Monitoring of Access to Health in Venezuela N. 22 May 2019

NEWSLETTER

2019

22

MAY

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

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

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

T A B L E

O F

C O N T E N T S

ANALYSIS AND INTERPRETATION OF AGGREGATE RESULTS MEDICINE SHORTAGE INDEX – MAY, 2019

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TO WOMEN AND MOTHERS IN VENEZUELA

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RESULTS: INDICATOR BEHAVIOR AND EVOLUTION GRAPHIC DEPICTION OF THE MEDICINE SHORTAGE INDEX BY MORBIDITY: DIABETES: HYPERTENSION: ACUTE INFECTIONS OF THE RESPIRATORY TRACT (ARIS): DIARRHEAL DISEASES: DEPRESSION OR PERSONALITY DISORDERS: SEIZURES:

10 10 11 12 13 14 15

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ON CONTRACEPTIVES SEXUAL AND REPRODUCTIVE HEALTH AT RISK

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#CONVITEDENOUNCES MAY 2019 VENEZUELA

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ANALYSIS AND INTERPRETATION OF AGGREGATE RESULTS MEDICINE SHORTAGE INDEX

MAY, 2019

CHRONOLOGICAL DETAILS OF THE SURVEY Period and Frequency of Data Collection : The survey consisted of two measurements conducted in the month of May of 2019, from the 13th to the 14th 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/

TO WOMEN AND MOTHERS IN VENEZUELA All through the history of the country, Venezuelans have traveled a path full of vicissitudes associated with its historical and cultural circumstances. Said vicissitudes have been particularly exacerbated over the last two decades due to political, economic and social reasons that have been widely documented by specialists, activists, political leaders and journalists, among other actors. Faced with the complicit silence of the authorities and State entities, numerous people have insisted on responsibly recording what happens in the country and on delivering analyses and proposing alternative solutions to so many structural and circumstantial problems.

Now, being a woman in Venezuela seems to be even more challenging than ever before. The context is not her best ally and she must constantly reinvent herself in order to “live” in a land where a considerable percentage of women become mothers at a very young age, due to a lack of either guidance or contraceptive methods. At the same time, medical care is limited because the country’s public health centers have been virtually dismantled and private healthcare has been dollarized. On the other hand, not all women have a partner to share the responsibility of raising their children, which means that they have to cope with an additional emotional and financial burden; moreover, the poor salary that they receive will never be enough or competitive as long as the economy remains hyperinflationary.

In 2015, there were 15,269,089 women in Venezuela, which accounted for 49 percent of the entire population. For the year 2020, 1

the National Statistics Institute (INE, by its Spanish acronym) has projected some 16,265,484 women in the country. This means that women represent half of the population. And what does that half of the population have to deal with? Regardless of the conditions in which they find themselves at a given moment in time or of their history and personal experiences, a significant number of women are the ones responsible for their households or the heads thereof, a role which, in many cases, does not only involve looking after the children: women in this position also bear the burden of having to take care of the elderly, the sick and other dependents, while trying to work magic to stretch their severely strained budget.

1. National Statistics Institute. Available at: http://www.ine.gov.ve/index.php?option=com_content&view=category&id=98&Itemid=51

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On the other hand, the current service crisis has differentiated effects. Many women have to subject their bodies to physical strain when they have to search for water in public water taps or from cistern trucks that carry water of dubious drinking quality.

They are the most exposed to the risks of cooking with firewood because of the lack of household gas. It is women, particularly those who play a double role at home, who have to walk long distances day after day to take their children to school because of the lack of transportation. It is women who have to go from store to store just to find menstrual pads, which are either in short supply or sold at high prices and of questionable quality.

Venezuelan women have had to adapt to a myriad of adversities and deal with a distorted economy that has made them experience situations which women in other countries do not always experience combined and as part of their everyday life.

Below there is a brief description of some of some representative groups of the female population:

Women in the face of disease: Women suffering from chronic or degenerative diseases are at risk of imminent death, not for reasons inherent in their condition, but because of the shortage of supplies and medicines, the lack of financial resources and because the public health system is in shambles. Similarly, even for healthy women, if they are the mothers or the caregivers of a sick person, the crisis and the shortage will not cease to hit them and wreak havoc on their physical and emotional health, and it will be very hard for them to keep a job and generate income, being the ones who provide support to the affected person.

The economically productive woman: Her role is invaluable. She is generally young and active and studies and works.

However, she does not have a range of options that would allow her to build a prosperous future in her birth country.

At present, goals commonly associated with personal growth or progress, such as purchasing one’s own home, or buying a brand new car or a used one, or pay for graduate studies to pursue a specialization and increase one’s competitiveness, or starting a family once one shall have found a certain economic stability, have become practically unattainable for women, wherefore they have found themselves forced to seek better opportunities abroad, at a time when the exodus of professionals continues to increase in the country.

The sexually active and of reproductive age woman: At present, goals commonly associated with personal growth or progress, such as purchasing one’s own home, or buying a brand new car or a used one, or pay for graduate studies to pursue a specialization and increase one’s competitiveness, or starting a family once one shall have found a certain economic stability, have become practically unattainable for women, wherefore they have found themselves forced to seek better opportunities abroad, at a time when the exodus of professionals continues to increase in the country.

Women in this category are sexually active women, of reproductive age, who do not want to bring children into the world in a country that is immersed in poverty or in a state of permanent social and political conflict. These women, whether single, married, with or without children, with some purchasing power or low-income, have not only been deprived of their capacity to decide whether or not to raise a family: they have also seen their sexual well-being compromised. The shortage of

contraceptives and barrier and other methods (which exceeds 80 percent) has resulted in early, unwanted or planned pregnancies, induced abortions and an increase in the maternal mortality rate.

According to the Human Rights Watch (HRW) report, the most recent official statistics from the Venezuelan Ministry of Health indicate that, in 2016, maternal mortality rose by 65 percent and infant mortality did by 30 percent as compared 2

with the data available for 2015 . With regard to unprotected sex, it is a well-known fact that it results in the proliferation 2. Human Rights Watch (April 4, 2019). “Venezuela: La ONU debería liderar una respuesta a gran escala a la emergencia humanitaria”(Venezuela: Large-Scale UN Response Needed to Address Health and Food Crisis). Available at: Disponible en: https://www.hrw.org/sites/default/files/report_pdf/venezuela0419_web_0.pdf

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of sexually transmitted diseases and in an increase in the number of deaths associated therewith.

Women in mourning: Women in Venezuela may experience two types of mourning: the one associated with the early death of a loved one, especially the death of a child, either due to illness or at the hands of criminals, and the one related to the forced exodus of family members. The pain of loss for death and emigration is part of everyday life in hospitals, land terminals and international airports.

We are referring again to women caregivers, especially those who have had to live through the ordeal of trying to keep a minor alive in a public health facility. The clearest example of this situation may be witnessed almost daily in the pediatric units where children and adolescents with chronic illnesses have their days numbered, but not only because of reasons attributable to their disease but also because of the deplorable conditions of the medical areas or services where they are treated.

The cases are varied and heartbreaking, but the one that best evidences the mourning associated with the Venezuelan

health crisis is the case of the J. M. de Los Ríos Hospital (Caracas). Unfortunate deaths have been reported in the “children’s hospital”, the main pediatric center in the capital city: a poor supply of antibiotics; bacteria contaminated catheters that are not replaced in due time; chemotherapies cycles that are not completed because of the lack of specific treatment or because the equipment required to apply it is damaged; shortage of reagents to perform laboratory tests... These factors, among others, have precipitated the death of children who, had they received adequate care to prevent their initial condition from aggravating, would have had the chance to improve their health and have their lives prolonged instead of their agony.

