Monitoring The Access to Health in Venezuela Newsletter N. 12

HEALTH

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

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AGGREGATE RESULTS NATIONWIDE: JULY 2018.

EVOLUTION AND BEHAVIOR OF THE MEDICINE SHORTAGE INDICATOR GRAPHIC DEPICTION OF RESULTS BY CITY AND MORBIDITY

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METROPOLITAN AREA OF CARACAS

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BARQUISIMETO

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MARACAIBO

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MÉRIDA

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NUEVA ESPARTA

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​#​C ONVITEDENOUNCES: JULY 2018: CHILDREN’S DAY IN VENEZUELA WAS CELEBRATED AMIDST STRIKES AND PROTESTS IN THE HEALTH SECTOR AND UNDER THE THREAT OF SERRATIA MARCESCENS.

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

F O R J U LY 2 0 1 8

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INDICATOR BEHAVIOR AND EVOLUTION The aggregate results of our measurements from January 2018 through July 2018 are broken down below:

July

Table No. 1 shows the January-July 2018 fluctuation of the Medicine Shortage Indicator for the four main causes of

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From January through July 2018, the best-stocked group of medicines is that of Antihypertensive Medication, with

morbidity affecting the Venezuelan. It can be noted that that,

a shortage of 74 per cent, which is below the General

over the period in question, the Medicine Shortage Index has

Shortage Index (GSI) but very close to it.

invariably remained above 80 per cent.

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The worst-stocked group of drugs continues to be the one prescribed for Acute Respiratory Infections (ARI), with a shortage of 92 per cent, well above the General Shortage Index.

1.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/

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As for the shortage of medication to treat diarrhea and diabetes, the Medicine Shortage indicator is quite close to the General Shortage Index, slightly below for diabetes

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The General Shortage Index shows a downward trend since the second measurement in February, when it stood at 90.8 per cent.

and slightly above for diarrhea.

Graph Nยบ 1: Behavior and Evolution of the General Shortage Index from September 2017 through July 2018.

As shown in Graph No. 1, since the second measurement

It is important to note that this 8 percent reduction does

of February 2018, the General Shortage Index (GSI) has

not represent a significant improvement in the supply and

experienced a sustained downward trend, standing at 90.8

distribution of medicines for these four causes of morbidity,

per cent during the second measurement of February and

at least not in the short term. An 82 per cent shortage,

falling to 82.2 per cent during the second measurement of

particularly in the case of drugs needed to treat chronic

July 2018.

ailments, is as alarming as it has been and is a real ATTACK on the health and life of thousands of Venezuelans who urgently need to be provided with medicines to preserve their lives.

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AGGREGATE RESULTS NATIONWIDE: J U L Y 2 0 1 8 .

Table No. 2 shows that, during the month of July 2018: The best supplied city was Maracaibo, where the indicator was below 55 per cent for three of the four morbidities surveyed.

The worst supplied city was Barquisimeto, where the indicator was above 90 per cent, dangerously close to 100 per cent, for the four causes of morbidity surveyed. In other words, nine out of ten pharmacies that we visited in Barquisimeto do NOT have medicines in stock for any of the diseases included in this survey.

Caracas showed a slight improvement as compared against June percentages, at least for drugs to treat hypertension and diabetes. However, for acute respiratory infections and diarrhea, the shortage remains above 90 per cent, as it does in Barquisimeto, Mérida and Nueva Esparta.

The situation in Mérida is hardly different from that encountered nationwide, with a medicine shortage index of over 95 per cent for three of the four causes of morbidity included in the investigation. This clearly depicts the size of the country’s Complex Humanitarian Emergency, especially if one takes into account that establishments in Mérida, being an Andean city, have access to Colombian markets

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EVOLUTION AND BEHAVIOR OF THE MEDICINE SHORTAGE INDICATOR

Graph No. 2: Behavior and Evolution of the Shortage Index by Morbidity. January-July 2018.

Graph No. 2 shows the behavior and evolution of the Medicine Shortage Index during the first seven months of the year: The Medicine Shortage Indicator for the group of drugs

the chances of tackling it successfully. It is worth recalling that

prescribed to treat acute respiratory infections has been, from

the WHO estimated “world mortality from diarrhea among

the very first measurements, above the General Shortage

children under the age of five at 1.87 million, which accounts

Index. This means that getting an infection of the respiratory

for approximately 19 per cent of the overall child mortality� .

