Monitoring of The Access To Health in Venezuela Newsletter N. 19

NEWSLETTER

19

2019

FEBRUARY

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 CARLOS DA COSTA KELLYN RUIZ BARQUISIMETO: JOSÉ RAMÓN QUERO LISSETTY PÉREZ LYDEA MORENO CARMEN MORENO CARMEN QUIÑONES MARACAIBO: ORGANIZACIÓN MULIER MAYERLING GUERRERO IVANNA MÁRQUEZ JHULIANA TORRES LENIN ALVAREZ MÉRIDA: ORGANIZACIÓN PROMEDEHUM RIGOBERTO LOBO FRANCISCO DE JESÚS SEGOVIA JUAN CARLOS LIENDO

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 - FEBRUARY 2019

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FEBRUARY 23 — VENEZUELA AWAITS HUMANITARIAN AID

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INDICATOR BEHAVIOR AND EVOLUTION

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GRAPHIC DEPICTION OF RESULTS BY CITY AND MORBIDITY:

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METROPOLITAN AREA OF CARACAS BARQUISIMETO MARACAIBO MÉRIDA BARQUISIMETO MARACAIBO MÉRIDA PUERTO ORDAZ

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ON CONTRACEPTIVES #CONVITEDENOUNCES : FEBRUARY 2019: VENEZUELA: HOSPITALS COLLAPSING

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ANALYSIS AND INTERPRETATION OF AGGREGATE

RESULTS MEDICINE SHORTAGE INDEX FEBRUARY 2019 CHRONOLOGICAL DETAILS OF THE SURVEY

Period and Frequency of Data Collection. The survey consisted of two measurements conducted in the month of February of 2019, from the 21st to the 22nd and from the 27th to the 28th —which dates fall on the second and fourth weeks 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/

FEBRUARY 23 - VENEZUELA AWAITS HUMANITARIAN AID The purpose of this newsletter is to report on the monthly results of our medicine shortage index measurements for six selected causes of morbidity in eight Venezuelan cities; however, a number of significant events occurred in February that are worth remembering

On February 7, the first shipment of humanitarian aid from the U.S. Agency for International Development (USAID) arrives at the collection center located in the city of Cúcuta, Colombia.

On February 11, the entry of supplies to the city of Caracas is set in motion. In a sudden and unexpected move, Interim President Juan Guaidó, alongside National Assembly (NA) congressman Miguel Pizarro, delivers to the Venezuelan Association of Health Centers (ASSOVEC, by its Spanish acronym) a lot 85,000 units of nutritional supplements for children aged 0 to 3, as well as 4,500 units of supplements for pregnant women, to be distributed to a healthcare network that encompasses hospitals and dispensaries in the most impoverished areas.

While the National Assembly and the Venezuelan interim president strive to materialize the arrival of humanitarian aid, and even establish February 23 as the concrete date therefor, Nicolás Maduro repeatedly refuses to accept any type of support, alleging that the country does not need help and describing the request for aid as a ‘bad and cheap show’ of the Venezuelan opposition (in a message that was broadcasted on national TV). The Venezuelan State adamantly insists that there is NO such thing as a ‘Complex Humanitarian Emergency’ in the country.

On Saturday, February 23, three of the trucks that were stationed in the city of Cúcuta (Colombia), loaded with medical supplies, personal hygiene items and food, were set on fire while trying to cross into Venezuela. Acts of violence were provoked by Venezuelan police forces and irregular pro-government armed groups. Not only were there substantial property losses: numerous people were reported injured or killed in the Venezuelan borders with Colombia and Brazil. In Santa Elena de Uairén, seven people from the Pemón indigenous community were murdered, victim of repression, as confirmed by the National Assembly indigenous congresswoman Gladys Guaipo.

Water spaces were also blocked: two ships carrying a civilian crew were threatened by Venezuelan military vessels;

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the former, facing imminent danger, decided to remain anchored in Curacao with more than 300 tons of humanitarian aid. As these events were unfolding on the Venezuelan borders, the death toll in the country’s hospitals due to the generalized shortage of medicines and medical supplies, the lack of health professionals, and the overall collapse of hospital infrastructure, continues to increase. This is entirely the responsibility of the State.

