lunes, 16 de mayo de 2016

REPORTAJE EN EL NYTIMES QUE DENUNCIA LA EMERGENCIA DE LA SALUD PÚBLICA QUE PADECEN LOS VENEZOLANOS

Dying Infants and No Medicine: Inside Venezuela’s Failing Hospitals




Slide Show|11 Photos

Venezuela’s Public Health Emergency

Meridith Kohut for The New York Times 

BARCELONA, Venezuela — By morning, three newborns were already dead.
The day had begun with the usual hazards: chronic shortages of antibiotics, intravenous solutions, even food. Then a blackout swept over the city, shutting down the respirators in the maternity ward.
Doctors kept ailing infants alive by pumping air into their lungs by hand for hours. By nightfall, four more newborns had died.
“The death of a baby is our daily bread,” said Dr. Osleidy Camejo, a surgeon in the nation’s capital, Caracas, referring to the toll from Venezuela’s collapsing hospitals.
The economic crisis in this country has exploded into a public health emergency, claiming the lives of untold numbers of Venezuelans. It is just part of a larger unraveling here that has become so severe it has prompted President Nicolás Maduro to impose a state of emergency and has raised fears of a government collapse.
Hospital wards have become crucibles where the forces tearing Venezuela apart have converged. Gloves and soap have vanished from some hospitals. Often, cancermedicines are found only on the black market. There is so little electricity that the government works only two days a week to save what energy is left.
At the University of the Andes Hospital in the mountain city of Mérida, there was not enough water to wash blood from the operating table. Doctors preparing for surgery cleaned their hands with bottles of seltzer water.
“It is like something from the 19th century,” said Dr. Christian Pino, a surgeon at the hospital.
The figures are devastating. The rate of death among babies under a month old increased more than a hundredfold in public hospitals run by the Health Ministry, to just over 2 percent in 2015 from 0.02 percent in 2012, according to a government report provided by lawmakers.
The rate of death among new mothers in those hospitals increased by almost five times in the same period, according to the report.

Yulitza Roa, 15, who has a brain tumor, is awaiting surgery that has been delayed because Luis Razetti Hospital does not have the needed scanning equipment. Meridith Kohut for The New York Times 

Here in the Caribbean port town of Barcelona, two premature infants died recently on the way to the main public clinic because the ambulance had no oxygen tanks. The hospital has no fully functioning X-ray or kidney dialysis machines because they broke long ago. And because there are no open beds, some patients lie on the floor in pools of their blood.
It is a battlefield clinic in a country where there is no war.
“Some come here healthy, and they leave dead,” Dr. Leandro Pérez said, standing in the emergency room of Luis Razetti Hospital, which serves the town.
This nation has the largest oil reserves in the world, yet the government saved little money for hard times when oil prices were high. Now that prices have collapsed — they are around a third what they were in 2014 — the consequences are casting a destructive shadow across the country. Lines for food, long a feature of life in Venezuela, now erupt into looting. The bolívar, the country’s currency, is nearly worthless.
The crisis is aggravated by a political feud between Venezuela’s leftists, who control the presidency, and their rivals in congress. The president’s opponents declared a humanitarian crisis in January, and this month passed a law that would allow Venezuela to accept international aid to prop up the health care system.
“This is criminal that we can sit in a country with this much oil, and people are dying for lack of antibiotics,” says Oneida Guaipe, a lawmaker and former hospital union leader.
But Mr. Maduro, who succeeded Hugo Chávez, went on television and rejected the effort, describing the move as a bid to undermine him and privatize the hospital system.
“I doubt that anywhere in the world, except in Cuba, there exists a better health system than this one,” Mr. Maduro said.
Late last fall, the aging pumps that supplied water to the University of the Andes Hospital exploded. They were not repaired for months.
So without water, gloves, soap or antibiotics, a group of surgeons prepared to remove an appendix that was about to burst, even though the operating room was still covered in another patient’s blood.
Even in the capital, only two of nine operating rooms are functioning at the J. M. de los Ríos Children’s Hospital.

A protest last month in Caracas, Venezuela, over the country’s hospital crisis. Meridith Kohut for The New York Times 

