractions. She’s entering the last month of her pregnancy and hasn’t gone to her first OB/GYN control yet. Doctors just found out she needs an emergency cesarean because the baby is too big and her pelvis too small. When Daisy’s seventeen year-old partner and her thirty-something mom answer your call, you tell them the hospital lacks absolutely all the material required for the surgery and unless they find it in the next couple hours, the young girl and her baby may die.

This isn’t a once-in-a-lifetime kind of story. It happens all the time. I can’t even remember how many times I’ve been standing in that door myself. Sometimes it’s 3:00 a.m., sometimes it’s the middle of the day, it can rain, the sun can shine. It’s always the same. Our never-ending crisis is mercilessly killing young mothers by the hundreds, one day at a time.

Earlier this week, we received a report prepared by a group of chavista activists, begging President Maduro to address the problem of maternal mortality. Pitched as a proposal, it’s really more of a research note. It points out that, while in the pre-Chávez years (1958-1998) the Maternal Mortality Rate hovered around 60 deaths per 100,000 live births, and fell to a low of 51 by 1998, the rate had notched back up to 70 by 2013 and exploded with the onset of the crisis, all the way up to 112.

The hospital lacks absolutely all the material required for the surgery and unless they find it in the next couple hours, the young girl and her baby may die.

The document has been widely shared among government-linked feminist organizations. It may even have made it to Maduro’s hands. Tellingly, it is unsigned.

By maternal mortality, we mean women dying during pregnancy or within the first 42 days after giving birth. Postpartum bleeding, unsafe abortions, infections, hypertension-related diseases and obstructed labor are the most common causes worldwide. About 99% of all pregnancy-related deaths happen in the developing world, making it a useful proxy for development. To measure it, the World Health Organization (WHO) generally uses the Maternal Mortality Ratio (MMR), defined as the number of maternal deaths during a given period of time per 100,000 live births (LB).

Although still a big problem, global MMR fell from 385 deaths per 100,000 LB in 1990 to 216 in 2015. Latin America as a whole reduced its ratio from 135 to 67. Nearly all maternal deaths are easily preventable with a functional health system.

Exactly what Venezuela has lost in the last five years.

The harsh economic crisis of the last two years has brought Venezuela’s MMR to nearly double the Latin American average.

The number itself isn’t as scary as the speed with which it’s increasing: according to the last published epidemiologic report, in 2016 no fewer than 756 mothers died due to pregnancy-related reasons. A 66% increase compared to the 456 of 2015. That’s just one year.

Something is obviously happening, and it’s so evident it even made it through chavista anthological blindness to social problems… sort of.

Even though the report acknowledges a 44% increase on the MMR compared to 1990 and presents carefully kept epidemiological data, while admitting the national legal framework completely fails to guarantee a safe labor in practice – quite something for the Reds’ standards, if you ask me –, it doesn’t really address the causes of this sharp increase: the Government’s terrible administration.

The harsh economic crisis of the last two years has brought Venezuela’s MMR to nearly double the Latin American average.

Venezuelan mothers are dying because the drugs needed to prevent preterm labor, hypertension or infections, have disappeared from both the public health system and most pharmacies around the country. Or because no effective prenatal control is being practiced in any Venezuelan town. They also die because the absolute lack of resources in rural hospitals forces them to cross an entire State to reach the few facilities remaining functional, only to wait for hours in the overcrowded emergency rooms while their families spend the little money they have finding the surgical materials needed to help them. But primarily, they’re dying due to the pervasive limitations that 18 years of socialism have put on  women hoping to do anything that resembles family planning: With thousands of girls dropping out school daily to work and help their families survive crippling inflation, the scarcity of contraceptive pills, that if found, can cost up to a whole minimum monthly wage and a cardboard feminist policy that indirectly rewards irresponsible sexuality, no one is more culprit of the sky-high mortality ratios than the government itself.

Although the report does mention a deficient hospital and primary attention infrastructure, low coverage of public health programs, lack of protocolized attention and even the low number of doctors in the hospital network; it also argues that maternal mortality in Venezuela is linked to the neoliberal policies and the “patriarchal” thinking inherited from the cuarta, not to the last two decades of corruption and economic nonsense. If the root of the maternal mortality crisis isn’t clearly understood, no coherent measures to reverse it will ever be taken. That’s why in order to change the current situation, the authors of the report suggest the creation of a situation room in Miraflores that monitors a ridiculous number of things: From the usage of economic resources to the presence of  mandatory posters in hospitals claiming them to be territories free of obstetric violence. Because the poster formula  obviously worked with street crime.

I’d like to think that the guys who wrote this used chavista newspeak as a way to get Maduro’s attention into a historically neglected problem, that they asked themselves something like this:

— Dude, how in the world can we get the fat communist’s attention to turn to these dying mothers?

— Bro I don’t know, he just doesn’t care… Wait… I got it! Blame capitalism!

— Oh God, that’s genius.

But I’m pretty sure many people – those in charge of our health system, for sure – still think the right thing to do is to change the “hegemonic, technocratic capitalist model of hospital management” rather than getting the economy running again.

Daisy’s family scrambled and somehow found the supplies she needed before sunrise. They spent ten times the minimum wage on them, I have no idea where they got the money. She was lucky: she left the hospital with a happy, healthy baby a few days later. But as I read that anonymous chavista report, I can’t stop thinking how many more Daisys out there will end up turning into just another number in a never-to-be-published epidemiologic report. Then I think of the lame excuses they couch their findings in. And I I feel this rage well up inside of me against those who think ideological evasion can be a decent response to this disaster.