Monitoring The Right To Health in Venezuela Newsletter Nro 3

CONVITE - Newsletter Nยบ 3. November, 2017.

Newsletter Nro 3 1

XLaSalud XLaSalud

NOV. 2017

CONVITE - Boletín Nro 3 NOV. 2017

Introduction: #ConviteXLaSalud Alert (#ConviteForHealth Alert). 3 Medicine Shortage Index – October, 2017.

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Overview 5 Location: Metropolitan Area of Caracas.

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Location: Barquisimeto

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Location: Maracaibo

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Location: Mérida

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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. 14 Convite strongly denounces: The State doesn’t care that our rights are being violated!

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XLaSalud

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CONVITE - BoletĂ­n Nro 3 NOV. 2017

ALERT

Behind the figures that we present in this Newsletter, there is a reality which the citizens of a country sunk in a dire and complex humanitarian emergency must face - one where the chances of suffering from a chronic illness or dying are equally high.

We in Convite, A.C. raise our voices to alert that these figures must be a reason for concern, especially considering that the conditions below may contribute to worsening the situation: Current Climate Conditions: Fluctuating rain periods and improper waste handling and disposal, including waste burning, among other polluting practices, have a direct impact on the emergence of acute infections of the respiratory tract and increase the chances that said diseases may occur or that people may suffer therefrom. In October, the general medicine shortage indicator for this morbidity closed at a trend of nearly 100%.

Poor Drinking Water Quality: Poor drinking water quality exponentially increases the risk of diarrheal diseases. In the Metropolitan Area of Caracas alone, a 100% medicine shortage index was recorded for diarrheal medication during the fourth week of the month of October.

This combination of factors may be detrimental to public health.

A Diet Rich in Carbohydrates, Processed Flours, Starches and Tubers: This is a common situation in most Venezuelan households, including those of diabetics, and has a direct bearing on the appearance of new diabetes cases, considering that these kinds of foods are processed into sugar.

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XLaSalud

CONVITE - Boletín Nro 3 NOV. 2017

MEDICINE SHORTAGE INDEX ANALYSIS AND INTERPRETATION OF AGGREGATED RESULTS from the first two surveys of the MEDICINE SHORTAGE INDEX conducted on October 2017.

AN OVERVIEW OF MSI TRENDS (OCTOBER, 2017)

1st Week, September

2nd Week, September

1st Week, October

2nd Week, October

General Shortage Index Diabetes High-Blood Pressure

Acute Infections of the Respiratory Tract

Diarrhea

Graphic Nº 1: Accumulated Shortage Indicator by Morbidity

Convite, A.C. has conducted a total of four surveys (September I – II and October I-II)1 to measure the availability or otherwise of the basic basket of active principles associated with the treatment of high-blood pressure, diabetes, diarrhea and acute respiratory tract infections (ARTIs).

MORBIDITY

September I

The findings have demonstrated that there is a severe shortage of medication to treat these morbidities, with a shortage trend of nearly 100%.

September II

October I

October II

Diabetes

90.7%

87.6%

89.3%

88.6%

High-Blood Pressure

92.8%

80.9%

80.6%

79.6%

ARTIs

94.0%

94.8%

95.5%

96.5%

Diarrhea

95.6%

87.2%

86.7%

89.2%

General Shortage Index

93.1%

91.4%

88.0%

88.5%

1. SURVEY CHRONOLOGICAL DETAILS: The survey consisted of two monthly measurements made between October 11-13, 2017, and October 24-27, 2017, 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 sNewsletter Nº 2, October, 2017. https://issuu.com/conviteac/docs/derecho_a_la_salud._2ndo_bolet__n

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XLaSalud

CONVITE - Boletín Nro 3 NOV. 2017

At the aggregate level (nationwide), there was a reduction in the general shortage index during the month of October; however, the reduction is still insufficient and shortage is alarming.

In the first measurement of October, which was conducted during the second week of the month, the general shortage index decreased by 5.1 percentage points, as compared against the same week in September, whereas the second mea-

surement of the month reflected a reduction of 2.9 percentage points below its counterpart from the previous month. This reduction stems from the behavior of high-blood pressure medication shortage during the first weeks of September and October, as measured, which forced the average down. Notwithstanding the foregoing, overall figures do not reflect substantial variations.