From 2017 to date, at least 25 nephrology patients in the hospital aforesaid have died from infectious outbreaks in the hemodialysis service; more than a dozen children who were being treated at the J. M., awaiting a spinal transplant, have also died.

And there is the case of the mother who mourns the murder of a child. It is not only the one who mourns a child whose life was cut short in the hands of criminals: there is also the mother who, in an environment of political and social conflict, has to deal with the void left by a child who one day decided to exercise his or her right to free protest and did not come back home alive. The NGO Provea recorded more than 270 deaths during demonstrations since Nicolás Maduro inaugurated 3

as president. Fifty-five (55) of those 270 occurred in the year 2019 alone, and the ages of those killed by repression range between 17 and 45 years; but children and adolescents as young as 12 to 16 years old have also been reported murdered.

On the other hand, there is the woman or the mother in migratory mourning. In Venezuela, the youngest are leaving their mothers and grandmothers behind, with the latter being increasingly left without the hope of enjoying a future with their children and grandchildren. There are no precise data on exile. Numerous studies try to approximate reality, but most agree that between 3 and 4 million people have emigrated, which is almost 15 percent out of a population of 31 million inhabitants. It is 4

estimated that 80 percent of the people who have emigrated from Venezuela did so during the 2017-2018 period , and the main reasons for leaving is their search for a better quality of life and job opportunities and to be able to financially support the relatives who remain in the country.

3. BBC News World (May 2, 2019). “Crisis en Venezuela: quiénes son los dos jóvenes muertos durante las protestas contra Maduro” (Crisis in Venezuela: Who Are the Two Young Men Who Died During Protests Against Maduro?). Available at: Disponible en: https://www.bbc.com/mundo/noticias-america-latina-48133661 4. Please see National Survey on Life Conditions (ENCOVI), 2019.

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Finally, all people, women and men, have the same right to enjoy a life of quality and well-being; however, given the differences described above, Venezuelan women are burdened with additional concerns and conflicts that do not always affect their male counterparts. All around the world, many women, regardless of their age and social status, are at a disadvantage because they traditionally carry loads such as long hours of domestic work and children (and other dependents) care, job instability, lower income or financial resources, limited access to health care, increasing gender-based violence, and other factors that undermine their physical and emotional stability and alienate them from integral well-being.

When talking about women and the violation of their rights, one cannot avoid dedicating a few lines to the research work of the Equivalencias en Acción coalition. Last May 17, this group of organizations disclosed its report, which they entitled Women on the Edge, 2019, whereby they exposed flagrant violations of the rights of Venezuelan women and the aggravated effects of the widening of the gender gap because of the complex humanitarian emergency. The study, which was undertaken by the Center for Justice and Peace (CEPAZ, by its Spanish acronym), the ‘Women Online’ Civil Association, the Venezuelan Association for Alternative Sex Education (AVESA, by its Spanish acronym) and the Freya Women’s Hispanic American Center, unveils highly concerning data.

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For instance, there is record of 2,246 abortions between August and December 2018. The experts who collaborated in the research work reported that the miscarriages were due to nutritional deficiencies and lack of prenatal care, while the induced abortions had to do with the lack of access to contraceptive methods and the impossibility of family planning. AVESA’s coordinator, Magdymar León Torrealba, stated that for every four births there was one abortion, with an average of 15 abortions a day in the four medical centers surveyed for the report.

For her part, Luisa Kislinger, a researcher at the ‘Women Online’ Civil Association, noted that the complex humanitarian emergency facing Venezuela has also increased the gender gap in terms of job performance and household care. The researcher relied on important data from the National Statistics Institute (INE) according to which by 2016 there were 3,071,881 women exclusively dedicated to the household, compared to 64,000 men who do so. Kislinger asserts that this responsibility (household care), when assumed without the support or assistance from the family, prevents women from developing professionally and brining in much-needed income.

In Women on the Edge 2019, reference is also made to the issue of violence against women, although there is no accurate information as to the number of complaints officially filed with the competent authorities. According to figures from the Cotejo. info website, which was cited in the report, 448 femicides were reported in Venezuela in 2018, a 10.89 percent increase vis-à-vis the femicide rate during 2017. Additionally, 35 of every 100 femicides are those of women aged 25 to 45, while 27 of every 100 femicides are committed against women under 25.

To conclude this brief preamble dedicated to the Venezuelan woman and mother, it is important to refer to the relationship between gender approach and the Sustainable Development Goals (SDGs), such as No Poverty, Zero Hunger, Good Health and Wellbeing, Quality Education and Gender Equality, which pose great challenges for all nations, especially for those in emerging 6

processes of evolution and development. The Sustainable Development Goals that must be met by the year 2030, include:

5.CIVILIS HUMAN RIGHTS Association (May 17, 2019). “Mujeres al Límite 2019: Urge implementación de planes y políticas que garanticen la vida digna de mujeres y niñas en Venezuela (Women On The Edge, 2019. Urgent Implementation of Plans and Policies Needed to Guarantee a Decent Life for Women and Girls in Venezuela).

Available

at:

:

https://www.civilisac.org/informes/mujeres-al-limite-2019-urge-implementacion-de-planes-y-politicas-que-garanticen-la-vida-digna-de-mujeres-y-

ninas-en-venezuela. Informe completo disponible en: https://qrcgcustomers.s3-eu-west-1.amazonaws.com/account5186516/3142956_1.pdf?0.8332350487795517 6. See: : http://www.unwomen.org/es/news/in-focus/women-and-the-sdgs

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Reduce the maternal mortality ratio to 70 deaths per 100,000 live births; Guarantee universal access to sexual and reproductive health services, including family planning, information and education, and the integration of reproductive health into national strategies and programs; End all forms of discrimination against women and girls around the world; Foster and promote the social, economic and political inclusion of all persons, irrespective of age, sex, disability, race, ethnicity, origin, religion or economic status or other considerations.

Now, the following questions arise: Will the conditions for advancing and achieving sustainable development ever be in place?

Will Venezuela be in a capacity to meeting those goals that would significantly favor the female population?

Unfortunately, as long as the authorities and other political and civil society actors in Venezuela do not immediately and jointly undertake to design and implement public plans and policies as part of a series of economic, political and social recovery actions that address in a timely manner the adverse impact of the Complex Humanitarian Emergency, it will be very hard and perhaps even impossible to guarantee life with dignity for the entire population and, therefore, achieve the much desired sustainable development of the nation.

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RESULTS:

INDICATOR BEHAVIOR AND EVOLUTION

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The shortage indexes reported in our May 2019 survey within the framework of the “Monitoring the Right to Health in Venezuela” project, which range from 31 percent and 93 percent, are shown below.

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

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

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

7. 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, disponibles en: https://conviteblog.wordpress.com/

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

Chart No. 3: Behavior of the Medicine Shortage Index by Morbidity: Diabetes. May 2019.

Graicy Castro, president of the Carabobo-based Sweet Hope Foundation (Fundación Dulce Esperanza), reported that the health of between 300 and 400 infants with diabetes is currently at risk due to the lack of insulin and medical supplies and because of the constant electric power outages that break the cold chain required to protect drugs.

In Castro’s words, “it is difficult to find medicines in the country; the majority of the people must buy them in Colombia, or in US dollars if and when available here in the country. An insulin pen can cost “from USD 20.00 to 8 USD 30.00”; “a [box of] blood glucose test strips can cost between USD 45.00 and USD 50.’’

