Monitoring of Access To Health in Venezuela Newsletter N. 21

NEWSLETTER

APRIL

2019

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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

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C O N T E N T S

ANALYSIS AND INTERPRETATION OF AGGREGATE RESULTS MEDICINE SHORTAGE INDEX – APRIL, 2019 VENEZUELA CELEBRATES WORLD HEALTH DAY IN SICKNESS AND AT RISK OF DYING

GRAPHIC DEPICTION OF THE MEDICINE SHORTAGE INDEX BY MORBIDITY: DIABETES: HYPERTENSION: ACUTE RESPIRATORY INFECTIONS (ARIS): DIARRHEAL DISEASES: DEPRESSION OR PERSONALITY DISORDERS: SEIZURES: SEXUAL AND REPRODUCTIVE HEALTH AT RISK WOMEN ARE PLACED A DIFFERENT BURDEN IN THE COMPLEX HUMANITARIAN EMERGENCY #CONVITEDENOUNCES APRIL 2019 VENEZUELA CELEBRATES WORLD HEALTH DAY IN SICKNESS AND AT RISK OF DYING

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RESULTS: INDICATOR BEHAVIOR AND EVOLUTION

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ANALYSIS AND INTERPRETATION OF AGGREGATE RESULTS MEDICINE SHORTAGE INDEX

APRIL, 2019

CHRONOLOGICAL DETAILS OF THE SURVEY Period and Frequency of Data Collection: The survey consisted of two measurements conducted in the month of April of 2019, from the 11th to the 12th and from the 24th to the 25th —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/

VENEZUELA CELEBRATES WORLD HEALTH DAY IN SICKNESS AND AT RISK OF DYING April 7 is World Health Day. It is a window to promote knowledge and awareness on public health issues affecting millions of people around the world.

As it does every year, the World Health Organization (WHO) addresses a different health issue via informative campaigns and other activities in various parts of the world. The theme selected for 2019 is “Universal Health Coverage”, meaning “ensuring that everyone 1

can obtain the care they need, when they need it, right in the heart of the community”.

Universal Health Coverage is WHO’s number one goal. Universal health coverage means that all countries in the world should guarantee quality, accessible health care. Accordingly, the annual campaign of the WHO includes essential goals such as:

To improve understanding of universal health coverage and of what services and support should be made available and where; To help policy makers in the health sector recognize people’s needs, particularly at the primary health care level; health-care workers will have an essential role to play in this connection; To offer ministers of health and other decision makers in the public administration the opportunity to commit to taking action to address gaps in universal health coverage in their countries, as well as to highlight the progress that has already been made; To release on World Health Day its annual publication on health data, namely the World Health Statistics Report, which incudes information on healthcare trends in specific areas such as newborn and child health, non-communicable diseases, mental health, environmental risks, universal health coverage and health systems;

1. From the World Health Organization (WHO) web site. Available at: https://www.who.int/es/campaigns/world-health-day/ world-health-day-2019. See also: https://www.who.int/es/campaigns/world-health-day/world-health-day-2019/about-the-campaign

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According to the WHO, most of the regions in the world are currently seeing substantial progress in universal health coverage.

Unfortunately, for Venezuela is this progress and development scenario is off-limits.

The Venezuelan healthcare crisis seems unprecedented. The growing deterioration of the country’s healthcare services is more apparent with each passing year. Alarming statistics on morbidities that seriously affect the Venezuelan population are on the increase, even on those morbidities that had been practically eradicated decades earlier, such as malaria. The latter disease has been spreading all over the country at a time when there are no prophylaxis and prevention programs in place to deal with it, and in the mining sectors that operate in the state of Bolivar (which is an endemic area) there are no controls to prevent its dissemination. As per the latest data of the WHO, Venezuela contributes 53 per cent of malaria cases in the entire Latin American region; during 2018 alone, one million people 2

were infected with malaria parasites in the country.

The list of items that explain the dire situation which the Venezuelan health system is currently experiencing is wide and discouraging: there is a long-standing shortage of medicines; hospitals lack all kinds of supplies; no preventive or corrective maintenance is made to the system’s infrastructure; a number of operating rooms have been shut down; the healthcare staff is insufficient; there is insecurity, both personal and in the workplace; instruments and equipment for diagnosis are out of order or non-operational; there are no reagents in laboratories; there is not enough blood in blood banks for transfusion; power plants are scarce; the water storage capacity for contingencies is poor; dialysis units are short of materials; there is not enough food to meet the nutritional needs of hospitalized patients, just to name a few. The consequences of the ineptitude and incapacity of the government to maintain and make investments in the system are innumerable. This is a devastated health system.

At the beginning of 2019, the country was offered the opportunity to receive millions of dollars in medical supplies and food via the humanitarian aid that the National Assembly, the only legitimate body of the Venezuelan State, managed to obtain. However, the aid was widely rejected and attacked by the national executive, with the resulting renewed politicization of the Venezuelan people’s health and food needs.