A number of decisions had to be made in the face of such violence, including to protect the shipments with aid in Colombia, give refuge to members of the Venezuelan Armed Forces who refused to follow their superiors’ orders and decided instead not to repress their fellow citizens, and convene an urgent meeting with the Lima Group to make a statement on the events of Saturday, February 23.

On Monday, February 25, 11 countries that were attending the Summit of the Lima Group concluded that what happened on February 23 at the borders was a ‘Crime Against Humanity’, wherefore they urged the International Criminal Court to take due account.

Venezuelan non-governmental organizations (NGOs) that defend people’s right to health condemned the acts of violence driven by the Venezuelan State, who systematically refuses to accept that there is a complex humanitarian emergency in place and not only prevented the entry of humanitarian aid but also destroyed part of it and attacked ordinary citizens who voluntarily and peacefully attempted to move the supplies to Venezuela with the sole purpose of saving lives.

It is not only the citizens, medical personnel or non-governmental organizations who denounce and warn about the undisputable deterioration of the country’s public health system and the worsening of the Complex Humanitarian Emergency. On February 19 of this year, Tarik Jasarevic, spokesman for the World Health Organization (WHO), warned about the vulnerability of the healthcare system in Venezuela, noting that the massive emigration of health workers and the high medicine shortage rates pose a serious threat to the 1

health of the Venezuelan people . At present, the country experiences serious difficulties in dealing with emergencies and epidemics.

The information provided by the WHO spokesman comes at a time when those usurping power refuse to allow the entry of humanitarian aid, including drugs that are in very short supply and that are so expensive that individuals who earn the minimum wave cannot afford 2

to buy them. Unfortunately, over the last three years, more than 200 pharmaceutical establishments have closed their doors and almost as many have been forced to change lines because the rampant hyperinflation that hits Venezuelans on a daily basis makes it impossible for them to restock. In this context, Convite, in cooperation with local organizations, surveyed drug retailers in five cities, reporting that in 2018 six pharmacies closed and three changed lines in Barquisimeto, 26 closed in Maracaibo, and 18 closed in Mérida.

1. EFE/Ginebra/DIARIO LA VERDAD (February 19, 2019). OMS: “Venezuela tiene problemas de sanidad para las emergencias” (WHO: Venezuela’s Health Problems for Emergencies). Available for consultation at: http://www.laverdad.com/zulia/152707-oms-venezuela-tiene-problema-de-sanidad-para-las-emergencias.html CONTRAPUNTO.COM (February 19, 2019). “Organización Mundial de la Salud alerta sobre problemas de la sanidad venezolana para atender emergencias” (WHO Alerts About Health Problems in Venezuela to Respond to Emergencies). Available for consultation at: https://contrapunto.com/nacional/organizacion-mundial-de-la-salud-alerta-sobreproblemas-de-la-sanidad-venezolana-para-atender-emergencias/ 2.At the present time, the price of a pack of losartan potassium tablets exceeds two minimum wages.

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RESULTADOS:

INDICATOR BEHAVIOR AND EVOLUTION

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The shortage indexes reported in our February 2019 survey within the framework of the Monitoring the Right to Health in Venezuela project are shown below. It should be noted that they ranged between 84 percent and 91 percent:

Table No. 1: Fluctuation of the Medicine Shortage Indicator by Morbidity Cause: September 2018 – February 2019.

Table No. 2: Nationwide Aggregate by City and Morbidity. February 2019.

3.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: available at: https://conviteblog.wordpress.com/

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Chart No. 1: Behavior of the Aggregate Shortage Index Nationwide. February 2019.

Chart No. 2: Behavior and Evolution of the General Shortage Index and by Morbidity.

October 2018 – February 2019.