She also commented on the rudimentary methods that people have had to resort to in order to prevent insulin damage, including to bury insulin vials in flowerpots or pots wrapped in a towel moistened with cold water.

Graicy Castro’s testimony is just an example of the painful reality that diabetics have to endure in Venezuela.

According to our report, the city of Barquisimeto was the worst supplied in May (87 percent shortage), whereas Maracaibo was the one where people were most likely to find medicines to control their diabetes (37 percent shortage). In the rest of the cities surveyed, shortage indexes ranged between 62 percent and 80 percent..

8.LARA, Ruth (May 9, 2019). “Falta de medicamentos y cortes eléctricos mantienen preocupados a pacientes con diabetes en Carabobo” (Shortage of Medicines and Blackouts Cause of Concern for Diabetes Patients in Carabobo). Available at: Disponible en: https://elpitazo.net/salud/falta-de-medicamentosy-cortes-electricos-mantienen-preocupados-a-pacientes-con-diabetes-en-carabobo/

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HYPERTENSION:

Chart No. 4: Behavior and Evolution of the Medicine Shortage Index by Morbidity: Hypertension. May 2019.

Hypertension is one of the major risk factors for death from cardiovascular

In addition to taking medications, this condition requires patients to have

disease. May 17 marked World Hypertension Day, which is observed

a balanced diet and a minimum exercise plan in place. In Venezuela, food

every year to raise awareness on hypertension prevention, detection

availability and personal security constraints prevent diabetes patients

and control. The World Health Organization proposes different themes

from following a comprehensive and effective treatment.

for each year’s campaign, and this time it was “Know your numbers”, which is aimed and promoting knowledge of the pathology and the

According to the May 2018 European Heart Journal survey, approximately

importance of keeping it under control.

75 percent of the elderly people in Venezuela have high blood pressure.

This morbidity is one of the major causes of death in the elderly.

According to the WHO, about 1.6 million people in Latin America and the Caribbean die each year from cardiovascular diseases such as

The shortage rate of the basket of medicines prescribed to control

ischemic heart disease and stroke, half a million of which die before the

hypertension was not as high as in previous months for they can be

age of 70, high blood pressure being the main risk factor.

more readily found in pharmaceutical establishments. Within the group of monitored cities, Ciudad Bolívar had the largest stock

In Venezuela, people with hypertension are subject to multiple violations of their Right to Health:

of antihypertensive drugs and a 31 percentage shortage, whereas Puerto La Cruz and Barquisimeto were the worst

The shortage of antihypertensive medication has forced people to replace their prescribed drugs with some others that are not always suitable for their specific condition. Self-medication is not convenient

stocked, with shortage indicators above 70 percent.

The rest of the cities surveyed had shortage rates of between 44

percent and 55 percent. Although the search for medicines to treat Worrying for the high cost of medicines and the impossibility to follow

high blood pressure is no longer that tortuous, the people who need

or maintain treatment as required produces stress and leads to anxiety

them complain that they are sold at high prices; accordingly, they see no

crises, which in turn translate into uncontrolled blood pressure levels

reason to celebrate that there are more antihypertensive drugs in stock

and the worsening of the condition.

in pharmacies if they cannot afford to them.

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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. May 2019.

With regard to treatments to control acute respiratory infections (ARIs), the serious shortage trend unfortunately remains unaltered. The lowest shortage indicator for the month of May was 66 percent, for Ciudad Bolívar, whereas the highest was almost 90 percent, for Barquisimeto. On the other hand, Puerto La Cruz, the Metropolitan Area of Caracas, Mérida and Puerto Ordaz had shortage rates higher than 83 percent, while in Maracaibo and Valencia they did not exceed 72 percent.

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DIARRHEAL DISEASES:

Chart No. 6: Behavior and Evolution of the Medicine Shortage Index by Morbidity: Diarrhea. May 2019.

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Sewage leaks in the city of Merida have their inhabitants worried because of their fear of experiencing health problems in a country where there is a shortage of medicines and where the costs of drugs, if and when found, is so high that not anyone can afford to buy them. Children and the elderly continue to be the most affected.

The case of Mérida is echoed in almost all Venezuelan regions. Most cities have poor drinking water and sewage treatment services, which severely impacts on their inhabitants’ quality of life, not only because they receive a terrible service, but because they must suffer the consequences of such inefficiency in the form of, for instance, outbreaks of infectious diseases that attack the digestive system.

In May, the cities of Maracaibo, Ciudad Bolívar and Valencia were among the best supplied with medicines to fight diarrhea, with shortage rates below 50 percent, whereas the worst stocked were Barquisimeto, at the top of the list (87 percent shortage), followed by Puerto La Cruz (74 percent), the Metropolitan Area of Caracas (68 percent), Puerto Ordaz (60 percent) and Mérida (54 percent).

9.

DELGADO, Jade (16 de mayo de 2019). “Entre heces fecales en las calles y carreteras destruidas viven en Mérida”. Disponible en: http://caraotalibre.cf/

regionales/entre-heces-fecales-en-las-calles-y-carreteras-destruidas-viven-en-merida/

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DEPRESSION OR PERSONALITY DISORDERS:

Chart No. 7: Behavior and Evolution of the Medicine Shortage Index by Morbidity: May 2019.

“In Venezuela, we live in scenarios that trigger panic attacks”, says Stefania Aguzzi, a clinical psychologist of the Central University of Venezuela. “We live in constant expectation of what we will be confronted with during the day, 10

day after day.” Depression, anxiety, irrational fear, fear of going out on the streets, etc., are some of the disorders experienced by Venezuelans. Interviews of specialists stating that throughout their professional life they had never received so many emotionally and psychologically exhausted patients as they are seeing now, which attests to the undermining of the mental health of citizens in the country, can be readily found in digital media.

It is true that personality disorders are controllable, but in Venezuela people are being constantly driven away from that possibility. Depression is one of the most dangerous disorders because, once the affected person loses control over him/herself, she or he can even attempt to take her/his own life if conditions do not improve. In May, the shortage rates for antidepressants, per city, exceeded 67 percent; the city with the greatest shortage was Barquisimeto, with 90 percent. The rest of the cities had shortage rates ranging from 71 percent to 88 percent for psychopharmaceuticals.

10. LLABANERO, Néstor (May 10, 2019) “Los venezolanos viven un contexto que propicia los ataques de pánico” (Venezuelans Live In An Environment that Favors Panic Attacks). Available at: Disponible en: http://caraotalibre.cf/destacada-del-dia/los-ataques-de-panico-llegansin-preaviso/

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SEIZURES

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

“The situation is alarming, sad and depressing”, that in the words of Dr. Luisa Elena del Moral, former president 11

of the Venezuelan Society of Neurology. She notes that she has had people coming to her office for consultation who have had to reduce their dosage of anticonvulsants in an effort to “ration” treatment.

As with antidepressants, anticonvulsants are still in short supply, despite its shortage rates having slightly decreased as compared to previous months. In May, Puerto Ordaz, the Metropolitan Area of Caracas and Barquisimeto had shortage rates in excess of 90 percent; Puerto la Cruz and Mérida had shortages of above 88 percent, while in Valencia, Maracaibo and Cuidad Bolívar the indicators showed shortage rates exceeding 74 percent.