Nicolás Maduro and his executive cadres have adamantly stated that Venezuela needs no humanitarian aid, that this is not a beggars’ country, and that its citizens do not need anyone’s alms, thereby negating that the country is experiencing a complex humanitarian emergency. They insist that the massive deficiencies in the healthcare system are due to the financial and economic sanctions imposed by the United States of America to high-ranking government officials. At the same time, if the international aid comes from Cuba, Russia or China (which are the government’s allied countries), it is well received, even if there is no information as to whether the drugs have been internationally certified for safe use or if said certification has been duly validated by the receiving country.

Nevertheless, at the end of March, Maduro accepted to meet with Francesco Rocca, president of the International Federation of Red Cross, who would later confirm to have been authorized to bring humanitarian aid into Venezuela to meet the needs of a sector of the population (650,000 people in a situation of vulnerability) only in the health area. Convite has warned that the aid in question is insufficient, considering that there are currently about 7,000,000 people who require urgent humanitarian assistance and protection.

Although the process was supposed to be tackled under the principles of impartiality and neutrality, when the first cargo of humanitarian aid arrived Minister Carlos Alvarado publicly declared that “these 24 tons of supplies come into the country thanks to President Nicolás 3

Maduro and the Bolivarian Government”.

2. EL PITAZO (15 de abril de 2019). “Científicos alertan de un millón de nuevos contagios con malaria en Venezuela” (Scientists Warn of One Million New Cases of Malaria in Venezuela). Available at: https://elpitazo.net/salud/cientificos-alertan-de-un-millon-de-nuevos-contagios-con-malaria-en-venezuela/ 3. RODRIGUEZ ROSAS, Ronny (April 16, 2019). “Ministro de Salud asegura que cargamento de la Cruz Roja viene de la mano de Nicolás Maduro” (Health Minister Affirms that Humanitarian Aid from the Red Cross Comes in Thanks to Nicolás Maduro). Available at: http://efectococuyo.com/principales/ministro-de-salud-asegura-quecargamento-de-la-cruz-roja-viene-de-la-mano-de-nicolas-maduro/

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The first shipment of humanitarian aid was 14 tons and included power plants, medical kits, and water purification pills; however, there number of medicines arriving in to combat the major morbidities affecting the population is still inadequate, and no provisions for the entry of medication and food have been made because it has not been authorized by Nicolás Maduro.

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Mark Lawcock , who is the head of the United Nations Office for the Coordinator of Humanitarian Affairs (OCHA), stated before the UN Security Council that Venezuela is “experiencing a real humanitarian problem” that could be summed up in the most alarming figures below: 7 million Venezuelans, that is 25 percent of the country’s population, are in need of humanitarian aid; 3.7 million Venezuelans suffered from malnutrition in 2018, and 1.3 million children require nutritional assistance; 2.8 million people need healthcare assistance.

Prior to this statement, on April 4 of 2019, a 73-page report was released jointly by the John Hopkins University Bloomberg School of 5

Public Health and Human Rights Watch (HRW). The reports states that there is a “Complex Humanitarian Emergency” in Venezuela and that it should be officially declared as such by the Secretary General of the United Nations Organization, António Guterres. These are some of the Venezuelan emergency situations listed in the HRW report: High levels of food insecurity and child malnutrition; Outbreaks of vaccine-preventable diseases, such as measles and diphtheria, and an increase of malaria and tuberculosis cases and high medication shortage rates; High infant and maternal mortality rates.

José Miguel Vivanco, HRW Director for the Americas, is of the opinion that Venezuelan authorities “underplay the crisis and harass and retaliate against those who collect data or speak about what is happening...” “These authorities are accountable for the needless loss of life that their denial and obstruction have inflicted on the Venezuelan people”.

The authors of the report consider that the UN Secretary General, in addition to officially declaring the state of emergency and leading and implementing a large-scale response to address the situation, must follow the guidelines below: To designate the UN Emergency Relief Coordinator, who is also the head of the United Nations Office for the Coordinator of Humanitarian Affairs (OCHA), to address the Venezuelan crisis as a priority issue that requires large-scale humanitarian assistance efforts and resources; Urge Venezuelan authorities to release official data on diseases, epidemics, food security, and nutrition that would enable UN agencies to conduct a comprehensive assessment of the humanitarian needs and of the size of the crisis in the entire country.

It is no longer just the opinion of the NGOs or of the human right activists and defenders or of the citizens that have to face the grim and harsh reality on a daily basis; it is also now the opinion of international experts who are increasingly clear about the Venezuelan crisis and demand a prompt response from the competent bodies.

