Monitoring The Access To Health in Venezuela Newsletter N. 23 June

NEWSLETTER

2019

23

JUNE

MONITOREO DEL DERECHO A LA SALUD EN VENEZUELA: MEDICIÓN DEL DESABASTECIMIENTO DE MEDICINAS Y LA SITUACIÓN DE LAS ENTIDADES DE ATENCIÓN DE PERSONAS MAYORES. CONVITE, A.C. 2018 LUIS FRANCISCO CABEZAS DIRECTOR GENERAL FRANCELIA RUIZ DIRECTORA DEL PROYECTO INVESTIGACIÓN Y REDACCIÓN: YANIRETH FERNÁNDEZ, FRANCELIA RUIZ. REVISIÓN Y EDICIÓN: LUIS FRANCISCO CABEZAS, WENDY RACINES. DIAGRAMACIÓN Y DISEÑO: CAMILO ESCOBAR. EQUIPO DE LEVANTAMIENTO: DISEÑO MUESTRAL Y PROCESAMIENTO ESTADÍSTICO: MIGUEL PADRÓN EQUIPOS LOCALES DE LEVANTAMIENTO: ÁREA METROPOLITANA DE CARACAS: ALEXANDER MONSALVE SANDRA PEPE DIEGO RAMÍREZ KELLYN RUIZ BARQUISIMETO: JOSÉ RAMÓN QUERO LISSETTY PÉREZ ISABEL BRAVO AQUILES QUERO CARMEN QUIÑONES MARACAIBO: ORGANIZACIÓN MULIER ESTEFANÍA MENDOZA MAYERLING GUERRERO ALEXANDRA NAVA JHULIANA TORRES LENIN ALVAREZ MÉRIDA: ORGANIZACIÓN PROMEDEHUM RIGOBERTO LOBO FRANCISCO DE JESÚS SEGOVIA JUAN CARLOS LIENDO ELVIS RIVAS

CIUDAD BOLÍVAR: ORGANIZACIÓN KAPÉ KAPÉ RAIZA GUAIPO MARY CARMEN SALAZAR ALCALA JOEL A OBDOLA FIGUEROA CARLOS R TORRES FLORES RANIER RAFAEL RICCIARDI PÁEZ PUERTO LA CRUZ: ORGANIZACIÓN DEFENSA EN ACCIÓN ALEJANDRA OLIVARES LUZ GUERRERO SUSANA DÍAZ MERCEDES CURIEL ZEZARINA GUEVARA VALENCIA: ORGANIZACIÓN FUNCAMAMA SOLEIR VALECILLOS YANIRA SUAREZ CARMEN BUENO ARACELYS COLMENAREZ MARIA ISABEL ALVARADO

PUERTO ORDAZ: ORGANIZACIÓN CODEHCIU MAIRIS BALZA NORKIS SALAZAR ROXANA MATHEUS ALEJANDRO HERNANDEZ ANGÉLICA SALAZAR

T A B L E

O F

C O N T E N T S

ANALYSIS AND INTERPRETATION OF AGGREGATE RESULTS MEDICINE SHORTAGE INDEX – JUNE, 2019 THE VENEZUELAN EMERGENCY EXACERBATES MENTAL DISORDERS

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RESULTS INDICATOR BEHAVIOR AND EVOLUTION

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GRAPHIC DEPICTION OF THE MEDICINE SHORTAGE INDEX BY MORBIDITY DIABETES: HYPERTENSION: ACUTE INFECTIONS OF THE RESPIRATORY TRACT: DIARRHEAL DISEASES: DEPRESSION AND PERSONALITY DISORDERS: SEIZURES:

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ON CONTRACEPTIVES SEXUAL AND REPRODUCTIVE HEALTH AT RISK #CONVITEDENOUNCES JUNE 2019 VENEZUELA: NO EXIT IN SIGHT FROM THE EMERGENCY

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ANALYSIS AND INTERPRETATION OF

AGGREGATE RESULTS MEDICINE SHORTAGE INDEX

JUNE, 2019

CHRONOLOGICAL DETAILS OF THE SURVEY Period and Frequency of Data Collection: The survey consisted of two measurements conducted in the month of June of 2019, from the 12th to the 13th and from the 26th to the 27th — which dates fall on the second week and fourth week of the month, respectively—, in order to detect variations that could be quantified and circulated regarding medicine supply protocols in pharmaceutical establishments.