THE MAIN CAUSE FOR ALARM: Treatment for acute infections of the respiratory tract: In this survey, records associated with ARTIs were the highest (95.5% and 96.5%, respectively), meaning a increase of 1 and 2 percentage points vis-à-vis September measurements.

A LITTLE RELIEF: A reduction in the shortage of high-blood pressure medication.

During the second week of October, the shortage of medication to treat high-blood pressure decreased by 12 percentage points as compared against the second week of the month of September, making it the ailment least affected by shortage. However, it is just “a little relief”, for the shortage trend remains at approximately 80%.

THE MIDPOINT: Medication for diarrhea and diabetes.

In the first measurement of October, the shortage index for diarrhea medication was smaller than the one recorded for the first week of the month of September (8 percentage points). For the fourth week of October, it increased by 2 percentage points as compared against the same week in September. As for diabetes, shortage levels remained slightly unchanged during the two measured months.

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XLaSalud

CONVITE - Newsletter Nº 3. November, 2017.

METROPOLITAN AREA OF CARACAS MEDICINE SHORTAGE IS CROSS-SECTIONAL IN THE FIVE MUNICIPALITIES OF THE METROPOLITAN AREA OF CARACAS

DIABETES

• A sustained and rising index of more than 90%.

OCTOBER I

OCTOBER II

93.1%

93.1%

HIGH-BLOOD PRESSURE OCTOBER I

OCTOBER II

91.4%

90.8%

ARTIs OCTOBER I

OCTOBER II

98.7%

98.7%

• The reduction of the shortage index for medication to treat high-blood pressure has been marginal and insufficient. This shortage index decreased by approximately 7.5 percentage points as compared against the first measurement of September (97.5%).

• Alarmingly, no measures have been taken to curb the shortage of high-blood pressure medication, which is one of the leading causes of death in Venezuela and one of the commonest in seniors.

• The new norm in Venezuela, imposed by the Venezuelan State, is that antibiotics are nowhere to be found. Only 1 out of 10 patients has a certain chance of finding medication to treat acute infections of the respiratory tract.

• There are no variations in figures for the month of October.

This is a dramatic picture in a metropolitan area subject to high pollution indexes.

• One of the most alarming indexes is the one pertaining to diarrhea. Since September, we warned about a shortage trend of 99.0% and 98.9%.

DIARRHEA

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• Treatment of type 2 diabetes calls for any of the following three (3) active principles: Metformin, Glyclazide, and Glibenclamide, in six (6) different dosages.

OCTOBER I

OCTOBER II

95.4%

100.0%

• During the second week of October, Caraqueños “shouldn’t have” fallen with diarrhea, and those who did just couldn’t have access to medication to treat it.

XLaSalud

CONVITE - Newsletter Nº 3. November, 2017.

BARQUISIMETO IN BARQUISIMETO, KNOWN AS THE DUSK CITY, MEDICATION IS NOWHERE TO BE FOUND.

DIABETES

• Dramatically, shortage is on the increase.

OCTOBER I

OCTOBER II

92.6%

100.0%

HIGH-BLOOD PRESSURE OCTOBER I

OCTOBER II

79.0%

81.5%

• We have warned that, being it a chronic disease that needs treatment for life, unavailability of medication in prescribed dosages may lead to death.

• A reduction was identified in the shortage index for high-blood pressure medication during the fourth week of September (92.0%).

• However, we estimate that only 2 out of 10 patients have been able to “easily” acquire medication to treat their ailment.

• This index fluctuates week by week. Patients with any form of AIRT are faced with a shortage of medication of over 90%, to treat the disease, at least in the last two months!

ARTIs OCTOBER I

OCTOBER II

91.1%

97.2%

• These figures are alarming, for they reflect a high shortage index of nine (9) active principles in thirteen (13) different dosages.

• The shortage of medication to treat diarrhea is on the increase. This month, it rose by 13.6 percentage points as compared with September.

DIARRHEA

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• In the fourth week of October, Barquisimetanos suffering from diabetes could not find any of the medications that they need to treat their condition.

