Monitoring The Right To Health in Venezuela Newsletter Nro 4

CONVITE - Newsletter Nยบ 4. December, 2017.

Newsletter Nro 4 1

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DEC. 2017

CONVITE - Newsletter NÂş 4. December, 2017.

Overview

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Location: Metropolitan Area of Caracas

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Location: Barquisimeto

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Location: Maracaibo

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Location: MĂŠrida

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Location: Porlamar

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Morbidity: Diabetes

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Morbidity: High Blood Pressure

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Morbidity: Acute Infections of the Respiratory Tract

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Morbidity: Diarrhea

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Convite strongly denounces

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Health in Times of a Complex Humanitarian Crisis in Venezuela

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CONVITE - Newsletter Nº 4. December, 2017.

MEDICINE SHORTAGE INDEX Analysis and interpretation of aggregate results for the first two measurements of the medicine shortage index november, 2017 Within the framework of the Monitoring the Right to Health in Venezuela: An Approximation from Medicine Shortages, Preventable Deaths, and Hospital Infrastructure, CONVITE, A.C. has conducted a total of six surveys (September I – II,

October I – II, and November I – II) to measure the availability or otherwise of the basic basket of active ingredients associated with the treatment the four morbidities under study, with findings showing an alarming trend towards 100% shortage.

AGGREGATE RESULTS AT THE NATIONAL LEVEL 100.0% 95.0% 95.0%

93.1%

91.4%

90.2%

88.0% 88.5%

85.0%

89.4%

80.0% 75.0% 1st Week, September

2nd Week, September

1st Week, October

2nd Week, October

1st Week, November

2nd Week, November

General Shortage Index

93.1%

91.4%

88.0%

88.5%

89.4%

90.2%

Diabetes

90.7%

87.6%

89.3%

88.6%

88.2%

89.8%

High-Blood Pressure

92.8%

80.9%

80.6%

79.6%

81.6%

82.6%

Acute Infections of the Respiratory Tract

94.0%

94.8%

95.5%

96.5%

96.8%

97.1%

Diarrhea

95.6%

87.2%

86.7%

89.2%

91.2%

91.4%

Graphic Nº 1: Accumulated Shortage Indicator by Morbidity

The General Shortage Index rose in November at the aggregate level (nationwide). The first measurement of the month reveals that the GSI increased by 1.4 % as compared against the same week in the month of October, whereas the second measurement indicates that it is 1.7 % above its counterpart in the previous month. An exception to the latter is the measurement for diabetes prescription drugs during the first week of the month of November, the shortage of which experienced a reduction, albeit marginal, as compared with the figures for the second week and the fourth week of the month of October.

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The sustained trend towards 100% medicine shortage of medication to treat acute infections of the respiratory tract (ARTIs) is still alarming, peaking at 97.1 % for active ingredients used in products in the basic basket of drugs prescribed for the treatment of said ailments. The same applies to the active ingredients used in products in the basic basket of drugs prescribed for the treatment of diarrhea. The most troubling aspect of these findings is that these two morbidities are precisely the most recurrent in Venezuelans, regardless of their age or social status. It should be recalled at this point that, as we warned in our October Newsletter, both the poor

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CONVITE - Newsletter Nº 4. December, 2017.

quality of drinking water and typical seasonal climatic factors play a direct role in the occurrence of ARTIs and diarrhea, and increase them exponentially.

Graphic Nº 1 illustrates how, despite a few sharp drops recorded during the second week of September, the shortage indicator trend is towards 100% or towards a full-scalelack of drugs to treat the four As for the shortage index associated with medica- most recurrent morbidity causes in Venezuela. tion to treat highblood pressure, even if the same remains below 90%, it showed an increase in the two measurements conducted in November versus the results of the measurements carried out during the same weeks in the month of October.

