Monitoring The Right to Health in Venezuela Newsletter N. 10

HEALTH

TA B L E O F C O N T E N T S ANALYSIS AND INTERPRETATION OF AGGREGATE RESULTS OF THE MEDICINE SHORTAGE INDEX MEASUREMENTS FOR MAY 2018

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AGGREGATE RESULTS NATIONWIDE - MAY 2018

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EVOLUTION AND BEHAVIOR OF THE SHORTAGE INDICATOR

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#CONVITEDENOUNCES: A MOTHERS’ DAY FILLED WITH TEARS AND PAIN FOR THE SUFFERING OF THEIR CHILDREN AND THEIR OWN

MONITORING THE RIGHT TO HEALTH IN VENEZUELA MAY 2018

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ANALYSIS AND INTERPRETATION OF AGGREGATE RESULTS OF THE FIRST TWO MEDICINE SHORTAGE INDEX MEASUREMENTS

F O R M AY 2 0 18

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The following is a cumulative table of the measurements taken from January to May 2018 :

Measurements of the Medication Shortage Indicator

Their lives are in constant danger, given that it is

made during the first five months of the year reveal the

virtually impossible to diagnose new cases or to

following:

monitor and control the disease once diagnosed.

Diabetes: Between January and May 2018, the shortage indicator for glucose-lowering drugs has remained in the 80 percent range, peaking at 89.8

Diabetic patients are also unable to adhere to a strict diet because:

percent during the measurement performed in the

The shortage of food forces them to eat tubers,

second week of February.

flours and other carbohydrates that are converted into sugars.

The reality facing diabetic patients is alarming, as

The price of the few proteins to which most

they CANNOT currently test their blood-glucose

Venezuelans can currently have access is

levels because:

constantly increasing.

They cannot afford to buy nutritional supplements

There are NO test strips There are NO reagents in the laboratories

1.Survey Chronological Details: The survey consisted of two measurements made between May 14-16, 2018, and May 28-30, 2018, which were the second and fourth weeks of the month, respectively, in order to detect variations that could be measured and circulated regarding medicine supply protocols in pharmaceutical establishments, available at https://tinyurl.com/IEM-1-Boletin 2. To obtain historical information on all the measurements taken since the beginning of the project, consult our newsletters No. 1 to No. 9, available at https:// conviteblog.wordpress.com/

MONITORING THE RIGHT TO HEALTH IN VENEZUELA MAY 2018

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Due to the increase in the intake of carbohydrates

Hypertension: The reality for people with high

by most Venezuelans, the incidence of diabetes has

blood pressure is not far from what diabetics face.

escalated, and the upsurge of cases of childhood diabetes poses a particular danger, according to the Venezuelan Cardiometabolic Health Survey 3

(2014-2017).

May closed with a shortage of 77 percent for the major antihypertensive drugs prescribed in the country. That is, 7 out of 10 pharmacies visited do not have a supply of antihypertensive

Today, leaving with this condition means having to face serious difficulties in accessing adequate treatment:

medication.

An estimated of at least 7 million people in the country suffer from high blood pressure, and they are directly affected by the shortage of drugs

There is an 83 percent shortage of the major

because they cannot comply with the life-long

oral hypoglycemic agents prescribed to treat the

treatment that they have been prescribed, being

condition, namely metformin, glibenclamide and

it a chronic disease.

gliclazide.

Faced with the shortage of medication, in an have

effort to maintaining health against all odds,

access to insulin syringes, which could lead to

hypertensive people are forced to prepare

their death. “In the case of insulin, there is only

and take home remedies, resorting to home

one laboratory that brings it to the country and it

prescriptions such as:

Insulin-dependent

patients

DO

NOT

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cannot cope with the high demand.” .

