Caracas Chronicles

Photo: New York Times retrieved

Public health in Venezuela is built on three pilars: the social security institute (IVSS), the Health Ministry’s hospitals and the mostly Cuban-ran Barrio Adentro outpatient clinic network. Together, they accounted for about 82% of all medical care in Venezuela in 2011. Today, all are in a state of near-total disrepair: yet faced with official denial, it’s falling to private NGOs to call a Complex Humanitarian Emergency a spade.

Even as far back 2015, the public network had lost around 40% of its hospitalization capacity and patient consultations had fallen almost 60%. The mind reels at what the numbers would look like if we had more recent data.

More narrowly, some newer data is available. The Barrio Adentro Network, consistently cited as one of the biggest achievements of the chavista regime, only received little more than 200,000 patients in 2017, compared to the 5,5 millions of 2011, a staggering 96% drop.

Public hospitals can’t guarantee the minimum hygiene conditions needed to prevent, or treat, nosocomial infections, as evidenced by how, between 2016 and 2018, 112 children died in Caracas’ Maternidad Santa Ana, with other 147 deaths in Barquisimeto’s Agustin Zubliaga Pediatric Hospital. Since 2017, 12 other kids died in Caracas’ JM de los Ríos Children’s Hospital.

All of them from hospital-acquired infections.

It’s even worse for especially vulnerable groups: The number of psychiatric patients treated in public hospitals dropped from 23,000 in 2013, to just 3,500 in 2018. By 2016, 63% of all psychiatric patients couldn’t find their medication in pharmacies. This data coincides with the rise of suicides in the country.

One of the most shocking aspects of the crisis is the Health Ministry’s determination to hide all data needed to measure its real impact.

Other groups of neglected patients include those with chronic and genetic conditions, like hemophilia, Parkinson’s disease and different forms of sclerosis. This group used to get their high-cost medicines for free through pharmacies in public hospitals, but since imports were cut in 2016, most stopped receiving treatment altogether and many have already died. Only four public radiotherapy units remain functional in the country and chemotherapy is increasingly hard to find in private centers (they’re completely gone from public ones), leaving over 140,000 cancer patients with no options of treatment. Death tolls among HIV+ patients rose from 1,800 in 2014, to some 5,000 in 2017 and 2018, after antiretroviral therapy became extremely rare. Patients receiving dialysis therapy have also been hit, with 2,500 out of 15,000 dying between 2017 and 2018.

Still, one of the most shocking aspects of the crisis is the Health Ministry’s determination to hide all data needed to measure its real impact.

That’s why a group of Venezuelan NGOs decided to create the National Report on the Right to Health Emergency, a detailed account on the destruction of healthcare in Venezuela, and the causes behind it.

The report is unprecedented for the wide range of activists involved (jointly elaborated by 12 NGOs helping patients with many different diseases, from HIV/AIDS to breast cancer) and, second, because it’s the first to label the Venezuelan condition as a Complex Humanitarian Emergency (CHE).

The United Nations defines a CHE as “a humanitarian crisis in a country, region, or society where there is total or considerable breakdown of authority resulting from internal or external conflict and which requires an international response that goes beyond the mandate or capacity of any single and/or ongoing UN country program.” One key aspect here is that, although CHEs can be triggered by natural disasters, their real cause is human, usually political, and can’t be addressed by humanitarian aid alone.

Venezuela may not be suffering a civil war, but the economic mayhem has destroyed the country’s health network to such a great extent, that it makes no difference.

The Venezuelan health system can’t even deal with heart attacks, the first cause of death in Venezuela and the world. While most countries take leaps reducing mortality there, 92% of Venezuelan hospitals lack medicines as common as aspirin, and 39% can’t even diagnose an infarction without ECG devices.

Infectious diseases have re-emerged in never seen numbers, becoming the worst public health problem in the country: 406,000 cases of malaria in 2017 and over 700,000 expected this year, 1,217 confirmed cases of diphtheria, 5,332 cases of measles until this August and a 67% increase in tuberculosis cases between 2011 and 2017, when the diseases affected 10,952 patients, all highlight the destruction of vaccination and epidemiologic vigilance programs.

Venezuela may not be suffering a civil war, but the economic mayhem has destroyed the country’s health network to such a great extent, that it makes no difference.

The Right to Health Emergency report is remarkable because, unlike most documents from the World Health Organization, the Pan-American Health Organization (WHO/PAHO) and other previous works by Venezuelan NGOs, it not only shows how bad the numbers are, it also paints a detailed portrait of the collapsed system behind them.

It details, for instance, how Venezuela’s health expenditure is just 1,5% of the GDP, the lowest in the continent and well below the regional average of 3,7%. That’s less than half the expense of 2000 when, according to the World Bank, it was a 4,4%. Reduction has been possible by increasing out-of-pocket expenses to a record-high 64%, easily confirmed by visiting any hospital and seeing how all medicine is bought by patients or their families, something increasingly harder as hyperinflation accelerates.

Talk about a caring government.

Something to understand here is the country’s dependence on imports: by 2010, 95% of all drugs sold in the Venezuelan market were imported and funded through government debt. The few companies producing drugs in Venezuela imported about 98% of the raw materials needed; between 2012 and 2016, long before U.S. individual sanctions were a thing, Venezuela reduced health-related imports in almost 70%, designing no backup plan and leaving a millionaire debt to both domestic and international pharmaceutical companies. The sudden cut on imports not only affected pharmaceutical companies, it virtually stopped the arrival of reagents for laboratories and critical equipment such as medical monitors, X-ray machines and CAT or MRI scans, as well as the spare parts needed to repair those already here.

Tellingly, Venezuela increased its military imports by 19% in 2017.

The collapse of health in Venezuela is not casual and could’ve been avoided, if the government had wanted to. Instead, it decided to ignore it and let it escalate to a point where it can no longer be tackled without help from the international community. The fact that it still minimizes its scale and keeps hiding epidemiologic data only proves its little interest in changing the current situation, making this kind of reports even more valuable.

The full report is available in Spanish and English.