In February, there were slight changes in the shortage percentages by morbidity surveyed. There General Shortage Index experienced a downward trend, decreasing by 5.9 percent (January: 79.2 percent- February: 73.3 percent). Venezuelans suffering from disorders that lead to seizures, acute infections of the respiratory tract (ARIs), or depression and other psychiatric or personality disorders have not ceased to experience difficulties in acquiring medication to initiate or continue treatment. February of 2019 saw a 91.2 percent shortage of anticonvulsants, an 88.1 percent shortage of drugs to treat ARIs, and an 86.5 percent deficit of antidepressants.

The country’s areas with alarming indicators are the Metropolitan Area of Caracas (MAC), Barquisimeto, Puerto La Cruz, and Mérida, with drug shortage rates in excess of 80 percent.

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GR APHIC DEPIC TION OF RESULTS BY CIT Y AND MORBIDIT Y: METROPOLITAN AREA OF CARACAS Caracas and its metropolitan area have a serious drug shortage problem that doesn’t seem to improve significantly.

Diabetes continues to be one of the morbidities whose treatment is becoming less and less accessible; the shortage rate of drugs to treat this disease is 90.1 percent, and gliclazide is still the scarcest active ingredient on the pharmacy shelves. People with hypertension are more likely to find their medication, albeit after a tortuous search, for the general shortage index for drugs to treat high blood pressure is just above 77 percent; however, patients in need of nifedipine faced a shortage of over 95 percent.

As for medicines to treat acute infections of the respiratory tract, they are highly scarce (92.9 percent), and the shortage rate for most of the active pharmaceutical ingredients surveyed, with the exception of amoxicillin (81.1 percent), is 94.6 percent. It is increasingly common for families to resort to home remedies in an effort to stop diarrhea, because the right medication to treat such condition is really hard to find: the Medicine Shortage Index (MSI) for drugs to treat diarrheal diseases is 91 percent, and trimethoprim is the scarcest bulk drug substance to cure it.

Depression, personality disorders and seizures are morbidities of great concern to both specialists and patients. It is now common for radio programs and social networks to offer tips on how to prevent and treat such conditions, which are now on the rise in the country (presumably triggered by the current situation). The shortage indexes for drugs to treat depression and seizures in the Metropolitan Area of Caracas are even at 91.5 percent. Among the most striking cases is that of sertraline hydrochloride, an active ingredient that is completely out of stock (100 percent), and phenytoin sodium and sodium valproate are virtually missing from pharmacy shelves (94.6 percent).

Chart No. 3: Shortage Index by Morbidity. Metropolitan Area of Caracas, February 2019.

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BARQUISIMETO

Reports from Barquisimeto, known as “the Dusk City�, show MSIs exceeding 80 percent for all morbidities surveyed. The hardest-to-find active ingredients to treat diabetes are glibenclamide and glicazide; in general, drugs to control this disease are in short supply, with a MSI of 88.5 percent. On the other hand, hypertension is a condition that is getting increasingly difficult to keep at bay because of the shortage of bulk drugs substances such as nifedipine, amlodipine and atenolol, and the MSI for this morbidity has soared and is now 91.1 percent.

The incidence of acute infections of the respiratory tract has become a latent risk: the shortage index for seven of the eight active ingredients surveyed is 100 percent, and the MSI for ARIs is 96.2 percent. It should be noted that the collapse of the domestic gas service has made it increasingly common for people in Barquisimeto to cook over wood. For their part, the supply of drugs to treat diarrheal syndromes has fallen short by 89.6 percent, trimethoprim being the scarcest active ingredient in pharmacies.

It is a known fact that ailments such as depression and other psychiatric disorders tend to worsen if people stop taking the required medication on a regular basis. The MSI for drugs to treat said morbidities is 96.5 percent, and four of the seven active ingredients surveyed, namely olanzapine, bromazepan, fluoxetine and escitalopram, are nowhere to be found. As for anticonvulsants, the MSI is 98.7 percent, and there is no supply of sodium valproate, phenobarbital, oxcarbazepine, lamotrigine and clonazepam.

Chart No. 4: Shortage Index by Morbidity. Barquisimeto, February 2019.

