World Report
Data reveal state of Venezuelan health system
Epidemiological data released by the Government of Venezuela after 2 years of silence betrays
how the political and economic crisis has taken a toll on the health system. Barbara Fraser reports.
Maternal and infant mortality have
skyrocketed in Venezuela in the past
2 years, and diphtheria and malaria,
diseases that were once controlled, are
on the rise according to data released
by the countrys Ministry of Health.
The epidemiological data show that
maternal mortality rose by about 9%
between 2014 and 2015, then jumped
by nearly 66% by the end of 2016with
756 deaths. Infant mortality rose by
about 30% between 2015 and 2016
11466 deaths in 2016according to
government figures.
Amid intensifying anti-government
protests, in which 48 people had died
as we went to press, two sets of weekly
epidemiological bulletins for 2015 and
2016, were recently published. It was
the first time the Health Ministry had
published full sets of epidemiological
bulletins since 2014. Just a few days
later, on May 11, Health Minister
Antonieta Caporale was fired and
replaced by Luis Salerfi Lpez Chejade.
Lpez Chejade is the eighth person
to hold the health minister post since
Maduro took office in April, 2013.
These figures confirm what we had
suspected about the disastrous state of
the health-care system, said Maritza
Durn, president of the Venezuelan
Society of Internal Medicine. Doctors
describe hospitals without functioning
equipment, basic medicines, or even
running water, and laboratories with-
out reagents.
Its very sad. We dont even have
an aspirin tablet in stock, said
Ivn Machado, chief of cardiology at
University Hospital of Caracas. The
Venezuelan Institute of Palliative care
published a letter on May 11 that
reported the country had run out of
all classes of analgesics, and doctors
are incapable of alleviating pain for
patients. Doctors took to the streets
on May 17 to protest the shortages.
www.thelancet.com Vol 389 May 27, 2017 2095
Maternal mortality reflects various
things in the health sector, including
preventive care, care throughout the
pregnancy, and the state of hospitals
at the time of delivery, [such as
whether] there are antibiotics, a
functioning intensive care unit, [or]
medications, said Julio Castro, an
infectious disease specialist at the
Central University of Venezuelas
Institute of Tropical Medicine.
Its very sad. We dont even have Hospitals cardiology unit, which
an aspirin tablet in stock...
Castro is part of a group of experts
who gather data regularly from health
centres around the country. They com
piled statistics during the years when
the government did not publish official
figures. The official figures for 2015
and 2016 are very close to the expert
groups extra-official statistics. Castro
said he was alarmed by the sharp spike
in maternal mortality.
The infant mortality rate is attribut
able to a shortage of vaccines, basic
medicines, and hospital facilities, as
well as increased child malnutrition,
Durn says. About 32% of Venezuelans
eat two meals a day or fewer, according
to a 2016 survey of living conditions
by a consortium of universities and
non-profit groups. That was up from
about 11% just a year earlier. In some
families, parents skip meals so their
children can eat, Castro said.
Children have also been the main
victims of a diphtheria outbreak in
the state of Bolvar, reflecting the
lack of vaccination, Durn said. The
outbreak apparently spread from the
unhealthy conditions of wildcat alluvial
gold mines in Venezuelas Amazonian
region. Malaria is also largely uncon
trolled in the mining region because
of a lack of medicines, Durn said. The
government data reported more than
240600 cases in 13 states in 2016, up
from 136400 the year before.
Faced with shortages at hospitals,
patients or their families scramble to
buy medicines or surgical supplies from
chronically understocked pharmacies.
Chronic diseases, which are usually
JUAN BARRETO / Getty
controlled by medication, go untreated
because of insufficient medicines, or
people take their medicines every other
day, instead of every day, to stretch Health-care workers
protesting against
the supply, Durn said. The University
President Maduros
Government in Caracas,
usually does 100 catheterisations and Venezuela, on May 17, 2017
30 open heart surgeries per month,
has done only 30 catheterisations and
20 open heart surgeries so far this year,
Machado said. Several operating rooms
are out of service and vital equipment is
idle for lack of replacement parts.
Even if the political situation were
to change overnight, rebuilding the
health system would take time, experts
say. Venezuela is haemorrhaging doc
tors, especially young ones. Thou
sands of doctors are thought to have
left the country, leaving the system
short-staffed. By the time his medical
students reach their fourth year,
Castro said, 60% of the class will have
emigrated.
Durn and others are calling for a
health emergency to be declared in the
country, which is wracked by a political
and economic crisis. This would
allow the import of medicines, while
pharmaceutical plants, which have
been idle for years, can begin producing
again. International organisations,
however, say they cannot act without
the governments approval. So far, the
regime of president Nicols Maduro
has been silent.
Health shouldnt be politicised,
Durn said. Health has nothing to do
with ideology. Health is a right.
Barbara Fraser