For further information on the technical data sheet of the survey and other methodological details, please refer to Newsletter No. 1, September 2017, available at https://conviteblog.wordpress.com/2017/10/17/informes-de-septiembre-del-proyectomonitoreo-del-derecho-a-la-salud-en-venezuela/

THE VENEZUELAN EMERGENCY EXACERBATES MENTAL DISORDERS There is no place in Venezuela where the discussion is other than the severe crisis facing the country, one that has a differentiated impact on people. Regardless of their status, Venezuelans have seen their daily routines and quality of life drastically altered.

These days, it is not uncommon to see women, men, and even gaunt, frail children on the streets wearing rags or clothes that have been adapted and adjusted to fit to their current size, nor it is to see people carrying their lunch bags —which mainly consists of carbohydrates such as rice, pasta, arepas and legumes— to bus stop lines, to the bank and to the doctor’s office. It is also frequent to hear people say that what they earn is not enough for them to make ends meet or utter phrases such as ‘What I earn can only buy me food’, ‘I can’t afford to by medicines with what I earn’, ‘There is no water’, ‘I have no domestic gas to cook’, ‘God forbid that there is another blackout’, ‘It has been ages since I last bought a piece of clothing for myself’, ‘My car is broken and I can’t afford to have it repaired’, ‘My children’s school fees have increased and I don’t know what I am going to do’, ‘I can’t buy myself a burger out there’, and an endless list of expressions that reflect how deep the crisis has turned in Venezuela.

Venezuelans, in addition to dealing with their day-to-day problems, must bear the consequences of the inefficiency of a government that, far from investing in the nation’s development and in the well-being of its population, has been systematically dismantling the State’s institutions and, in the process, has destroyed the country’s production capacity, infrastructure, and public and private services, just to name a few of the sectors that are essential to the country’s sustainability.

People —regardless of their educational status, socioeconomic condition, gender, ideology or political leaning— long for an expeditious change to the situation; they no longer want the country to be ruled by perverse and embezzling leaders. But that longing has triggered feelings of permanent uncertainty, unsatisfied expectations and hopelessness in people. In the words of Dr. Wadalberto Rodríguez, former president of the Venezuelan Society of Psychiatry: “It is not so much the uncertainty of not knowing what is going to happen, but of how and when what needs to happen in order for things to change will actually happen.” 1 The World Health Organization defines health as “a state of comprehensive physical, mental and social well-being, and not merely the absence of disease or infirmity.” Unfortunately, it is not the case in Venezuela. Specialists affirm that it is not only evident in the manifest physical deterioration of many people, but also in the emotional and psychological burden that ordinary

1. ZAÁ, José Manuel (February 8, 2018). “Sicólogo advierte aumento de trastornos mentales en venezolanos” (Psychologist Warns of Increase in Mental Disorders in Venezuelans). Available at:https://www.elimpulso.com/2018/02/08/sicologo-advierte-aumento-trastornosmentales-venezolanos/

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citizens have to carry and that is undermining their mental health. The psychosocial imbalance caused by this type of large-scale socioeconomic crisis, which is further compounded by individual biological, psychological, chemical and even cultural factors, have resulted in depression, anxiety, panic attacks, irrational fear, fear of going outside, among others.

One of the mental disorders that affects people the most is depression. Experts agree that this is a high-risk condition because it triggers other morbidities and may even lead to suicide attempts. Sociologist Roberto Briceño León, director of the Venezuelan Observatory of Violence (OVV, by its Spanish acronym), notes that one of the main causes of suicide in the country is the depression associated with the severe crisis that it is facing.

Mr. Briceño León affirms that, before Chavismo, only four or five out of every 100,000 inhabitants committed suicide; after that, even in the buoyant days of the late Hugo Chávez’s government, the ratio increased to eight or nine, and from 2015 on, “suicide rates skyrocketed to an average of nineteen people per every 100,000 inhabitants.” And it has quadrupled 2

in the last fifteen years, “turning into a social phenomenon.” Sadly enough, Venezuela currently ranks first in suicides in the American continent.

According to Dr. Briceño León, people with chronic illnesses such as cancer, HIV/AIDS, kidney disease, etc., are also part of these statistics. Unable to find the medication they need to survive, they chose to take their own lives to avoid more suffering and “resort to self-euthanasia so as not to strain their families financially,” he concluded.

