The Collapse of Chávezcare

LA VICTORIA, Venezuela — Leonardo Flores lay listlessly in his bed, passing the day much as he had the previous three months of his stay in a rundown ward of the Jose Benitez State Hospital. In January, the 42-year-old computer technician was riding in a car when it was hit by a truck being driven by a drunk driver. He was rushed to the hospital, where doctors managed to stabilize him and immobilize his right leg, which had suffered a compound fracture.

“They told me that I needed surgery to place two pins in my femur,” he said. “But the hospital didn’t have them, so my family had to buy them. And then when they had them, the doctors couldn’t operate, as they didn’t have the right drugs, supplies, and anesthesia. I was placed on a waiting list.”

One surgeon offered to operate on Flores for a bribe of 18,000 bolivares ($2850, at official exchange rates) — three times the minimum wage, which he paid. But a pre-operative x-ray revealed that his bone had begun to re-knit itself off-center. So the doctors had to re-break it before they could operate, creating yet another delay. “Now I have no idea when they’re going to operate. I can’t work. My family is spending all of their money in trying to schedule me the operation and get me out of here,” Flores said.

This is far from what the late Hugo Chávez had it mind when he won the presidency in a landslide in 1998, thanks in part to his promise to provide free health care to all. At the outset, Chávez was true to his word, bringing in thousands of Cuban doctors to head up new health centers in the country’s slums, where many Venezuelan physicians were reluctant to work due to high crime.

Chávez, who died of cancer in March 2013 after receiving treatment in Cuba (he refused treatment at home, likely out of fear that the truth of his condition would leak), also created new diagnostic centers, many of which were manned by Cubans, that offered free exams. Results were promising: from 1998 to 2012, life expectancy at birth in Venezuela rose by two years from 72 to 74, while infant mortality rates fell, according to the World Bank.

But today, Chávismo is increasingly viewed as a hazard to one’s health, due to pervasive shortages of medicines and health supplies, an exodus of doctors, bureaucratic ineptitude, and corruption. “We have a humanitarian crisis here,” says Mauricio Gutierrez, who heads Positive Collective, a non-government health organization for HIV-positive patients. “The public health sector isn’t protecting people. It’s allowing them to die.” Health Ministry officials did not return phone calls or e-mail requests for an interview.

At least part of this health crisis is due to Venezuela’s ever-worsening economic situation, which has forced the government to slash health care funding and reduce imports of vital medical supplies, resulting in the closure of many state-run health centers and clinics. Weak oil prices have further cut into government revenues, causing further cutbacks. Meanwhile, the annual inflation rate, around 70 percent last December, could climb to at least 150 percent this year in response to dropping oil global prices.

But even before its economic woes, Venezuela’s government had failed to prioritize health care. According to the World Bank, Caracas earmarked about 3.4 percent of GDP for healthcare in 2013, versus 4.7 percent the year before. Countries with much less resource wealth at their disposal spent more in 2013: Belize, Jamaica, and the tiny island of Grenada devoted 5.4, 5.8, and 6.3 percent of GDP to health care, respectively.

The money that Caracas does allocate, meanwhile, is often lost to a corrupt bureaucracy, manned by an ever-revolving procession of ministers. Under 16 years of Chávismo, the Health Ministry has been led by 13 different ministers, most of whom served less than a year. President Nicolás Maduro, who succeeded Chávez in March 2013, has already appointed four health ministers in his first two years of office. Not one of the quartet lasted more than 10 months. These bureaucrats last as long as the public doesn’t complain about the myriad problems plaguing the health care system. But once the people raise a stir, the ministers are the government’s scapegoats, explained one high-ranking Health Ministry official who agreed to speak on the condition of anonymity.

Uncertain of when their tenures will end, ministers work quickly to enrich themselves. “The result is that there is a constant pilfering of supplies and medicines. The ministry may buy the medicines, but they are then resold to private clinics and doctors by corrupt ministry officials,” the official said.

The consequences for Venezuelans are stark. Many medicines, such as insulin, aspirin, antibiotics, and blood pressure drugs, are scarce. Supplies required for operations are similarly lacking. The Red de Medicos por la Salud, an NGO, reported last month that nearly half of the Venezuela’s operating rooms cannot function due to a lack of supplies and trained personnel. A survey of pharmacies and operating rooms from this month cited by the organization shows a 68 percent shortage of surgical instruments, and a shortfall of medicines that now totals 70 percent.

The lack of medications and medical supplies is also due to a lack of dollars available to importers. Under Venezuela’s complex exchange controls, the government decides who receives its hard-to-find dollars. Theoretically, pharmaceutical companies are supposed to be prioritized as recipients of dollars and should get the most advantageous rate. In practice that isn’t the case, especially as Venezuela’s financial crisis has exploded in the face of a possible default. On April 24, the Venezuelan Pharmaceutical Federation said that its members, who produce drugs for the national market, now owe international suppliers about $4 billion for previously imported materials (they haven’t received the dollars to pay off this debt), and they have been cut off from fresh imports.