Due to the lack of medicines and the increasing cost of the few that are available, diabetics are altering or abandoning treatments, naturalizing practices such as: a) Stretch treatments by

Taking 1 garlic clove, half in the morning, half in the afternoon, as an alternative antihypertensive treatment to keep their blood pressure at bay.

splitting pills and taking half a dose, or just taking

One

them every other day, in an effort not to surrender

recommendations

to the harsh reality to which the Humanitarian

hypertensive patients is the adherence to a

Emergency subjects them; b) Suspend treatment

balanced diet; however, the lack of food makes it

indefinitely due to the shortage of medicines;

an impossible task. Also, in addition to the food

c) Replace the hypoglycemic agents they have

scarcity, the health and well-being of people with

been prescribed with alternative treatments,

high blood pressure are directly affected by the

including the intake of herbs such as Moringa.

increase in food prices, when food is found: they

of

the

most for

important the

medical

treatment

of

cannot afford to buy it and meet their minimum

3. EVESCAM (1 de Octubre de 2017). 7 millones 400 mil venezolanos hipertensos, 2 millones 400 mil diabéticos y más de 8 millones de prediabéticos. Obtenido de: http://estudioevescam.info.ve/jornadas/362/7-millones-400-mil-venezolanos-hipertensos-2-millones-400-mil-diabeticos-y-mas-de-8-millones-de-prediabeticos/ 4. Laguna, A. I. (9 de Marzo de 2018). Aumentan casos de diabetes en Venezuela. Obtenido de sitio Web de El Carabobeño: https://www.el-carabobeno.com/ aumentan-casos-de-diabetes-en-venezuela/

MONITORING THE RIGHT TO HEALTH IN VENEZUELA MAY 2018

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nutritional requirements, and, in many cases, are

In view of the terrible shortage of oral saline

forced to reduce the number of meals from three

solutions and agents that reconstitute the

to one a day, which leads to weakness, dizziness

intestinal flora, or to the high costs of the

and altered blood pressure

few that are available, people are advised to take plenty of liquids to prevent dehydration,

Since high blood pressure is a condition that

including natural juices, water, or any other

fundamentally affects older people, the almost

beverage that helps to restore mineral

impossible access to food has a direct impact on

salts; however, the poor quality of the water

the health of the elderly. At present, as a result

intended for human consumption, which is

of the complex humanitarian emergency we

also used to prepare said natural juices, is in

are enduring, senior citizens lose between one

itself a source of infection.

and two kilos per month, according to a survey conducted by Convite AC in the State of Miranda

The shortage of anti-diarrheal medication

at the end of 2017.

is forcing people to substitute treatments with the so-called ‘grandmother’s home remedies’, which, being home prepared,

Diarrhea: The antidiarrheal medication shortage

can worsen the condition instead of helping

indicator showed a marginal reduction between

them heal.

March and May 2018, which, in principle, indicates a trend for said indicator to remain above 80 percent

The increase in the number of people who eat

and close to 100 percent.

straight from garbage dumps exposes them to countless bacteria and parasites that cause

The incidence of diarrheal syndrome cases is mainly the result of two types of vectors or conditions that may contribute - as they in fact do - to an increase in the number of cases of bacterial or non-bacterial viruses:

intestinal bacterial diseases. This is a threat and a risk factor for the onset of intestinal infections such as salmonella, which require the application of broad-spectrum antibiotics that, needless to say, are NOT available in the country. Currently in Venezuela, there

The erratic supply of drinking water, together

is NO metronidazole, which in the past was

with the deplorable sanitation conditions

the parasite killer of choice in any outpatient

of water intended for human consumption,

clinic for healthy infants in the country and

forces Venezuelans to prepare food with

whose distribution was free of charge.

water

of

questionable

quality

and

in

unsanitary conditions, which increases the risk of diarrhea, especially in children under five years of age.

