Caracas Chronicles

Photo by Rayner Peña R

It’ll be fine, I thought. Just another night shift, like the dozens before and the hundreds to come. I’ll sit in Merida’s Hospital Pediatric Emergency Evaluation Room with Gabriel, Patricia and Nay, we’ll take care of asthma crisis with a sole bottle of bronchodilators and we’ll stabilize diarrheas that can’t be properly treated in small hospitals. You know, the usual dose of underdevelopment we’ve gotten used to.

Little did I know, my night was about to turn into a parade of Sub-Saharan diseases.

It started before 8:00 p.m. with a 20-month-old girl named Lucía, from a small town south of Lake Maracaibo. Her mom arrived after a three hour bus ride because Lucía’s legs were swollen. She had diarrhea two weeks ago, received intravenous rehydration and now the 20-something mom feared her girl may have gotten too much liquid. A quick look proved her wrong: Lucía’s heart and lungs were ok, like her blood pressure. She was scared and started crying, so I rubbed her head until a patch of thin, fragile hair stayed in my hand. I took a new look and realized how her ribs were pushing through the skin of her chest. We see so many skinny kids nowadays that sometimes it goes unnoticed. I took her to our weighing scale and my stomach squirmed. It said she was 8 kg (about 18 pounds). That’s the weight she should have… if she were nine months younger! This girl was badly malnourished and her swollen legs were a sign.

“Severe malnutrition, type Kwashiorkor” I wrote as presumptive diagnosis.

In less than twelve hours, I had seen three patients with diseases that most doctors around the world only read about.

Kwashiorkor, which literally means “the sickness the baby gets when the new baby comes” in Ghana’s tongue, is a form of malnutrition provoked by insufficient protein intake. People in Ghana realised it usually appeared in older brothers as their mothers reduced their rations to feed newborns. Low protein levels cause water from blood vessels to escape the neighbouring tissues, swelling them. The disease became famous in the 60’s, when it was commonly seen in Nigeria during the Biafran War. I read about it, heard the news about it, but I was emotionally unprepared for that tiny baby in front of me.

“What do you eat in your house, ma’am?”

I hadn’t finished the question when I was already afraid of the answer.

The closest they got to eating meat was the beef broth they could afford once every two weeks. Other than that, it was arepas and homemade cheese from the farm where her husband worked. She was happy because at least they could eat three times a day – and she should be, one third of Venezuelans aren’t that lucky.

A nurse took Lucía to her new bed, next to an 18-month-old baby who got malaria after a trip to the Bolívar mines, where his parents were illegally mining to sustain themselves. A perfect third world combo, pues.

We were almost done with Lucía’s entry form when 10-year-old José crossed the wooden door on a gurney. He had been vomiting for hours, after telling her mom about a headache. Now he couldn’t even talk, his neck was rigid and he had a 40°C (104°F) fever. Textbook meningitis. This disease is traditionally linked to poverty but, most importantly, it can be prevented with vaccines.

The closest they were from eating meat was the beef broth they could afford once every two weeks.

In Venezuela, most meningitis is caused by bacteria and vaccine exists against the three more common strains (Streptococcus pneumoniae, Haemophilus influenzae and Neisseria meningitidis). The local vaccine against H. influenzae comes in the same vial as the one against diphtheria, so it’s easy to see how deficient vaccination propels both diseases at once. The vaccines against S. pneumoniae are also included in the national vaccination scheme, but have recently disappeared from most public institutions and are sold privately for up to $100.

11 minimum wages.

Vaccines against N. meningitidis were available through private practitioners, since they’ve never been included in the state-sponsored scheme. There’s no need to tell you how that’s going today.

We transferred José to his bed and started the antibiotics he needed immediately. There were a couple of vials left in the hospital. I guess miracles do happen.

At 2:00 AM, when I thought I could get some sleep, I heard the characteristic sound of an ambulance parking and my colleague Gabriel’s words “that’s definitely for us” were a little too ominous for the pain we were about to face.

María, 5 years old, came in the hospital in her mother’s arms. She had a fever, could barely breathe and her neck looked like a football. Her mom told us it all started the night before, when she said she had a sore throat and refused dinner. The next day she couldn’t even drink water. She was taken to a Barrio Adentro consultory where some Médico Integral Comunitario told her she had a common cold.

Patricia asked the girl to open her mouth and all we could see was pus.

That’s diphtheria” I thought, scared, looking for a disposable mask. There were none.

“Common cold my ass,” she whispered as we felt the smell coming from her tiny mouth. It was like something died in there. We cleaned it with water and we saw it, a grayish bleeding membrane sticking to her swollen throat, obstructing most of her airway.

“That’s diphtheria” I thought, scared, looking for a disposable mask. There were none.

Diphtheria: a disease eradicated in the 80’s. It’s been over a year since the current outbreak started in Bolívar, and things have only gotten worse. María is the third case I see in the last month, and now we have reports from alleged well-being oasis like El Hatillo. Meanwhile, our Health Minister called the situation a “media scam.”

In less than twelve hours, I had seen three patients with diseases that most doctors around the world only read about. Three patients who shouldn’t be sick and who represent all that’s wrong with Venezuela. They don’t care about bondholders or defaults. For them, it’s just suffering.

Things calmed down after María arrived and we managed to sleep a couple of hours before waking up at 6:00 AM, to get things ready for a new day of socialist paradise. A new day with more Only in Revolution stories.

After four days of brave struggle, María died on November 13th, 2017, at the ICU. She was a victim of a perfectly preventable disease for which a vaccine exists since 1920. Her death is inexcusable.

Este artículo es para ti, María, que en paz descanses.