Monitoring of Access to Health in Venezuela N. 30 January 2020

NEWSLETTER

JANUARY

2020

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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

MÉRIDA: ORGANIZACIÓN PROMEDEHUM RIGOBERTO LOBO FRANCISCO DE JESÚS SEGOVIA ANAGABRIELA CENTENO ELVIS RIVAS

CIUDAD BOLÍVAR: ORGANIZACIÓN KAPÉ KAPÉ RAIZA GUAIPO MARY CARMEN SALAZAR ALCALA 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

T A B L E

O F

C O N T E N T S

ANALYSIS AND INTERPRETATION OF AGGREGATE RESULTS OF THE MEDICINE SHORTAGE INDEX MEASUREMENTS FOR JANUARY 2020

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MONITORING ACCESS TO HEALTH IN VENEZUELA

AGGREGATED RESULTS FOR THE MEDICINE SHORTAGE INDEX: JANUARY, 2020 GRAPHIC DEPICTION OF THE MEDICINE SHORTAGE INDEX BY MORBIDITY DIABETES: HYPERTENSION: ACUTE INFECTIONS OF THE RESPIRATORY TRACT: DIARRHEAL DISEASES: DEPRESSION AND PERSONALITY DISORDERS: SEIZURES:

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ON CONTRACEPTIVES SEXUAL AND REPRODUCTIVE HEALTH AT RISK

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#CONVITEDENOUNCES JANUARY 2020 VENEZUELA

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ANALYSIS AND INTERPRETATION OF AGGREGATE RESULTS OF THE MEDICINE SHORTAGE INDEX MEASUREMENTS FOR JANUARY 2020 CHRONOLOGICAL DETAILS OF THE SURVEY Period and Frequency of Data Collection: The survey consisted of two measurements conducted on January 28 and 29, 2020.

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/

MONITORING ACCESS TO HEALTH IN VENEZUELA AN ASSESSMENT THAT TAKES INTO ACCOUNT THE SHORTAGE OF MEDICINES AND ANALYZES AND RECORDS THE STATE OF THE FACILITIES THAT PROVIDE HEALTH CARE TO THE ELDERLY AS WELL AS THE LIFE AND HEALTH CONDITIONS THEREOF. Convite A. C. kicks off the year 2020 by monitoring access to health through measurements of the medicine shortage index; it also places the spotlight on the state of the facilities that provide health care to the elderly, and characterizes and analyzes the life conditions of this particularly vulnerable sector of the population. Such tasks will remain a priority in the agenda of our organization. Convite A.C. will not cease in its commitment to provide timely, verifiable, and relevant information that will permit verification —by use of evidence and under a rigorous technical approach— of the right to health and social security and its current exercise and guarantees in Venezuela in the context of a complex humanitarian emergency.

We will start the year with an expanded and strengthened monitoring activity. Having successfully completed the second phase of our #ConviteForHealth project, we have established new alliances that have extended our coverage to three additional cities in the central-western and eastern regions of the country, namely San Carlos (State of Cojedes), San Juan de Los Morros (State of Guárico), and Maturín (State of Monagas). ). Information will be now collected in these new locations, in addition to the eight areas that we have already been working on since the onset of the project, concerning the right to health and its guarantees, the life and health conditions of the elderly, and the conditions of the health care institutions that must treat them.

We will also collect information on the life and health conditions of the elderly elderly in at least four state capital cities. The results of this research work, in addition to contributing to raising awareness on the status of the elderly’s human rights through documentation, complaint reporting, and dissemination, will illustrate how the complex humanitarian emergency places a differentiated burden on older people.

And in Convite A.C. we intend to go further. Not only will we research and document cases; we will also support initiatives aimed at strengthening the civil society’s organization and articulation efforts so that, regardless of its range of interests, it is able to develop and act upon its own menu of actions for advocacy, activism, and impact on human rights issues.

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AGGREGATED RESULTS FOR THE MEDICINE SHORTAGE INDEX: JANUARY, 2020

INDICATOR BEHAVIOR AND EVOLUTION

Table No. 1: Nationwide Aggregate by City and Morbidity. January, 2020.