4. EFECTO COCUYO (April 10, 2019). “ONU pide apoyo para responder al problema humanitario muy real de Venezuela” (UN Asks for Support to Respond to the Very Real Humanitarian Problem of Venezuela). Available at: http://efectococuyo.com/principales/onu-pide-apoyo-para-responder-al-problema-humanitario-muy-real-de-venezuela/ 5. Human Rights Watch (April 4, 2019). “Venezuela: La ONU debería liderar una respuesta a gran escala a la emergencia humanitaria” (The UN Should Lead a Large-Scale Aid Response to the Humanitarian Emergency). Press Note. Available at: https://www.hrw.org/es/news/2019/04/04/venezuela-la-onu-deberia-liderar-una-respuesta-gran-escala-laemergencia-humanitaria

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Each day that goes by without humanitarian aid, the emergency worsens. Aid distribution follows international protocols whose independence and autonomy principles must prevail, and its sole purpose is to save lives and no other. The principles at issue must be widely recognized and respected, particularly by those responsible of running a country of more than 31.8 million inhabitants who since 2015 are enduring an unheard-of, unprecedented crisis such as the country has never seen before.

RESULTS:

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INDICATOR BEHAVIOR AND EVOLUTION

The shortage indexes reported in our April 2019 survey within the framework of the Monitoring the Right to Health in Venezuela project, which range between 42 percent and 97 percent, are shown below.

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

Chart No. 1: Behavior of the Medicine Shortage Index Nationwide. April 2019.

6. 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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Chart No. 2: Shortage Index Aggregate Percentages, December 2018 – April 2019.

In April, the General Medicine Shortage Index was 68 percent, thus far the lowest recorded since the beginning of the last phase of the project in December of 2018. This could be due to the fact that the owners of pharmaceutical establishments have to go to great lengths not to close business, including to purchase imported or subsidized medication, which are commercialized in foreign currency and sold to the public at prices that vary with the exchange rate of the day, or pay the price of the products in US dollars without having to use the local currency.

Venezuelans in need of medication to control seizures, depression or personality disorders and acute infections of the respiratory tract (ARIs) are still struggling to find their medication; unfortunately, the shortage indexes therefor exceed 80 percent.

Barquisimeto, the Metropolitan Area of Caracas (MAC), Puerto La Cruz and MĂŠrida remain the locations with the highest medication shortage indexes, which range from 60 percent and 97 percent.

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

Chart No. 3: Behavior and Evolution of the Medicine Shortage Index by Morbidity: Diabetes.

December 2018 – April, 2019.

Once again, citizens in Puerto La Cruz have little possibilities to find drugs to treat diabetes, regardless of their presentation or active ingredients. The highest shortage index was that of Puerto La Cruz, which was of approximately 86 percent. Next up are Barquisimeto: 85 percent, Mérida: 84 percent, and the MAC: 81 percent. The shortage indexes for the remaining locations did not exceed 70 percent.

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HYPERTENSION

Chart No. 4: Behavior and Evolution of the Medicine Shortage Index by Morbidity: Hypertension.

December 2018 - April 2019

Puerto La Cruz is, once more, ahead of the rest in terms of medicine shortage figures with an 85 percent shortage index. This means that most of the pharmacies surveyed had no stock (and still have none to date) of hypertension medication. MĂŠrida, Barquisimeto and Puerto Ordaz recorded shortage indexes of between 60 percent and 71 percent, with atenolol and nifedipine being the least available active ingredients on the shelves.

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ACUTE INFECTIONS OF THE RESPIRATORY TRACT (ARIS):

Chart No. 5: Behavior and Evolution of the Medicine Shortage Index by Morbidity: ARIs. December 2018 - April 2019.

All the cities in our survey samples record medicine shortage indicators in excess of 60 percent for this ailment: the means that medicines to treat acute respiratory infections remain in short supply. ARIs are a morbidity that is mostly present during the dry months (December through April) and the associated high temperatures, low rainfall and large extensions of dehydrated topsoil that are prone to fire, whether induced or spontaneous.

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Air in the hottest cities in the country turns thick, smoky and hazy, which has environmental effects on the respiratory system and triggers ailments such as long-lasting allergies, asthma attacks and pneumonia.

Antibiotics and active ingredients to nebulize adults and children are not easy to find in the pharmacies or in healthcare centers.

7. Haze, or calima, is a meteorological phenomenon where dust, ashes and sand particles are suspended in the air.

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DIARRHEAL DISEASES:

Chart No. 6: Behavior and Evolution of the Medicine Shortage Index by Morbidity: Diarrhea.

December 2018 - April 2019.

Bacteria-borne stomach viruses and infections are still an everyday occurrence in the country. Just as ARIs, diarrheal ailments are associated with triggering elements that, in this case, are most of a human than of an environmental nature: the intermittency in the supply of fresh water (which has been widely documented) is the result of the shameless inefficacy of the competent governmental agencies.

