Monitoring The Right To Health in Venezuela Newsletter Nro 8

NEWSLETTER

In loving memory of Grandpa Felipe Carrasquel Your will be in our hearts forever. Our work at Convite, A.C. was always intended to keeping you with us, alive, whole and healthy.

Now, in your name, we will work harder and we will continue to denounce that #TheStateDoesn’tCare, wherever necessary, because we DO care, and not having you around anymore saddens our souls and hearts.

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

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BEHAVIOR AND EVOLUTION OF THE INDICATOR

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AGGREGATE RESULTS NATIONWIDE – MARCH 2018

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GRAPHICAL REPRESENTATION OF RESULTS

BY CITY AND MORBIDITY CAUSE

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DIABETES

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HIGH BLOOD PRESSURE

ACUTE RESPIRATORY INFECTIONS (ARIS)

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DIARRHEA

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HOLY W EEK 2018 IN V ENE ZU EL A: PA RIS HIONERS H A D TO GI V E 1 U P THEIR S E V EN CH U RCHES V IS ITATION [TN] FOR A PILGRIM AGE TO 7 PH A R M ACIES OR MOR E IN S E A RCH OF MEDICINES

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1. Translator’s Note: The Seven Churches Visitation is a Roman Catholic tradition where seven churches are visited on Holy Thursday.

MONITORING THE RIGHT TO HEALTH IN VENEZUELA MARCH 2018

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ANALYSIS AND INTERPRETATION OF AGGREGATE

RESULTS OF THE FIRST TWO MEDICINE SHORTAGE INDEX

MEA SUREMENTS FOR MARCH 2018 2 Within the framework of the Monitoring the Right

affecting the Venezuelan population: high blood pressure,

to Health in Venezuela: An Approximation Based on

diabetes, diarrhea, and acute respiratory infections (ARIs).

Medicine Shortages, Preventable Deaths and Hospital Infrastructure project, Convite, A.C. has conducted a total

In

of 14 measurements (September I and II; October I and

Humanitarian Emergency, access to medicines to treat the

II; November I and II; December I and II; January I and II,

major causes of morbidity afflicting the population remains

February I and II, and March I and II) of the basic basket of

restricted at best.

Venezuela,

a

country

ravaged

by

a

Complex

active ingredients for the four major causes of morbidity

BEHAVIOR AND EVOLUTION OF THE INDICATOR The aggregate results of the fourteen measurements conducted so far are broken down below:

Upon an analysis of the behavior of the Medicine

in a country undergoing a complex humanitarian

Shortage Index based on the results obtained from each

emergency of such size and characteristics: it has been

measurement conducted to date, the following may be

deliberately caused, it is massive and systematic, it has

observed:

been inflicted by those who have the authority and the means to address it and it exceeds the State’s capacity

General Shortage Index (GSI): The GSI closed at 88.1

for action.

percent in March. This means that in seven (7) of the

In light of these results, it is impossible to deny the

fourteen (14) measurements conducted to date, the GSI

existence of a humanitarian emergency in Venezuela, as

closed just below 90 percent. These figures are devastating

well as the inability of the State to respond to this situation.

2.Survey Chronological Details: The survey consisted of two monthly measurements made between March 14-16, 2018, and March 21-23, 2018, which were the second and fourth weeks of the month, respectively, in order to detect variations that could be measured 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 NÂş 1, September 2017, available at https://goo.gl/Vrh1EJ.

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AGGREGATE RESULTS NATIONWIDE: M A R C H 2 0 1 8

3 Caracas, the city of Los Palmeros , welcomed the Holy Week with an 84.6 percent shortage of hypoglycemic agents, an 89.3 percent shortage of medicines to treat hypertension, a 90.6 percentage shortage of antidiarrheal drugs, and a 98.7 percentage shortage of drugs to treat acute respiratory infections (ARIs).

The crepuscular city of Barquisimeto remains, along with Caracas, one of the cities with the worst supply of medicines to treat the morbidity causes at issue. All along the entire period, Barquisimeto has had the roughest time: the results from the survey on the availability of drugs for the four causes of morbidity aforementioned are particularly critical for all Barquisimetans.

In the measurements conducted during the month of March, the group of drugs with the best supply in Barquisimeto was that of medications to treat high blood pressure. It is extremely alarming to find that the indicator for both hypoglycemic agents and medication to treat acute respiratory infections was 96.3%, which confirms the sustained trend towards 100 percent shortage.

