Venezuela's health-care system is collapsing, doctors report
Thursday, November 7, 2013
MARACAY, Venezuela -- Evelina Gonzalez was supposed to undergo cancer surgery in July after chemotherapy but wound up shuttling from hospital to hospital in search of an available operating table.
On the crest of her left breast, a mocha-colored tumor doubled in size and bulges through her white Spandex tank top.
Gonzalez is on a list of 31 breast cancer patients waiting to have tumors removed at one of Venezuela's biggest medical facilities, Maracay's Central Hospital. But like legions of the sick across the country, she's been neglected by a health care system doctors say is collapsing after years of deterioration.
Doctors at the hospital sent home 300 cancer patients last month when supply shortages and overtaxed equipment made it impossible for them to perform non-emergency surgeries.
Driving the crisis in health care are the same forces that have left Venezuelans scrambling to find toilet paper, milk and automobile parts. Economists blame government mismanagement and currency controls set by the late President Hugo Chavez for inflation pushing to 50 percent annually. The government controls the dollars needed to buy medical supplies and has simply not made enough available.
"I feel like I've been abandoned," Gonzalez, 37, tells a bright-eyed hospital psychologist trying to boost her morale. Her right eye is swollen by glaucoma diagnosed two years ago but left untreated when she had trouble getting an appointment.
Doctors not allied with the government say many patients began dying from easily treatable illnesses when Venezuela's downward economic slide accelerated after Chavez's death from cancer in March. Doctors say it's impossible to know how many have died, and the government doesn't keep such numbers, just as it hasn't published health statistics since 2010.
Almost everything needed to mend and heal is in critically short supply: needles, syringes and paraffin used in biopsies to diagnose cancer; drugs to treat it; operating room equipment; X-ray film and imaging paper; blood and the reagents needed so it can be used for transfusions.
Last month, the government suspended organ donations and transplants. At least 70 percent of radiotherapy machines, precisely what Gonzalez will need once her tumor is removed, are inoperable in a country with 19,000 cancer patients -- meaning fewer than 5,000 can be treated, said Dr. Douglas Natera, president of the Venezuelan Medical Federation.
"Two months ago we asked the government to declare an emergency," said Natera, whose doctors group is the country's largest. "We got no response."
The Associated Press sought comment from Health Minister Isabel Iturria but her press office did not respond to repeated interview requests. On Wednesday, President Nicolas Maduro said she was being replaced after six months in the job. He did not explain why.
Last week, a deputy health minister, Nimeny Gutierrez, denied on state TV that the system is in crisis, saying supplies are arriving regularly from Cuba, Uruguay, Colombia and Portugal, and additional purchases "will let us be moderately relaxed until the end of the year."
The interviewer read a viewer's question about Central Hospital patients being forced to buy their own supplies. "It's a hospital that received permanent stocks from us," Gutierrez said, promising to investigate.
The country's 1999 constitution guarantees free universal health care to Venezuelans, who sit on the world's largest proven oil reserves. Maduro's government insists it's complying. Yet of the country's 100 fully functioning public hospitals, nine in 10 have just 7 percent of the supplies they need, Natera said.
The other nearly 200 public hospitals that existed when Chavez took office were largely replaced by a system of walk-in clinics run by Cuban doctors that have won praise for delivering preventative care to the neediest but do not treat serious illnesses.
The woes are not restricted to the public system.
Venezuela's 400 private hospitals and clinics are overburdened and strapped for supplies, 95 percent of which must be imported, said Dr. Carlos Rosales, president of the association that represents them.
The private system has just 8,000 of the country's more than 50,000 hospital beds but treats 53 percent of the country's patients, including the 10 million public employees with health insurance. Rosales said insurers, many state-owned, are four to six months behind in payments and it is nearly impossible to meet payrolls and pay suppliers.
Worse, government price caps set in July for common procedures are impossible to meet, Rosales said. For example, dialysis treatment was set at 200 bolivars ($30 at the official exchange rate and less than $4 on the black market) for a procedure that costs 5,000 bolivars to administer.
"The health care crisis is an economic crisis. It is not a medical crisis," said Dr. Jose Luis Lopez, who oversees labs at the Municipal Blood Bank of Caracas.
Dr. Jose Manuel Olivares, a 28-year-old medical resident in Caracas, recounted having to tell a father who brought his son in with a broken ankle that the man would have to spend more than half his monthly wages on bandages, plaster and antibiotics.
At Maracay's 433-bed Central Hospital, mattresses are missing, broken windows go unrepaired and the cafeteria has been closed for a year. Paint peels off walls and rusty pipes lie exposed. In the halls, patients on intravenous drips lie recovering on gurneys.
"We have some antibiotics but they aren't usually appropriate for what you are specifically treating," said Dr. Gabriela Gutierrez, the surgeon caring for Gonzalez. There is no anesthesia for elective surgery.
Medical students quietly showed AP journalists around to avoid alerting government supporters, who bar reporters from recording images in public hospitals. Broken anesthesia machines and battered stainless-steel instrument tables, some held together with tape, filled one of five idled operating rooms. Foul odors and water from leaky pipes continue to seep into the rooms, doctors said.
In August, cancer patients protested at the eight-month mark since the hospital's two radiotherapy machines broke down. The machines remain out of order.
Half the public health system's doctors quit under Chavez, and half of those moved abroad, Natera said.
Now, support staff is leaving, too, victim of a wage crunch as wages across the economy fail to keep up with inflation.
At the Caracas blood bank, Lopez said 62 nurses have quit so far this year along with half the lab staff. It now can take donations only on weekday mornings.
The last pre-Chavez health minister, Dr. Jose Felix Oletta, said that while the public health care system had its problems, the Cuban-run program of 1,200 clinics is a politically motivated waste of billions.
It doesn't vaccinate or do PAP smears for uterine cancer, while the Chavista system reversed important gains against tropical diseases including malaria, Oletta said. Dengue fever, he said, is making a worrisome comeback. The number of women dying in childbirth has also risen, to 69 per 100,000 in 2010 from 51 in 1998.
Under Chavez, Venezuela began buying most medical equipment through Cuba, China and Argentina. That has led to considerable waste, because it is cheaper to buy direct from the manufacturer, critics say.
The Health Ministry's oncology chief, Dr. Morella Rebolledo, said it is negotiating with Argentina maintenance contracts for the idled radiotherapy machines that had lapsed.
Back home in San Mateo, a 90-minute bus ride away in a neighborhood where even the dogs look hungry, Evelina Gonzalez sits outside the tin-roofed, plywood-walled two-room shack she shares with her family of five. Because her last chemotherapy was in June, she needs more sessions before surgery, but the drugs are not available and the cancer has reached lymph nodes beneath her armpit.
Gonzalez says she adored Chavez for his anti-poverty programs, always voted for him and constantly applied for government benefits, though she never received any.
She has a good chance of survival if she gets the right care, Gutierrez said.
But that's not happening.
"I've got nowhere else to turn," Gonzalez says.