People with schizophrenia are particularly impacted by the shortage of medicines, which has wreaked havoc on their health.

As stated by Dr. Rodríguez, there are few types of psychiatric drugs available to treat the disease, and although the number of patients with this morbidity does not seem to have increased, the symptomatology for lack of treatment sure has. “If a patient does not take his/her medication, the disease gets worse,” he warns. His statement regarding the lack of treatment is readily verifiable from our surveys: the Medicine Shortage Index (MSI) for drugs to treat personality disorders has ranged between 79 percent and 90 percent over the last six months.

For the World Health Organization, the local context can be a determining factor in the mental health of people. Some individuals and social groups are at a greater risk of suffering from mental health problems, amongst whom the most vulnerable are the victims of human rights violations and those exposed to conflicts, natural disasters or other humanitarian emergencies . If anything characterizes Venezuela’s complex humanitarian emergency, it is the multiple, massive, systematic and deliberate violation of human rights.

The importance of understanding that the determinants of mental health “include not only individual attributes such as the ability to manage one’s thoughts, emotions, behavior and interactions with others, but also social, cultural, economic, political and environmental factors such as national policies in place, access to social protection, the standard of living, working conditions, and social support from the community, cannot be overemphasized. Exposure to adversity at a young age is an established preventable risk factor for mental disorders.”

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2. CARBALLO, Betzimar (May 8, 2019). “Venezuela ocupa el primer puesto en la tasa de suicidios en el continente americano” (Venezuela Ranks First in Suicide Rates in the Americas). Available at: http://caraotalibre.cf/nacionales/venezuela-tasa-suicidios/ 3. World Health Organization (WHO): Mental Health Action Plan 2013-2020. For further information, please visit: http://caraotalibre.cf/nacionales/venezuela-tasa-suicidios/ 4. Ídem.

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As stated by the WHO, personality or mental disorders are becoming more and more frequent, and depression is a common disease everywhere in the world. It is currently estimated to affect more than 300 million people and may become a serious health problem, especially when it causes great suffering, disrupts daily activities (work, school and family related), incapacitates people and, at its worst, leads to suicide. About 800,000 people kill themselves each year, and suicide is the second leading cause of death in the 15-29 age group.

The WHO has acknowledged that the global burden of mental disorders is increasing. Accordingly, as of May of 2013, the WHO has urged for a comprehensive, coordinated response from countries to tackle such health and social ailments, including the adoption of a Mental Health Action Plan. Within the framework of the latter, by 2020 countries will have: • “developed or updated their policies/plans for mental health in line with international and regional human rights instruments”; • “increased service coverage for severe mental disorders by 20%”; • “reduced the rate of suicide by 10%.”

Governments are the primary protectors of their people’s mental health and are responsible for implementing institutional, legal, financial and service mechanisms to ensure that the mental health needs of the population are met and that good mental health is encouraged. We are just a few months before 2020, which is the deadline year for the fulfillment of the WHO goals, and Venezuela is clearly lagging behind. It is unfortunate that the country’s State is not protective of its citizens and does not guarantee the health and integral well-being of its population.

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RESULTS

INDICATOR BEHAVIOR AND EVOLUTION

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The shortage indexes reported in our June 2019 survey within the framework of the “Monitoring the Right to Health in Venezuela” project, which range from 51 percent and 82 percent for the basic baskets of drugs prescribed to treat the six causes of morbidity selected, are shown below. There has been a downward trend in shortages during the first semester of 2019.

In Convite, A.C., we are of the opinion that the reduction in the shortage of some pharmaceutical items seems to have been caused by the alleged proliferation of uncontrolled private import markets: medicines from other countries are arriving in disproportionate amounts and, in some cases, not through regular channels. Most regrettably, said medicines used to be mass produced in Venezuela, as Tito López, president of the Chamber of the Pharmaceutical Industry (CIFAR, by its Spanish acronym), has denounced.6 But now the production of medicines in the country barely reaches 30 percent, and the sector’s fall has remained unchanged at 49.1 percent in recent months.

Table No. 1: Nationwide Aggregate by City and Morbidity. June 2019.