11. PINEDA, Julett (May 24, 2019) “Pacientes obligados a reducir dosis de anticonvulsivantes por la escasez y altos precios” (Patients Forced to Reduce Anticonvulsant Dosage Due to Shortages and High Prices). Available at: Disponible en: http://efectococuyo.com/principales/pacientes-obligados-areducir-dosis-de-anticonvulsivantes-por-la-escasez-y-altos-precios/

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SEXUAL AND REPRODUCTIVE HEALTH AT RISK

ON CONTRACEPTIVES

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

Magdymar León Torrealba, coordinator of the Venezuelan Association for Alternative Sex Education, indicates that there was one abortion for every four births, with an average of 15 abortions per day in the four medical centers monitored by the Equivalences in Action Coalition (Coalición Equivalencias en Acción) for its annual report ‘Women on the Limit 2019’ (Mujeres al límite 2019), namely: the ‘Dr. José María Vargas’ Maternal and Children Hospital, also known as La Maternidad del Sur, located in the state of Carabobo; the ‘Supreme Commander Hugo Chávez Frías’ High Risk Maternity Hospital, in the Enrique Tejera Hospital City in the state of Carabobo; the ‘Victorino Santaella’ Hospital in the state of Miranda, and the ‘Concepción Palacios’ Maternity Hospital, in Caracas.

The psychologist and activist claimed that the Venezuelan State condemns abortion but does not guarantee sexual and reproductive rights to its citizens, wherefore they are increasingly left unable to decide on and purchase contraception methods. Our survey of more than 100 pharmacies in the cities of Caracas, Barquisimeto, Maracaibo, Mérida and Puerto la Cruz to determine contraceptive shortage rates yielded the results below.

In May, condoms and emergency contraceptives were among the least scarce; they were the least difficult to find in most places; however, it was not the case for the rest of the contraceptive methods surveyed: injectable contraceptives, intrauterine devices, implants, patches and vaginal rings were virtually inexistent in the pharmacies visited, with shortage rates ranging from 58 percent to 100 percent. As for oral contraceptives, they could only be found without so much of a pilgrimage in the city of Maracaibo

12. To select the contraceptive methods measured by the index we had the support of the Equivalences in Action Coalition (Coalición Equivalencias en Acción), which is made up of the Center for Justice and Peace (CEPAZ), the ‘Women Online’ Civil Association, the Venezuelan Association for Alternative Sex Education (AVESA) and the Freya Women’s Hispanic American Center.

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REFLEXIÓN DESDE LOS MOVIMIENTOS DE MUJERES DE LAS REGIONES For some years now, Venezuela has been seriously affected by a crisis of such proportions that it has been identified as a 13

complex humanitarian emergency and has moved the international community and UN agencies to action in the form of aid.

Women’s rights organizations have devoted much effort to showing how the crisis, as unbearable as it is for all, is ruthless when it comes to women. May is the month where Mothers’ Day is celebrated in Venezuela, and we would like to take that opportunity to show how motherhood is one of the most affected by the crisis and to what extent it is women who carry the disproportionate burden of the failure of those in power.

In recent decades, motherhood in Venezuela has meant that women are exposed to situations that are not mere difficulties but involve cruel violations of their rights and those of their offspring. To begin with, the simple decision of whether or not to have children is highly conditioned in a country where the statutory minimum wage, scourged by hyperinflation, is too low to guarantee decent living conditions for a single person, let alone for an entire family. Women are not only deprived of a decent 14

income: they also lack guarantees for sexual education and access to contraceptive methods to plan their family life. This is precisely why our country is the third country in Latin America with the highest number of teenage pregnancies, according to the 15

latest UNFPA State of World Population Report for 2019. As a consequence of the total inaction on the part of the government, we continue to lead this index that only shows that young Venezuelan women are being condemned to poverty.

But it is not casual: poverty in Venezuela is used by the State as an instrument of social control. Chavismo’s programs are based on handouts in the form of aid that adversely impact our economy and generate dependence among its beneficiaries.

Additionally, initiatives such as the Misión Madres del Barrio, which provides women with financial aid for each child born, have resulted in the singling out and social condemnation of the women who take them forced by need. At the same time, a sector of society, from its privileged distance, ends up holding them accountable for something that is the logical consequence of the lack of educational policies in matters of family planning by an indolent State that tries to take advantage of them, because the main source of violence faced by women is State violence.

Regardless of whether they planned to have children or went through an unplanned pregnancy because they had virtually no access to contraceptive methods through the public health system or the private sector, as Convite has been documenting, women have no options for voluntary termination of pregnancy because Venezuela has one of the most restrictive abortion laws in Latin America. Furthermore, in a dollarized economy where access to private health is not at the reach of the majority of the population, women are forced to have their pregnancies managed by a collapsed public health system. The extent of the collapse is such that one of the country’s major maternity hospitals, the ‘Concepción Palacios’, located in the capital city, 16

has been granted precautionary measures by the IACHR in an effort to try to hold the State responsible for its obligation to guarantee the right to life and health of the women who come to said healthcare center.

The response from the State has been to turn a deaf ear, despite the fact that maternal mortality according to Epidemiological Bulletin 52 of 2016, which has the last official known figures, reported the death of 756 pregnant women, a 65.79 percent increase with respect to the 456 pregnant women recorded dead in 2015.

13. http://acnudh.org/informe-oral-de-actualizacion-sobre-la-situacion-de-derechos-humanos-en-la-republica-bolivariana-de-venezuela%EF%BB%BF/ 14.http://sinergia.org.ve/2019/05/17/mujeres-al-limite-2019-urge-implementacion-de-planes-y-politicas-que-garanticen-la-vida-digna-de-mujeres-y-ninas-en-venezuela/ 15. https://venezuela.unfpa.org/es/publications/estado-de-la-poblaci%C3%B3n-mundial-2019-4 16. http://www.oas.org/es/cidh/decisiones/pdf/2019/13-19MC150-19-VE.pdf

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Women with children must not only fight the hunger that plagues the country: they must also be lucky enough to have perfect health because there are no medicines, no medical personnel, and particularly no public healthcare institutions equipped to care for vulnerable children such as those with chronic diseases. The ordeal of the mothers of the J. M. de Los Ríos Hospital , a health center specialized in pediatric care, can be easily described as a nightmare for any human being who brings children into the world, because they see their children die before the incompetence and evil of a liar State that ignores its responsibilities and obligations. The government’s representatives will be forever indebted to them, and the damage that said women had been inflicted cannot be redressed by justice, for they had been subjected to unspeakable suffering, which is proof of the size of the former’s infamy.

These violations of the right to life and health of mothers and their children occur in the capital of the country, there where the State makes its last and pitiful effort to maintain the appearance of a government to appease discontent as much as possible.

If this is the case of the capital city, one can only imagine the reality in the rest of the country, where nothing works: there is no water, there is no electricity, there is no public transportation, waste is not picked up or disposed of on a regular basis, and there is no gas for cars. It is also there where the private sector and, therefore, employment opportunities, fall down by the effects of the crisis, and where cash is almost non-existent, so foreign currencies such as the Colombian peso, the US dollar and even gold are used to purchase food and dominate the economy. Those living in that Venezuela have seen their human rights violated and said violation even normalized. That is the reality in which the mothers of Zulia, Cojedes, Maturín, Ciudad Bolívar and the rest of the country are raising their children.