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tract in this juncture could be a potential death sentence for lack of proper medication. In nine out of ten pharmacies that

The basket of drugs to treat hypertension and diabetes is

we visited, there were NO drugs to treat acute respiratory

relatively better supplied, with shortage rates below the GSI in

infections.

all measurements conducted so far in 2018. However, shortage thereof has always been above 50 per cent and very close to

A very similar phenomenon occurs with the group of drugs

80 per cent, which means that the best scenario was that of a

prescribed to treat diarrheal syndromes: we found NO

LACK of antihypertensive or hypoglycemic medication in five

antidiarrheal medication in eight out of ten pharmacies. The

out of the ten pharmaceutical establishments that we visited.

situation is made even worse by the imminent collapse of the public drinking-water supply and distribution services, which not only increases the likelihood of acquiring some type of intestinal infection or diarrheal syndrome, but also reduces

2. http://www.who.int/bulletin/volumes/86/9/07-050054-ab/es/

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GRAPHIC DEPICTION OF RESULTS

BY C I T Y A N D M O R B I D I T Y

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METROPOLITAN AREA OF CARACAS HYPERTENSION:

DIABETES

Graph No. 3: Medicine Shortage Index by Active Ingredient for Diabetes. MAC, July 2018.

ACUTE RESPIRATORY INFECTIONS (ARI´S)

Graph No. 5: Medicine Shortage Index by Active Ingredient for Acute Respiratory Infections. MAC, July 2018.

Graph No. 4: Medicine Shortage Index by Active Ingredient for Hypertension. MAC, July 2018.Julio 2018

DIARRHEA

Graph No. 6: Medicine Shortage Index by Active Ingredient for Diarrhea.

MAC, July 2018.

3.This is a graphic depiction of the behavior and evolution of the Medicine Shortage Indicator by morbidity and city for the measurement conducted in July 2018.

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BARQUISIMETO DIABETES

Graph No. 7: Medicine Shortage Index by Active Ingredient for Diabetes.

Barquisimeto, July 2018.

ACUTE RESPIRATORY INFECTIONS (ARI´S)

Graph No. 9: Medicine Shortage Index by Active Ingredient for Acute respiratory Infections. Barquisimeto, July 2018.

HYPERTENSION

Graph No. 8: Medicine Shortage Index by Active Ingredient for Hypertension. Barquisimeto, June 2018.

DIARRHEA

Graph No. 10: Medicine Shortage Index by Active Ingredient for Diarrhea.

Barquisimeto, July 2018.

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MARACAIBO:

DIABETES

Graph No. 11: Medicine Shortage Index by Active Ingredient for Diabetes.

Maracaibo, July 2018.

ACUTE RESPIRATORY INFECTIONS (ARI´S)

Graph No. 13: Medicine Shortage Index by Active Ingredient for Acute Respiratory Infections. Maracaibo, July 2018.

HYPERTENSION

Graphic No. 12: Medicine Shortage Index by Active Ingredient for Hypertension. Maracaibo, July 2018.

DIARRHEA

Graph No. 14: Medicine Shortage Index by Active Ingredient for Diarrhea.

Maracaibo, July 2018.

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MÉRIDA:

DIABETES

Graph No. 15: Medicine Shortage Index by Active Ingredient for Diabetes.

Mérida, July 2018.

ACUTE RESPIRATORY INFECTIONS (ARI´S)

Graphic Nº 17: Behavior and Evolution of the Medicine Shortage Index for ARI. Mérida, June 2018.

HYPERTENSION

Graph No. 16: Medicine Shortage Index by Active Ingredient for Hypertension. Mérida, July 2018.

DIARRHEA

Graphic Nº 18: Behavior and Evolution of the Medicine Shortage Index for Diarrhea. Mérida, June 2018.

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NUEVA ESPARTA:

DIABETES

Graph No. 19: Medicine Shortage Index by Active Ingredient for Diabetes.

Nueva Esparta, July 2018.

ACUTE RESPIRATORY INFECTIONS (ARI)

Graph No. 21: Medicine Shortage Index by Active Ingredient for Acute Respiratory Infections. Nueva Esparta, July 2018.

HYPERTENSION

Graph No. 20: Medicine Shortage Index by Active Ingredient for Hypertension. Nueva Esparta, July 2018

DIARRHEA

Graph No. 22: Medicine Shortage Index by Active Ingredient for Diarrhea.