Chart No. 1: Behavior of the Aggregate Medicine Shortage Nationwide – June 2019

5. For details on the historical data of all the measurements carried out since the beginning of the project, please refer to our Newsletters No. 1 to No. 11, available at: https://conviteblog.wordpress.com/ 6. EFECTO COCUYO (June 28, 2019). “Producción de medicamentos en el país alcanza el 30%, según cifras de Cifar” (Drug Production in the Country At 30 Percent, CIFAR Figures). Available at: http://efectococuyo.com/salud/produccion-de-medicamentos-en-el-pais-alcanza-el-30-segun-cifras-de-cifar/

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Chart No. 2: Behavior and Evolution of the Medicine Shortage Index by Morbidity. January 2019 – June 2019

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GR APHIC DEPIC TION OF THE MEDICINE SHORTAGE INDEX BY MORBIDIT Y DIABETES

Chart No. 3: Behavior of the Medicine Shortage Index by Morbidity. Diabetes. June 20019

In spite of the fact that the behavior of the shortage index shows a downward trend, medicines to treat diabetes are not easy to find. People need to make the tour of several pharmacies before they can find them. The city where diabetes medication is the scarcest is Barquisimeto, with a shortage index approaching 89 percent, followed by the Metropolitan Area of Caracas, with 83 percent. Maracaibo is the city with the largest supply of diabetes drugs, with a 29 percent shortage index, whereas Valencia has a shortage index below 60 percent.

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HYPERTENSION:

Chart No. 4: Behavior of the Medicine Shortage Index by Morbidity: Hypertension. June 2019.

The shortage of drugs to treat hypertension in most of the cities that we surveyed to obtain our Medicine Shortage Index was low, with Barquisimeto, Puerto La Cruz, the Metropolitan Area of Caracas and Puerto Ordaz being the locations with shortage indicators in excess of 50 percent, while the remaining four cities had low percentages of between 23 percent and 48 percent. This means that people who live there or who purchase their medication there are less impacted by the shortage.

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ACUTE INFECTIONS OF THE RESPIRATORY TRACT:

Chart No. 5: Behavior of the Medicine Shortage Index by Morbidity: ARIs. June 2019.

The shortage of antibiotics to fight respiratory infections has not stopped being a reason for concern. Although shortages of antibiotics to treat ARIs are no longer in the vicinity of 100 percent, as they were in early 2019, the people affected are still forced to go on a pilgrimage to find their medication. The worst supplied areas are Barquisimeto (90 percent shortage), the Metropolitan Area of Caracas (88 percent shortage), Puerto La Cruz (85 percent shortage), Puerto Ordaz (80 percent shortage), Mérida (76 percent shortage) and Ciudad Bolívar (73 percent shortage). The shortage of drugs to treat ARIs in Valencia and Maracaibo does not exceed 70 percent.

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DIARRHEAL DISEASES:

Chart No. 6: Behavior of the Medicine Shortage Index by Morbidity: Diarrhea. June 2019.

At a time when the supply of water is inefficient, the potability of water is questionable, sewerage systems are poorly maintained, and sewage water spills multiply when it rains, the fact that there has been a reduction in the shortage of drugs to fight diarrheal diseases is a respite amid so much vicissitude. However, there are still critical cases such as that of Puerto La Cruz (77 percent shortage), Barquisimeto (76 percent shortage), Puerto Ordaz (56 percent shortage) and the Metropolitan Area of Caracas (60 percent shortage).

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DEPRESSION AND PERSONALITY DISORDERS:

Chart No. 7: Behavior of the Medicine Shortage Index by Morbidity: Depression. June 2019.

The shortage of antidepressants has diminished during this first semester of the year; however, the shortage indexes for the cities surveyed are still in excess of 60 percent. Puerto La Cruz is the city with the largest shortage of antidepressants, with 94 percent, whereas the shortage in Puerto Ordaz, the Metropolitan Area of Caracas and Barquisimeto is above 87 percent, and in the remaining cities above 65 percent.

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SEIZURES:

Chart No. 8: Behavior of the Medicine Shortage Index by Morbidity: Seizures. June 2019.

The outlook for people searching for anticonvulsants is not that different from that of people looking to purchase antidepressants. Shortage percentages for anticonvulsants are gradually decreasing, but they remain at approximately 60 percent and 70 percent, which is still high. Puerto Ordaz is the city with the largest shortage of drugs to treat seizures (93.2 percent), followed by Puerto La Cruz (92 percent) and AMC (87 percent).

Barquisimeto, Mérida, Maracaibo, Valencia and Ciudad Bolívar have shortage indexes of between 67 percent and 84 percent.