Barquisimeto, Puerto La Cruz, the MAC and MĂŠrida are the locations most affected by the shortage of drugs to treat diarrheal diseases, with indexes above 75 percent.

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DEPRESSION OR PERSONALITY DISORDERS:

Chart No. 7: Behavior and Evolution of the Medicine Shortage Index by Morbidity: Depression.

January 2019 - April 2019.

“Some people experience fear, sadness or anxiety because of past events; they suffer from posttraumatic stress disorder. The problem is that we are immersed in an unprecedented situation that is yet to come to an end; it 8

is an ongoing traumatic stress situation.” Such is the explanation of the chairman of the Venezuelan chapter of Psychologist without Borders, Marisol Ramírez, to refer to life for Venezuelans: they find themselves plunged into a daily scenario of nonstop uncertainty amid chaos that undermines their emotional stability and their quality of life.

The emotional and psychological damage from circumstantial events or organic causes may be serious if people do not immediately search for the necessary tools to cope with the situation and self-manage their own wellbeing.

Sadly, the shortage indexes for medication to control numerous personality disorders and depression remain high, which contributes to obscuring the outlook for the people affected.

Maracaibo and Valencia are two of the eight cities surveyed with shortage indexes below 71 percent; the rest of the surveyed samples show indexes of 80 percent, with Puerto La Cruz, again, being the city with the worst shortage of antidepressants: 96 percent.

8. PINEDA, Julett (April 5, 2019). “Psicóloga Marisol Ramírez: Estamos en una situación inédita de estrés traumático” (Psychologist Marisol Ramírez: “We are in a situation of unprecedented traumatic stress”. Available at: http://efectococuyo.com/salud/psicologa-marisol-ramirez-estamos-en-una-situacion-inedita-de-estres-traumatico/

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SEIZURES:

Chart No. 8: Behavior and Evolution of the Medicine Shortage Index by Morbidity: Seizures. April 2019.

As with antidepressants, anticonvulsants are extremely difficult to find in the country’s major cities. All the data collected for this report indicate that the shortage of anticonvulsants is above 80 percent: Valencia, Barquisimeto, the MAC, Puerto Ordaz and Puerto La Cruz are the cities where pharmacy chains, whether local or domestic, and private drugstores do not have drugs to control seizures in stock.

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SEXUAL AND REPRODUCTIVE HEALTH AT RISK

Women Are Placed a Different Burden in the Complex Humanitarian Emergency

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

It appears from the data obtained during our monitoring work that the shortage of contraceptives remains unaltered at the national level. Barquisimeto, Puerto La Cruz and the Metropolitan Area of Caracas are still the locations with the most critical reports, with shortage indexes of up to 100 percent in products such as injectable contraceptives, oral contraceptives, implantable contraceptive devices, contraceptive patches and vaginal rings.

In Maracaibo it is only possible to find oral contraceptives and condoms without having to do a lot of searching, whereas in MĂŠrida it is almost impossible to find oral contraceptives, injectable contraceptives, implantable contraceptive devices, contraceptive patches and vaginal rings in pharmacy chains and private pharmacy stores, but there is a better chance that people may find condoms and emergency contraceptives.

Therefore, statistics show once again that sexual and reproductive health continues to be in a significantly vulnerable status that puts the lives of Venezuelan women at risk; Venezuelan women are exposed to sexually transmitted diseases (STDs) in a country where it is almost impossible to find or purchase antibiotics, let alone antiretroviral drugs.

Pregnancy control is another increasingly difficult task to accomplish due to the poor conditions of hospitals and the high costs of private health care. Additionally, the price of medicines and vitamin complexes which are necessary for both the pregnant woman and the development of the foetus have increased.

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#CONVITEDENOUNCES APRIL 2019: VENEZUELA: VENEZUELA CELEBRATES WORLD HEALTH DAY IN SICKNESS AND AT RISK OF DYING

A TSUNAMI WHOSE DEVASTATION LEAVES 7,000,000 MILLION PEOPLE IN NEED OF #ASSISTANCE AND #PROTECTION April kicks in and it is dragging March’s problems. The second quarter of 2019 begins with the continuing power failures that so adversely impact the life of an entire nation.

On April 2, the government announced that it would enforce electric power rationing as a “load management 9

plan” . The official measure is but a restriction in the supply of electric power for six or more hours a day to unspecified areas in the country. Unfortunately, entities such as Zulia, Lara and Mérida, just to name a few, have been plunged into darkness ever since the massive countrywide blackouts; it means that they go five or more days without electricity, which affects all areas in their lives.

The electric power crisis in Venezuela has been going on for a long time now, and the so-called “mega blackouts” of March are just the consequence of negligent public management and bear no relation with acts of internal or foreign sabotage. The situation with the water supply service is no different, for the water crisis is the result of the unscrupulous management of resources where no early investment provisions were made to efficiently meet the service demand or to conduct preventive maintenance of the equipment and the infrastructure.