Within the framework of the “Monitoring the Right to Health in Venezuela� project, we have compiled information on the medicine shortage index for January 2020, which shows weighted averages of between 47 percent and 69 percent shortage in the basic baskets of drugs prescribed to treat the six selected causes of morbidity.

As in December of last year, the causes of morbidity for which medicines registered the highest shortage rates in January of 2020 were depression or personality disorders (69 percent) and seizures (67 percent). On the other hand, drugs to treat hypertension continued to show the lowest shortage indicators since the end of 2019 and up to the current measurement, remaining the cause of morbidity for which medicines were most readily available in drugstores. The same applies to the basket of drugs to control diarrhea syndromes, whose shortage indicator was below 40 percent.

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Chart No. 1: Behavior of the Aggregate Medicine Shortage. January, 2020.

Chart No. 2: Behavior of the Aggregate Medicine Shortage, Overall and by Morbidity: January, 2020.

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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, January 2020.

Maracaibo (77 percent), the Metropolitan Area of Caracas (69 percent), Barquisimeto (60 percent), Valencia (57 percent), and Puerto La Cruz (57 percent) were the areas with the highest shortage of active ingredients to control diabetes. The supply of such active ingredients was less compromised in cities such as San Carlos (15 percent shortage), Ciudad Bolivar (29 percent), í (33 percent), San Juan de los Morros (38 percent), Puerto Ordaz (41 percent), and Maturín (45 percent)..

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HYPERTENSION:

Chart No. 4: Behavior of the Medicine Shortage Index by Morbidity: Hypertension, January 2020.

Barquisimeto had the highest shortage index (71 percent), with an almost imperceptible variation as compared against that of December 2019. For hypertensive people, the cities in the sample surveyed with the best supply of drugs to treat high blood pressure were San Juan de los Morros (22 percent shortage), San Carlos (31 percent shortage), Puerto La Cruz (33 percent shortage), and Valencia (34 percent shortage), with a shortage index below the General Shortage Index (40 percent).

Hypertension saw 2019 come to an end and 2020 start as the cause of morbidity with the highest availability of medication in the Venezuelan pharmaceutical market.

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ACUTE INFECTIONS OF THE RESPIRATORY TRACT:

Gráfico N° 5: Comportamiento del índice de escasez de medicamentos por morbilidad: IRA – Agosto 2019 Chart No. 5: Behavior of the Medicine Shortage Index by Morbidity: Acute Infections of the Respiratory Tract, January 2020.

The behavior of the General Shortage Index for drugs to control acute infections of the respiratory tract showed a slight improvement as compared against that of December 2019. However, the shortage was still substantial in most of the areas surveyed, the worst supplied cities being San Juan de Los Morros and Barquisimeto (91 shortage), while the best stocked was Mérida, with less than 50 percent shortage

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DIARRHEAL DISEASES:

Chart No. 6: Behavior of the Medicine Shortage Index by Morbidity: Diarrheal Diseases, January 2020.

Diarrhea is one of the leading causes of death in children under age five in developing countries. The supply of medicines to treat diarrheal syndromes was good in San Carlos (8 percent shortage), Maturín (26 percent shortage), Ciudad Bolívar (28 percent shortage), and Mérida (30 percent shortage), all below 50 percent shortage. Conversely, people affected by this cause of morbidity in Barquisimeto and San Juan de Los Morros had little chance of finding the required treatment, for the shortage of drugs to treat the condition was 66 percent and 70 percent, respectively.

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DEPRESSION AND PERSONALITY DISORDERS:

Chart No. 7: Behavior of the Medicine Shortage Index by Morbidity: Depression and Personality Disorders, January 2020.

The beginning of the year witnessed a slight improvement in the supply of drugs to treat depression and personality disorders as compared against that at the end of 2019. People suffering from depression or other personality disorders who reside in Barquisimeto, Caracas, Valencia, San Juan de Los Morros, Maturín, and Puerto Ordaz had greater difficulty in finding the medicines they need to control their condition: in January, the shortage of antidepressants stood above 80 percent in the cities aforementioned. Only the city of San Carlos recorded a substantially low shortage rate (18 percent) in its basket of antidepressants, and was the best stocked city.