3.Los Palmeros is a typical event of the Holy Week in Venezuela , particularly in Caracas. The tradition, which dates back to the late 17th century, evokes the biblical passage of Jesus’ entrance into Jerusalem. Palms are collected from trees, blessed, and later distributed among the believers, who braid them and fold them into crosses that they keep in their homes as a sign of faith.

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In order of availability to the public, Mérida was the city with the worst supply of antidiarrheal medication, with a 100 percent shortage. As for drugs to treat acute respiratory infections (ARIs) and hypoglycemic agents, the shortage in the city was a dangerous 98.1 percent for antidiarrheal agents, and a disturbing 86.4 percent for the drugs to treat ARIs. In terms of the availability of drugs to treat high blood pressure, the Andean capital was “the best stocked” with a shortage indicator of 74.7 percent.

In Maracaibo, the indicator behaved the same as in the previous month, with an 80 percent shortage for 3 of the 4 morbidity causes included in the survey. The supply of drugs to decrease glucose levels was the best in Maracaibo; yet, the shortage thereof reached 74.2 percent, whereas that of medication to treat high blood pressure was 79.6 percent, followed by the shortage of antidiarrheal medication, at 78.5 percent. But the shortage of drugs in the basic basket to treat acute respiratory infections was the worst in Maracaibo, at 92.3 percent.

As for the island of Margarita, there was a not very relevant but worth mentioning reduction in the shortage index. The drugs in the shortest supply, as in the four remaining cities, were those prescribed to treat acute respiratory infections (a shortage of 94.8 percent). The shortage of hypoglycemic agents was slightly reduced, at 81.6 percent and 81.0 percent, respectively. On the other hand, in Margarita, antidiarrheal drugs were the largest available, with a 75.9 percent shortage.

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Graphic Nº 1: Behavior and Evolution of the Medicine Shortage Index by Morbidity Cause. September 2017 – March 2018.

Graphic Nº 1 shows that the General Shortage Index has ranged between 87 percent and 93 percent in the basic basket of drugs to treat the four major morbidity causes hitting the Venezuelan population, peaking at the beginning of the survey. In March, the GSI was below 90 percent, which is a slight reduction as compared against the four previous measurements (January I-II and February I-II).

The stock of drugs to treat hypertension was the largest

ONCE AGAIN, WE DRAW ATTENTION TO DRUGS TO TREAT ACUTE RESPIRATORY INFECTIONS (IRAs), THE SHORTAGE INDEX OF WHICH WAS

IN EXCESS OF THE GLOBAL

S H O R TA G E I N D E X

throughout the survey, remaining below 90 percent in thirteen of the fourteen data collection periods.

Once again, the supply of drugs to treat acute respiratory infections (ARIs) was the worst, closing at 96.5 percent shortage.

Nuevamente llamamos la atención

MONITORING THE RIGHT TO HEALTH IN VENEZUELA MARCH 2018

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GRAPHICAL REPRESENTATION OF RESULTS

BY CIT Y AND MORBIDIT Y CAUSE 4 DIABETES

Graphic Nº 2: Behavior and Evolution of the Medicine Shortage Index for Diabetes, by City. September 2017 – March 2018.

Graphic Nº 2 depicts the behavior and evolution of the

2017, when it reached 80.6 percent. In subsequent

shortage indicator for the group of prescription drugs

measurements, it has ranged from 71 percent to 79

for type 2 diabetes in the five cities surveyed. It can

percent, and has remained so.

be observed that, in the case of hypoglycemic agents, the General Shortage Index (GSI) has ranged almost

On the contrary, the city with the worst supply of

homogeneously from 84 percent to 91 percent, with

hypoglycemic agents and the poorest probability of

its lowest peak reaching 83.8 percent in the second

obtaining them is Barquisimeto, where the lowest that

measurement of the month of March.

the GSI has been was 87.7 during the first measurement of September 2017, and it didn’t drop below 90 percent

The city with the best stock of drugs to regulate blood

in the three following measurements, recording 96.3

sugar levels has been Maracaibo, where the indicator

percent in the month of March.

has remained below 81 percent in all measurements; it was at its highest in the first measurement of 4.This is a graphical depiction of the behavior and evolution of the shortage indicator by morbidity and city for every measurement conducted between September 2017 and March 2018.

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HIGH BLOOD PRESSURE

Graphic Nº 3: Behavior and Evolution of the Medicine Shortage Index for High Blood Pressure, by City.

