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 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 now 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.
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.
President Nicolas 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.
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