The World Health Organization (WHO) established January 13 as the World Depression Awareness Day. Depression is a disorder that, according to the organization, could be the second leading cause of ill health in the world in 2020.

Depression is considered one of the most serious health problems of the 21st century, and it has been on the rise in the last few years.

In recent days, the Venezuelan Society of Psychiatry warned that the shortage of drugs to treat anxiety rose to 80 percent, which is well in line with our surveys’ reports. In mid-January, the Venezuelan Health Alliance coalition began to hold a series of talks aimed at raising public awareness on the subject and dismissing the Government’s versions contained in the 2019 Report on the State of the Health Sector, which was released on January 7, 2020 by Health Minister Carlos Alvarado. Pedro Delgado, a member of the Venezuelan Society of Psychiatry, discussed the current conditions of psychiatric hospitals in the country, where the supply of running water and electric power is constantly interrupted. He also addressed the progressive dismantling thereof, which is behind the precarious conditions in which they operate, to the extent that their capacity to treat patients has been reduced by 25 percent all around the country.

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SEIZURES:

Chart No. 8: Behavior of the Medicine Shortage Index by Morbidity: Seizures, January 2020.

Neurological disorders that lead to seizures can be controlled with medication. However, the basket of drugs to treat them continues to be poorly stocked. All the areas included in this survey, with the exception of San Carlos (20 percent shortage), show shortage indicators in excess of 50 percent, the worst supplied being San Juan de Los Morros (90 percent shortage), the Metropolitan Area of Caracas (86 percent shortage), and Barquisimeto (83 percent shortage).

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ON CONTRACEPTIVES

SEXUAL AND REPRODUCTIVE HEALTH AT RISK

Chart No. 9: Behavior of the Medicine Shortage Index by Morbidity: The Case of Contraceptives, January 2020.

In January, the cities with the lowest stock of contraceptive products were Maturín, Puerto La Cruz, and Puerto Ordaz, where most of the monitored items were in short supply, male condoms being the easiest to find. However, the situation in capital cities such as Caracas and Mérida was dramatic: the shortage of most contraceptive methods was almost total in the pharmacies surveyed, although it was still possible to find condoms and emergency contraceptive pills.

In the January meetings organized by the Venezuelan Health Alliance coalition, the subject of maternal mortality from hemorrhaging during childbirth was discussed. Jairo Fuenmayor, a member of the board of directors of the Obstetrics Society, stated that the number of cases in Venezuela almost double the world’s average. Fuenmayor explained that the main causes of maternal mortality in the country are preventable through planning, but planning has not been in the official agenda for more than seven years. He added that the Ministry of Women’s Affairs had offered to provide cabs in order to reduce the number of pregnant women that are taken from one hospital to another because they have no means of 1

transportation of their own; “That is what Humanized Childbirth is about.” Accounts such as these reveal that reproductive health in Venezuela is of little or no importance and, therefore, it is not guaranteed by the State or its competent agencies.

1.BARRETO, Jesús (January 24). “Escasez de medicinas para la ansiedad asciende a un 80%”. (Shortage of Drugs to Treat Anxiety Up To 80 Percent). Available at https://elpitazo.net/salud/escasez-de-medicinas-para-la-ansiedad-asciende-a-un-80/

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#CONVITEDENOUNCES

JANUARY 2020 VENEZUELA AND SO 2020 BEGINS… The Venezuelan Complex Humanitarian Emergency took no break during the Christmas holidays. It continued unaltered, fulfilling its dark mission of making the lives of most people in Venezuela more difficult. Although it is a fact that consumption was further dollarized, with presumably more than 50 percent of the country’s population transactions being carried out in U.S. currency —according to Asdrúbal Oliveros, Director of Ecoanálitica, a Venezuelan financial and econ consulting firm—, the phenomenon, far from alleviating the people’s economic problems, has impacted the most underprivileged sectors of society; as a result, the poor are getting poorer, with the pensioners, civil servants, and employees being the most fragile amongst them.

As long as hyperinflation, the collapse of the local currency, an exchange rate that is yet to be adjusted, and an approach that sacrifices national production over massive imports and relaxes the associated controls shall persist, more dollars will be needed to purchase the same goods and services, including the most basic ones, whose demand will be further restricted due to the limited purchasing power of the majority of the population.