10. PINEDA, Julett (24 de mayo de 2019) “Pacientes obligados a reducir dosis de anticonvulsivantes por la escasez y altos precios”. Disponible en: http:// efectococuyo.com/principales/pacientes-obligados-a-reducir-dosis-de-anticonvulsivantes-por-la-escasez-y-altos-precios/

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ON CONTRACEPTIVES

Sexual and Reproductive Health at Risk

Chart No. 9: Shortage Index Aggregate Nationwide, by City. The Case of Contraceptives. June 2019.

Contraceptive methods and those to prevent sexually transmitted diseases are still in the most wanted list. Patches and vaginal rings are nowhere to be found in pharmacies, and injectable contraceptives, implantable devices and intrauterine devices are also difficult to find in the surveyed cities.

As for oral contraceptives and the emergency “morning after� pill, people can buy them, but not after a long search because they are still highly scarce in some cities such as Puerto La Cruz and Barquisimeto. On the other hand, condoms are more readily available at the pharmacies or convenience stores that we visited for our survey.

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#CONVITEDENOUNCES

JUNE 2019 VENEZUELA: NO EXIT IN SIGHT FROM THE EMERGENCY Venezuela continues to be plunged into a major and devastating complex humanitarian emergency. International agencies have finally attested to that fact by disclosing alarming figures associated therewith. Most non-governmental organizations, including Convite, A.C., agree that the reaction of the United Nations protection agencies has come rather late, but it is regardless acknowledged and welcome. The NGOs have been alerting international organizations on the real status of the country’s crisis for more than four years now, and have not ceased in their arduous and continuing task of denouncing the persistent systematic violation of human rights in Venezuela.

These are some of the relevant data that were disclosed to the public and disseminated in digital media during the month of June: • According to the International Organization for Migration (IOM) and the United Nations Refugee Agency (UNHCR), the number of Venezuelan migrants has reached 4 million. The United Nations High Commissioner for Refugees reported that at least 5,000 Venezuelans leave the country on a daily basis due to the humanitarian, political and economic crisis facing the country.

• The United Nations is calling nations to keep their borders open to Venezuelans fleeing a complex humanitarian emergency.

• The UNHCR calls for measures to put an end to the wave of shipwrecks of Venezuelan migrants.

• The United Nations High Commissioner for Human Rights, Michelle Bachelet, visited Venezuela and met with officials of the Maduro regime, the president of the National Assembly Juan Guaido, representatives of human rights NGOs, and victims of human rights violations.

• For the first time in Venezuela, two staff members of the office of the United Nations High Commissioner for Human Rights will stay in the country with the mandate to provide assistance and technical advice and monitor the situation of human rights in Venezuela.

The complexity of the emergency has increased at a rapid pace during the first semester of the year.

Venezuelan Children Neglected: The State Kills Our Future.

According to information provided by UNICEF, one out of every three children requires nutritional, health and educational assistance, which means that of the 10,000,000 children in the country, at least 3.2 million are in need of basic care.

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Christophe Boulierac, spokesman for UNICEF, declared in Geneva on June 7 that Venezuelan children have been affected by restrictions on access to essential services, which, in turn, has exacerbated their condition of vulnerability.

Boulierac also reported that the biggest inconvenience that he finds to work in Venezuela at the present time is the one pertaining to the availability of funds, but said that UNICEF will continue pursuing humanitarian work in the country and that their first plan of action will involve the implementation of more immunization and nutrition campaigns.

7. CARRILLO, Rubén (June 7, 2019). “Unicef alerta grave desnutrición en niños venezolanos” (UNICEF Warns of Severe Malnutrition in Venezuelan Children). Available at http://caraotalibre.cf/hoy/unicef-revelo-gran-nivel-de-desnutricion-y-fallas-en-la-educacion-de-ninos-venezolanos/

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#CONVITEDENOUNCES For its part, Venezuelan NGO Caritas de Venezuela has urged Michelle Bachelet to take a strong stand to help curb the enormous deterioration to which Venezuelans’ lives are being subjected, so that they may eventually “be in a position to healing the deep wounds that have been inflicted upon them for so many years.” In its public letter, Caritas discloses the 8

data collected in its ‘Monitoring the Nutritional Status and Food Security of Families, January – March 2019’ report , which 9

fairly illustrate the complex humanitarian emergency that is consuming Venezuela, including:

• 52 out of every 100 children arriving at Caritas have some kind of newly acquired nutritional deficit.