“There are people dying for lack of medicine, children dying of malnutrition and others dying because there are no medical personnel,” said Dr. Yamila Battaglini, a surgeon at the hospital.
Yet even among Venezuela’s failing hospitals, Luis Razetti Hospital in Barcelona has become one of the most notorious.
In April, the authorities arrested its director, Aquiles Martínez, and removed him from his post. Local news reports said he was accused of stealing equipment meant for the hospital, including machines to treat people with respiratory illnesses, as well as intravenous solutions and 127 boxes of medicine.
Around 10 one recent night, Dr. Freddy Díaz walked down a hall there that had become an impromptu ward for patients who had no beds. Some clutched blood-soaked bandages and called from the floor for help. One, brought in by the police, was handcuffed to a gurney. In a supply room, cockroaches fled as the door swung open.
Dr. Díaz logged a patient’s medical data on the back of a bank statement someone had thrown in the trash.
“We have run out of paper here,” he said.
On the fourth floor, one of his patients, Rosa Parucho, 68, was one of the few who had managed to get a bed, though the rotting mattress had left her back covered in sores.
But those were the least of her problems: Ms. Parucho, a diabetic, was unable to receive kidney dialysis because the machines were broken. An infection had spread to her feet, which were black that night. She was going into septic shock.
Ms. Parucho needed oxygen, but none was available. Her hands twitched and her eyes rolled into the back of her head.
“The bacteria aren’t dying; they’re growing,” Dr. Díaz said, noting that three of the antibiotics Ms. Parucho needed had been unavailable for months.
He paused. “We will have to remove her feet.”
Three relatives sat reading the Old Testament before an unconscious woman. She had arrived six days before, but because a scanning machine had broken, it was days before anyone discovered the tumor occupying a quarter of her frontal lobe.

Lisquer Pulido, 17, left, and Marilin Mago, 25, waiting last month to enter the neonatal area of the maternity ward at a hospital in Puerto La Cruz to feed their premature babies who had been born that week. Meridith Kohut for The New York Times 

Samuel Castillo, 21, arrived in the emergency room needing blood. But supplies had run out. A holiday had been declared by the government to save electricity, and the blood bank took donations only on workdays. Mr. Castillo died that night.
For the past two and a half months, the hospital has not had a way to print X-rays. So patients must use a smartphone to take a picture of their scans and take them to the proper doctor.
“It looks like tuberculosis,” said an emergency room doctor looking at the scan of a lung on a cellphone. “But I can’t tell. The quality is bad.”
Finding medicine is perhaps the hardest challenge.
The pharmacy here has bare shelves because of a shortage of imports, which the government can no longer afford. When patients need treatment, the doctors hand relatives a list of medicines, solutions and other items needed to stabilize the patients or to perform surgery. Loved ones are then sent back the way they came to find black-market sellers who have the goods.
The same applies to just about everything else one might need here.
“You must bring her diapers now,” a nurse told Alejandro Ruiz, whose mother had been taken to the emergency room.
“What else?” he asked, clutching large trash bags he had brought filled with blankets, sheets, pillows and toilet paper.
Nicolás Espinosa sat next to his tiny daughter, who has spent two of her five years with cancer. He was running out of money to pay for her intravenous solutions. Inflation had increased the price by 16 times what he paid a year ago.
He flipped through a list of medicines he was trying to find here in Barcelona and in a neighboring city. Some of the drugs are meant to protect the body during chemotherapy, yet the girl’s treatments ended when the oncology department ran out of the necessary drugs a month and a half ago.
Near him, a handwritten sign read, “We sell antibiotics — negotiable.” A black-market seller’s number was listed.
Biceña Pérez, 36, scanned the halls looking for anyone who would listen to her.
“Can someone help my father?” she asked.

The pediatric emergency room of a government-run clinic in Catia La Mar. Meridith Kohut for The New York Times 

Her father, José Calvo, 61, had contracted Chagas’ disease, a sickness caused by a parasite. But the medication Mr. Calvo had been prescribed ran out in his part of Venezuela that year, and he began to suffer heart failure.
Six hours after Ms. Pérez’s plea, a scream was heard in the emergency room. It was Mr. Calvo’s sister: “My darling, my darling,” she moaned. Mr. Calvo was dead.
His daughter paced the hall alone, not knowing what to do. Her hands covered her face, and then clenched into fists.
“Why did the director of this hospital steal that equipment?” was all she could say. “Tell me whose fault is this?”
The ninth floor of the hospital is the maternity ward, where the seven babies had died the day before. A room at the end of the hall was filled with broken incubators.
The glass on one was smashed. Red, yellow and blue wires dangled from another.
“Don’t use — nonfunctional,” said a sign dated last November.
Dr. Amalia Rodríguez stood in the hallway.
“I had a patient just now who needed artificial respiration, and I had none available,” Dr. Rodríguez said. “A baby. What can we do?”
The day of the power blackout, Dr. Rodríguez said, the hospital staff tried turning on the generator, but it did not work.
Doctors tried everything they could to keep the babies breathing, pumping air by hand until the employees were so exhausted they could barely see straight, she said. How many babies died because of the blackout was impossible to say, given all of the other deficiencies at the hospital.
“What can we do here?” Dr. Rodríguez said. “Every day I pass an incubator that doesn’t heat up, that is cold, that is broken.”

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