OCTOBER I

OCTOBER II

93.8%

93.8%

• Barquisimetanos joined the tour de force of searching for any of the five (5) active principles taken into account for measurement purposes: Ciprofloxacin, Trimethoprim, Sulfamethoxazole, Ceftriaxone, and Metronidazole, in nine (9) different dosages.

XLaSalud

CONVITE - Newsletter Nº 3. November, 2017.

MARACAIBO THE “BELOVED LAND OF THE SUN” DOES NOT ESCAPE TO SHORTAGE.

DIABETES OCTOBER I

OCTOBER II

78.5%

71.0%

HIGH-BLOOD PRESSURE OCTOBER I

OCTOBER II

59.7%

55.4%

ARTIs OCTOBER I

OCTOBER II

91.1%

91.1%

DIARRHEA

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OCTOBER I

OCTOBER II

62.4%

63.4%

• In October, only 3 out of 10 Maracaiberos were able to have access to any of the active principles in the basic basket of medication for type 2 diabetes.

• Despite it being a border state, Maracaibo is still accounted for in the nationwide shortage index, as already reported by other organizations.

• High-blood pressure patients are less subject to anxiety when it comes to finding their medication in Maracaibo, as compared with those suffering from other ailments.

• However, it should be noted that a 50% shortage is still an indicator of potential violations to the right for health, considering that access to medication remains restricted for, at least, half of high-blood pressure patients.

• The major shortage warning in Maracaibo pertains to drugs to treat acute infections of the respiratory tract. This morbidity is likely to be the most difficult to treat, given the dramatic lack of antibiotics.

• The shortage of medication to treat diarrhea has slightly decreased as compared against September figures (78.5% and 64.5%, respectively), but it remains high in the opinion of the research team.

• The shortage index for diarrhea medication remains at approximately 60%, which impacts at least half of those affected by this ailment.

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MÉRIDA MERIDEÑOS SHOULD STAY AWAY FROM INFECTIONS OF THE RESPIRATORY TRACT. THERE IS ALMOST NO MEDICINE TO TREAT THEM!

DIABETES OCTOBER I

OCTOBER II

92.6%

88.9%

HIGH-BLOOD PRESSURE OCTOBER I

OCTOBER II

68.5%

65.4%

• Fluctuations in the index during the last two months are not encouraging and raise alarms for those living in the Andean city.

• In this case, the shortage index has been decreasing progressively, which may be encouraging for high-blood pressure patients in Mérida.

• Since the last peak recorded in September (85.8%), the supply of high-blood pressure medication improved by approximately 20 percentage points. However, the shortage trend remains above 60% for high-blood pressure drugs.

• Getting an infection in Mérida is, without doubt, one of the major risks for this last quarter of the year.

ARTIs OCTOBER I

OCTOBER II

96.4%

97.2%

• Fluctuations in the shortage index of ARTIs medication place it above 90%, which means that, with luck, only 1 out of 10 Merideños succeeds in finding antibiotics in the city.

• Sadly, the shortage trend for antidiarrheals remains high, placing the shortage thereof at above 80% in October.

DIARRHEA

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• Diabetic Merideños are still suffering from a shortage of drugs to treat the disease. Indicators suggest that only 1 or 2 patients out of 10 have access to the basic basket of diabetes medication.

OCTOBER I

OCTOBER II

87.7%

86.4%

• There was a slight reduction from the last peak recorded in September (88.9%), but figures remain daunting: only 2 out of 10 Merideños are likely to overcome the ordeal of looking for medication to treat diarrhea.

XLaSalud

CONVITE - Newsletter Nº 3. November, 2017.

PORLAMAR SHORTAGE WORSENS IN THE ISLAND CITY.

DIABETES OCTOBER I

OCTOBER II

90.8%

90.8%

HIGH-BLOOD PRESSURE OCTOBER I

OCTOBER II

87.4%

87.9%

• Result from the first measurements in September already revealed an index above 90%, which remained unaltered in October.

• The situation for high-blood pressure patients in Porlamar is not encouraging either. After the peak in the fourth week of September (89.1 %), it decreased by 2 percentage points only.