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VALENCIA

Valencia, a city that was once characterized by its beautiful greenery and was famous for growing the sweetest oranges in the country, is now just another collapsing town. Nevertheless, in all fairness, the shortage of drugs in Valencia is milder than in the other cities surveyed. The shortage indexes for medication to treat diabetes and high blood pressure are 66.7 percent and 47.3 percent, respectively; glicazide (90.9%) and Nifepidine (75.8) are the active ingredients with the least presence in pharmacies.

People with ARIs have the hardest time: the MSI for drugs to treat acute respiratory infections is 80,3 percent.

Antibiotics such as cefuroxime axetil and moxifloxacin are not easy to find (100% out of stock in the drug stores surveyed). Nevertheless, individuals with diarrheal diseases may not suffer from complications because medications to treat this morbidity are not so scarce (40.4 percent).

On the other hand, the MSI for antidepressants is 74.5 percent, whereas that for anticonvulsants is 82.7 percent, which makes it a true ordeal for people afflicted by these conditions to find their medication.

Chart No. 5: Shortage Index by Morbidity. Valencia, February 2019.

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MÉRIDA

Merida is one of the cities most affected by the shortage of medicines behind the Metropolitan Area of Caracas, Barquisimeto and Puerto La Cruz. Metabolic or cardiac morbidities such as diabetes and hypertension can be manageable as long as they are controlled with medications, but with shortage indicators to the tune of 87 percent and 77.45 percent, respectively, the situation tends to become more complex. In the case of diabetes, the scarcest active pharmaceutical ingredients are glibenclamide and glicazide, whereas for hypertension these are losartan and nifedipine.

Viral or infectious diseases such as diarrhea and acute infections of the respiratory tract are increasingly frequent in children and older adults (which are the most vulnerable groups), and treating them has become quite an ordeal. The reported MSIs are 63.8 percent for antidiarrheal medication and antiparasitic agents, and 94.6 percent for antibiotics.

As regards antidepressants, there is an 87-percent shortage, whereas the outlook for anticonvulsants is bleaker with a shortage index in excess of 94 percent. The stock of sodium valproate, phenobarbital and lamotrigine is, again, almost inexistent on the shelves of the pharmacies surveyed.

Chart No. 6: Shortage Index by Morbidity. MĂŠrida, February 2019.

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MARACAIBO

The so-called “Beloved Land of the Sun� is one of the cities, just as Valencia, with the lowest shortage rates. In the case of drugs to control diabetes, the shortage index is 35.5 percent; for hypertension, it is 36.1 percent. It should be noted, though, that atenolol is nowhere to be found in the establishments surveyed.

There is greater difficulty to treat acute respiratory infections, emotional disorders or depression and seizures, with sustained shortage rates of over 75 percent.

Despite the serious problems that the inhabitants of Maracaibo face on a daily basis to get safe drinking water, ones that may lead to an increase in diarrhea outbreaks, they are more likely to find the required drugs in local pharmacies or franchised pharmacies. The MSI for drugs to treat diarrhea is 32.3 percent, although the supply of trimethoprim is limited.

The fact that Maracaibo has lowest shortage rates as compared to the rest of the cities surveyed continues to be attributable to the border location of the state of Zulia, which facilitates access to imported medicines; unfortunately, due to their high cost, only a privileged group of people can afford to buy them.

Chart No. 7: Shortage Index by Morbidity. Maracaibo, February 2019.

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PUERTO LA CRUZ This iconic city in eastern Venezuela is the third location surveyed with the highest shortage rates. Diabetes is definitely a difficult morbidity to control in the country. The Medicine Shortage Index for drugs to treat this condition in Puerto La Cruz is above 80 percent, and people in need of glibenclamide and glicazide must search multiple establishments until they find these active ingredients, which have almost disappeared from the shelves. The picture for hypertensive patients is similar: there is a shortage of over 77 percent for hypertensive agents, and the shortage index for most of the active pharmaceutical ingredients that are prescribed to treat the condition exceeds 80 percent.

The supply of antibiotics that are ordered to treat acute respiratory infections is 93.8 percent short, and seven of the eight active ingredients surveyed are 95.5 percent scarce. In like manner, diarrheal diseases are difficult to treat with sustained MSIs in excess of 80 percent.