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So, it does no come as a surprise that women who live closer to the border with Colombia or Brazil cross the borders to give birth, vaccinate their children, find them medical attention or buy them food. They come and go, whenever they can, trying to make ends meet and making enormous sacrifices because the crisis has made it increasingly hard for them to guarantee the well-being of their children and because it seems that in Venezuela they cannot longer offer them a better future. Too many women have been forced, against their wishes, to migrate to other countries, leaving their children behind under the care of grandparents, sisters and other relatives while they settle and find the conditions to send for them; unfortunately, in their new destination, women are exposed to dangers such as violence or human trafficking and many are victims of an unexpected xenophobia whose lesser manifestation is to call them venecas [a pejorative and insulting term to refer to Venezuelan migrants] and husband stealers, and have even been asked to stop giving birth in sadder instances of discrimination.

The migratory dynamic has also forced numerous grandmothers, who should already be retired from a life of work, to spend their golden years caring for grandchildren at a stage in their lives when they themselves need to be taken care of, and that if they are lucky, because there are many women who have been left without their children and grandchildren and are living their senior years like empty nesters, for their entire families have emigrated. These are the women who, having devoted their whole life to their family, might end up dying alone.

This is the reality of Venezuelan women who still struggle to get through it all and work hard to secure a new reality for 19

themselves and their loved ones. Meanwhile, Venezuela ranks 82nd in a list of 129 countries rated according to their progress in achieving gender equality, which is the fifth sustainable development goal to be achieved by 2030. It is the worst ranking in South America, and it is the doing of a government that calls itself feminist while it systematically strips women of their rights and pushes women and girls, who account for more than half of the country’s population, away from a better reality.

17.https://prodavinci.com/el-j-m-de-katherine/ 18. https://www.bbc.com/mundo/media-44168930 19. https://data.em2030.org/wp-content/uploads/2019/05/EM2030_2019_Global_Report_ENG.pdf

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In the organizations that protect and defend the rights of Venezuelan women we believe in gender equality and in the guarantee of women rights as the way to approach true development. We hope that everyone will join our struggle.

*EstefanĂ­a Mendoza Planning, Programs and Projects Mulier Feminism

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#CONVITEDENOUNCES

13 diphtheria deaths of children

MAY 2019 VENEZUELA

and adolescents in the first trimester of 2019.

Balance 30 April – May 1. An Attempt to Restore Constitutional Order

Tuesday, April 30, 5:45 a.m. It was just before sunrise in the city of Caracas and the social networks were already bursting with activity. Something peculiar and totally out of the agenda was happening. Interim President Juan Guaidó, along with political leader Leopoldo López and a group of military supporters, were outside La Carlota Air Base in Caracas calling on citizens from all over the country to accompany him in the streets until the constitutional order was restored and the usurpation ceased This early morning action took off many of their beds and impregnated the atmosphere with a mixture of emotions ranging from early euphoria to whipping uncertainty; citizens were torn between their desire for early celebration and their need to remain sensibly calm. What happened between the last day of April and the first day of May 2019 triggered a series of events that did not meet the immediate expectations of many and left an unfortunate balance of: de acontecimientos que no satisficieron las expectativas inmediatistas de muchos y además dejaron un balance lamentable: •

205 people detained;

•

17 complaints of use of tear gas;

•

108 people injured and 4 murdered;

•

32 complaints of use of rubber pellets;

•

3 raids and 3 robberies;

•

3 events of intimidation with armored vehicles;

•

21 acts of repression;

•

15 complaints of use of firearms.

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This report, courtesy of the NGOs Sin Mordaza, the Penal Forum and the Observatory of Social Conflict , summarizes the events of two days of citizen protest that were strongly repressed by officers from the Bolivarian National Guard (GNB, by its Spanish acronym), the Bolivarian National Police (PNB, by its Spanish acronym), the National Anti-Extortion and Kidnapping Command (CONAS, by its Spanish acronym), as well as by the so-called “colectivos” irregular armed groups. The federal entities most affected by the repressive acts were the Metropolitan Area of Caracas and the states of Miranda, Anzoátegui, Aragua, Barinas, Bolívar, Carabobo, Falcón, Guárico, Lara, Monagas, Táchira, Trujillo, Vargas, Yaracuy and Zulia.

In addition to the serious attack on those who decided to take to the streets to exercise their right to protest, there was a flagrant violation of the freedom of expression and the right to information. Data from the monitoring system of the Venezuelan Press and Society Institute (IPYS, by its Spanish acronym) revealed that press coverage of the events that occurred between Tuesday, April 30 and May 1 “faced obstacles that amounted to at least 22 cases of violations of the right 21

of expression and access to information”; additionally, arbitrary arrests were made, damage was inflicted to the physical integrity of reporters and photographers, equipment was stolen, and censorship measures were taken against traditional media and digital platforms. medios tradicionales y plataformas digitales.

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The balance was as follows:

•

Twitter,

Periscope,

YouTube

and

Facebook

•

16 journalists attacked by public order forces;

were blocked after Guaidó announced the final stage of

•

3 radio stations were taken off the air and

“Operation Freedom” from the military base in La Carlota,

vandalized;

according to information posted by Netwblocks on its

•

website.

2 international news channels were taken off the

grid of subscription TV providers; 20. Check Un mundo sin mordaza infographics in Instagram: @sinmordaza 21. Available at: https://ipysvenezuela.org/alerta/balance-semanal-ipysve-48-casos-de-violaciones-a-la-libertad-de-expresion-en-abril/ 22. ARRIAGA, Marco (May 2, 2019). “Periodistas que cubrían las protestas también fueron blanco de la brutal represión ordenada por Maduro” (Journalists Covering Protests Also Target of Brutal Repression On Maduro’s Orders). Available at: Disponible en: http://caraotalibre.cf/nacionales/periodistas-que-cubrian-las-protestastambien-fueron-blanco-de-la-brutal-represion-ordenada-por-maduro/

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#CONVITEDENUNCIA: Unfortunately, things did not end there: as the hours passed, the arbitrariness of the government and its security forces continued to materialize. The NGO Doctors United for Venezuela (Médicos Unidos por Venezuela denounced the strong repression demonstrators by the State and warned of the detention of 11 health workers; the arrests were made in the 23

states of Zulia, Aragua, Caracas, Carabobo and Falcón.

Dr. Jaime Lorenzo, who performs as the director of the organization aforesaid, reported that seven volunteer paramedical staff had been fiercely assaulted since the events of April 30. For Dr. Lorenzo, it is no secret that medical personnel are at risk in conflict situations, but “they were always respected”. Shooting at point-blank range at paramedical personnel or ramming healthcare centers or duly identified medical and aid vehicles are acts that do not occur even in countries at war. Attacks on medical neutral areas, facilities and personnel are prohibited under the Geneva Convention of 1949 and its additional protocols of 1977, to which Venezuela is a signatory State.

In the meantime...

The Complex Humanitarian Emergency is still there, relentless, worsening with each passing day, while the population is desperate and in urgent need of the timely activation of each and every humanitarian action mechanism necessary to appease their tragic situation.

ACAPS, an organization that provides analysis by independent specialists in humanitarian needs to competent actors on the trends and on the likely impact of the humanitarian crisis, has recently published the following indicators On a scale from 0 to 5, with 5 being the highest value:

Severity of the Crisis: 3.8. The severity score of

Complexity of the Crisis: 3. The highest the

value of the indicator, the fewer the factors that influence

1 to 5 is based on 31 indicators, aggregated into three

its mitigation or resolution;

dimensions: impact, conditions and complexity;

•

Impact of the Crisis: 4, indicating the extent of

the effects of the crisis in geographical and human terms;

Constraints for Access to Humanitarian Aid:

4, which is the highest value. Humanitarian assistance is subject to political interference and may be highly restricted.