The squares, public spaces, and shopping malls that were splendidly and eye-catchingly decorated for Christmas, especially in the country’s major cities; the proliferation of bodegones — which are physical stores that sell all sorts of imported goods—; the USD remittances and bonuses that a tiny group of workers in the private sector receive, which allow them to better cope with the country’s situation, are but an illusion that the government is trying to hold on to and make the most of in an effort to generating a false sense of normality while the crisis persists and worsens.

Chronic Crisis = Chronic Malnutrition Specialists predict that 2020 will witness an increase in the number of cases of chronic malnutrition in Venezuela. The lingering of the crisis, with no expectations for change, is apparent from the effects of poor nutrition in people, mainly in infants. According to information provided by nutritionist Marianella Herrera, a member of the Bengoa Foundation and coordinator of the Venezuelan Health Observatory (OVS, by its Spanish acronym), there were cases of underweight people or problems associated with acute malnutrition before; however, from 2018 on, nutrition problems have become more severe because the crisis is now chronic. An example of this is that of children born to malnourished mothers.

The effects of poor nutrition and the lack of timely medical attention and care are increasingly noticeable in the most vulnerable communities, especially those in the countryside and other areas outside Venezuela’s capital city. The condition of babies under six months and children under five years of age, as well as that of adolescents and young men and women, have deteriorated sharply. Dr. Herrera notes that there are families who have decided to ‘sacrifice’ the meals of older children and adults so that the younger children can eat. “And so we entered a vicious circle and we have begun to see the effects widespread to adolescents and women and men of childbearing age,” she said.

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2. SOUQUETT, Mariana (January 12, 2020). “Marianela Herrera: Desnutrición crónica infantil aumenta en Venezuela” (Marianela Herrera: Chronic Malnutrition in Infants Increases in Venezuela). Available at: https://efectococuyo.com/salud/desnutricion-cronica-infantil-aumenta-en-venezuela-advierte-especialista/

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#CONVITEDENOUNCES When Will the Situation of the J.M. de Los Rios Hospital be Reversed?

This is yet another distressing beginning of the year for the J. M. de Los Ríos Hospital. On January 2, 2020, a child died from respiratory failure during a blood transfusion. Specialists in the healthcare facility warn about irregularities in the administration of medication and treatment to children that make them more susceptible to contracting other diseases.3 Following this unfortunate occurrence, Prepara Familia, an organization that verifies whether or not human rights are guaranteed in the hospital, is soon to submit a report to the Inter-American Commission on Human Rights (IACHR).

Another deplorable situation that marked the month of January was the inability to perform blood transfusions to hospital patients that required them. Katherine Martinez, director of Prepara Familia, claims that by December 31, 2019, the children’s parents were already being asked to find blood donors and bring them to the Municipal Blood Bank so that the donated blood can be sent to the J. M. de Los Ríos; yet, their ordeal is far from being over because the hospital cannot always take donors due to the precarious conditions under which it operates and the lack of reagents, supplies, equipment, and human 4

resources.

Children who do not get to receive the blood they need are put at great risk, especially those who suffer from diseases such as acute lymphoblastic leukemia, thalassemia major, thalassemia minor, and sickle cell anemia, and whose lives depend on such transfusions.

As if that were not enough, the J. M.’s operating rooms were temporarily closed in mid-January because of the continued interruption in the supply of water, which has been a longstanding problem that just got worse as soon as the water cistern trucks stopped coming in. Surgeries were suspended, and three areas of the J. M. were shut down in less than one month.

The year 2020 kicked off with the closure of the Cardiology and Hemodynamics Department, which had been operating nonstop for 83 years. The Hematology Service was also suspended for lack of staff and supplies and given the deterioration of the service’s facilities.5 In addition to the water supply problem, operating rooms have been also affected by the fact that the elevators do not work and that the hospitalization and surgery areas are located on the top floor of the building, which limits the possibility for family members and NGOs to look for alternative solutions to alleviate the situation.

Venezuelan Non-Governmental Organizations in a Permanent State of Distress People in Venezuela are defenseless because their access to health is not guaranteed, in violation of their right to life.