MONITORING THE RIGHT TO HEALTH IN VENEZUELA MAY 2018

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Acute Respiratory Infections (ARI): In May, there

With malnutrition at 72 percent in February, 5

according to a survey conducted by Caritas ,

was a 92 percent shortage of drugs to treat this type

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the lives of diarrhea patients are in great

of morbidity in Venezuela, an alarming phenomenon

danger, for people suffering from severe

that becomes more complex when other aggravating

malnourishment – particularly children - see

variables are included in the analysis. In this connection,

their immune system weaken exponentially

due to the shortage of medicines to treat acute

from dehydration and the effects of infectious

respiratory infections, bronchitis - which had always

diseases.

been considered sort of a “poorly cured” flu - is now a potential cause of death in Venezuela in the current context of a complex humanitarian emergency.

Faced with such devastating figures, it is more than necessary and imperative to generate actions to demand the Venezuelan State to recognize the existence of a Humanitarian Emergency in Venezuela, and to acknowledge its own incapacity to respond and face the situation.

But more importantly, it is time to demand that the State (that “abstract” person who is responsible for guaranteeing the lives of its citizens) accept, once and for all, before another Venezuelan dies, the need to establish mechanisms for receiving the humanitarian aid that we need to save the lives of those who are currently at latent risk of dying.

THE SITUATION IN HOSPITALS 60 PERCENT OF DIAGNOSTIC EQUIPMENT IS INOPERATIVE

5. CARITAS VENEZUELA (January 2018), Baseline of Sentinel Monitoring of the Nutritional Status of Children Under 5 [S.L.], v. 31, N. 2, Apr. 2015. ISSN 4434396. Available at: http://caritasvenezuela.org/wp-content/uploads/2017/12/Primer-Bolet%C3%ADn-SAMAN-Octubre-Diciembre-2016.-Caritas-de-Venezuela.pdf

MONITORING THE RIGHT TO HEALTH IN VENEZUELA MAY 2018

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AGGREGATE RESULTS NATIONWIDE: M A Y 2 0 1 8

The table above shows how five of the capital cities in the country are suffering the ravages of the #ComplexHumanitarianCrisis under relatively equal circumstances.

Maracaibo continues to be the best supplied city, for it

On the other hand, the worst supplied city throughout the

is the only one of the five cities in which the shortage

project was Barquisimeto, where the shortage indicator

indicator is measured where index has been below 70

has remained above 85 percent and dangerously close

percent. An interesting phenomenon occurred in the

to 100 percent. As regards antihypertensive drugs,

“Beloved Land of the Sun�: the shortage indicator for

the pattern repeats in Barquisimeto as in the other

the group of antihypertensive drugs stood at 57 percent.

the cities in the survey: antihypertensive drugs are the

We found that it is increasingly feasible to obtain some

best supplied among those prescribed to treat the four

losartan potassium albeit at prices that are in no case

causes of morbidity monitored; however, the shortage

below 2 million bolivars for a box of 14 tablets.

index for this basket of medicines was 77 percent in May.

MONITORING THE RIGHT TO HEALTH IN VENEZUELA MAY 2018

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EVOLUTION AND BEHAVIOR

O F T H E S H O R TAGE I N D I C ATO R :

CHART NO. 1: BEHAVIOR AND EVOLUTION OF THE MEDICINE SHORTAGE INDEX BY MORBIDITY: JANUARY 2018 – MARCH 2018

Chart No. 1 shows that, although the general shortage

The shortage of medicines prescribed to treat acute

index has been experiencing a slight downward trend

respiratory infections is absolutely discouraging and

in the 2018 measurements so far, it remains at between

frightening. They remain the worst supplied at a shortage

85 percent and 90 percent for the basket of medicines

rate of between 93 percent and 95 percent in April, well

prescribed to treat the four main causes of morbidity

above the General Shortage Index, a situation that is

affecting the Venezuelan population, with its highest

quite similar to the one in May.

point at the beginning of the survey. Accordingly, it is important to note that:

The 80 percent shortage indicator for medication to treat diarrheal syndromes is a wake-up call for the country’s

Although antihypertensives remain the most widely

health authorities, especially when the proliferation of

supplied group of drugs throughout the survey, it is still

intestinal infections and diarrheal diseases caused by the

insufficient because, as we already mentioned in the

poor quality of water intended for human consumption

first part of this newsletter, 3 out of 10 Venezuelans are

increases, as does the number of people forced to

hypertensive.

consume a “diet” based on waste taken directly from garbage cans.