According to ACAPS’ ranking that measures access to humanitarian assistance at the global level, Venezuela shares the status of “almost inaccessible” with Iraq, Afghanistan, Libya, Myanmar, Nigeria and Southern Sudan, among other nations.

Other alarming figures reported by ACAPS on the Venezuelan emergency include: •

29,255,000 people affected;

•

3,700,000 displaced persons;

•

14,920,000 people in need

The State continuously fails to guarantee citizens the full exercise and enjoyment of their right to health; therefore, it violates people’s right to life.

23. MORENO LOSADA, Vanessa (May 2, 2019). “Ataque directo a paramédicos e iglesias viola protocolos internacionales en situación de conflictos”. (Direct Assault on Paramedics and Churches Infringes International Conflict Protocols). Available at: Disponible en: http://efectococuyo.com/sucesos/ataque-directo-a-paramedicose-iglesias-viola-protocolos-internacionales-en-situacion-de-conflictos/

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#CONVITEDENUNCIA: The J. M. de Los Ríos Hospital Is Still a Death Scene 24

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26

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Giovanni Figuera (6 years old) , Robert Redondo (7) , Yeiderbeth Requena (8) , Erick Altuve (11) and Yoider Carrera 28

(2) add to the list of children who have died since December 2018 in this healthcare facility, specifically in the hematology service

4

These children died in less than a month, just days apart from each other; four of them children have died in

died while waiting for a bone marrow transplant or did not get to receive first-line

less than a month at the

chemotherapy while they were still alive to fight acute lymphoblastic leukemia (Figuera,

J. M. de Los Ríos Hospital.

Redondo and Requena), non-Hodgkin’s lymphoma (Altuve) and a brain tumor (Carrera).

They were all awaiting a

They also required to be administered difficult to obtain broad-spectrum antibiotics

bone marrow transplant.

(vancomycin and meropenem) to prevent potential infections to which they were prone due to their depressed immune systems.

There were 19 minors in the “children’s hospital,” specifically in the hematology service, of the 26 patients there who need a bone marrow transplant; meanwhile, the government claims to lack the funds to help them because of the financial blockade and sanctions imposed by the United States of America..

ElThe transplant agreement between Petróleos de Venezuela (PDVSA, by its Spanish acronym) and the Italian Bone Marrow Transplant Association (ATMO, by its Spanish acronym), which was established in 2006, is no longer in force because the state-owned oil company has failed to repay the EUR 10,746.014.07 debt that it has with the 29

Italian public system; operational problems with the agreement began in 2015, when the Venezuelan Foundation for the Donation and Transplant of Organs, Tissue and Cells (FUNDAVENE, by its Spanish acronym), an agency attached to the Ministry of Health, delayed the assessment of transplants cases because of internal issues.

In like manner, pediatrician Huníades Urbina, who is the chairman of the Venezuelan Society of Pediatrics and Puericulture and the director of the J. M. de Los Ríos Hospital, claims that reports have been filed since 2014 30

with the Office of the Comptroller General that expound on the crisis of the medical institution in question.

The Hematology Service has had more than 4 years of unresolved difficulties, as has the Nephrology Service, which to date continues to deal with an infectious outbreak that puts the lives of more than a dozen users at risk.

Ironically, on the night of May 23, Maduro approved EUR 56.8 million to manufacture military uniforms and machine guns domestically. That same morning, one of the children in the hospital (Robert Redondo) died.

According to information provided by FUNDAVENE, a spinal cord transplant in Europe can cost between EUR 175,000.00 and 250,000.00 on average.31 24. EL PITAZO (May 6, 2019). “Muere niño con leucemia que esperaba un trasplante en el J.M. de los Ríos”. (Child Dies of Leukemia Awaiting Transplant at the J. M. de Los Ríos). Available at: https://elpitazo.net/gran-caracas/muere-nino-con-leucemia-que-esperaba-un-trasplante-en-el-j-m-de-los-rios/ 25. PINEDA, Julett (May 23, 2019). “Muere segundo niño durante espera de un trasplante medular en menos de un mes” (Another Child Dies Awaiting Bone Marrow Transplant in Less Than A Month). Available at: http://efectococuyo.com/principales/muere-segundo-nino-durante-espera-de-un-trasplante-medular-enmenos-de-un-mes/ 26. PINEDA, Julett (May 25, 2019). “Yeiderberth es el tercer niño que muere en mayo a la espera de un trasplante medular” (Yeiderberth is the Third Child to Die in May Awaiting A Bone Marrow Transplant). Available at: http://efectococuyo.com/principales/yeiderberth-es-el-tercer-nino-que-muere-en-mayo-a-la-espera-de-untrasplante-medular/ 27. PINEDA, Julett (May 26, 2019). “Erick Altuve es el cuarto niño que fallece en el J.M. a la espera de un trasplante medular” (Erick Altuve is the Fourth Child to Die at the J. M. de Los Ríos Awaiting a Bone Marrow Transplant). Available at: http://efectococuyo.com/salud/erick-altuve-es-el-cuarto-nino-que-fallece-en-el-j-m-a-laespera-de-un-trasplante-medular/ 28. CARBALLO, Betzimar (May 28, 2019) “En 21 días cinco niños han muerto en el J. M. de los Ríos” (Five Children Have Died Within 21 Days at the J. M. de Los Ríos).

Available at http://caraotalibre.cf/nacionales/cinco-ninos-muerto-j-m-rios/ 29.ALTUVE, Armando (May 27, 2019). “Madres del J.M. de los Ríos: “Más salud, menos armas”. (Mothers of J. M. de Los Ríos Patients: “More Health, Less Weapons”).

Available at https://elpitazo.net/salud/madres-del-j-m-de-los-rios-mas-salud-menos-armas/ 30. PARRAGA, María Isabel (May 27, 2019) “Huníades Urbina: “La crisis del J.M. de los Ríos data de mucho antes del bloqueo”. (Huníades Urbina: “The J. M. de Los Ríos Crisis Dates Back to Long Before the Blockade”). Available at: https://soundcloud.com/elpitazoenlaradio/el-tema-del-dia-huniades-urbina-la-crisis-del-jm-de-losrios-data-de-mucho-antes-del-bloqueo 31. PINEDA, Julett (May 25, 2019). “Más de 200 trasplantes medulares se pueden costear con lo aprobado para armas y uniformes”. (More than 200 Bone Marrow Transplants Could Be Covered With Funds Approved to Purchase Weapons and Uniforms). Available at: http://efectococuyo.com/salud/mas-de-200-trasplantesmedulares-se-pueden-costear-con-lo-aprobado-para-armas-y-uniformes/

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#CONVITEDENUNCIA: The total amount approved for the production of war material and equipment could fund some 227 bone marrow transplants in Europe (calculated at the highest cost) for transplants with non-compatible donors; in the case of transplants of compatible donors, the procedure can be performed locally in Venezuela (at the ‘Dr. Enrique Tejera’ Hospital in Valencia and at the Hospital de Clínicas Caracas), but government funds are also needed because the majority of the people in charge of the affected patients cannot afford to pay for all the expenses involved.

In the meantime, patients at the “children’s hospital” continue to wait for a bone marrow transplant, all with different pathologies: relapsed acute lymphoblastic leukemia, thalassemia major, medullary aplasia, severe sickle cell anemia, high-risk myeloid leukemia and Hodgkin’s and non-Hodgkin’s lymphomas.