THE HEALTH OF THE VENEZUELAN POPULATION

IS NOT A PRIORITY FOR THE VENEZUELAN STATE 100.0% 95.0% 90.0% 85.0% 80.0% 75.0% 70.0%

General Shortage Index

90.7%

89.3% 88.6%

87.6%

88.2%

90.3%

1st Week, September

2nd Week, September

1st Week, October

2nd Week, October

1st Week, November

2nd Week, November

90.7%

87.6%

89.3%

88.6%

88.2%

90.3%

91.9%

90.8%

93.1%

93.1%

93.1%

94.1%

87.7%

90.1%

92.6%

100.0%

93.8%

96.3%

79.0%

96.3%

92.6%

88.9%

91.4%

93.8%

74.2%

78.5%

78.5%

71.0%

73.1%

76.3%

90.8%

96.6%

90.8%

90.8%

90.8%

95.4%

Graphic Nº 2: Accumulated Shortage Indicator by City

Graphic Nº 2 depicts the behavior of the indicator, on a per city basis, in each of the measurements that we have conducted so far. While the shortage index in Caracas and Porlamar has remained above 90%, close to 100%, Mérida, Barquisimeto and

Maracaibo have experienced marginal variations in that regard. This means that the national aggregate figures depict the complex humanitarian emergency Venezuelans are enduring.1

1 Period and Frequency of Data Collection: Two measurements were conducted in November between the 10th and the 13th and between the 23rdand the 27th, which are the second and fourth week 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 methodology applied, please refer to Newsletter Nº 2, October 2017, available at https://issuu.com/conviteac/docs/boleti_cc_81n_20_233_20convite.

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METROPOLITAN AREA OF CARACAS MEDICINE SHORTAGE IN THE METROPOLITAN AREA OF CARACAS HAS REACHED STAGGERING PROPORTIONS, PARTICULARLY IN THE MUNICIPALITIES OF BARUTA, CHACAO, EL HATILLO AND SUCRE.

DIABETES November 93.1%

HIGHBLOOD PRESSURE November

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November was by far the darkest month for those who suffer from diabetes and live in the Metropolitan Area of Caracas, considering that only one of the three active ingredients surveyed, namely Glyclazide, could be found, albeit in very small quantities and only in the Municipality of Libertador.

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The shortage of diabetes medication was total in the municipalities of Baruta, Chacao, El Hatillo and Sucre.

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The one municipality with the “best” supply of medication to treat high blood pressure is still Libertador, where some Enalapril, Valsartan, Nifedipine and Amlodipine could be found.

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On the other hand, the municipalities of Baruta, Chacao, El Hatillo and Sucre experienced 100% shortage of five of the six active ingredients prescribed for treatment of high blood pressure surveyed herein, with Enalapril being the only one available.

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The outlook is completely disheartening as far as the supply of medication to treat acute infections of the respiratory tract is concerned, considering that the shortage was 100% for six of the seven active ingredients prescribed for treatment of AIRTsin the Municipality of Libertador, where only some Amoxicillin could be found in the midst of a 97% shortage,which was also the case for Moxifloxacyn in Chacao, where the shortage was 80%.

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The shortage of medication to treat AIRTs was total in the municipalities of Baruta, El Hatillo and Sucre.

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Diarrhea is one of the most frequent mortality causes in children under 5. In November, as per the results of our survey, those who got a diarrheal disease in the Metropolitan Area of Caracas were at risk of dying.

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The shortage of medication to treat diarrhea was TOTAL in all the municipalities surveyed.

90%

ACUTE INFECTIONS OF THE RESPIRATORY TRACT November 99%

DIARRHEA November 100%

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BARQUISIMETO THE PICTURE LOOKS BLEAK FOR BARQUISIMETO AS A RESULT OF INCREASING MEDICINE SHORTAGES.

DIABETES November 96.3%

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HIGHBLOOD PRESSURE November

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In Barquisimeto, a shortage index of 96.3% for diabetes medication was reported in November. This meant a marginal variation with respect to the figures recorded for the previous month, which can be explained by the fact that some Metformin and some Glibendclamide could be found.

However, the shortage of active ingredients for medication to treat diabetes was close to 100%, with 92.6% for Metformin and 96.3% for Glibenclamide.

In November, Barquisimetanos COULD NOT FIND Glyclazide.

Barquisimetanos were not able to find Valsartan or Nifedipine in none of the prescribed dosages surveyed.

The shortage index for Enalapril was below 50%, which is an interesting finding, considering that a large number of high blood pressure patients take Enalapril in any of the available strengths.

The shortage index for Losartan was 85.2%, whereas that for Nifedipine remained at 96.3%.

87.7%

ACUTE INFECTIONS OF THE RESPIRATORY TRACT November

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97.7%

DIARRHEA November 96.3% 6

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Barquisimetanos could only find three of the eight active ingredients for treatment of ARTIs: Amoxicillin (88.9% shortage), and Levofloxacyn and Moxifloxacyn (96.6% shortage in all surveyed strengths and dosages).