• In the parishes of three of the 14 states surveyed, acute malnutrition is at emergency levels (Lara: 15.1 percent, Portuguesa: 15.2 percent, and Sucre: 27.5 percent), which is well in excess of the 15 percent cap set by the World Health Organization.

• 24 percent of the pregnant women that they receive in their facilities have some degree of malnutrition.

One third of said women are yet to attain the age of 18.

• Child growth is delayed due to chronic malnutrition.

• More than one third (35 percent) of the children arriving in Caritas already have irreversible physical growth delay. These are children who have been living in nutritional deprivation for at least five years. In 2017, they accounted for 27 percent of all children received.

• Growth retardation has been detected even in children less than 1 month old.

• Six in ten families to which they have had access live on begging and scavenging for food in garbage dumps.

• Milk, vegetables, meat, fish, eggs and fish have disappeared from the tables of the most impoverished people.

• Seven out of every ten people are absolutely dependent on the box of food that the State sells them at subsidized prices.

Venezuelans In Search of Refuge Are Not Vacationing: They Are Fleeing From Death. #TheyAreNotMigrants #TheyAreRefugees More than 4 million Venezuelans have left the country since 2015, 341,800 of whom have applied for refugee status, most of them in Peru.The UN High Commissioner for Refugees, Filippo Grandi, presented the annual report of the United Nations Refugee Agency, with details on the latest figures on forced displacement worldwide. The numbers have doubled in the last 20 years: in 2018, there were 2.3 million more people than the previous year. This phenomenon has been caused by the complex humanitarian emergency that Venezuela is enduring.

Grandi explained that while a minority of Venezuelans have sought asylum, the majority are in need of international protection because their exodus is caused by insecurity, retaliation for political dissent, shortages of food and medicines, 10

deterioration of public services, and the inability to support themselves and their families.

Non-Communicable Diseases Such As Diabetes Should Be Included In the Protocol to Respond to Humanitarian Crises.

The Lancet diabetes & endocrinology, , a British digital platform specialized in health issues, held a conference sponsored

by Harvard University in Boston, United States of America, where experts in the field committed to join efforts until diabetes treatment is included in the protocol to respond to humanitarian crises.

8. Consultar en: http://caritasvenezuela.org/wp-content/uploads/2019/06/X-Bolet%C3%ADn-Enero-Marzo-2019-V2.pdf 9. Consultar en: https://reliefweb.int/report/venezuela-bolivarian-republic/c-ritas-venezuela-alerta-michelle-bachelet-sobre-la-cr-tica 10. EFECTO COCUYO (June 19, 2019). “Desplazados en el mundo vuelven a batir triste récord en el que destaca Venezuela” (Displaced People in the World Break a Sad Record Again, with Venezuelans in a Leading Position). Available at: : http://efectococuyo.com/la-humanidad/desplazados-en-elmundo-vuelven-a-batir-triste-record-en-el-que-destaca-venezuela/

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#CONVITEDENOUNCES 11

The specialists subscribed the so-called “Boston Declaration” , where four major goals were set to work towards over the next three years and must be adhered to in the protocol to address humanitarian crises: “Unified and strengthened advocacy; universal access to insulin and other essential medicines, and diagnostics for glycemic and blood pressure control in humanitarian crises; establishment of a unified set of clinical and operational guidelines for diabetes in humanitarian crises; and improved data and surveillance”.

The agreement comes about because “people with Type 1 Diabetes who cannot access insulin and

continuity of care in a crisis are at acute risk of death.” Specialists in humanitarian issues agree that poor provision, the high cost of insulin and the difficulties in accessing blood glucose monitors for correct diagnosis are “barriers to both humanitarian responders and their host countries.”

In 2018, Convite documented the testimony of Doralys Ollarve, whose son, Jeiver, died because he could

not afford to purchase an insulin vial.

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The Latent Risk of Epidemics

According to data from the Pan American Health Organization (PAHO), Venezuela ranks eighth on a list

of ten countries in the American region with the most cases of dengue fever recorded so far in 2019. Venezuela reported 3,636 suspected cases of dengue between January 1 and April 27 of 2019.13 The PAHO, in its latest epidemiological bulletin on dengue in the Americas (February 22, 2019), reported that Venezuela had a first surge in the number of cases in May 2018, which has remained on the rise. According to the document, between the months of August and October of last year, an average 620 weekly dengue cases were reported in the country.