Depression and personality disorders continue to be the most difficult morbidities to contain: the shortage index for drugs to treat them is 89 percent. With respect to anticonvulsants, the MSI is 90.3 percent, and the shortage of most of the active ingredients prescribed to treat them exceeds 90 percent in Puerto La Cruz.

Chart No. 8: Shortage Index by Morbidity. Puerto La Cruz, February 2019.

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CIUDAD BOLÍVAR Diabetes patients in the capital of the state of Bolívar have it somehow easy to find metformin, but the shortage index for other drugs to treat the condition is over 80 percent. The stock of medicines to manage hypertension is short by 63.2 percent, and nifedipine is the scarcest active ingredient of them all.

Infectious morbidities such as acute infections of the respiratory tract tend to linger, which turns the clinical outlook of affected patients ever so bleak because of the lack of available medication. The Medicine Shortage Index for respiratory infections exceeds 88 percent. On the other hand, diarrheal diseases may be slightly controllable in Ciudad Bolívar because the shortage index for medicines to treat them does not exceed 60 percent.

As far as drugs to manage depression and seizures, the situation is similar in all the establishments surveyed: the shortage of drugs to treat them is in excess of 90 percent, and there are few options because most of the active ingredients are out of stock.

Chart No. 9: Shortage Index by Morbidity. Ciudad Bolívar, February 2019.

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PUERTO ORDAZ The situation in Puerto Ordaz, which is also located in the state of BolĂ­var, is similar to that in its neighboring city. The Medicine Shortage Index for drugs to treat diabetes exceeds 77 percent. It should be noted that the supply of antihypertensive drugs is less compromised, with a MSI of 60 percent, and at least losartan is somehow easiest to find in pharmacies (its MSI is 28 percent).

Nonetheless, the rest of the active ingredients do not follow the same trend and are scarce by over 60 percent.

The shortage index for antibiotics to fight acute respiratory infections is above 86 percent. People with diarrheal diseases face limitations because the shortage index for drugs to treat them is almost 70 percent. These are infectious outbreaks that put the lives of patients at risk and aggravate their pathologies.

The shortage index for medication to treat depression and seizures is 90 percent, which poses an increasing threat to the physical and mental health of those affected by these morbidities.

Chart No. 10: Shortage Index by Morbidity. Puerto Ordaz, February 2019.

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ON CONTRACEPTIVES

Sexual and Reproductive Health at Risk

Chart No. 11: Shortage Index Aggregate Nationwide, by City. The Case of Contraceptives. February 2019.

The quality of life of Venezuelans has deteriorated not only as a consequence of the shortages of food, medicine, income-destroying hyperinflation, insecurity, etc.; the risks that the crisis poses to sexual and reproductive health add to the list.

The shortage of contraceptives and protection methods has led to early, unwanted or unplanned pregnancies and may translate into a potential increase in maternal mortality. Moreover, in this Complex Humanitarian Emergency context, safe sex is an uphill battle, especially in a country where the price of a pack of condoms can eat up to 50 percent of the minimum wage of an ordinary citizen. Unsafe sex can result in the proliferation of sexually transmitted diseases.

The shortage of birth control methods has a differentiated impact on women, particularly if one bears in mind that it is women who face the greatest pregnancy risks, living in a country where maternal mortality increased by 65 percent between 2015 and 2016. Women are unquestionably the most affected by sexual and reproductive health deficiencies.

An analysis of the data obtained from our survey indicates that the availability of contraceptives is NOT improving.

The Metropolitan Area of Caracas and the city of Puerto la Cruz continue to be the most critical locations, with shortage rates of up to 100 for items such as injectable contraceptives, oral contraceptives, implantable devices, patches, vaginal rings and emergency contraceptives.

Barquisimeto showed an increase in the shortage of contraceptives during the month of February: rates for all items exceeded 90 percent, with the exception of condoms (69.2 percent), which is alarming because their shortage rate is the highest behind that of Puerto La Cruz. And this analysis does not take into account how expensive they are.

Shortage rates in Maracaibo are up to 100 percent, although some oral contraceptives and condoms are still available.