September 2017 – March 2018.

The stock of drugs to treat high blood pressure remains

medicine. In both cases, the shortage indicator has

the best throughout the survey. It recorded the highest

remained below 85 percent.

shortage index during the first measurement (92.8 percent). Most recently, it remained below 90 percent,

As for Nueva Esparta, the situation is as critical

but peaked again during the second measurement

as in Caracas and Barquisimeto. During the six

of January 2018. In March, the GSI for this type of

measurements of 2018 made so far, the indicator

medication was 84 percent and 85.1 percent for the

has remained close to 90 percent, which is short of

two measurements, respectively.

encouraging.

In terms of the cities where the survey is conducted,

Particularly during this year, the shortage of medication

the availability of drugs to treat this cause of morbidity

to treat high blood pressure was at its lowest in the

is slightly regular in Maracaibo and Mérida, which have

second measurement of March, at 81 percent.

the best stock, comparatively, of antihypertensive

MONITORING THE RIGHT TO HEALTH IN VENEZUELA MARCH 2018

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ACU TE RESPIR ATORY INFEC TIONS

(ARIS)

Graphic NÂş 4: Behavior and Evolution of the Medicine Shortage Index for Acute Respiratory Infections,

by City. September 2017 – March 2018.

The shortage of drugs to treat acute respiratory

shortage indicator was close to 90%. On the other

infections (ARIs) remains high in the five cities in the

hand, in Maracaibo, the shortage index of medication

survey. The General Shortage Index for this morbidity

to treat IRAs was 88 percent, whereas in the state of

cause has ranged from 93 percent to 98 percent

Nueva Esparta, it was 79.7 percent.

throughout the measurement period, which has been going on for seven months now.

The fact that the trend in the shortage of drugs to treat acute respiratory infections is towards a dangerous

In Venezuela, it is still an ordeal to get the flu. Shortage

100 percent is spine-chilling.

figures have been utterly disheartening across the survey and for the five cities under study.

Only in the first measurement of September 2017, conducted during the second week of the month, the

MONITORING THE RIGHT TO HEALTH IN VENEZUELA MARCH 2018

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DIARRHEA

Graphic Nº 5: Behavior and Evolution of the Medicine Shortage Index for Diarrhea, by City. September 2017 – March 2018.

In terms of antidiarrheal medication, it is the second

In Maracaibo, which is the city with the best stock of

worst stocked group of medicines along the fourteen

medicines to treat this morbidity cause, the shortage

measurements conducted up to the month of March,

index has remained below 80 percent, peaking during

with a General Shortage Index always in excess of 85

the first and second measurements of September and

percent. It should be noted that drops in the GSI for

March, when it reached 78.5 percent. By the same token,

drugs to treat diarrhea have been recorded, at times

in five of the fourteen measurements made so far, the

marginal, at times substantial, in Maracaibo and Nueva

indicator was below 70 percent, which evidences a more

Esparta.

dynamic medication distribution scheme in Maracaibo as compared with the other cities in the survey.

MONITORING THE RIGHT TO HEALTH IN VENEZUELA MARCH 2018

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HOLY WEEK 2018 IN VENEZUELA: PARISHIONERS HAD TO GIVE UP THEIR THE SEVEN CHURCHES VISITATION FOR

A PILGRIMAGE TO 7 PHARMACIES OR MORE IN SEARCH OF MEDICINES

For Venezuelans, especially for Catholics, the Holy Week

unassisted, all under the cold gaze of a state that simply

is a special holiday commemorating the death and

does not care about the suffering of its citizens.

resurrection of Jesus Christ with different traditional religious manifestations, among which the celebration of

On the other hand, those who usually participate in the

the Eucharist, the Stations of the Cross, the Washing of the

adoration of the Nazarene had to tackle the ‘adoration’ of

Feet, the Visitation of the Seven Churches, the adoration of

the boxes with subsidized food distributed by the Local

the Nazarene, and the vigil at the Holy Sepulcher stand out.

Provisioning and Production Committees (CLAP, by its Spanish acronym) and/or call the 0800-Salud, a call-center

Some people fast on Council Friday, while others fast on

set up by the national government to distribute drugs, which

Good Friday. But this Holy Week in Venezuela unfolded

are two mechanisms that we have already denounced and

amidst the calamity of the Complex Humanitarian

questioned because the criteria of political discrimination

Emergency that has hit the nation’s life in all areas. Not even

under which they are allocated prevent access thereto to

the religious aspect is saved from this situation.

people without the ‘Carnet de la Patria’ [TN].