Now, the cost of health care is increasingly falling on those who need it most. Aurelia Loudres, a 28-year-old mother of two in the village of El Consejo outside La Victoria, said her obstetrician warned her not to show up empty-handed when she visited the hospital in January. “He told me I had to buy latex gloves for [him] and the nurses,” along with gauze, bandages, and antibiotics, she said. “My doctor said the hospital had nothing and it was my responsibility to come prepared.”

Although Loudres and her husband said they received first-rate care from the hospital, they were surprised that they had to buy everything. “I was under the impression that the public hospitals were free, as Chávez said they were,’’ said Maximiliano, Aurelia’s 22-year-old husband, who works as a farm laborer. “That wasn’t the case at all.”

But at the rate Venezuela is losing doctors, it may have bigger problems than lack of medicine. In 2007, Venezuela, which has a population of 30 million, had more than 70,000 doctors. Since then, 13,000 physicians have left the country. Much of the decrease has been due to large-scale emigration and natural attrition through retirement. More than half — some 7,600 — worked in the country’s public health sector.

Pedro Fuentes, who graduated from the country’s Central University medical school, is one of them. After graduating in 2012, he began working at a state health center in Tejerias, a town in the central industrial state of Aragua known as a hotbed of gang violence. “When a gang member was shot and brought to us for care, we would try to send him as quickly as possible to the state hospital so that rival gang members wouldn’t come looking for him in our center,” Fuentes said. “There was no security for us at all. More than once I was robbed by thugs in the parking lot. The center has one guard, who is unarmed. What could I do?”

Fuentes was also paid a pittance for his work, earning about 7,000 bolivares a month. Under the official exchange rate of 6.3 bolivares to the dollar, that comes out to $1,111. But using the more realistic floating rate of 193 bolivares to the dollar, it comes out to a paltry $36. Fuentes has since emigrated to Spain.

And it’s not just Venezuelan doctors who are fleeing. Cuban medical personnel are also leaving en masse. According to the Miami-based Solidaridad sin Frontera, a support group that helps Cuban medical staff immigrate to the United States, there are currently about 22,000 Cuban medical staff in Venezuela, including doctors, dentists, nurses, and other health care professionals. But hundreds continue to slip across the borders to Colombia or Brazil, en route to the United States where the law allows them to claim instant residency and work. Many are leaving due to high crime and low pay. Positive Collective’s Gutierrez estimates that only 30 percent of the health centers in the Barrio Adentro program, which placed Cuban-manned health centers in slums, are now operational.

The dearth of imports is also slowing domestic pharmaceutical production. Ali Mora, a union leader for workers at Pfizer’s manufacturing plant in the central industrial city of Valencia, told reporters on April 8 that production at the facility was down 60 percent, due to a lack of imported supplies. “We had a diversified range of 80 products, but now we’re barely producing five,” Mora said. “The majority of the rest are being made in Europe.”

Venezuela, which imports about 70 percent of the products it consumes, has tried to boost domestic production of medicines, signing accords with Cuba, Colombia, China, and Portugal to build new pharmaceutical plants. Although the money has been allocated, work on the facilities has been suspended. This means that many common medications, such as aspirin, must be imported. In addition, there is a lack of supplies needed for many diagnostic tests — as well as vitamins and even condoms.

Price controls on food are also inadvertently creating a generation of overweight Venezuelans prone to diabetes and hypertension. The government has created this problem by regulating and subsidizing prices on foodstuffs, primarily those heavy in carbohydrates, sugars, and fats. Although a kilogram of corn meal is set at 19 bolivares, tomatoes, whose price is unregulated, cost three to four times as much; lettuce three times as much; and fruits anywhere from two to three time as much. Today, nearly 70 percent of Venezuelans are now overweight and nearly 40 percent are obese. Those percentages are expected to rise in the coming years along with their attendant health problems.

To counteract the increase in obesity, the government has instituted a fitness program. But in a country where waiting in line for food is commonplace, such exhortations will likely have minimal impact. “I buy what I can find,” said Minerva Salazar, a 40-year-old housewife and mother of three. “It would be nice to have the option to buy healthier food but it’s one that doesn’t exist right now.”

From his hospital bed in La Victoria, Leonardo Flores feels similarly trapped as he awaits his leg operation. At least he has the hope of leaving through the front door. Other patients — fighting cancer, heart disease, and the debilitating effects of strokes — too often leave the hospital straight to the morgue.

“Maybe someday, I will look back on this and laugh,” he says, pausing while his eyes fill with tears. “That’s what I tell myself. I doubt I will.”

Photo Credit: Mario Tama / Getty Images News