On the other hand, in MĂŠrida it is difficult to find implantable devices, patches and vaginal rings in drugstore chains or independent pharmacies, but it is easier to find condoms and emergency contraception.

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#CONVITEDENOUNCES FEBRUARY 2019: VENEZUELA: HOSPITALS COLLAPSING No relief has yet been provided to the ‘José Manuel de Los Ríos’ Hospital On the one hand, there is the constant rejection of donations; on the other, the suspension of elective surgeries for lack of anesthesia, which is an every-day paradox in the J. M. de Los Ríos. The mothers of the patients protested on February 6 to denounce 4

the repeated refusal of the hospital’s board of directors to accept donations. .

Non-governmental organizations and individuals come to the clinic on a daily basis to leave donations; unfortunately, it is not authorized. Hospital users have witnessed how volunteers are denied entry and are sent back with unopened packages of diapers, prostheses valued in dollars, hygiene products, mattresses, food, and other supplies that are much needed because they are not provided by the hospital.

At the same time, surgeries are postponed. As of February 12, elective surgeries were suspended due to lack 5

of anesthesia: there were only two vials of propofol in stock in the hospital’s pharmacy. Patients who had been waiting for their surgery for the past year could not be treated. In addition to the lack of anesthesia, the precarious situation in the hospital is compounded by the fact that two of the eight operating rooms are inoperative and that the proliferation of bacteria remains unchecked in the Nephrology Service: according to reports from those who tend to the sick children, the tanks that feed the hemodialysis osmosis plants do not receive the required maintenance and cleaning.

The list of children who died at the country’s hospitals is growing; this time it was La Guaira’s turn. The right of children to life and health is systematically violated in Venezuela. People who declared on the condition of anonymity reported the death of seven newborns in the ‘José María Vargas’ Hospital, attached to the Venezuelan Institute of Social Security; the cause of death was a bacterial infection that turned into deadly meningitis.6 The children were placed in a makeshift area that lacked adequate conditions for treatment: no air conditioning, irregular water supply, and poor hygiene because the maintenance staff at the hospital compound has no supply of basic products such as chlorine and disinfectant to clean the areas.

The ‘José María Vargas’ Hospital is a healthcare facility where all services are hanging by a thread. In addition to contributing to the spread of infections, serious deficiencies in the supply of running water considerably impairs the cleaning condition of the bathrooms, turning them into a breeding ground for multiple illnesses. The neonatal and pediatric care areas are the most affected: on top of the bathroom situation, only 5 of 15 incubators are in working order, and there are not enough beds to accommodate babies and children.

People with oncological and renal diseases live on the edge February has been a distressing month for cancer and kidney patients. The Caracas ‘Luis Razetti’ Oncology Hospital has no supplies to perform surgeries, an 7

inadequate supply of antineoplastic drugs, no radiotherapy service, a shortage of reagents, and an irregular water service. Oncology patients must wait to have surgery because there are no dressings or suture material; they must have their preoperative tests performed outside the hospital, and those who need radiotherapy cannot receive it because the radiotherapy service is inoperative.

4. PINEDA, Julett (February 6, 2019). “Madres del J.M de Los Ríos denuncian que la directiva del hospital rechaza ingreso de donaciones” (Mothers at the JM de Los Ríos Hospital Denounce that the BOD Rejects Donations Entry). Available for consultation at :http://efectococuyo.com/principales/madres-del-j-m-de-los-rios-denuncian-que-directiva-del-hospitalrechaza-ingreso-de-donaciones/ 5. PINEDA, Julett (February 12, 2019). “Suspenden cirugías electivas en el J.M. de Los Ríos por falta de anestesia” (Elective Surgeries Suspended at the JM de Los Ríos Hospital for Lack of Anesthesia). Avaliable for consultation at: http://efectococuyo.com/salud/suspenden-cirugias-electivas-en-el-j-m-de-los-rios-por-falta-de-anestesia/ 6. RUIZ, Rodolfo (February 8, 2019). “Mueren 7 niños en menos de un mes en área neonatal del seguro” (Seven Children Die in the Neonatal Area of a Venezuelan Institute of Social Security Hospital). Available for consultation at: : http://laverdaddevargas.com/24/mueren-7-ninos-en-menos-de-un-mes-en-area-neonatal-del-seguro/2019/02/08/ 7. PINEDA, Julett (February 10, 2019). “Fallas en servicios y en quimioterapias persisten en el oncológico Luis Razetti” (Defficiencies in Services and Chemotherapy Persist in the ‘Luis Razetti’ Oncology Hospital). Available for consultation at http://efectococuyo.com/salud/fallas-en-servicios-y-en-quimioterapias-persisten-en-el-oncologico-luis-razetti/