Scourged by the emergency and stress of finding their

Those who used to participate in the vigil of the Holy

medicines, Venezuelans had to trade the celebration

Sepulcher were forced to keep vigil over the emergency room

of the Eucharist for queues to purchase food and gas.

of hospitals instead, witnessing how their lives or those of a

They replaced the traditional Stations of the Cross with

relative are put at serious risk by the lack of quality medical

denunciations and protests against the State for the already

services and medical supplies in hospitals and facing the

unsustainable collapse in the distribution of food, medicines

consequences of the exacerbated deterioration of health

and domestic gas and in the provision of public services

care services in general.

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such as electricity, transport and solid waste collection facing them.

As for those accustomed to fasting on Council Friday or Good Friday, they probably could not differentiate these

In this religious holiday, instead of tracing the Seven

holy days from the rest, because Venezuelans are forced to

Churches Visitation, Venezuelans had to go through 7 or

fast anyway given that the monthly minimum wage is not

more pharmacies looking for medicines for themselves or

enough to eat two days in a row and, therefore, people must

for a family member, an ordeal that was made worse by the

choose which of the three daily meals they can afford to eat.

anguish of not knowing whether or not they would actually

In this context, it is the women and the elderly who are hit

find them or if they could afford them if they did, given that

the hardest by this forced fasting, as they are basically the

their exorbitant prices make them impossible to afford

first ones to refrain from having a bite when food at home

for most Venezuelans, increasingly impoverished and

is insufficient to meet the needs of the entire family group.

5.Translator’s Note: The “Carnet de la Patria” (roughly, the Motherland Card), is an ID card created by the government to track the identity and number of recipients of benefits within the framework of social and subsidized-food state programs and as a requisite for access to medication via the 0800SaludYa call center.

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During this Holy Week 2018, Venezuelans were forced to put aside their tradition to commemorate the Passion of Christ to incarnate their own passion and suffering, given that their quality of life has been

iV 53 percent of operating rooms are not functioning.

V

reduced, almost destroyed, and is now limited to

21.9 percent of emergency rooms are inoperative.

At the same time, 70.7 percent of ERs work intermittently.

struggling for the most basic rights such as life, health and food, which is a clear setback in terms of citizen achievements.

In March, access to health for Venezuelans was in the red:

1

percent of kitchens in hospitals do not serve VI 96 food.

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claimed the lives of more than 34 people between the

in medicines to treat the four main causes of morbidity

end of 2016 and the first quarter of 2018. It should by lack of medication or blood coagulation factors,

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according to the Venezuelan Hemophilia Association.

percent shortage of medical and surgical supplies Hospital Survey conducted by the National Assembly and the Doctors for Health NGO.

a

be noted that thirteen of these deaths were caused

There is an 88 percent shortage of drugs and a 79 in the country’s hospitals6, according to the National

risk from the lack of coagulation factor VII, which is nowhere to be found in Venezuela since 2016 and has

March closed with a shortage of more than 80 percent affecting the population.

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The lives of about 270 hemophilia patients is at

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The shortage of reagents in almost all laboratories in the country is becoming a risk factor for Venezuelans, and people with hemophilia are not escaping this awful reality. Hemophiliac patients are affected by

The survey also found that in the national public health

this situation in different ways. Several children have

system facilities:

been born who are suspected of having the disease and cannot be diagnosed because there is no material

i

94 percent of x-ray services and 97 percent of

II

100 percent of the laboratories in the country do

to test for it, said the president of the Venezuelan Hemophilia Association.8

tomography services are not operating.

not operate properly due to lack of reagents.

percent III 79 problems.

6.AFP (March 19, 2018).

of hospitals have water supply

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Transplant recipients are racing against time in their struggle to preserve their organs and, consequently, their lives. From January 2018 to March 2018 alone, the Coalition of Organizations for the Right to Health and Life (CODEVIDA, by its Spanish acronym) has recorded 64 organ rejections for lack of medicines.