More than 90 percent of the Venezuelan population does not get running water on a continuous regular basis and it is common to see groups of people in the streets of cities or towns carrying plastic containers into long water lines, where they would get the water either from a tanker truck or, even worse, from highly contaminated bodies of water such as the “El Guaire” river in the Metropolitan Area of Caracas.

This difficulty in supplying the country with potable water poses another challenge of enormous proportions which must be taken up and swiftly resolved through efficient action —not with “Band-Aid solutions”—, because 10

an epidemiological crisis is looming that will aggravate the existing health emergency. Children, the elderly and adults are consuming water that is not potable, and non-potable water is a cause of potentially deadly diarrheal diseases, skin infections such as scabies, and the spread of viruses and bacteria, among others.

In addition to the chaos associated with the consumption of contaminated water, patients in Venezuelan hospitals are at constant risk because the bathrooms have to be closed for sanitary reasons and are a potential source of infections, the medical and nursing staff cannot properly follow sanitizing protocols before a medical procedure, the kitchens have no running water to wash and prepare food, and because of so many other conditions that combine to create a dangerous insanitary pattern that affects the patients, the staff and the caregivers alike.

9. GARCÍA, Ariadna (April 2, 2019). “Oficializan racionamiento eléctrico de dos horas sin precisar las zonas” (Power Rationing to Two Hours for Unspecified Areas Official). Available at: http://cronica.uno/oficializan-racionamiento-electrico-de-dos-horas-en-algunas-zonas-del-pais/ 10. SOTELDO, Eduardo (April 1, 2019). “Susana Raffalli: Escasez de agua puede convertirse en una catástrofe sanitaria” (Susana Raffalli: Water Shortages May Lead to a Health Catastrophe). Available at: https://www.laprensalara.com.ve/2019/04/susana-raffalli-escasez-de-agua-puede-convertirse-en-una-catastrofe-sanitaria/

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#CONVITEDENOUNCES Operation “Small [water] Bucket”: from domestic routine to part of the dynamics in Venezuelan hospitals and nursing homes.

Healthcare centers now depend on cistern trucks for water supply. Entire areas have been dedicated to storing water buckets and temporary water tanks where caregivers must fill their plastic containers. Such is the case in the 11

J. M. de los Rios hospital since the latest power blackouts. The stored water is intended for multiple purposes, including patient hygiene and bathroom and room cleaning.

The physical exhaustion and strain from having to go up and down stairs carrying the weight of water containers add up to the agony of having a sick relative and the fear of having to leave him or her alone for a short while, knowing that anything can happen in the meantime, which further complicates the situation.

Ever since the power cuts and the ensuing interruption in water supply began, people’s access to healthcare has been subject to some restrictions: consults are not as frequent as usual, and “non-priority” patients are being discharged, as is the case in the ‘José María Vargas’ hospital in Cotiza; in the children’s hospital, the priority is to keep the dialysis and emergency units up and running, while the remaining areas are not fully operational until the water service is restored. These are just some of the steps taken by healthcare centers to deal with the crisis 12

situation.

Nursing homes do not escape this harsh reality. Senior citizens in nursing homes are not living their last years with the quality of life that they deserve. For instance, in the ‘Padre Machado’ home located in Los Teques, state of Miranda, the elderly are being hit —and hard— by the severe power crisis.

Grandpas and grandmas feel anxious when they are left in the dark, and fear overtakes them; the nuns running the nursing home and their employees have seen their daily work routine disrupted, not only because they lose power and have no electric light available, but also because they have to collect water in buckets from a nearby water intake just to be able to wash the 45 elderly and prepare meals for them. The nuns are extremely concerned about the precarious conditions in which they find themselves, and they denounce the disinterest and neglect on the part of government agencies.

Unfortunately, the situation in the Padre Machado replicates in most of the nursing homes in Venezuela, unless they are privately-owned and can outsource help; these geriatric enclosures have gradually become a warehouse of people who are left to their fate and whose growing demands are not answered neither by their families nor by the State.

Science is also obscured by power losses The Zoology and Tropical Ecology and Tropical Medicine institutes of Universidad Central de Venezuela (UCV) 13

have plunged into “scientific darkness”. The scientific community of the UCV denounces the irreparable loss of cultures, strains and biological samples that took years to collect and grow.

Research and teaching activities are paralyzed as a result of said losses, which, in turn, are the consequence of the constant blackouts. Decades-old studies on organisms and parasites that can only be found in Venezuela must now be started from scratch by professors and researchers.

11. PINEDA, Julett (April 1, 2019). “Pacientes llenan botellas en tanques de plástico mientras hospitales siguen sin una gota de agua” (Patients Fill Bottles From Plastic Tanks While Hospitals Are Out of Water). Available at: http://efectococuyo.com/salud/pacientes-llenan-botellas-en-tanques-de-plastico-mientras-hospitales-siguen-sin-una-gota-de-agua/.

