This is a Deepl translation of an article published in the Swiss newspaper Tages-Anzeiger on May 19, 2018. The original German article can be found here .
A stench of decay in the ER
The Venezuelan dictatorship is trying to cover up the miserable conditions in the country’s hospitals. A visit.
Marc Chéhab, Caracas
A morgue in the emergency room, with medical waste piled up right next to it: A photo from inside the Domingo Luciani Hospital in the Venezuelan capital Caracas. (May 2018)
Doctor Andrea’s (name changed) tone is expressionless, her fine features unreadable. ‘How are you supposed to run a hospital without running water?’ she says in the Domingo Luciani Hospital in the Venezuelan capital Caracas. ‘It’s impossible to examine patients if you can’t wash your hands,’ Andrea continues. The water supply would fail at weekends, says the doctor. ‘Usually from Friday evening. We then have to make do with disposable gloves. But there are also days when we have neither water nor gloves.’ Andrea is taking a considerable risk: In the Venezuelan dictatorship, medical staff have to fear reprisals if they speak openly to journalists - let alone show them round a hospital.
Outpatient treatments are carried out in the reception area, several patients sit on the waiting benches with infusions. In the gloomy corridor of the emergency department, Andrea shows the way to the various departments. The air conditioning has broken down in the resuscitation room. In the warm room, four patients are being cared for in beds by family members. The doctor leans forward and whispers: ‘Many people die unnecessarily here. For example, we often lack adrenalin - that makes it almost impossible to resuscitate someone.’
The paediatrics department is closed due to a child with diphtheria. This infection of the nose and throat is highly contagious and potentially life-threatening - but could easily be prevented with a vaccination. The child dies within a few days. The ward is later going to be decontaminated and reopened.
Like measles, diphtheria was virtually eradicated in Venezuela. But with the collapse of the health system, these diseases spread again. The World Health Organisation (WHO) has so far confirmed 1631 cases of measles and 976 cases of diphtheria. The situation is so bad that the government has stopped publishing health data - just as it stopped publishing economic or crime statistics before.
An overwhelming accumulation of corruption and incompetence
Outside the gynaecology department, Andrea says that the hospital only performs births in emergencies - there is a lack of equipment and medication to do any more. Doctors regularly have to turn pregnant women away and tell them to find another hospital. However, there is a lack of medical equipment throughout the country. According to Amnesty International, thousands of pregnant women travel to neighbouring countries. The infant mortality rate has reached its highest level in 25 years. ‘The causes include the lack of medicines, such as anticoagulants, painkillers, antibiotics, antiseptics, the lack of basic medical equipment and materials, such as scalpels, needles and gloves, and the ever-decreasing number of medical staff who are still willing to work without equipment and pay,’ summarises the organisation.
Fifty metres from the reception, there is a strong smell of decay in the air. ‘This is the mortuary - they haven’t taken the dead away,’ says Andrea. ’The mortuary should actually be in the basement in a secluded area and not here next to the patients.’ Why is that? ‘I have no idea, but it’s not right.’ In a corridor next to the mortuary, medical waste is piled up openly in the corridor. An indefinable trickle, mixed with blood, stretches from the rubbish across the floor to the other side. A few weeks earlier, the rubbish had covered the entire corridor, Andrea says later.
In contrast to the gloomy emergency ward, the atrium is large and beautiful. The Domingo Luciani Hospital was the last of Caracas’ large public hospitals to open in 1987. Its architecture, with its many exposed cement elements and open-plan interiors, makes a solid impression. With adequate care, professional administration and maintenance, it could be an excellent hospital - as it used to be.
A hospital without blood tests?
But almost everything that isn’t mere cement is falling into disrepair. Andrea points to a locked room: ‘There’s the laboratory, we had to close it. The mortuary has contaminated it via the ventilation. But even if it were open, we don’t have the reagents for most of the blood tests.’ A hospital without blood tests? ‘At the moment, yes. But that’s not all: our X-ray machines and our MRI are also broken. We don’t even have ultrasound.’ A few days later, rudimentary blood tests and X-rays are available again for emergencies.
The immediate cause of the shortage in Venezuela is the catastrophic economic policy. There are laboratories in the country that could synthesise many of the missing drugs. But they cannot obtain the necessary US dollars to import the raw materials. This is because Venezuela exports almost exclusively oil. The US dollars received in return flow to the state oil company and thus to the government, where they trickle away. In addition, the fatally managed state oil company is earning less and less and is becoming increasingly indebted. Although low oil prices can influence this, the much more important variable remains the sheer inefficiency of the oil company: Compared to the beginning of the noughties, the company’s oil production has halved.
Behind these immediate reasons for Venezuela’s collapse ultimately lies the government’s thirst for power. Like Hugo Chávez before him, Nicolás Maduro elevates loyal servants to positions of power, mostly members of the military. The hospital director of Domingo Luciani is a colonel in the Venezuelan army. And so, for 19 years now, senior officials have been selected according to the motto ‘loyalty before professionalism’, which has led to an overwhelming accumulation of corruption and incompetence.
In view of the shortage of medicines, doctors have to ask patients to look for medicines themselves. Health problems that could easily be treated with modern medicine - such as an asthma attack or high blood pressure - are suddenly becoming serious problems. Nursing staff and doctors are also fighting this hard battle for wages that are not even enough to ensure their bare survival. Andrea knows of a nurse who has to sell fruit from her garden in the evenings.
Officials loyal to the government blame hospital staff for the lack of materials. They claim that the staff are stealing supplies and selling them on to private clinics. This may be happening, but certainly not on a scale that would explain the supply crisis.
Medicines up to 3000 per cent more expensive
Andrea has experienced this accusation herself. Three police officers brought a severely malnourished prisoner with tuberculosis to the A&E department. When the doctor wanted to administer an intravenous sugar solution to the patient, she had to use a venous catheter that was too small, which meant that the treatment took longer. One of the police officers quickly accused her of stealing the larger catheters that were not available.
Venezuela’s Pharmaceutical Association (Fefarven) estimates that the necessary medication is missing in over 80 per cent of cases. For chronic conditions such as cancer, HIV or diabetes, the figure is as high as 90 per cent. And the prices of the few drugs that are still available have risen between 1000 and 3000 per cent in January alone, says Fefarven’s president Freddy Ceballos. However, the government does not want to admit that there is a real supply crisis in Venezuela and rejects humanitarian aid from other countries and NGOs.
NGOs organise the logistics
The shortage of medicines has led to large-scale collection operations organised by private individuals. One of the most important initiatives is Acción Solidaria (Solidarity Action). The NGO’s original mission was to educate people about HIV. But when the activists saw the urgent need for antiretroviral drugs, they began to bring them into the country informally. Today, the NGO organises the logistics of hundreds of thousands of individual donations of all kinds of medicines from all over the world. The donations first arrive at their centres in Miami and Madrid. From there, they are either brought into the country in the luggage of individual activists, or the NGO sends the medicines into the country.
The head office in Caracas has a small call centre with three employees. Patients call from all over Venezuela to ask whether the medicines they need are available. The NGO distributes the medicines free of charge.The centre also offers a rudimentary medical examination and blood tests.