NO Benzathine Penicillin,Clarithromycin, Cefuroxime Axetil, Clindamycin or Doxycylin could be found.

This is a frightening scenario, given that, as we warned in our third newsletter, current climate conditions of fluctuating rainy periods and sustained improper waste handling and disposal, such as waste burning, have a direct impact on the emergence of acute infections of the respiratory tract and are a health risk in an almost total shortage situation.

Barquisimetanos could find some Ciprofloxacin; however, the shortage index was 85.2%.

The supply of Metronidazole was very marginal, with a shortage index of 96.3% (close to 100%). As for Trimethoprim, shortage was total.

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MARACAIBO PEOPLE IN MARACAIBO HAVE A BETTER CHANCE OF FINDING DRUGS TO TREAT HIGH BLOOD PRESSURE.

DIABETES November 76.3%

HIGHBLOOD PRESSURE November

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This is mainly due to the fact that the shortage index for Metformin was below 50%, closing at 41.9%, the lowest for the active ingredient at the national level in the November survey. In this regard, Marabinos were luckier than people living in other regions.

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The shortage index for Glyclazide was 87.1%, and there was NO supply of Glibenclamide for Marabinos.

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Maracaibo recorded the lowest shortage index for high blood pressure medication as compared against the other regions surveyed.

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In November, Marabinos suffering from hypertension were able to find all six active ingredients, with Enalaprilbeing the one found in larger quantities, since the shortage indicator therefore was below 40%.

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Maracaibo does not escape the reality affecting the rest of the country as far as the shortage of medication to treat ARTIs is concerned. Despite its being a border city, the shortage index was close to 100%.

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However, some Penicillin, Amoxicillin, Clarithromycin and Doxycylin could be found, with shortage indexes of 93.5%, 58.1%, 90.3% and 93.5%, respectively. The rest of the active ingredients prescribed for ARTIs were nowhere to be found.

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The landscape in the “Beloved Land of the Sun” for diarrhea medication was quite similar, since the three active ingredients surveyed were available.

65.1%

ACUTE INFECTIONS OF THE RESPIRATORY TRACT November 91.9%

DIARRHEA November 73.1% 7

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MÉRIDA SHORTAGE IS STILL THE COMMON DENOMINATOR.

DIABETES November 93.8%

HIGHBLOOD PRESSURE November

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Diabetic Merideños are still experiencing rising shortages of drugs to treat their disease, with a shortage of diabetes medication of nearly 100%.

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From the three active ingredients surveyed for this morbidity, Glyclazide was the least scarce, with a shortage index of 88.9%.

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The overall shortage of high blood pressure medication was 72.8%; however, Merideños taking Enalapril, which is one of the most used active ingredients for hypertension, were lucky because the shortage index thereof was 25.9%, and that for Valsartan was 37%.

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This may be due to the fact that Mérida is a border state. On the other hand, shortage of Atenolol was 100%.

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The outlook is almost the same as for Maracaibo. Although the general shortage index was 97.7% (very similar to the aggregate national percentage), Merideños were able to find some Penicillin, Cefuroxime Axetil and Moxifloxacyn in November.

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Nevertheless, those in need of Amoxicillin, Clarithromycin,Levofloxacyn,Clindamycin or Doxycylin were helpless faced with the shortages.

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In the case of medication to treat diarrhea, the situation is very similar. Even if the shortage indicator was close to 100%, two of the three active ingredients surveyed for this morbidity were available to patients, albeit in marginal amounts.

72.8%

ACUTE INFECTIONS OF THE RESPIRATORY TRACT November 97.7%

DIARRHEA November 96.3%

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PORLAMAR FINDING MEDICINES IN MARGARITA IS STILL A PRIVILEGE.

DIABETES November 95.4%

HIGHBLOOD PRESSURE November

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A minimum supply of medication to treat type 2 diabetes seems to be the norm in Porlamar. People in the State of Nueva Esparta faced a shortage of hypoglycemic agents of 95.4%, close to 100%.

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However, the three active ingredients surveyed were available in small quantities.

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The situation for high blood pressure patients in Porlamar remained unchanged as compared against October figures.

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Enalapril was found in larger amounts in drugstores; however, those taking Nifedipine, in whatever strength, faced a shortage index of 100%.

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The landscape for the basket of drugs to treat ARTIs is also bleak.

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Some Amoxicillin,Cefuroxime Axetil and Moxifloxacyn could be found, but shortage of the remaining five active ingredients was total.