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#CONVITEDENOUNCES Dialysis units in Caracas, Carabobo, Aragua, Puerto Ordaz, Lara, Portuguesa, Apure and Táchira were partially paralyzed due to problems with the supply of lines, filters and fistula needles and, of course, to interruptions in the supply of running water. People with kidney failure go through many a tribulation; sometimes they are sent back home without therapy; at other times they only receive one of the three dialysis sessions that they need; there are cases of patients who receive dialysis for less than the required four hours, and they must by the expensive dialysis 8

kits out of their own pocket every single week.

Malaria comes from the south and stays in the east of the country. Anzoátegui continues to be news. In addition to the diarrheal diseases that have been seriously affecting both children and the elderly since the beginning of 2019, thanks to the proliferation of bacteria in water. Cases of malaria have been reported in a substantial number of municipalities to the north of the state. Guanta, Bolívar, Sotillo and Simón Rodríguez are the most affected local entities, with between 200 and 600 cases so far this year. Omar Aray, president of Salud Anzoátegui (Saludanz) claims that he guarantees, jointly with the Ministry of Health, the supply of material, treatments and reagents 9

needed for a quick diagnosis of the disease.

Malaria cases have also been reported in non-endemic areas, as is the case of the Andean states. This atypical proliferation may be attributed to mining activities, given that many people from various federal entities migrate to the state of Bolivar to engage in mineral extraction under very precarious conditions, get the disease, and spread it to their places of origin once they return. Unfortunately, the mining arc is becoming a highway for malaria in Venezuela.

NGOs in the crosshairs. Apparently, defending the rights of citizens in Venezuela is considered a crime.

Organizations dedicated to the fight for the rights of people with HIV have been the object of attacks, including Manos Amigas por La Vida Foundation (Mavid Foundation), which is located in Valencia (state of Carabobo), and Consciencia por la Vida’ (Awareness for Life), which is located in Barquisimeto (state of Lara).10 The most seriously affected by the attacks was the Mavid Foundation because officials of the Scientific, Penal and Forensic Investigations Corps (CICPC, by its Spanish acronym) arbitrarily raided its headquarters, seizing children formula and antiretroviral drugs for children and pregnant mothers, condoms donated by UNAIDS, rapid diagnostic tests, and patient files and computers, and detained a number of representatives of the organization without a 11

warrant. Raíza Farnataro, president of Conciencia por la Vida, denounced having been threatened and harassed by state security forces.

It wasn’t until early February when the Ministry of Health barely began the distribution of 100,000 bottles of antiretroviral drugs that had arrived in Venezuela in December 2018 from the Global Fund to Fight AIDS, Tuberculosis 12

and Malaria as part of the first stage of the Master Plan ; this means the donations had been withheld for two months; the NGOs have not been summoned to take part in the distribution process.