May 29, Day of the Elderly in Venezuela: another year and no reasons for celebration The most recent data from the Global Ageing Index indicates that Venezuela ranks 76th among the 96 worst 32

countries to grow old, that in terms of income security, health, favorable environment and competencies. The report dates back to 2015; still, the country’s conditions continue to be the least favorable for the elderly.

Long lines of senior citizens standing at banking institution’s door to collect their pensions are still a daily occurrence, mostly during the third week of each month and from very early in the morning. It is a monthly long day for them that violates their right to social security. The most devastating aspect about this situation is that they are not only affected by the unnecessary hurdles that they have to overcome to withdraw their pension money: their pension money is insufficient to cover even a quarter of their basic needs.

The elderly live one ordeal after the other; in addition to the exhausting lines to collect their pension, they must also make long lines to purchase food at regulated prices. Many do not have enough money to buy protein and vegetables, which increases their intake of simple carbohydrates (pasta, rice, bread) and leads to raised blood glucose levels; others have no other alternative than to complement their diet with the products, of questionable quality, that come in the food boxes distributed by the Local Supply and Production Committees (CLAP, by its Spanish acronym).

As a consequence, elderly people in Venezuela are malnourished, their physical health is compromised, and they are immersed in a context of food insecurity.

And it is not only a matter of the quality of the food that they eat: they have to deal with medicine shortages and increased medicine prices. The most common morbidities in the Venezuelan elderly are hypertension and diabetes, and the drugs to control them are not only in short supply (60 percent to 80 percent shortage) but expensive, so most of the patients in this category have chosen not to take them or to take them every other day, which worsens their pathology. Older people do not have multiple options here: either they eat or they control themselves medically.

Another evil that afflicts the Venezuelan elderly is loneliness, either because of circumstances inherent in their family circle (children who leave home, widowhood, etc.) or because they are abandoned. It has become common in Venezuela to find old people living alone, not only due to the fact that their closest relatives have left home, or but also because people have to travel thousands of kilometers to visit relatives, which is one of the effects of forced migration.

32.Available at https://www.helpage.org/global-agewatch/about/about-global-agewatch/

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#CONVITEDENUNCIA: Some of them have the financial support of their family members who have moved abroad; others have been left to their own devices, isolated, unassisted and abandoned at home or in nursing homes that operate in deplorable conditions; they are thus left vulnerable to the underworld and dependent on the solidarity of a neighbor, a caregiver or non-governmental human rights organizations that provide support and generate alternative solutions to the lack of public policies that could effectively put an end to the state of defenseless of the most vulnerable population groups.

The Organic Law for the Social Security System and the Integral Attention of the Elderly, the Law on Social Services, and the Law of Compulsory Social Security, among others, have just become dead letter because people over 60 continue to go through serious hardship despite the juridical support that they have in Venezuela and because there seems to be no real intention on the part of the State to support this sector of the population.

Despite the evident deterioration of the lives of the elderly, the government intends to implement a program called “Plan Chamba Mayor” aimed at inserting senior citizens back into the national productive system. What is a serious cause for concern in this case is that most elders in Venezuela are living in precarious conditions, and factors such as poverty, age discrimination and deteriorated health may make them perform work under no contract and without insurance or benefits, the kind of job that is generally poorly remunerated and may potentially expose them to hazards and have them perform tasks that may be detrimental to their physical health.

In 2015, Venezuela already ranked 76th among 96 countries designated as the worst countries to grow old.

The government institutions are making no effort to seek viable and beneficial solutions to allow older adults to live with dignity from their pensions and enjoy their retirement in good health and wellbeing. The elderly’s desire to continue working and active must be driven by a very personal decision. Senior citizens should not be compelled to seek employment to secure financial means just to be able to subsist.

The International Nurses Day Is Commemorated Amidst a Brain Drain and a Health Crisis Low wages, shortages of supplies, job insecurity and the paralysis of health services are the main reasons that force nursing professionals to leave their jobs and even their country.

In most hospitals, nurses do not have the necessary equipment and supplies to properly perform their tasks and do not even have biosecurity implements on hand to implement health protocols. Additionally, the complexity of their job increases with each unscheduled electric power interruption and with the water shortages that they have to deal with at the workplace..

50 percent of the nurses

In the state of Carabobo alone, 50 percent of the 12,000 registered nurses have

registered in the state of Carabobo have quit their jobs.

2,500 have left the country and are working in better-paid jobs.33

quit their jobs; there is a shortage of nursing staff in all the hospitals in the state:

Nurses are constantly intimidated for denouncing the deficiencies of the domestic public health system or are threatened by the patients’ relatives when they are warned of the lack of medicines and supplies.

33.CASTILLO, Ruth (May 13, 2019). “Más de seis mil enfermeros en Carabobo abandonaron cargos por crisis del sector salud” (More than 6,000 Nurses in Carabobo Have Quit Their Jobs Due to the Health Sector Crisis). Available at: https://elpitazo.net/centro/mas-de-seis-mil-enfermeros-en-carabobo-abandonaron-cargos-porcrisis-del-sector-salud/

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#CONVITEDENUNCIA: Venezuela at the Top of the List of Countries in the Americas with the Highest Suicide Rate Sociologist Roberto Briceño León, director of the Venezuelan Observatory of Violence (OVV, by its Spanish acronym), reported that Venezuela is at the top of the list of countries with the highest suicide rates in the American continent The expert pointed out that, before Chavismo, there were between 4 and 5 suicides for every 100,000 inhabitants.

Despite the oil bonanza of the government of the late Hugo Chávez, the rate increased to between 8 and 9 suicides, and from 2015 on, “the rate skyrocketed to an average of 19 suicides per 100,000 inhabitants”. The suicide rate 34

quadrupled in the last 15 years and “became a social phenomenon” , which is unfortunate.

According to Briceño León, one of the main causes of suicide in Venezuela is the depression associated with the severe crisis ravaging the country. Some people decide to leave the country; other people choose to take their own lives.

Another cause of suicide is job loss, which leads people to levels of despair that they are unable to control. And there is also the triggering effect of the shortage of psychoactive drugs, which also increases anxiety levels. For some people there is no choice but to ration their pills to half to make their stock last longer, but when they run out of pills, they try to kill themselves.

People with chronic illnesses, including cancer, AIDS and kidney disease, are also part of the statistics. When they cannot find their much needed medication, they prefer to commit suicide because they cannot cope with more suffering or they “resort to self-euthanasia to avoid being a financial burden to their families”, concluded the sociologist.

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suicide per 100,000 inhabitants.

Venezuela is at the top of the list of suicide rates in the American continent.

Roberto Briceño León reported that Nicolás Maduro’s regime does not publish figures and statistics on violence in Venezuela since 2003 “for fear that the truth is known about the ugly face of the allegedly beautiful revolution”.

Children and Adolescents Are the Most Affected by Rising Diphtheria Mortality Rates

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children and adolescents died of diphtheria during the first trimester of 2019

The Ministry of Health reported 13 deaths from the bacterial infection during the first three months of the year. Children aged 5 to 9 and adolescents aged 10 to 15 years died. The increase in the mortality rate for these age groups was 7 percent and 4 percent

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, respectively. The infants should have been immunized against diphtheria, as per the country’s immunization guidelines.

The Pan American Health Organization (PAHO) reported that, so far in 2019, 190 confirmed cases of the disease have been diagnosed in 45 municipalities in 16 states in the country, including the states of Amazonas, Apure,

Anzoátegui, Bolívar, Carabobo, Falcón, Lara, Miranda, Portuguesa, Táchira, Trujillo, Zulia and the Capital District.