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Antidiarrheal medication is also scarce in Porlamar drugstores, although the shortage index for the month of November revealed a slight improvement with respect to previous months. Shortage was 100% for one of the active ingredients, namely Trimethoprim; however, people in Nueva Esparta were able to find Ciprofloxacin and Metronidazole.

87.4%

ACUTE INFECTIONS OF THE RESPIRATORY TRACT November 98.3%

DIARRHEA November 87.4%

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Three (3) Active Ingredients: • Metformin • Glyclazide • Glibenclamide

MetropolitanArea of Caracas Diabetes (Active Ingredients)

94,1%

92,6%

85,0% 80,0%

88,9%

Porlamar Diabetes (Active Ingredients) 96,6%

95,0%

96,6%

93,1%

90,0%

70,0% 65,0% 60,0%

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Glyclazide

75,0%

Metformin

80,0%

Glibenclamide

85,0%

95,4% Diabetes Medication in Porlamar

100,0%

96,8%

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96,3% Diabetes Medication in Mérida

76,3%

93,3%

Glibenclamide

Diabetes Medication in Maracaibo

Glyclazide

0,0%

Metformin

20,0%

41,9%

Glibenclamide

60,0% 40,0%

100,0% 95,0% 90,0% 85,0% 80,0% 75,0% 70,0% 65,0% 60,0% 55,0% 50,0%

87,1%

Metformin

100,0%

80,0%

96,3%

Mérida Diabetes (Active Ingredients)

Maracaibo Diabetes (Active Ingredients) 100,0%

Glibenclamide

90,0%

Glyclazide

82,4%

96,3% 95,0%

Metformin

80,0%

Metformin

85,0%

Glyclazide

90,0%

Glibenclamide

95,0%

100,0%

100,0%

Diabetes Medication in Brquisimeto

100,0% Diabetes Medication in the Metropolitan Area of Caracas

100,0%

100,0%

Barquisimeto Diabetes (Active Ingredients)

Glyclazide

DIABETES

Dosage: Six (6) different dosages

CONVITE - Newsletter Nº 4. December, 2017.

Six (6) Active Ingredients: • Enalapril • Valsartan • Atenolol • Nifedipine • Amlodipine • Losartan

100,0% High Blood Pressure Medication in the Metropolitan Area of Caracas

89,7%

89,7%

89,7%

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Losartan

Amlodipine

Nifedipine

Atenolol

60%

Valsartan

70%

Enalapril

80%

72,4%

82,8%

High Blood Pressure Medication in Porlamar

100,0%

100%

Losartan

Amlodipine

96,3%

96,3%

87,4%

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High Blood Pressure Medication in Mérida

Losartan

Amlodipine

81,5%

Porlamar High Blood Pressure (Active Ingredients)

90%

87,7%

72,8%

100,0%

Nifedipine

High Blood Pressure Medication in Maracaibo

54,8%

Losartan

51,6%

Amlodipine

Nifedipine

Atenolol

Valsartan

40%

38,7%

50%

Enalapril

60%

57,7%

80% 70%

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

80,5%

90%

85,2%

Mérida High Blood Pressure (Active Ingredients)

65,1%

96,8%

Nifedipine

0,0%

Atenolol

20,0%

Atenolol

Losartan

40,%

Maracaibo High Blood Pressure (Active Ingredients) 100%

96,3%

48,1%

Valsartan

60,0%

89,7%

Amlodipine

Nifedipine

Atenolol

Valsartan

52,9%

80,0%

Enalapril

85,0%

100,0%

37,0%

91,2% 90,0%

96,3%

80,0%

Valsartan

95,0%

Enalapril

97,1% 97,1%

100,0%

100,0%

25,9%

100,0%

100,0%

Barquisimeto High Blood Pressure (Active Ingredients)

High Blood Pressure Medication in Barquisimeto

Área Metropolitana de Caracas High Blood Pressure (Active Ingredients)

Enalapril

HIGHBLOOD PRESSURE

Dosage: fourteen (14) different dosages

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Nine (9) Active Ingredients • Moxifloxacyn • Penicillin • Levofloxacyn • Amoxicillin • Clindamycinand • Clavulanic Acid • Doxycylin • Clarithromycin • Cefuroxime Axetil