Dengue fever in Venezuela recorded a year-on-year increase of 10.08 percent as compared against Epidemiological Week 17 in 2018, according to the information provided by the ministry of health on cases from January to April of this year combined. Infectious Diseases Specialist Jaime Torres, MD, of the Institute of Tropical Medicine of the Central University of Venezuela, predicts that the incidence figure at the end of 2019 could be higher than the one reported in 2018 (19,118 cases), and adds that it would be in excess of the 54,152 cases reported in 2015.

The specialist notes that this increase in the number of cases is due to the fact that there are more serotypes of the virus circulating in Venezuelan territory. The World Health Organization warns that when all serotypes of the dengue virus circulate in a country, the risk of an epidemic increases accordingly.

The Chronically Ill in Chronic Conditions: The Lives of People with Chronic Diseases Hang by a Thread.

People with kidney diseases, hypertension, diabetes, psychiatric disorders and oncological and neurological ailments have once again declared themselves in a state of emergency at the doors of the Health Directorate of the State of Lara.

11.Lancet Diabetes & Endocrinology 2019 (Published Online on June 6, 2019). “Diabetes in Humanitarian Crises: The Boston Declaration”: Available at: http://dx.doi. org/10.1016/S2213-8587(19)30197-4 12.Watch full testimony in https://www.youtube.com/watch?v=ULBe1XSxsSA 13.ALTUVE, Armando (June 9, 2019). “Venezuela ha reportado 3.636 casos de dengue a la OPS este año” (Venezuela Has Reported 3,636 Dengue Cases to PAHO So Far This Year). Available athttps://elpitazo.net/salud/venezuela-ha-reportado-3-636-casos-de-dengue-a-la-ops-este-ano/

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#CONVITEDENUNCIA: Their demands are: maintenance and repair of the work environment equipment in the entity’s nine dialysis units; installation of power plants; full rounds of treatment for the chronically ill; steady supply of immediate-release and prolonged-release insulin for diabetics; replacement of catheters and treatment of fistulas for people on peritoneal dialysis and hemodialysis; reactivation of wards in the ‘Antonio María Pineda’ Central Hospital; laboratory tests and specialized studies; guarantee of transportation and improved salaries for the medical and nursing staff, who quit their jobs because of lack of incentives.

Programs to treat the chronically ill have been closed or operate with unqualified personnel; the dialysis units lack nephrologists and specialists to treat transplanted patients; there are no internal medicine physicians or endocrinologists to treat diabetes patients. And the government’s solution is to hire Cuban or integral doctors to take care of patients, “but they are unqualified for the task”, says Susana Mújica, a young insulin-dependent patient from the state of Lara who is on peritoneal dialysis and who contributed her testimony to the report.

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“In Venezuela there is no adequate or continuous treatment due to various factors, including the lack of medicines and supplies for chronic diseases such as diabetes, hypertension, leukemia and hemophilia, and for disorders of the digestive system, neurological diseases or acute and emergency diseases such as infections. We have seen diseases tragically progress. Patients suffer from the most severe complications and their health deteriorates dramatically,” notes Luzmila Leal, director of Médicos Unidos, Lara Chapter.

In the meantime, the State insists on denying the emergency by hiding information, repressing demonstrations and disregarding the claims and complaints from the doctors and health staff of hospitals. The Human Rights Network in the state of Lara issued a communication rejecting “the systematic campaigns of harassment, persecution and dismissal of the medical and paramedical personnel” that speak up without fear about “conditions so dire that worsen the patients’ illness and even lead to their death.” Several doctors from the state of Lara have been detained by the Scientific, Criminal and Forensic Investigations Corps (CICPC, by its Spanish acronym).

Non-governmental organizations warn of the dangers for the medical profession of the creation of a Division of Crimes against Public Health in the CICPC, given that there is no rule of law in Venezuela.

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World Blood Donor Day in a Context of Health Crisis and Shortages: Risky Donations Are A Fairly Common Occurrence.

Blood banks in Venezuela are short of supplies, and it is not only due to the absence of programs that promote voluntary blood donation, but also to a number of factors that currently affect their operation.