At the beginning of 2019, ten states were yet to reach the 95 percent coverage guideline recommended by the World Health Organization (WHO).

34. CARBALLO, Betzimar (May 8, 2019). “Venezuela ocupa el primer puesto en la tasa de suicidios en el continente americano”. (Venezuela First in Suicide Rates in the American Continent). Available at: http://caraotalibre.cf/nacionales/trasladaron-herido-camion-basura/ 35. ALTUVE, Armando (May 10, 2019). “Mortalidad por difteria aumentó en niños y adolescentes venezolanos en 2019”. (Diphtheria Mortality Rates Rose in Venezuelan Children and Adolescents in 2019). Available at: http://efectococuyo.com/principales/caracas-sin-ambulancias-la-crisis-para-trasladar-a-los-pacientes/

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#CONVITEDENUNCIA: 203 Measles Cases Confirmed So Far This Year

45%

percent increase in measles cases so far this year (140 cases)

According to the Pan American Health Organization (PAHO), the Ministry of Health reported 558 suspected cases of measles, including 203 confirmed cases.

Ten Venezuelan states are the protagonists of this epidemiological drama that has been brewing for the first 18 weeks of 2019: Anzoátegui (87), Zulia (84), Carabobo (9), Monagas (8), Capital District (7), Miranda (3) Cojedes (2), Amazonas (1), Aragua (1) and Bolívar (1). The PAHO indicated that the last laboratory-confirmed case was reported in Caracas of a resident of the El Valle parish, in the Libertador municipality.

Indigenous peoples have also been strongly affected by this disease. Although PAHO has not provided updated information on the incidence of measles or its mortality among Venezuelan ethnic groups, it is important to note that by the end of 2018 there were 513 inhabitants of indigenous peoples with measles, 62 of whom died.

Measles does not only wreaks havoc inside our borders; neighboring countries such as Colombia and Brazil have reported cases of the viral infection spread by Venezuelan migrants who were received there and came into contact with fellow Colombian and Brazilian citizens, thereby transmitting the disease until it proliferated in various areas

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As reported by UNICEF, Venezuela ranked fifth among countries with the highest measles transmission rates in the world in 2018.

The Health and Food Crisis Continues to Raise the Number of Deaths from Malnutrition and Diarrhea in Anzoátegui José Santoyo, a human rights activist in the state of Anzoátegui, denounced that deaths continue to occur in the state 37

due to malnutrition and severe diarrhea. The main victims are still the children, who are admitted to hospitals with disturbing cases of emaciation, dehydration and gastrointestinal infections.

The ‘Rafael Tobías Guevara’ Children’s Hospital in Barcelona, one of the entity’s main healthcare centers, treats up to 10 cases of malnutrition a day. Santoyo argues that doctors have no supplies to ensure treatment to minors who arrive with decompensation symptoms and whose health is further complicated by deficiencies in the stock of medicines, which hinders the administration of a combination of antibiotics and vitamin complexes to provide for recovery.

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people have died due to diarrheal diseases and severe malnutrition, the majority being children under 6 years of age

During a “Humanitarian Emergency, Hunger and Property Rights” working group session held on May 15 of 2019 held at the Andrés Bello Catholic University (UCAB, by its Spanish acronym), the director of the Venezuelan Health Observatory (OVS, by its Spanish acronym), Marianella Herrera, reported that “malnutrition 38

in Venezuela is alarming” and detailed how the health of newborns continues to deteriorate, as they come into the world with problems from gestation.

37. PELLICANI, Giovanna (May 14, 2019). “Suman 25 las muertes por desnutrición y cuadros diarreicos en Anzoátegui” (Already 25 Deaths Caused by Malnutrition and Diarrhea in Anzoátegui). Available at: https://www.unicef.org/es/comunicados-prensa/alarmante-oleada-mundial-sarampion-amenaza-creciente-para-infancia 38. EL PITAZO (May 15, 2019). “Observatorio Venezolano de la Salud: la desnutrición infantil en Venezuela se presenta desde la gestación”. (Venezuelan Health Observatory: Child Malnutrition in Venezuela From Gestation). Available at: https://elpitazo.net/oriente/suman-25-las-muertes-por-desnutricion-y-cuadros-diarreicos-en-anzoategui/

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#CONVITEDENUNCIA: Herrera is concerned about reported cases of infants who are less than 6 months of age and who weigh less than when they were born

Chaos from Fuel Shortage Impacts Public Health Services It is no longer the brain drain or the urban transport crisis that prevent more and more people from going to work in the hospitals’ medical areas: the situation is now aggravated by the scaling up of gasoline shortages.

At the regional level, there are few gas service stations that have fuel in stock, and when they do, lines to pump gas seem to be endless.

Authorities from the ‘Los Ándes University Hospital’ Autonomous Institute (IAHULA, by its Spanish acronym), located in the state of Mérida, denounced that user and patient care has been adversely affected because the hospital’s staff cannot get to the workplace either because they cannot fill their cars’ tanks with gas or because they find no public 39

transportation units to get to work, given that only a few operational units can manage to keep providing the service.

Health services lack specialist doctors and nursing staff. The emergency and surgery

Refineries in the country are working at 10 percent of their installed capacity, according to oil economy expert José Toro Hardy

areas of the university hospital in Mérida are the most affected, which has forced doctors to refer patients to other health centers and suspend elective surgeries. In addition to the health sector, the food sector will also begin to feel the brunt of the current economic crisis, particularly in terms of the distribution of meat, dairy and vegetable products.

Although Maduro’s government has done everything in its power to ensure that the shortage of fuel does not affect the Metropolitan Area of Caracas and its surrounding areas (states of Miranda and Vargas) as much as it affects the rest of the country, the shortage of food items will not take long to be felt because distribution and supply mechanisms are highly dependent on regional production.

Minister of Health Carlos Alvarado does not take any responsibility for the situation and blames the crisis in the health sector on the government of the United States of America.

Carlos Alvarado assured in a press conference that the shortage of medical supplies and medicines in Venezuela is due to the measures imposed by the administration of President Donald Trump on the Venezuelan government.

“Venezuela is now listed alongside countries such as Yemen, Ukraine or Syria. Venezuela belongs today in the 40

same category as countries with diseases that had been long eradicated”, noted Félix Oletta, an internist and former minister of health.

22,000 medical doctors, 6,000 nurses and 4,000 bioanalists have left the country, according to Dr. Oletta

Dr. Oletta called Alvarado a “liar,” stating that the humanitarian health crisis worsened at the end of 2013, long before the U.S. government applied sanctions against Nicolás Maduro and his closest allies. He also pointed out that migration has considerably affected the sector

39. DELGADO, Jade (May 21, 2019). “Salud en riesgo en Mérida: médicos y enfermeros no acuden a hospitales por falta de gasolina”. (Health At Risk in Mérida: Physicians and Nurses Do Not Get to Hospitals Due to Fuel Shortages). Available at: http://caraotalibre.cf/regionales/salud-en-riesgo-en-merida-medicos-y-enfermeros-no-acuden-a-hospitales/ 40. RAMOS, Gabriel (May 23, 2019) “Exministro Félix Oletta: Crisis humanitaria de salud comenzó antes de las sanciones de Trump”. (Former Minister Félix Oletta: Health Humanitarian Crisis Began Before Trump Sanctions). Available at: https://elpitazo.net/salud/exministro-felix-oletta-crisis-humanitaria-de-salud-comenzo-antes-de-las-sanciones-de-trump/

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