Nueva Esparta, July 2018.

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#CONVITEDENOUNCES JULY 2018: CHILDREN’S DAY IN VENEZUELA WAS CELEBRATED AMIDST STRIKES AND PROTESTS IN THE HEALTH SECTOR AND UNDER THE THREAT OF SERRATIA MARCESCENS.

MONITORING THE RIGHT TO HEALTH IN VENEZUELA JULY 2018

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OUTLOOK OF HEALTH IN VENEZUELA:

1 During the

month of July, there was a shortage of over 70

person in just a matter of 12 hours. We need to get to

per cent of drugs to treat the four main causes of morbidity

work on a solution because days pass and bacteria get

affecting the Venezuelan population :

increasingly resistant.

a. b. c. d.

Diabetes: 78,4%

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b. Demanding to be paid decent wages, health workers

Hypertension: 74.2%.

Acute Respiratory Infections (AIR´s): 92.4%.

protested at the Office of the Governor of the State

Diarrhea: 84.0%

of Lara , and the protest was repressed by the police,

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reports said.

2 Status of the right to health in the various states surveyed:

c. Renal

patients in Lara protested to denounce that

seven of their peers have died in less than 15 days for

a. Lara:

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I. The state of Lara is on health alert due to persisting damage from Serratia Marcescens in the Pediatric Hospital of Barquisimeto, where the bacteria is so 4

widespread that by July 12:

lack of medicines.

3 Nueva Esparta: a. Health sector unions in the State of Nueva Esparta

1. 33 children had been affected by the bacteria.

protested the catastrophic health situation and the

2. 11 had died killed as a result of infection with the

government’s silence in the face of the crisis.

bacteria.

3. MAPANI (Mothers and Fathers for Venezuela), an NGO, filed a constitutional appeal of amparo with the Supreme Court of Justice in Lara to defend and protect the constitutional rights of the victims.

4. The Twentieth and Sixteenth Prosecutors in Lara with jurisdiction over matters concerning children and adolescents know of the case and are leading the investigations.5 5. According to Grethna El Alabi, president of

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I. Dr. Germán Rojas, of the Pediatrics Society, insisted that “the situation of patients is more and more dramatic due to the shortage of medicines and the high prices that they need to pay for the few drugs available; on the other hand, the poor salaries of health workers don’t 11

even cover their transportation fares.

II. The nurses’ payroll shrunk by between 35 percent and 12

40 percent in the State of Nueva Esparta, leaving the entity with a deficit of at least 300 nurses.

MAPANI, “Serratia is so aggressive that it can kill a 4. Vilchez, Juan. #REPORT. 16th Prosecutor to Investigate Complaint Files by the Director of HUPAZ on Serratia Marcescens #30Jul (2018). Available at: http://www.elimpulso.com/noticias/informe-fiscalia-16-del-mp-investigara-denuncia-realizada-por-el-director-del-hupaz-sobre-serratiamarcescens-30jul 5.

Vilchez, Juan. #REPORT. 16th Prosecutor to Investigate Complaint Files by the Director of HUPAZ on Serratia Marcescens #30Jul (2018). Available at: http://www.elimpulso.com/noticias/informe-fiscalia-16-del-mp-investigara-denuncia-realizada-por-el-director-del-hupaz-sobre-serratiamarcescens-30jul 6. Bacteria at the Agustín Zubillaga Hospital in Barquisimeto turned Endemic (2018). Available at: http://www.elimpulso.com/noticias/regionales/ong-mapani-interpone-amparo-pormuertes-de-serratia-marcescens-en-el-pediatrico-de-barquisimeto-31jul 7. EL NACIONAL WEB. Health Workers Protested at the Office of the Governor of the State of Lara. (2018). Available at: http://www.el-nacional.com/noticias/protestas/trabajadores-saludprotestaron-gobernacion-lara_242954 8. Available at https://goo.gl/Zv48Hf 9. EL NACIONAL WEB. Lara Patients Protest for Lack of Medication (2018). Available at http://www.el-nacional.com/noticias/sociedad/pacientes-del-estado-lara-protestan-por-faltamedicamentos_242350 10. Arias, Ana. Health Unions in Nueva Esparta Protest against the Government’s Silence (2018). Available at: http://www.eluniversal.com/venezuela/15894/gremios-de-la-salud-ennueva-esparta-protestan-contra-silencio-del-gobierno 11. Ídem 12. Arias, Ana. Nueva Esparta Needs 300 Nurses to Guarantee Health Care (2018). Available at: http://www.eluniversal.com/venezuela/15342/nueva-esparta-necesita-300-enfermerospara-garantizar-la-atencion-en-salud

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4 Zulia: a.