Venezuelan blood banks face difficulties including the lack of reagents and essential supplies such as blood collection bags, as well as a deficit of specialized staff. For instance, in the Municipal Blood Bank, which is located in the capital city and is a national reference institution, there is a shortage of hematology nurses and there are no donors, one of the reasons being that “people find it increasingly difficult to go there because of the problem with 16

public transportation,” said hematologist Claudia Reyes.

The situation has been recently compounded by the fact that many a donor does not meet the body weight requirements necessary to qualify as such.

14.GAZCÓN, Liz (June 11, 2019). “Pacientes crónicos están al borde del colapso por falta de tratamientos” (Chronic Patients On The Verge of Collapse From Lack of Treatment). Available at: https://elpitazo.net/occidente/pacientes-cronicos-colapso-falta-tratamientos/ 15.TORRES, Keren (June 12, 2019). “Amedrentan a médicos larenses que han denunciado fallas en el sistema sanitario” (Doctors from the State of Lara Who Denounce Defficiencies in the Health System Intimidated). Available at: https://elpitazo.net/occidente/amedrentan-a-medicos-larenses-que-han-denunciadofallas-en-el-sistema-sanitario/ 16.PINEDA, Jullet (June 14, 2019). “La escasez marca el Día Mundial del Donante de Sangre en el Banco Municipal de Caracas” (Shortages Mark World Blood Donor Day at Caracas Municipal Bank). Available at: http://efectococuyo.com/principales/la-escasez-marca-el-dia-mundial-del-donante-de-sangre-enel-banco-municipal-de-caracas/

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#CONVITEDENUNCIA: Fortunately, the Municipal Bank has a regular supply of reagents, but this is not the case in the other blood centers.

The seven reagents needed to perform serology tests and rule out diseases such as Chagas, syphilis, HIV or hepatitis C, are in short supply in blood banks throughout the country, which dangerously compromises the health of people in need of blood transfusions.

The ‘Concepción Palacios’ Maternity Hospital on the Verge of Collapse Despite persistent complaints from its workers and medical personnel, the first six months of the year have gone by and the precarious situation of the main maternity center in Caracas remains unchanged. Its employees complain that the healthcare center is in bad shape and that their working conditions are terrible.

The union representatives of the ‘Concepción Palacios’ Maternity Hospital demand that their collective bargaining requests are met. At present, the hospital’s employees do not even have uniforms to work in and they cannot afford to buy them with the poor salaries that they earn.

The executive secretary of Fetrasalud, Pablo Zambrano, reports that the maternity hospital has “received nothing” since September 2018. Moraima Hernández, head of the hospital’s Infectious Diseases department, denounced 17

that the center is below 40 percent operational. There are no medicines or supplies and, what is worse, there are not enough vaccines to immunize the newborns (only the BCG).

Older People Need More than 100,000 Bolivars (An Average of 13 Dollars) to Purchase Their Medicines.

With a pension of less than 6 dollars a month, an elderly person needs to engage in sort of a balancing act to purchase food, move around (transportation expenses) and buy his/her medicines to control his/her morbidities.

In addition to the issue of shortages, products are sold at high prices that are often difficult for people to afford.

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According to testimonies gathered by journalist Kervin García from Caraota Digital news site, the elderly must choose between buying medicines and eating. They add that the price of a vitamin complex can be the equivalent of what they receive as a pension. Other interviewees argue that the drugs that they find are imported, mostly from the Dominican Republic, and that they are sold at prohibitive prices.

The most expensive and sought-after medicines include losartan (antihypertensive) and amoxicillin (antibiotic).

Unfortunately, most Venezuelans, particularly the elderly, do not have 100,000 bolivars or more a month to set aside exclusively for medical treatment.

17.EL PITAZO (June 12, 2019). “Trabajadores de la Maternidad Concepción Palacios protestan por condiciones laborales y pésimo salario” (Workers of the ‘Concepción Palacios’ Maternity Hospital Protest for Poor Working Conditions and Wages). Available at:https://elpitazo.net/salud/trabajadores-de-la-maternidad-concepcionpalacios-protestan-por-condiciones-laborales-y-pesimo-salario/ 18.GARCÍA, Kervin (June 18, 2019). “¡Amoxicilina y Losartán! Los medicamentos más caros y complejos de conseguir en Caracas” (Amoxicillin and Losartan: The Most Expensive and Difficult To Find Drugs in Caracas). Available at: http://caraotalibre.cf/nacionales/amoxicilina-y-losartan-los-medicamentos-mas-caros-y-complejos-deconseguir-en-caracas

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