100,0%

100,0% 100,0%

Porlamar ARTIs (Active Ingredients) 100,0%

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98,3%

ARTIs Medication in Porlamar

Doxycylin

Clindamycin

60,0%

Moxifloxacyn

65,0%

Levofloxacyn

70,0%

Cefuroxime Axetil

75,0%

100,0% 100,0% 96,6%

93,1%

Clarithromycin

80,0%

Benzathine Penicillin

85,0%

100,0% 96,6%

95,0% 90,0%

100,0%

Amoxicillin

100,0%

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Doxycylin

Clindamycin

Moxifloxacyn

91,9% ARTIs Medication in Mérida

Clindamycin

Moxifloxacyn

Levofloxacyn

50,0%

Cefuroxime Axetil

60,0%

Clarithromycin

70,0%

58,1%

80,0%

93,5%

90,3%

Doxycylin

93,5%

100,0% 100,0% 100,0% 100,0%

Amoxicillin

Doxycylin

Clindamycin

Moxifloxacyn

Levofloxacyn

Cefuroxime Axetil

90,0%

ARTIs Medication in Maracaibo

92,6%

100,0%

97,7%

Benzathine Penicillin

100,0% 100,0% 92,6%

Clarithromycin

70,0%

100,0%

97,7%

Mérida ARTIs (Active Ingredients)

96,3%

Amoxicillin

80,0%

Benzathine Penicillin

90,0%

100,0% 100,0%

Levofloxacyn

88,9%

Maracaibo ARTIs (Active Ingredients) 100,0%

100,0% 100,0% 96,3% 96,3%

Clarithromycin

100,0% 98,0% 96,0% 94,0% 92,0% 90,0% 88,0% 86,0% 84,0% 82,0%

Amoxicillin

Doxycylin

60,0%

Clindamycin

65,0%

Moxifloxacyn

70,0%

Levofloxacyn

75,0%

Cefuroxime Axetil

80,0%

Clarithromycin

85,0%

Amoxicillin

90,0%

Benzathine Penicillin

95,0%

99,3%

Benzathine Penicillin

100,0% 97,1% 100,0% 100,0% 100,0% 97,1% 100,0% 100,0%

ARTIs Medication in the Metropolitan Area of Caracas

100,0%

Barquisimeto ARTIs (Active Ingredients)

ARTIs Medication in Barquisimeto

Área Metropolitana de Caracas ARTIs (Active Ingredients)

Cefuroxime Axetil

ACUTE INFECTIONS OF THE RESPIRATORY TRACT

Dosage: thirteen (13) different dosages

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Five (5) Active Ingredients: • Ciprofloxacin • Trimethoprim • Sulfamethoxazole • Ceftriaxone • Metronidazole

Barquisimeto Diarrhea (Active Ingredients)

Área Metropolitana de Caracas Diarrhea (Active Ingredients)

100,0%

100,0%

96,3%

95,0%

85,0% 80,0% 75,0%

85,2%

Mérida Diarrhea (Active Ingredients)

Maracaibo Diarrhea (Active Ingredients)

51,6%

Diarrhea Medication in Maracaibo

0,0%

Trimethoprim

20,0%

Ciprofloxacin

60,0%

Metronidazole

73,1%

Porlamar Diarrhea (Active Ingredients) 100,0%

100,0%

13

82,8%

Diarrhea Medication in Porlamar

Metronidazole

80,0%

79,3%

Trimethoprim

85,0%

Ciprofloxacin

95,0% 90,0%

96,3%

96,3%

92,6%

87,4%

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Diarrhea Medication in Mérida

77,4%

100,0%

Trimethoprim

90,3%

80,0%

40,0%

100,0% 95,0% 90,0% 85,0% 80,0% 75,0% 70,0% 65,0% 60,0% 55,0% 50,0%

Ciprofloxacin

100,0%

Diarrhea Medication in Barquisimeto

90,0%

Metronidazole

93,8%

Metronidazole

Trimethoprim

100,0%

Ciprofloxacin

100,0%

Diarrhea Medication in the Metropolitan Area of Caracas

100,0%

Metronidazole

100,0%

Ciprofloxacin

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0%

Trimethoprim

DIARRHEA

Dosage: nine (9) different dosages

CONVITE - Newsletter Nº 4. December, 2017.

Strongly Denounces

Health in Times of Complex Humanitarian Emergency in Venezuela.