“Blackouts and voltage drops are a recurring event

To protest against the emergency in the health

(...) we have to run all over the area and manually CPR

sector, medical doctors in the State of Zulia called

critical patients, then we have to run to the ICU, and

for an indefinite strike. They maintain that, as a

so on. It is complete chaos. There have been outages

result of the situation, hundreds of patients are

of 12 hours.

forced to endure dire conditions. They ratified their call for a state-wide strike, claiming that they lack the necessary basic supplies to provide medical

a. Medical

professionals in the State of Mérida took

part in strikes and demonstrations in July to protest

Additionally, the salary of health workers in the

against the serious crisis affecting the health sector 16

and against low salaries.

region is deficient.

Insalubrity is an added factor that aggravates the already unbearable emergency facing the health sector in Venezuela. In the State of Zulia, hospital patios have turned into medical waste dumps and a potential source of bacteria and contamination, with the ensuing risk for the lives of the patients. “But insalubrity doesn’t stop there: the lack of cleaning products and supplies is a contamination threat for patients and relatives and the medical staff, a situation that can be verified in the hospital network 14

of Maracaibo and San Francisco”.

c.

5 Mérida:

care in hospitals and ambulatories in the region.

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b.

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6 Protests and conflict in demand of the right to health in July: a. The health sector is in a situation of emergency.

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I. There were 1,233 protests in July in the health sector.

II. Health workers held 1,192 protests, whereas patients, the chronically ill and their relatives took part in a total of 41 demonstrations.

III. Health workers protested in 19 of the 24 states of the country.

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Hospital infrastructure problems have not been solved, and Hospital General del Sur is constantly subjected to power outages. According to one nurse:

13. NAD. Medical Doctors Call for an Indefinite Strike in Zulia to Protest against the Health Crisis (2018). Available at: https://www.aporrea.org/trabajadores/n328206.html 14.

Calisa. Hospitals in the State of Zulia are Drowning in Medical Waste Dumpsters (2018). Available at: http://www.venezuelaaldia.com/2018/07/20/1vertederos-

desechos-medicos-ahogan-hospitales-zulia/ 15. Prensa El Luchador. Power Outages Strike Zulia’s Hospital General del Sur (2018). Available at: http://elluchador.info/web/2018/07/11/hospital-general-del-sur-dezulia-sufre-la-falla-de-energia-electrica/ 16. EL NACIONAL WEB. Mérida’s Medical Sector to Start a Strike Demanding Improvement of Work Conditions (2018). Available at: http://www.el-nacional.com/ noticias/protestas/gremio-medico-merida-iniciara-paro-para-exigir-mejoras-laborales_245384 17. Available at http://www.observatoriodeconflictos.org.ve/destacado/conflictividad-social-en-venezuela-durante-julio-de-2018 18. Health Workers in Venezuela Protest in 19 of the 24 States in the Country (2018) Available at: https://www.diariolasamericas.com/america-latina/trabajadores-lasalud-venezuela-protestan-19-los-24-estados-del-pais-n4157515

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According to the Venezuelan Observatory of Social Conflict “the trend is for protests in the health sector protests to intensify, while response mechanisms remain absent.”

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7 The forced migration of a substantial number of Venezuelan professionals due to the country’s complex humanitarian emergency is a major blow to health services. In a “system” where there is a lack of absolutely EVERYTHING, there is also a shortage of doctors and, in general, health professionals.

a.

The Venezuelan Medical Federation (FMV) reports that at least 22,500 Venezuelan doctors have emigrated, 20

which “represents approximately 33 per cent” of the total number of medical doctors in the country in 2014.

These data account for “the progressive weakening of 21

the so-called “National Health System” , which worsens by the day under the cold gaze of a State for which the health of its citizens is not a priority in the political agenda.

19. Ídem 20.

Migration of Venezuelan Medical Doctors: Another Drama in the

Health Sector (2018).

Available at:

https://www.lapatilla.com/2018/07/08/

migracion-de-medicos-venezolanos-el-otro-drama-del-sector-salud/ 21. Ídem

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