8. PINEDA, Julett (February 10, 2019). “Por falta de insumos suspenden sesiones de diálisis al menos en ocho estados” (At Least Eight States Suspend Dialysis Sessions for Lack of Supplies). Available for consultation at: http://efectococuyo.com/principales/por-falta-de-insumos-suspenden-sesiones-de-dialisis-en-al-menos-ocho-estados/ 9. ARIZA, Vivian (February 16, 2019). “Gobierno combate la malaria en Anzoátegui” (Government Fights Malaria in Anzoátegui). Available for consultation at Disponible en: http://efectococuyo.com/principales/por-falta-de-insumos-suspenden-sesiones-de-dialisis-en-al-menos-ocho-estados/ 10. Diario La Verdad web/redacción Zulia (February 15). “Policía allana y decomisa medicamentos a Mavid” (Police Rides Mavid and Seizes Medication). Available for consultation at:. http://www.laverdad.com/zulia/152595-policia-allana-y-decomisa-medicamentos-de-la-fundacion-mavid.html 11. PINEDA, Julett (February 18, 2019). “Funcionarios atacan a dos ONG de derechos de personas con VIH en sólo 72 horas”. (In Just 72 Hours, Officials Attack Two HIV ONGs). Available for consultation at: http://efectococuyo.com/principales/funcionarios-atacan-a-dos-ong-de-derechos-de-personas-con-vih-en-solo-72-horas/ 12. The Master Plan is a tool aimed at coordinating international technical support to control HIV, malaria and tuberculosis epidemics in Venezuela over the next three years. It was created with the cooperation of the Panamerican Health Organization (PHO), USAID, officials from the Ministry of Health, the Venezuelan Society of Infectology, and the Venezuelan Positive People Network.

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Unfortunately, actions of this type, ordered by the government of Nicolás Maduro, are just a form of retaliation against those who have been fearlessly denouncing the hardships that people with HIV have to endure every day; by the way, twelve AIDS patients have already died so far this year. Activists for the rights of HIV-positive persons constantly raise their voices to demand the provision of drugs to treat the disease and ask to be part of the monitoring and social oversight of their distribution, when they finally arrive in the country; however, in most cases, they are not taken into account.

The results of the Venezuelan ‘Encovi 2019’ Encuesta de Condiciones de Vida (Living Conditions Survey) research were disclosed on February 27, and they are alarming. According to the findings, the situation in Venezuela is comparable to that of the former Soviet Union at the time of its dissolution or like that of Cambodia during the 1997 crisis. The following were the most striking facts:13 • An estimated 20,000 children under one year are predicted to die in Venezuela by 2019; • Life expectancy at birth has been reduced to 3.5 years; • In 2018, 52 percent of pregnant women lived in poverty conditions.

• Humanitarian aid should be focused on the states of Apure, Bolívar, the southern part of the state of Guárico, the southeastern part of the state of Anzoátegui, the southern part of the state of Mérida and the Páez municipality in the state of Zulia. As per the data, these are the regions with the poorest areas in the entire country and they should be provided with aid the longest once the emergency shall have been resolved.

The results of this survey are totally reversible as long as there is international funding available during and after the complex humanitarian emergency and, needless to say, as long as there is an urgent and much needed change of government.

Not only were the Encovi results announced: those of the National Survey of Hospitals, which is conducted and disseminated by the Médicos por la Salud (Doctors for Health) NGO were announced as well.14 The most shocking figures at the national level are the following: 1,557 deaths were reported over a three-month period (November 2018 - January 2019), broken down into 756 from polytrauma (injuries from projectiles or accidents), 801 from cardiovascular diseases, and 79 from power outages. Only 15 percent of all emergency rooms are operational, only 27 percent of all operating rooms are available for use, and only 40 percent of all ICUs are still functioning.

With regard to essential medicines to treat emergencies in public hospitals, there is a 75 percent shortage of morphine, a 60 percent shortage of minor analgesics, and a 46 percent shortage of disposable material.

13. MARTINEZ, Andrés (February 27, 2019). “La esperanza de vida al nacer se redujo a 3,5 años” (Life Expectancy At Birth Reduced to 3.5 Years). Available for consultation at http://elestimulo.com/blog/encovi-y-plan-pais-2019-la-esperanza-de-vida-al-nacer-se-redujo-35-anos/ 14. GIL ANZOLA, Gretta M. (February 21, 2019). “En 83 días fallecieron 1557 pacientes por fallas en los hospitales” (1,557 Patients Died in 83 Days for Hospital Crisis).

Available for consultation at : http://elestimulo.com/blog/en-83-dias-fallecieron-1-557-pacientes-por-fallas-en-los-hospitales/

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