Non-governmental organizations have been filling the role of the State for years, when their real purpose should be to support it in the implementation of public policies. Regrettably, the work of the NGOs is not recognized, much less valued; on the contrary, it is systematically the object of threats and attacks.

On January 14, Prepara Familia went through an unnecessarily unpleasant experience: at first, it looked like an invasion by a group of people of the house that the organization was using as a warehouse; however, it turned into a situation that only brought tension and unrest to Katherine Martínez —who is the main representative of Prepara Familia— and for part of her

3. REIMI, Isabella (January 3, 2020). “Muere niño en servicio de Nefrología del JM de Los Ríos, el primero de 2020” (Child Dies in the Nephrology Service of J. M. de Los Ríos, First in 2020).”

Available at: https://efectococuyo.com/salud/muere-el-primer-nino-de-2020-en-el-hospital-jm-de-los-rios/ 4. SOUQUETT, Mariana (January 11, 2020). “Familiares deben buscar donantes para que niños del JM puedan transfundirse” (Family Members and Relatives Must Search for Blood Donors for J. M.’s Children Transfusion.” Available at: https://efectococuyo.com/salud/familiares-deben-buscar-donantes-para-que-ninos-del-jm-puedan-trasfundirse/ 5. BARRETO, Jesús (January 22, 2020). “J. M. de los Ríos suspende cirugías por falta de agua” (J. M. de Los Ríos Suspends Surgeries for Lack of Water). Available at: https://elpitazo.net/ salud/j-m-de-los-rios-suspende-cirugias-por-falta-de-agua/

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#CONVITEDENOUNCES team, relatives, and neighbors. The matter could have been settled through simple mediation with the invaders to restore order in the site, but it escalated as officials of the Bolivarian National Police (PNB, by its Spanish acronym) tried to remove the supplies that were stored in the collection center to, allegedly, launch an ‘investigation’.

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After heated exchanges and resistance by the NGO’s director, as well as through pressure from all the representatives of the human rights organizations that were present at the site and the activation of the Network for the Human Rights of Children and Adolescents (Redhnna, by its Spanish acronym), whose members immediately reported the incident and denounced that the staff of Prepara Familia was being threatened with detention by the PNB officers, the latter finally gave in and decided not to continue with their purported investigation.

Katherine Martinez took the opportunity to urge the authorities to show up at the hospitals and see firsthand what is really happening and the countless obstacles that they face, and reiterated that her duty and that of Prepara Familia is none other than to help.

January and Your Customary New Year’s Resolutions Maduro was no exception in his first speeches of the year; he, as many people, released his list of resolutions for the year 2020, 90 percent of which he will probably fail to deliver, not only because making promises is typical of bad politicians, but also because his resolutions are unreasonable and incoherent ideas.

One of his New Year’s announcements is the introduction of a financing platform, called PetroSalud, which will aim to guarantee access by Venezuelans to medicines through the petro cryptocurrency. The plan was designed for the public health system. Maduro said the initiative includes a card that will be distributed through the Misión Barrio Adentro [a social welfare program that seeks to provide publicly funded healthcare to poor and marginalized communities] and will be accepted in all community pharmacies in the country so that Venezuelans can buy their medicines ‘regardless of their price.’7 It should be noted at this point that, in December, pensioners and public officials received a bonus in petros that would ‘facilitate’ payment of their purchases in different establishments; however, transactions with the petro gave users a headache because the system that would enable said payments failed to run as expected during the last days of the year and long queues ensued due to the delays in using the biometric payment devices, which were insufficient in number and were constantly crashing.

It is as though, in the mind of the regime’s leader, the Venezuelan population is experiencing memory issues or lives in an alternate reality that is different from the one that strikes them hard every single day. While Maduro announces the creation and implementation of new systems or mechanisms to supposedly alleviate people’s difficulties, people complain of those that are already in place. Take the 0800-SaludYa system. The service, which was designed by the government to distribute subsidized medicines, can take up to four months to deliver the drugs and, in many cases, what people receive is not 8

enough to complete treatment. Unfortunately, people with chronic diseases cannot afford to wait that long because their condition deteriorates with each passing day.