The increased incidence of diabetes cases, mainly due to the poor quality of Venezuelans’ food intake, is frightening. The outlook is similarly dangerous to that of hypertension, due to difficulties in following a proper diet.

MONITORING THE RIGHT TO HEALTH IN VENEZUELA MAY 2018

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CONVITE DENOUNCES: A MOTHERS’ DAY FILLED WITH TEARS AND PAIN FOR THE SUFFERING OF THEIR CHILDREN AND THEIR OWN.

El balance de la situación del derecho a la Salud en

c. The

PAHO warned that “In Venezuela, the

Venezuela en mayo 2018, mes de las madres, se refleja

diphtheria outbreak, which began in July 2016, is

en los trágicos hallazgos:

still active”.

1. The balance of the situation of the right to health in Venezuela in May 2018, Mother’s month, is reflected in these tragic findings:

3. There are also warnings about the return and upsurge of diseases such as meningitis and neonatal and adult tetanus.

a. Diabetes: 85.1% b. Hypertension: 78.2%. c. Acute Respiratory Infections: 93.8%. d. Diarrhea: 85.5%.

4. One year has passed since Antonieta Caporale was dismissed as minister of the People’s Power for

Health for publishing epidemiological bulletins that showed the increase in infant and maternal mortality figures, which is the same time that the website of

2. There has been an upsurge in endemic diseases that had been long eradicated in the country: malaria,

diphtheria, measles, malaria, Chagas disease and dengue fever:

a. The main cause behind this serious situation is the lack of health prevention in terms of the regular 6

provision of vaccines and vector control. There are NO vaccines for pneumococcus, rotavirus, seasonal influenza, hepatitis A, chickenpox, or type B influenza in Venezuela.

b. b.

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the MPPH has been inoperative. The policy of opacity when it comes to dealing with epidemiological data remains institutionalized in a country hit by at least five epidemics and struggling for survival in the midst of one. Attitudes such as this make the Complex Humanitarian Emergency less and less refutable.

5. Carina

Vergara, 16, an adolescent protected by

precautionary measures of the Inter-American Court of Human Rights (IACHR), died on May 14 in the Nephrology Room of the J.M. de Los Ríos Hospital.

Deficiencies in fumigation plans prevent

the control of vectors such as Aedes aegypti – a known vector of dengue virus -, insects of the subfamily Triatominae - which carry the Chagas

Two months after the IACHR granted the protective measure in favor of children at Venezuela’s once flagship pediatric center, no State representative has spoken out.

disease -, and female mosquitoes of the genus 7

Anopheles - which spread malaria.

6.

Pan American Health Organization (April 16, 2018). Epidemiological Update Diphtheria: Diphtheria in the Americas - Summary of the

situation. Available at: https://www.paho.org/hq/index.php?option=com_docman&task=doc_view&Itemid=270&gid=44499&lang=es 7. Ídem 8. Ídem

MONITORING THE RIGHT TO HEALTH IN VENEZUELA MAY 2018

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6. 6The increasingly serious situation of water scarcity

c. The

terrible shortage of immunosuppressants

in the country poses new risks to the health of

claimed its fifth and sixth victims during the

Venezuelans, especially those suffering from health

month of May.

conditions that require special attention. In May:

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I José Herrera, who lived in the state of Zulia, lost his liver transplant because he did not

a. The

suspension of chemo in the Hematology

Service of the J. M. de los Ríos for two weeks due to lack of water affects and endangers the lives 9

of at least 16 children. In addition to the scarcity 10

of water, there is a shortage of medicines:

I To

treat lymphoblastic leukemia - one of

the most common types of cancer in the

have access to immunosuppressants, which are drugs that any transplant patient needs to prevent his/her body from rejecting the transplanted organ and are only distributed by the Venezuelan Institute of Social Security.