Ver también: http://efectococuyo.com/salud/dan-de-alta-a-pacientes-del-vargas-y-del-j-m-de-los-rios-por-fallas-en-suministro-de-agua/ 12. PINEDA, Julett (April 8, 2019). “Hermanas cargan tobos y botellas para asear a los 45 abuelos de la casa Padre Machado” (Sisters Carry Buckets and Bottles to Wash the 45 Grandparents Living in the Padre Machado Nursing Home). Availale athttp://efectococuyo.com/principales/hermanas-cargan-tobos-y-botellas-para-asear-a-los-45-abuelos-dela-casa-padre-machado/ 13. PINEDA, Julett (April 1, 2019). “Ciencia a oscuras: apagones dejan pérdidas de cultivos y materiales biológicos” (Science in the Dark: Cultures and Material Lost from Blackouts). Available at: http://efectococuyo.com/principales/ciencia-a-oscuras-apagones-dejan-perdidas-de-cultivos-y-materiales-biologicos/

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#CONVITEDENOUNCES In addition to the lack of resources and funds, the insecurity, and the exodus of specialists, there is now an added element: the lack of high-cost fuel (diesel) to run the power plant that helps operate the refrigeration equipment where reagents and components of treatments to combat tropical morbidities such as malaria, leishmaniasis and Chagas disease are stored.

Treating hemophilia in Venezuela is also a tragedy 14

Hemophiliacs have had to resort to “all-risk” transfusions because there are currently no clotting factors, which used to be distributed by the Venezuelan Institute of Social Security (IVSS). This situation has forced hospitals to implement a method called “cryoprecipitate” in order to deal with the shortage and prevent the death of people with this morbidity, moving the treatment of hemophilia back to practices of the 1980s.

In addition to the current lack of basic treatment, there are no serological reagents available to rule out the presence of viruses in the blood; therefore, patients can easily catch diseases such as hepatitis C or HIV via blood transfusions.

Venezuelan hemophiliacs have been left with no guarantee of their fundamental right to health.

Furthermore, in the face of the severe shortage of drugs to treat their ailment, hemophiliacs suffer from psychological disorders such as anxiety, depression and others that aggravate their primary illness.

On the other hand, blood banks all over the country were also affected by the power cuts, but in a way that is different from that in other health institutions. It is not only the lack of power plants or the loss of material that have struck them: the blackouts have also prompted absenteeism and reduced donors because there is no public transportation. Blood banks, both in hospitals and private clinics, have had to make the difficult decision to suspend activities or to organize contingency schedules in order not to stop providing the service.

Tuberculosis ravages Monagas

Marcela Velásquez, who is the head of the anti-tuberculosis program at the ‘Dr. Manuel Núñez Tovar’

University Hospital, reports that 18 cases of tuberculosis are diagnosed there on a daily basis, 5 of which come 15

back for consultation and treatment. A poor food intake and malnutrition combine into triggering factors that leave people with weakened immune systems, which makes it easy for them to contract the disease.

The majority of tuberculosis cases come from low-income families that eat at best two meals a day and live in precarious and overcrowded conditions. The sick also lack an efficient network of ambulatory hospitals, and most are forced to abandon treatment midway. It should be noted that the drugs that have arrived in the state of Monagas can only provide treatment for 100 cases.

Not only tuberculosis, but also morbidities such as child malnutrition, diarrheal diseases and respiratory infections are common occurrences at the ‘Dr. Manuel Núñez Tovar’ University Hospital. In the last four months, 29 pediatric 16

patients have been reported dead who were admitted to the hospital with severe diarrhea and dehydration.

14. PINEDA, Julett (April 4, 2019). “Crisis eléctrica deja a bancos de sangre con pocos donantes”. (Power Crisis Reduces Donors in Blood Banks). Available at http://efectococuyo. com/principales/crisis-electrica-deja-a-bancos-de-sangre-con-pocos-donantes-y-trabajadores/ 15. AÑEZ, Jesimar (April 6, 2019). “En Monagas se detectan 18 casos de tuberculosis a diario” (Eighteen Malaria Cases Detected Daily in Monagas). Available at en: https:// elpitazo.net/salud/en-monagas-se-detectan-18-casos-de-tuberculosis-a-diario/ 16. AÑEZ, Jesymar (April 5, 2019). “Desnutrición infantil: 29 víctimas en cuatro meses en Monagas” (Child Malnutrition Leaves 29 Victims in Four Months in Monagas). Available at http://efectococuyo.com/salud/https://elpitazo.net/oriente/desnutricion-infantil-29-victimas-en-cuatro-meses-en-monagas/

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#CONVITEDENOUNCES During the first week of April, two children from Maturín died, both of them from malnutrition. Ten out of every 10 infants in the hospital’s pediatric emergency unit have been admitted with malnutrition, diarrhea and respiratory ailments. Sadly, these babies are not breastfed and are given oat, rice or cornstarch water instead.