Encuesta Nacional de Hospitales constató que falta 88% de medicamentos (National Hospital Survey Verified an 88 Percent

Shorgage of Medicines). Available at El Nacional’s website: http://www.el-nacional.com/noticias/crisis-humanitaria/encuesta-nacional-hospitalesconstato-que-faltan-medicamentos_227478 7.Altuve, A. (February 17, 2018). Mueren tres pacientes hemofílicos por falta de factores de coagulación (Three Hemophilic Patients Die for Lack of Blood Coagulation Factors. Available at El Pitazo website https://elpitazo.com/salud/mueren-tres-pacientes-hemofilicos-por-falta-de-factores-de-coagulacion/ 8.Pineda Sleinan, J. (. (February 1, 2018). . Pacientes hemofílicos sin examines ni transfusiones por escasez de reactivos (Hemophilic Patients Without Tests or Blood Transfusions Due to Lack of Reagents). Available at Efecto Cocuyo website : http://efectococuyo.com/principales/pacientes-hemofilicossin-examenes-ni-transfusiones-por-escasez-de-reactivos

MONITORING THE RIGHT TO HEALTH IN VENEZUELA MARCH 2018

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6 7

A

Marta Solórzano and Luz Marina Fuentes were victims of the shortage of immunosuppressant drugs and lost both

Without reagents for serology, people with HIV cannot be tested for the status of the virus in their

their organs and their lives. In Convite A.C. we denounce

bodies. The situation is further complicated by the

that Marta and Luz were also killed by the State.

fact that it is not possible to make new diagnoses.

b

One month after the Inter-American Commission on Human Rights granted precautionary measures in favor

With the outbreak of epidemics such as malaria, hepatitis, tuberculosis and, more recently, dengue

of the patients of the Nephrology Unit of the J.M. de

fever, the lack of reagents can be a potential death

Los Ríos Hospital, the Venezuelan State has not taken

sentence, given the impossibility of getting a timely

concrete action to meet the needs of the patients; in fact,

diagnosis.

no representative of the State has commented on the measures to be taken. In the meantime, the lives of the children remain threatened.

A

In light of the above, the mothers of the patients of the J.M. de Los Ríos Hospital took to the streets on March 20

Grandpa Felipe Carrasquel, a patient with chronic obstructive pulmonary disease (COPD), diabetes and hypertension, whose testimony on how the shortage of medicines affected him was collected by Convite

to protest for the poor condition of the hospital and for

A.C. in November 2017 , died in a context of a complex

the State’s failure to act and solve the terrible situation

humanitarian emergency. The death of Grandpa Felipe is

that the children and their hospitalized relatives are

a death that could have been perfectly avoided had he had

enduring, denouncing that:

i II

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the medicines to treat his diseases in a timely manner. The whole context of the Complex Humanitarian Emergency

The Hematology Unit and the area where children should receive chemotherapy treatment have no

that we have documented was nothing but a death sentence for him. During his testimony, he told us how the shortage

air conditioning equipment operating.

of medicines and food had impaired the quality of life and,

The Hematology Unit is paralyzed.

helpless because, in order to stay alive, he needed specific

as a result, his health had deteriorated. He said he felt doses of his medication in a timely manner. Grandpa Felipe

supply of pediatric and adult lines in the III The Hemodialysis Unit is intermittent. “Medications such as Paricalcitol, an important drug for the management of metabolic disease, have been lacking for more than a year.”

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The shortage of reagents significantly complicates the already dark panorama of access to healthcare in Venezuela, because it makes it impossible for laboratories

did not get his treatment on time or, when he was lucky to get it, the drugs were too expensive and he couldn’t afford them: like most of the elderly people in Venezuela, Grandpa Carrasquel only had his old age pension to make it through the month and it was not enough (and is not enough for anyone) for him to purchase neither food for his diet nor the treatment he needed. Grandpa Felipe was also killed by the State.

to screen for diseases such as hepatitis C or HIV. 9.Reporte Proiuris. (March 21, 2018). El Estado desacata medidas de la CIDH y niños del J.M. de Los Ríos siguen en peligro de muerte (The State Ignores Precautionary Measures from the Inter-American Commission on Human Rights and Children in J.M. de Los Ríos Hospital Are In Danger of Dying). Availableat Prouiris website Proiuris: http://proiuris.org/?p=48550 10.Carrasquel,

F.

(February,

2018).

#AlEstadoNoLeDuele Caso de Felipe Carrasquel (C. A.C. Entrevistador

(#TheStateDoesn’tCare The Case of Felipe Carrasquel (C. A.C. Interviewer). Available at https://www.youtube.com/ watch?v=O2BpLu1TMjk

MONITORING THE RIGHT TO HEALTH IN VENEZUELA MARCH 2018

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