6. SOUQUETT, Mariana (January 14, 2020). “Todo fue aclarado”, dice Prepara Familia tras situación con la PNB.” (It Has All Been Cleared Up, Said Prepara Familia After Situation with the PNB.” Available at: : https://efectococuyo.com/salud/todo-fue-aclarado-dice-prepara-familia-tras-situacion-con-la-pnb/ 7. From the Editor’s Desk, El Pitazo (January 8, 2020). “Maduro crea plataforma petrosalud para adquisición de medicamentos” (Maduro Creates Petrosalud Platform for Medicine Purchase.”

Available at: https://elpitazo.net/salud/maduro-crea-plataforma-petrosalud-para-adquisicion-de-medicamentos/ 8. BARRETO, Jesús (January 21, 2020). “Hasta cuatro meses tardan en entregar medicinas a través del 0800-SaludYa” (Drugs Distributed Through 0800-SaludYa Take Up to Four Months to be Delivered). Available at: https://elpitazo.net/salud/hasta-cuatro-meses-tardan-en-entregar-medicinas-a-traves-del-0800-saludya/

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#CONVITEDENOUNCES Bolivarian government.” According to Alvarado, the country’s maternal mortality rates have dropped, and show a sharp downward trend. But Jairo Fuenmayor, representative of the Venezuelan Society of Obstetrics and Gynecology, stated that mortality rates have not seen a reduction in the last 15 years and that, up to the year 2019, the maternal mortality rate was, on average, 112.2 per 100.000 live births; he added that the three leading causes of maternal mortality in the country are postpartum haemorrhage, sepsis, and pregnancy-induced hypertension, all of which are totally predictable and treatable with adequate control… one that, unfortunately, mothers are not receiving.

Marianella Herrera, representative of the Venezuelan Health Observatory (OVS) and member of the Bengoa Foundation, said that the health minister left some details out in his assessment, for he failed to mention the havoc that food insecurity is wreaking on Venezuelans. The rise in chronic malnutrition is one example: she claims to have records on communities surveyed with an average of 30 percent to 40 percent chronic malnutrition and its adverse consequences in the form of stunted growth, neurological and psychomotor disorders, and delayed cognitive development.

Another of the issues that the report on the state of the health sector failed to mention is that of epidemiological figures.

Malaria was one of the morbidities with the highest incidence rates in 2019, according to Dr. José Felix Oletta, former health minister, who stated that the country registered eight times more cases of malaria than in 2010 —with rates just comparable to those of the 1950s—, and that the disease is still present in 20 states. It is estimated that there were 887,129 cases of malaria in 2019. Additionally, there was also a significant upsurge in diseases such as measles and tuberculosis.

In the official’s opinion, immunization was also a success, stating that immunization plans were 95 percent implemented.

However, Dr. Huniades Urbina said that immunization coverage during 2019 was 40 percent. Based on the information provided by the president of the Venezuelan Society of Childcare and Pediatrics (SVPP, by its Spanish acronym), coverage of immunization with the BCG vaccine was up to 92 percent, while that with the polio vaccine barely reached 53 percent; coverage of immunization for diphtheria was 60 percent, according to the Pan American Health Organization, whereas that of immunization for rotavirus was 18 percent and that of immunization for pneumococcus was 7 percent. According to Dr. Urbina, it has been 4 years since vaccines for the latter two diseases were last purchased. As regards measles, vaccination coverage was 74 percent, despite the incidence rates of this morbidity.

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The figures reported by these specialists, who are part of the Venezuelan Health Alliance , are backed up by their research work. Carlos Walter, a physician and director of the Universidad Central de Venezuela’s Center for Development Studies (Cendes, by its Spanish acronym), reported that the coalition, which has taken on the task of dismounting the government’s versions of the state of the public health system, is soon to submit proposals on the main health issues that need to be addressed in 2020.

Pensions: Insufficient and Not Received in Full Due to Lack of Cash For pensioners in Venezuela, 2020 began with the same difficulties and challenges of 2019. With a pension of barely 3 dollars a month (VEB 250,000.00), the elderly continue to make long queues at banks to collect their ‘benefit’ in cash; unfortunately, they receive less than 50 percent of what they are entitled to, simply because there is not enough cash in the banks.

