Don’t Get Sick in Venezuela

In the 1980s, few singers in Venezuela were as popular as Yordano Di Marzo. By combining elements of jazz, Caribbean bolero, and Italian pop music with poetic lyrics, the Rome-born Yordano became a smashing success. It is fair to say that everybody in the country older than thirty knows at least one Yordano song by heart.

So it’s not surprising that the beloved pop idol’s latest TV appearance caused quite a stir. Appearing on CNN En Español, the singer broke down when he announced he had bone-marrow cancer and was unable to find the medicine he needed back home in Caracas. Through his tears, he thanked anonymous fans for helping him find the drugs he needed in Colombia.

Yordano’s predicament has become all too common in Venezuela. The challenge of obtaining quality, affordable health care is affecting everyone — celebrities as well as regular folk. Whether it is the lack of medicine in the country’s drug stores, the dearth of doctors, the resurgence of endemic diseases, or the violence in the country’s hospitals, Venezuela’s health care sector is desperate for some good news.

The lack of doctors has long been an issue. When Hugo Chávez first came to power, he brought in thousands of Cuban health care workers to overcome a perceived lack of doctors in poor neighborhoods. But the program, though well intentioned, has run into severe problems. Many Cuban doctors working in Venezuela complain about the poor working conditions and low salaries, and hundreds are fleeing to the United States, as a recent report by the LA Times confirms. (In the photo above, a dummy representing a Cuban doctor hangs from a traffic light as part of an opposition protest in March.)

It’s not only the Cubans who are leaving. A recent report by the Venezuelan Doctors Federation stated that over half of the country’s physicians have already emigrated in search of better opportunities.

Part of the reason for this is the alarming incidence of crime inside health care facilities. Stories about shootings inside hospitals have become commonplace. In July, for example, a shooting occurred inside an operating room at one of Caracas’ best known hospitals while surgeons were operating on a patient. (The patient died as a result.) Doctors have even taken to the streets to demand increased safety measures.

But the crime wave isn’t even the country’s most pressing health care problem. That distinction belongs to the acute lack of medicine. Even other types of products, such as diapers, birth control pills, or breast implants, are hard to find.

Venezuela imports most of its medicines. There is a local drug manufacturing industry, but they do little research and simply manufacture medicine using imported raw material. The country’s cash shortage is throwing a wrench in that process. As one drug manufacturer explained, "I have a backlog of requests for currency that have not been approved, and without [currency] I cannot import the raw material I need. When I manage to get a shipment of medicine out, much of it ends up in the black market." The Central Bank said in March of this year that 50 percent of drugs are missing from the shelves. It has since stopped publishing the data.

Due to the country’s overbearing price controls, there is a thriving black market for Venezuelan drugs. A fraction of the country’s drugs ends up in neighboring countries, where they fetch market prices. Unsurprisingly, Venezuelans have started bartering drugs on Twitter and other social media.

One of the side effects is that this has prompted an unusual crime wave. A person I spoke to was only lucky enough to find the chemotherapy medicine she needed for her sick father with the help of connections in a city close to Caracas. She asked for the contact to ship the medicine via courier. The truck carrying the medicine was held up at gunpoint in Caracas. The burglars then called the woman I spoke to, demanding a ransom in exchange for the drugs. She paid, but never got the entire shipment.

The crisis in the country’s health care system is partly caused by severe underfunding. Official estimates put overall national health care spending at 4.6 percent of GDP, far below the Latin American average of 7.6 percent. The United Nations says that the government spends three times as much on subsidizing gasoline as it does on public health care spending.

The overall decay in the health care system means that endemic diseases such as dengue fever and malaria have made a strong comeback. There is also an alarming increase in cases of the mosquito-borne virus Chikungunya. Late last week, doctors in the central city of Maracay said that eight people had died in a short period of time from a mysterious illness that caused internal bleeding and high fevers. The doctors asked the government to investigate, but the government has responded by calling the doctors "terrorists" and announcing legal actions against the president of the Maracay medical association.

Venezuela’s health care crisis has no easy fixes. Entrenched distortions in the markets for health care products and services, coupled with a deteriorating working environment for physicians, have led the country to becoming the sick man of South America. One has to wonder what dramatic development — a celebrity death, an out-of-control epidemic — would have to happen for patients and citizens at large to start demanding answers from their rulers.

Until something dramatic changes, the prognosis for Venezuela’s health care system will continue to be dire.

Juan Nagel is the Venezuela blogger for Transitions, editor of Caracas Chronicles, and author of Blogging the Revolution. Read the rest of his posts here.