Health is “a fundamental social right, an obligation of the State, who shall guarantee its exercise as part of the right to life. The State shall promote and develop policies aimed at improving the quality of life, collective wellbeing and access to services. All persons have a right to health protection and the duty to play an active role in its furtherance and defense and to comply with such health and sanitation and hygiene standards as provided by law and under the international treaties and conventions signed and ratified by the Republic”.

Article 83 of the Constitution of the Bolivarian Republic of Venezuela.

1.

The shortage of medication to treat the four most frequent morbidity causes in the country was above 90%.

2.

At least two (2) transplanted patients died as a result of the lack of the much needed anti-rejection medication to preserve their donor organs, their health and their lives.

3.

As a result of the lack of medicine, one hundred (100) transplanted patients are facing a crisis, and two thousand five hundred (2,500) more risk losing their donor organs and dying.

We at Convite, A.C., convinced as we are of the importance of understanding health as recognized in Venezuelan laws, have decided to disseminate our findings on the current status of the human right to health in Venezuela and to document cases where said rights are infringed by an incompetent State that doesn’t care about its suffering population. In November, said findings include:

4.

One patient with kidney disease died because he couldn’t take the prescribed medication to treat his chronic ailment due to drug shortages.

5.

Yet another kid died in the Nephrology Service of Hospital J. M. de Los Ríos as a result of bacterial contamination.

6.

Only seventy-seven thousand (77,000) of the three hundred thousand (300,000) HIV patients nationwide receive antiretroviral drugs from the Ministry of the People’s Power for Health.

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CONVITE - Newsletter Nº 4. December, 2017.

7.

Only four (4) of the twenty-four (24) antiretroviral drugs required to complete treatment are being currently received at the offices of the regional health coordinators at the national level.

8.

Reagents are also scarce. Today, HIV patients have no access to the necessary tests to determine the status of the HIV in their bodies.

Physicians and patients cannot monitor the patients’ immune system and the response thereof to antiretroviral therapy.

9.

There are no serological tests for HIV or reagents available to determine whether or not an individual has been infected with HIV.

10. There is a complete shortage of medical supplies. Patients in public hospitals need to purchase their own blood sample collection tubes for blood testing.

11. Individuals with inflammatory bowel disease must travel to Colombia to purchase their medication.

12. Patients treated in public hospitals need to purchase everything from painkillers to anesthesia, dressings, gloves, iodine, gauze, and even cotton.

13. The Supreme Court of Justice dismissed for the fourth time a writ of amparo (a remedy for the protection of constitutional rights) that was filed to protect children from the effects of medicine shortages.

14. Breast cancer patients must face the fact that sixty percent (60%) of mammography machines in the public health system are out of service.

15. Only ten (10) of the thirty-two (32) radiotherapy machines in the country are in working order.

17. Hospital José María Vargas, one of the largest and busiest health centers in the country, is currently running at 30% capacity.

18. The minister of Health has refused to acknowledge the reemergence of diseases long eradicated in the country, arguing that reports on diphtheria cases are just a media fabrication.

We raise our voices and denounce that we Venezuelans are at the mercy of the acts and omissions of a State that has death at the center of its policies because it refuses to acknowledge the existence of a complex humanitarian emergency that continuously inflicts pain and suffering on those who are unable to find their much needed medication, from the most basic drugs, such as painkillers, to the most specialized ones, such as chemotherapy or immunosuppressant drugs.

People die each day for lack of timely and quality health care in public health centers of for lack of access to the drugs needed to treat their ailments.

The Venezuelan State fails to comply with the basic criteria and core principles set forth by the World Health Organization, particularly those in connection with good quality, for “health facilities, goods and services must be scientifically and medically appropriate and of good quality.

This calls, among other things, for skilled health professionals, scientifically proven drugs and hospital equipment, adequate sanitation and safe and potable water.” The people in this country are treated in decaying public hospitals where it is normal for emergency rooms to be flooded with sewage and feces, for laboratories to lack reagents or tubes, and for X-ray machines and elevators to be out of order.

16. An average one thousand seven hundred (1,700) women die in Venezuela from cancer.

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Créditos de traducción:

YAZMINE LIVINALLI FERNÁNDEZ, B.A.

Bachelor of Arts in Translation and Interpretation, English-French-Spanish, Universidad Central de Venezuela, Caracas, Venezuela, 1985; Legal Translator Degree, Universidad Metropolitana, Caracas, Venezuela, 2006.

ATA member. Registered with and accredited by the Ministry of the Interior and Justice, Venezuela. yazlivi@gmail.com.

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