9. SOUQUETT, Mariana (24 de enero de 2020). “Sin reducción de mortalidad materna y aumento de la malaria: médicos desmienten Balance de Salud 2019”. Disponible en: efectococuyo.com/salud/sin-reduccion-de-mortalidad-materna-y-aumento-de-la-malaria-medicos-desmienten-balance-de-salud-2019/

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#CONVITEDENOUNCES Although the Nicolás Maduro regime constantly tries to alleviate the situation by granting bonuses to pensioners and to the bearers of the Carnet de la Patria (Homeland’s Card), he does so by implementing mechanisms that end up belittling and causing suffering to those who need it the most. This is what happened in December of 2019, when the Government deposited half a petro to pensioners: as of the date hereof, the petros could only be spent in a limited number of stores that accept the cryptocurrency through a dedicated mobile application or through a bio payment system that constantly fails and crashes for indefinite periods.

Pregnant Women Arrive in Cúcuta in Poor Health Conditions Venezuelan women arrive at health centers in Cúcuta, Colombia, in poor health, as reported by Julia Piedad Mejía, coordinator of the Gynecology and Obstetrics Department of the Erasmo Meoz University Hospital, which is located in that city.10 Underweight children, mothers with syphilis and other sexually transmitted diseases, many of whom are malnourished and with hypertensive crises, are some of the patients that the hospital is dealing with, the specialist said. As per the records of the Cúcuta University Hospital, a significant number of Venezuelan women only come to their facilities to deliver their babies, after which they return to Venezuela.

Cases of perinatal deaths —babies who die during pregnancy— have also raised alarms at the hospital. Dr. Mejía said the rate is high and spiking at the medical center due to a number of causes, including that pregnant women did not receive prenatal medical care.

Medicines on the Shelves, But No One to Buy Them Factors such as the economic crisis, recession, hyperinflation, and the high volatility of the exchange have adversely affected a number of sectors, including the pharmaceutical industry. The national production of medicines is low, but imports are high because of the fiscal policies currently in place. Consequently, drugs become less affordable with each passing day.

A research work conducted by the digital newspaper El Estímulo revealed that most of the drugs that are sold in Venezuela are more expensive here than in other countries of the region. They started by preparing a list of drugs that are used to treat certain diseases, particularly chronic diseases, including immunosuppressants and anticoagulants, and compared their prices against those in the Colombian pharmaceutical market.

Although there are cases where Venezuelan medicines are cheaper, most of the drugs on our pharmacies’ shelves are offered at prices that exceed those in the international market. For example, Lantus insulin in Colombia is sold at approximately USD 28.5, whereas in Venezuela it is sold at around USD 40.00; levothyroxine is sold at USD 7.00 in Colombia, whereas in Venezuela it costs USD 21.00; by the same token, a pack of Enterogermina (stomach treatment) in Colombia costs approximately USD 15.00 and USD 12.00 in Argentina, in Venezuela it is 11

sold at around USD 25.00.

10. HERNÁNDEZ, Rosalinda (January 29, 2020). “Madres venezolanas llegan desnutridas y enfermas a dar a luz en Cúcuta” (Venezuelan Pregnant Woman Arrive Malnurished and Sick to Give Birth in Cucuta). Available at : https://elestimulo.com/madres-venezolanas-llegan-desnutridas-y-enfermas-a-dar-a-luz-en-cucuta/ 11. MARTÍNEZ, Andrés (February 3, 2020). “Medicamentos en Venezuela son más caros que en otros países ¿Por qué?” (Why are Medicines More Expensive in Venezuela than in Other Countries?). Available at: https://elestimulo.com/elinteres/medicamentos-en-venezuela-son-mas-caros-que-en-otros-paises-por-que/

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#CONVITEDENOUNCES While the minimum wage in Colombia is approximately USD 250.00, it is barely USD 3.00 a month in Venezuela, and it loses value day after day. This reality hits Venezuelans and older adults who depend on a meager USD 3.00 pension to survive a full month, and if their health is at stake and they depend on medication, their situation worsens drastically.

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