The possibility of immunization in Venezuela decreases “There is nothing that we can do without electric power because the immunization program depends on the 17

provision of a safe and reliable cold chain for vaccines” , notes Alejandro Rísquez, who is a vaccinology specialist and the head of the Department of Preventive and Social Medicine of Universidad Central de Venezuela (UCV).

The instability in the supply of electric power has compromised immunization plans in Venezuela. Vaccines ought to be stored at temperatures ranging from 2° C to 8° C. Should the cold chain be broken, they could lose effectiveness.

The lack of vaccines in healthcare centers adversely affects vaccination programs and schedules for children and adults, who need protection and prevention from the spread of diseases and epidemics that, unfortunately, are now in progress.

The Warao indigenous people continue to die from preventable diseases Spokespersons from the indigenous communities of the municipality of Tucupita report the death of 242 Warao 18

patients who had been admitted to the ‘Dr. Luis Razetti’ and Tucupita’s ‘Dr. Oswaldo Brito’ Mother and Child Hospital during the first trimester of the year According to data from the Hospitalized Indigenous Care Service, 143 of the deceased patients were adults (90 women and 53 men), while the remaining 99 were children. The main cause of death was diarrhea, dehydration, tuberculosis, infections of the respiratory tract, anemia and pneumonia. These pathologies can be controlled and kept at bay with timely treatment and, needles to say, proper medication and supplies. These unfortunate deaths could have been prevented.

Malaria cases are still on the rise in the region. Although there are still no official figures available, the indigenous communities of Hacha Meru, Hacha Ken, Wamewaken, San José de Wadamapa and Parkupik, in the Ikabaru sector of the Ikabaru parish of the Gran Sabana municipality in the state of Bolívar, have reported a new outbreak of the disease to the NGO Kapé Kapé. In March alone, between 60 and 80 cases were recorded in children, young people and adults, as per information contributed by members of the community.

The staggering crisis that our country is undergoing has had serious consequences for the health and nutrition of its people. This situation most severely affects the most disadvantaged and vulnerable, as are the indigenous peoples

17. PINEDA, Jullet (April 24, 2019) “Principales planes de vacunación también se paralizan por la crisis eléctrica” (Major Immunization Plans May Also be Paralized due to the Electric Power Crisis). Available at: http://efectococuyo.com/principales/planes-de-vacunacion-tambien-se-paralizan-por-la-crisis-electrica/ 18. KAPÉ –KAPÉ Asociación Civil (April 15, 2019). “Indígenas warao siguen muriendo de enfermedades prevenibles” (Warao Indigenous People Continue to Die From Preventable Diseases). Available at: https://kape-kape.org/2019/04/15/indigenas-warao-siguen-muriendo-de-enfermedades-prevenibles/

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#CONVITEDENOUNCES 19

and their communities; their lives and the continuity of their cultural, linguistic and spiritual heritage are in danger because they are dying in large numbers from preventable diseases.

The first quarter of 2019 closes with 140 confirmed cases of measles.

According to the Pan American Health Organization (PAHO) Measles Report, as published in its bulletin, Zulia (76), Anzoátegui (43), Carabobo (9), the Capital District (4), Monagas (2), Cojedes (2), Amazonas (1), Aragua (1), Bolívar (1) and Miranda (1) were the Venezuelan states where measles cases were recorded between January and March 20

of 2019 , adding that no measles-related deaths have been accounted for.

Measles is back in Venezuela since July 2017. The Ministry of Health had recognized the death of 76 people since the virus resurfaced; the cumulative incidence rate increased to 20.4 cases per 100,000 inhabitants between 2017 and 2019, with the Capital District, Amazonas, Delta Amacuro, Vargas, Bolívar and Miranda being the entities with the highest number of reported cases. This last bulletin also indicates that, between January and February of the current year, the PAHO has confirmed 10 deaths from diphtheria and a total of 164 persons infected with the disease.

The outlook for Venezuela on World Malaria Day The ‘Dr. Arnoldo Gabaldón’ Center for Studies on Malaria of Universidad the Central de Venezuela (UCV) has 21

reported fewer malaria cases thus far in 2019. Oscar Noya, who is the Center’s coordinator, reported that these first-quarter figures are completely different from those of 2017 and 2018, when records were broken in the number of people with the disease.

The specialist affirms that this 50-percent reduction in the number of cases with respect to the first months of 2018 is attributable to the prevention and treatment work of the NGOs Rotary International and Doctors without Borders, the Pan American Health Organization (PAHO) and the Ministry of Health in the villages south of the state of Bolivar, where the country’s main focus of malaria is located.

