Caracas Chronicles

Photo: The Economist

Breiner was laying on a bed in Merida Hospital’s pediatric intensive care unit when I first met him, in early March. A Spider-Man blanket covered a 7-year-old body that looked half that age, with malnourishment and disease. His dark skin hid how anemic he really was, but a quick look into his pale mouth told the truth. He was stable nonetheless, and as I approached him, he said hi, and even laughed when I told him I liked Spider-Man, too.

Breiner was recovering from cerebral malaria, one of the deadliest complications of infection with Plasmodium falciparum, one of the three species of parasites that cause malaria in Venezuela. He arrived to the hospital on the last week of February, barely conscious after a seizure, following a week of high fever and chills.

“I was devastated,” Breiner’s uncle says, a fortysomething man sitting in one of the only two chairs of the bedroom. “I just kept thinking about what happened to his cousin.”

Breiner’s cousin got sick two weeks before him and died a few days after being admitted in the hospital with the same diagnosis. They were both very close, living in the same house.

The situation of malaria in Venezuela runs against the global trend.

That same week, I also met an entire family in the hospital’s emergency area, two sisters and their mother, a cousin and even the grandma, all with malaria. Like Breiner and the other 15 patients I’ve seen this year, they all came from Las Dolores, a small village near Caja Seca, Zulia.

The situation of malaria in Venezuela runs against the global trend. The World Health Organization launched a campaign in 2016, aimed at reducing malaria incidence and mortality in 90% by 2030. The plan is complex and implies governments taking measures to: 1) Grant universal access to diagnosis techniques and quality treatment, 2) prevent the expansion of the disease to new areas, and 3) intensify epidemiological surveillance programs to collect and deliver information to health practitioners.

Venezuela is failing in every one of these three pillars.

Antimalarial drugs are solely distributed by the Health Ministry, and although generally available in major hospitals, they’re extremely difficult to find in high-incidence regions, particularly Bolivar State, where they’re sometimes exchanged for foreign currency or gold. Furthermore, although most patients (at least in Merida) do receive treatment, its duration is usually cut before the recommended time, to cope with dwindling stocks. This is particularly bad in infections caused by Plasmodium vivax, the most common species in the country, and usually involved in relapsing infections when not treated properly.

The Venezuelan government isn’t doing anything to prevent the expansion of the disease throughout the country, either. Two years ago, on World Malaria Day, we celebrated Arnoldo Gabaldón’s legacy, effectively eradicating the disease from most of the territory, restricting it to a few hotspots in the jungle. With 411,586 cases reported in 2017, and the Venezuelan Society of Public Health expecting up to a million cases for 2018, the disease is rising at a faster rate than what’s seen in sub-Saharan countries, accounting for the 72% increase in cases seen in the Americas between 2015 and 2017.

The reasons behind this re-emergence predate chavismo, but have been dramatically worsened by the revolution’s catastrophic administration.

The main driver is illegal mining deep in Bolivar’s jungles, a problem blatantly ignored (and even fostered) by a government that profits from the activity. By 2016, the last year with official epidemiological data available, cases of malaria had already been reported in 17 out of the 24 states of Venezuela. In 2018, Oscar Noya, coordinator of the Central University of Venezuela’s Center for Malaria Studies, assured that domestic cases had already been reported in every single state of the country, including Caracas.

I’ve experienced it myself, back when I started interviewing patients, in 2017: most of them had personally traveled, or had relatives who traveled to Bolivar’s mines (where almost 20% of all cases of malaria in the American continent were reported that year). Now, out of the 15 patients from Las Dolores, none of them had left the village in the last six months.

The Venezuelan government isn’t doing anything to prevent the expansion of the disease throughout the country, either.

Furthermore, according to the World Malaria Report 2018, Venezuela ranked 19th out of 21 countries regarding malaria funding per person at risk in the 2015-2017 period, well below Haiti, Nicaragua or Guyana. The consequences of this underinvestment are bleak: the number of Long Lasting Insecticidal Nets distributed by the Venezuelan Health Ministry fell from 30,000 in 2016 to 5,000 in 2017, and the number of people benefiting from Indoor Residual Spraying programs fell from 2,7 million in 2015 to 3,900 in 2017. That’s a 99,85% drop in two years, in case you’re wondering.

Even epidemiological surveillance networks have been practically dismantled. The government published the last weekly epidemiological bulletin over two years ago, and the numbers we manage come from the little information the Health Ministry still provides (many experts believe it falls short) and estimations from medical guilds.

“I hope you never have to come back here,” I said to Breiner when I left his room, but I know they’ll probably return. As long as infected mosquitoes aren’t wiped out from their village, the disease will remain, and a previous infection doesn’t protect you from getting it again. Just like its eradication almost 60 years ago, malaria’s unrelenting advance on Venezuela isn’t casual, but entirely man-made, the criminal negligence of Venezuelan health authorities has dilapidated the conquests of one of the most effective public health campaigns the world has ever seen. No matter what happens in the coming months, kids like Breiner and his family will pay the consequences, sitting in one of the emergency rooms around the country, shivering with fever, pale and weak, with sad jaundiced eyes, waiting for a blood test that confirms a country’s failure for the nth time.