II iJesús

Rondón, 28, died on May 10, having

spent 20 days in hospital waiting for the treatment that he required to preserve his life.

Hematology department -, there are only two treatments out of a total of seven that are necessary to complete the first cycle of chemo.

d. Ana

Flores joins the list of Venezuelans who

lose their lives in the face of the terrible Complex

II The two antineoplastics used for maintenance therapy, which is applied for one and a half years to attack live malignant cells that may have remained from previous treatments, are not available in the hospital.

b. Austin Troya, only 5 months old, who was born with a complex cardiopathy, died on May 26 in the country’s major pediatric medical center while waiting for a heart operation that could not be performed because, on that same day, a number of failures in the structure’s electrical system occurred that caused the power plant to stop working and no help could be given to Austin went he went into respiratory arrest and required

Humanitarian Emergency facing the country: at the age of four, she became the third person to die 13

of diphtheria at the J.M. de los Ríos Hospital . In our Newsletter No. 8, we had already denounced the death of Diego Herrera, who was only 8 years old and was the nephew of Idalia Brito, mother of Carlos Santiago Mijares, whose case we have documented within the framework of our project, and who was unfortunately identified as the first child to die of diphtheria in the hospital.

With Diego’s death, which was totally avoidable, Idalia is a victim for the second time of the inaction of a State that #SimplyDoesn’tCare for its citizens’ hunger, pain, and death.

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resuscitation.

09. Pineda (2018) J. M. de Los Ríos Second Week with Chemo Suspended for Lack of Water. Available at: http://efectococuyo.com/principales/j-m-de-los-rios-cumplesegunda-semana-con-quimios-suspendidas-por-falta-de-agua/ 10. Ídem 11. Efecto Cocuyo (2018) Five-Month-Old Baby Died at J. M. de Los Ríos from Power Failures. Available at: http://efectococuyo.com/principales/bebe-de-cinco-mesesde-nacido-murio-en-el-jm-de-los-rios-por-fallas-electricas/ 12. Efecto Cocuyo (2018) Shortage of Immunosuppressants Takes its Sixth Victim in 2018. Available at: http://efectococuyo.com/salud/escasez-de-inmunosupresoresse-cobra-su-sexta-victima-este-2018/ 13. Pineda (2018) Third Patient Dies of Diphtheria at J.M. de Los Ríos Children’s Hospital. Available at: http://efectococuyo.com/salud/muere-tercer-paciente-pordifteria-en-hospital-de-ninos-jm-de-los-rios/

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e. The shortage of supplies and medicines, along

f.

In just one week, six children died from contamination at 15

with the fact that patients are referred from one

the Dr. José María Vargas Hospital in La Guaira. The lack

hospital to another and another without getting

of refrigeration caused one of the corpses to explode

medical attention, which is an institutionalized

and other areas of the hospital to become contaminated.

and normalized practice in Venezuelan hospitals,

The contamination affected the hospitalized children,

prevented Eli Martínez, 22, from celebrating

according to Juan García, a radiologist and neighbor of

Mother’s Day and cost her the life of her first child,

one of the deceased .

who died in her womb because in the hospital where she was to be treated there was no Pitocin and she was forced to go to several hospitals in 14

search of medical care she DID NOT receive.

14. Rivas (2018) Routed from Hospital to Hospital: Lack of Pitocin Prevented Her from Giving Birth to the Baby that Died in Her Womb (+Video) (SIC). Available at: http:// www.caraotadigital.net/carrusel/ruleteo-de-hospital-en-hospital-falta-de-pitocin-le-impide-dar-a-luz-al-bebe-que-murio-en-su-vientre-video/ 15. Efecto Cocuyo (2018) Six Children are Reported Killed by Pollution in the IVSS Hospital in La Guaira. Available at: : http://efectococuyo.com/salud/denuncian-muertede-seis-ninos-por-contaminacion-en-hospital-del-ivss-en-la-guaira/

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