• Only 2 out of 10 Margariteños, if lucky, have a chance to finding treatment for high-blood pressure with any of the fourteen (14) dosages of the six (6) active principles monitored

by Convite, A.C.: Enalapril, Valsartan, Atenolol, Nifedipine, Amlodipine and Losartan.

• The scene for the basic basket of ARTIs medication is also discouraging.

ARTIs OCTOBER I

OCTOBER II

97.4%

97.8%

• Margariteños must avoid infectious diseases at all costs, since the shortage of drugs for treatment thereof remains dangerously at nearly 100%, and the trend is still on the increase, as compared against September figures.

• Antidiarrheal medication is difficult to find on the shelves of drugstores in Porlamar.

DIARRHEA

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• A marginal supply of type 2 diabetes medication seems to be the “normal” situation in Porlamar. It is disturbing and unfortunate that access to drugs to treat diabetes is so limited.

OCTOBER I

OCTOBER II

93.1%

94.3%

• The trend is on the increase since the fourth week of September, with an 18 percentage point increase (79.4% and 97.7%, respectively). In October, the reduction of the shortage index was marginal.

XLaSalud

CONVITE - Newsletter Nº 3. November, 2017.

DIABETES

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

Dosage: Six (6) different dosages.

DIABETES, TIPO 2 CITY

September I

September II

October I

October II

Metropolitan Area of Caracas

91.9%

90.8%

93.1%

93.1%

Barquisimeto

87.7%

90.1%

92.6%

100.0%

Mérida

79.0%

96.3%

92.6%

88.9%

Maracaibo

74.2%

78.5%

78.5%

71.0%

Nueva Esparta

90.8%

96.6%

90.8%

90.8%

General Shortage Indez

90.7%

87.6%

89.3%

88.6%

Table Nº 2: Shortage Indicator for Diabetes Medication by Location

1st Week, September

2nd Week, September

1st Week, October

2nd Week, October

General Shortage Index MAC Barquisimeto Mérida Maracaibo Nueva Esparta Graphic Nº 2: Accumulated Shortage Indicator for Diabetes Medication by Location

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CONVITE - Newsletter Nº 3. November, 2017.

HIGH-BLOOD PRESSURE

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

Dosage: Fourteen (14) different dosages.

HIGH-BLOOD PRESSURE CITY

September I

September II

October I

October II

Metropolitan Area of Caracas

97.5%

88.5%

91.4%

90.8%

Barquisimeto

85.8%

92.0%

79.0%

81.5%

Mérida

75.6%

85.8%

68.5%

65.4%

Maracaibo

59.7%

59.7%

59.7%

55.4%

Nueva Esparta

73.6%

89.1%

87.4%

87.9%

General Shortage Index

92.8%

80.9%

80.6%

79.6%

Table Nº 3: Shortage Indicator for High-Blood Pressure Medication by Location

1st Week, September General Shortage Index

2nd Week, September

1st Week, October

2nd Week, October

MAC Barquisimeto Mérida Maracaibo Nueva Esparta Table Nº 3: Shortage Indicator for High-Blood Pressure Medication by Location

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CONVITE - Newsletter Nº 3. November, 2017.

ACUTE RESPIRATORY TRACT INFECTIONS Nine (9) Active Principles: Moxifloxacyn Penicillin Levofloxacyn Amoxicillin Clindamycin Clavulanic Acid Doxycylin Clarithromycin Cefuroxime Axetil

Dosage: Thirteen (13) different dosages.

ACUTE RESPIRATORY TRACT INFECTIONS CITY

September I

September II October I

October II

Metropolitan Area of Caracas

95.8%

97.8%

98.7%

98.7%

Barquisimeto

92.1%

93.5%

91.1%

97.2%

Mérida

97.1%

99.1%

96.4%

97.2%

Maracaibo

88.7%

90.3%

91.1%

91.1%

Nueva Esparta

79.7%

98.7%

97.4%

97.8%

General Shortage Index

94.0%

94.8%

96.5%

96.5%

Table Nº 4: Shortage Indicator for ARTIs by Location

1st Week, September General Shortage Index

2nd Week, September

1st Week, October

2nd Week, October

MAC Barquisimeto Mérida Maracaibo Nueva Esparta Graphic Nº 4: Accumulated Shortage Indicator for ARTIs by Location

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CONVITE - Newsletter Nº 3. November, 2017.