However, Noya admits that while the State is taking responsibility for the epidemiological situation, it took it a long time to respond to it, which explains why the figures for the last two years are so high. The Venezuelan Society of Public Health (Sociedad Venezolana de Salud Pública) and the ‘Network for the Defense of National Epidemiology’ (Red Defendamos la Epidemiología Nacional) projected that by the end of 2018 Venezuela would have a total of 1,064,544 malaria cases, including unreported infections and relapses.

Bioanalysts’ Day: There is no reason to celebrate it Venezuela Bioanalysis specialists and students celebrated their day on April 25 amid active protests in various locations in Venezuela. The lack of reagents has hindered the work of these professionals and has prevented people from being safely and swiftly diagnosed and, therefore, from getting the necessary treatment.

19. KAPÉ –KAPÉ Asociación Civil (April 7, 2019). “Indígenas sin garantías de atención médica” (Indigenous Peoples With No Guarantee of Health Care). Available at: https:// kape-kape.org/2019/04/07/indigenas-sin-garantias-de-atencion-medica/ 20.ALTUVE, Armando (April 19, 2019). “Diez estados de Venezuela confirmaron casos de sarampión en lo que va de 2019” (Ten Venezuelan States Confirmed Measles Cases Thus Far in 2019). Available at: https://elpitazo.net/salud/diez-estados-de-venezuela-confirmaron-casos-de-sarampion-en-lo-que-va-de-2019/ 21.PINEDA, Jullet (April 25, 2019). “Disminuyen casos de paludismo por primera vez en 10 años en el Centro de Estudios de Malaria”. (Malaria Cases Decrease for the First Time in 10 Years: Center for Studies on Malaria). Available at: http://efectococuyo.com/principales/disminuyen-casos-de-paludismo-por-primera-vez-en-10-anos-en-el-centro-deestudios-de-malaria/

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#CONVITEDENOUNCES “The scarcest reagents are those used for serological and immunological testing, such as tumor markers, thyroid markers, hormonal tests and tests for people with HIV, including viral load and CD4 count, which provide for 22

treatment and disease monitoring” , noted Judith León, president of the Venezuelan Federation of Associations of Bioanalysts.

Bioanalysts claim that they have had to resort to old practices, some of which date back 40 years, to be able to obtain results from the applied tests. The lack of supplies adds to the high costs of tests in private laboratories.

Patients must pay considerable sums of money even for the most basic blood test; they also have to visit numerous laboratories until they find the one with the required reagents, and they have had to almost entirely forget about going to the diagnostic units of the public health network because they are, for the most part, out of stock.

We never cease to be astonished: an injured person is taken to the hospital in a garbage truck.

The NGO Doctors United for Venezuela (Médicos Unidos por Venezuela) denounced through a video that a wounded man had to be transferred to the ‘Jesús María Casal’ hospital, a healthcare facility located in the 23

state of Portuguesa, in the back of a garbage truck, just where the solid waste is deposited. Not only was the patient in danger, considering his initial condition, but he was also exposed to an imminent risk of infection from contamination from the area where he was transported.

This event in Portuguesa is just an example of the severe crisis facing the Venezuelan health system as a whole; the pre-hospital and emergency care subsystem does not escape this painful situation. According to the standards, there must be at least one ambulance for every 25,000 inhabitants in an area such as the Metropolitan Area of 24

Caracas, that is, a total of 200 units.

The truth is that there are about 20 units to cover 18 hospitals and more than 30 private healthcare centers, and only 10 percent of said ambulances have advanced support capabilities (oxygen, ventilation machine, equipment and technical staff); therefore, most of the ambulances that circulate in the city of Caracas and its surroundings are exclusively for use for basic transfers that do not require specialized attention.

22. PINEDA, Jullet (April 25, 2019). “Bioanalistas claman por reactivos y dicen que no hay nada que celebrar en su día” (Bioanalysts Demand Reagents and Claim Not Having Reasons to Celebrate their Day). Available at: http://efectococuyo.com/principales/bioanalistas-claman-por-reactivos-y-dicen-que-no-hay-nada-quecelebrar-en-su-dia/ 23. CARBALLO, Betzimar (March 17, 2019). “Trasladaron a un herido en camión de basura porque no había ambulancia” (Wounded Man Transferred on Garbage Truck Because of Lack of Ambulance). Available at: http://caraotalibre.cf/nacionales/trasladaron-herido-camion-basura/ 24. GARCÍA, Cristopher (March 17, 2019) “Caracas sin ambulancias: La crisis para trasladar a los pacientes” (Caracas Without Ambulances: Crisis to Transport Patients).

Available at: http://efectococuyo.com/principales/caracas-sin-ambulancias-la-crisis-para-trasladar-a-los-pacientes/

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