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Data reveal state of Venezuelan health system
World Report
Data reveal state of Venezuelan health system
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 country’s 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 2016—with 756 deaths. Infant mortality rose by about 30% between 2015 and 2016— 11 466 deaths in 2016—according 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 López Chejade. López 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 Durán, president of the Venezuelan Society of Internal Medicine. Doctors describe hospitals without functioning equipment, basic medicines, or even running water, and laboratories without reagents. “It’s very sad. We don’t even have an aspirin tablet in stock”, said Iván 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
“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 Venezuela’s Institute of Tropical Medicine.
“‘It’s very sad. We don’t even have 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 group’s 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, Durán 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 Bolívar, reflecting the lack of vaccination, Durán said. The outbreak apparently spread from the unhealthy conditions of wildcat alluvial gold mines in Venezuela’s Amazonian region. Malaria is also largely uncon trolled in the mining region because of a lack of medicines, Durán said. The government data reported more than
240 600 cases in 13 states in 2016, up from 136 400 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 controlled by medication, go untreated because of insufficient medicines, or people take their medicines every other day, instead of every day, to stretch the supply, Durán said. The University Hospital’s cardiology unit, which usually does 100 catheterisations and 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. Durán 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 government’s approval. So far, the regime of president Nicolás Maduro has been silent. “Health shouldn’t be politicised”, Durán said. “Health has nothing to do with ideology. Health is a right.”
JUAN BARRETO / Getty
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.
Health-care workers protesting against President Maduro’s Government in Caracas, Venezuela, on May 17, 2017
Barbara Fraser 2095
Data reveal state of Venezuelan health system
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 country’s 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 2016—with 756 deaths. Infant mortality rose by about 30% between 2015 and 2016— 11 466 deaths in 2016—according 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 López Chejade. López 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 Durán, president of the Venezuelan Society of Internal Medicine. Doctors describe hospitals without functioning equipment, basic medicines, or even running water, and laboratories without reagents. “It’s very sad. We don’t even have an aspirin tablet in stock”, said Iván 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
“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 Venezuela’s Institute of Tropical Medicine.
“‘It’s very sad. We don’t even have 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 group’s 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, Durán 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 Bolívar, reflecting the lack of vaccination, Durán said. The outbreak apparently spread from the unhealthy conditions of wildcat alluvial gold mines in Venezuela’s Amazonian region. Malaria is also largely uncon trolled in the mining region because of a lack of medicines, Durán said. The government data reported more than
240 600 cases in 13 states in 2016, up from 136 400 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 controlled by medication, go untreated because of insufficient medicines, or people take their medicines every other day, instead of every day, to stretch the supply, Durán said. The University Hospital’s cardiology unit, which usually does 100 catheterisations and 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. Durán 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 government’s approval. So far, the regime of president Nicolás Maduro has been silent. “Health shouldn’t be politicised”, Durán said. “Health has nothing to do with ideology. Health is a right.”
JUAN BARRETO / Getty
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.
Health-care workers protesting against President Maduro’s Government in Caracas, Venezuela, on May 17, 2017
Barbara Fraser 2095