Diarrea

Five (5) Active Principles: Ciprofloxacin Trimethoprim Sulfamethoxazole Ceftriaxone Metronidazole

Dosage: Nine (9) different dosages.

DIARRHEA CIUDAD

September I September II October I October II

General Shortage Index

99.0%

98.9%

95.4%

100.0%

Barquisimeto

80.2%

88.9%

93.8%

93.8%

Mérida

79.0%

88.9%

87.7%

86.4%

Maracaibo

78.5%

64.5%

62.4%

63.4%

Nueva Esparta

79.3%

97.7%

93.1%

94.3%

General Shortage Index

95.6%

88.5%

86.7%

89.2%

Table Nº 5: Shortage Indicator for Diarrhea Medication by Location

1st Week, September General Shortage Index

2nd Week, September

1st Week, October

2nd Week, October

MAC Barquisimeto Mérida Maracaibo Nueva Esparta Graphic Nº 5: Accumulated Shortage Indicator for Diarrhea Medication by Location

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XLaSalud

CONVITE - Newsletter Nº 3. November, 2017.

Strongly Denounces We at Convite, A.C. are convinced of the importance of demanding respect for Venezuelans human rights. In closing this space for creating awareness and raising a voice against the deterioration and vulnerability of human rights by the Venezuelan State, it should be noted that Convite has played a role in the following initiatives: 1. Convite in the Inter-American Commission on Human Rights: We participated in the 165 Ordinary Period of Sessions of the IACHR and, on the subject of the elderly, we denounced that the Venezuelan government is yet to subscribe the 2015 Inter-American Convention on Protecting the Human Rights of Older Persons.

2. From Pregnancy to Death: Fourteen (14) women die on a weekly basis in Venezuela for causes associated with pregnancy, which are highly preventable.

3. The Reemergence of Eradicated Diseases: The reemergence of diseases that had been eradicated in Venezuela for more than 20 years is more than obvious, including malaria, which grows relentlessly to become an epidemic. Another potential epidemic is that

of diphtheria, with at least 39 cases recorded in the first eight weeks of 2017, 8 out of which were confirmed and 2 resulted in the death of the patient. The situation remains uncontrolled (Venezuelan Health Observatory, 2017).2 4. Opaqueness as a Government Policy: The Government’s policy is to conceal information and try to make it appear as a “normal” practice. That is why it prevents organizations and the general population from accessing official figures.

The foregoing hinders the determination of the scope and real status of potential epidemics, outbreaks and diseases. The highest authority embodied in the Ministry of the People’s Power for Health does not assume responsibility therefor and limits itself to qualifying these findings as part of a biased media matrix. (Avendaño, 2017).3 In the meantime, Venezuelan health authorities do not recognize the malaria epidemics, although experts (Saavedra, 2017)4 and even the Pan American Health Organization (PAHO) have submitted indicators and empirical evidence on the alarming occurrence of said diseases in the country. (Pan American Health Organization (PAHO), 2017).5

2 Venezuelan Health Observatory. (July, 2017). Diphtheria. From the Venezuelan Health Observatory website: https://www.ovsalud.org/descargas/boletines/Difteria.pdf.

3 Avendaño, S. (November 6, 2017). The Ministry of the People’s Power for Health Qualified Claims About Diphtheria as a “Media Biased Matrix”. From Efecto Cocuyo website: https://efectococuyo.com/principales/de-matriz-mediatica-califico-ministro-de-salud-casos-de-difteria-en-Venezuela.

4 Saavedra, N. (November 5, 2017). Records of Malaria Cases in the Country are Alarming. From Diario 2001 website: https://www.2001.com.ve/en-la-agenda/173796/registros-de-malaria-en-el-pais-son-alarmantes.html.

5 Pan American Health Organization (PAHO). (September 6, 2017). Guidelines are Validated for the Treatment of Malaria Cases in Venezuela. From the Pan American Health Organization website: https://www.paho.org/ven/index.php?option=com_content&view=article&id=validan-pautas-para-el-tratamiento-de-los-casos-de-malaria-en-venezuela&Itemid=215.

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XLaSalud

XLaSalud With support of:

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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