Venezuelans Suffer Amid Crumbling Health System

Venezuelans Suffer Amid Crumbling Health System

As country’s economy struggles, lack of hospital funding and widespread shortages of medicine and surgical supplies put patients at risk

By Juan Forero in the Wall Street Journal

CARACAS, Venezuela—His heart failing fast, Pedro Gonzalez checked into one of Venezuela’s leading public hospitals in September, hoping for a new heart valve to save his life. He prayed day and night for a successful surgery, clutching a blanket embroidered with an image of the Virgin Mary.

In late November, the director of cardiovascular surgery at the University Hospital sent out letters to the cardiology ward’s patients, telling them they were being discharged. The reason cited: a dearth of operating-room supplies—no catheters, no working blood-processing machine, no heart valves.

A week later, as Mr. Gonzalez gave an emotional talk to young catechists at the Catholic Church near his home, he collapsed and died in front of the altar. Mr. Gonzalez, a machinist at a state-run utility, was 39 and left behind a wife, Indimar Rivero, and an 8-year-old son.

“If they had found what they needed, surgical material and the valve, I believe that God and the doctors would have saved him,” said Ms. Rivero, who is deeply religious, as her husband was, and spends her free time giving catechism classes to children. “But in the end, they sent him home.”

Hospital administrators didn’t respond to requests for comment.

Free, quality health care was a centerpiece in the socialist system championed by late President Hugo Chávez—a right he guaranteed in a new constitution. But two years after Mr. Chávez’s death and 16 years after he took power, what the populist firebrand called a revolution is fast unraveling.

Inflation, at nearly 70%, is the highest in the world, and the International Monetary Fund says the economy will contract 7% this year. Widespread nationalizations and price controls have hobbled local industry, and currency controls starved the country of dollars provided by the state and needed to pay for imports. The result: shortages of everything from car parts to toilet paper and medical supplies in a country that produces few of its consumer goods.

Of all the myriad crises in Venezuela, none has so shattered the illusion of a government able to provide for its people than the collapse of health care. Interviews with more than 100 doctors, patients, medical industry personnel and former Health Ministry officials, as well as guided tours of public hospitals in three states, paint a picture of a system in crisis.

Affecting both public and private hospitals, the deficiencies are drastically altering people’s health care—to the point of ratcheting up preventable deaths, according to doctors and medical associations.

Drugs from aspirin to antibiotics, insulin to anesthetics, are scarce. All manner of equipment—X-ray machines, ultrasound scanners and defibrillators—is often out of service because of a lack of spare parts.

In little more than two months, from October to early January, 12 other patients treated at the University Hospital who needed heart surgery died. Liz Giraldo, 38, who waited seven months for a heart valve, died in the emergency room, said the daughter she left behind, Erlys Daza, 19.

“What you feel is a high level of helplessness,” said Dr. Marcos Durand, who along with other doctors here outlined how heart patients died, one after another. “It’s looking at the family and saying, ‘He’s going to die. There is nothing that can be done.’ ”

Dr. Gabriel Silva, the head of the cardiovascular surgery unit who sent Mr. Gonzalez and the others home in November, said all the doctors live with remorse. “Patients who went to the hospital to find life instead found death,” he said.

Health Minister Nancy Perez didn’t respond to multiple requests for comment. Offices within the health ministry that deal with cancer, the administration of public hospitals, health care in poor neighborhoods and health data also didn’t return calls or emails.

Meanwhile, the suffering cuts across all age and income groups, with the poor bearing the brunt of the crisis. At the J.M. del Rios Children’s Hospital in Caracas, babies were recently placed on office desks because space was so tight. Across the city, at the aging hospital in Coche, patients injured in accidents and shootings were lined up in beds in one ward. Some said they had been waiting weeks and months for operations to repair shattered bones.

Neither hospital responded to requests for comment.

Of 45,000 beds in Venezuela’s public hospitals, only 16,300 are operational. Private hospitals, with another 8,000 beds, have helped overwhelmed public facilities, but they, too, are hurting. The association representing private hospitals says elective surgery at private facilities—from knee operations to gastric bypasses and other procedures that aren’t life-threatening—are down by 90%. That is because falling currency reserves are making it nearly impossible for hospitals to get the dollars needed to pay for imported medicine and medical equipment.

Venezuela needs about $1 billion annually in medical equipment imports, said Antonio Orlando, president of the Venezuelan Association of Medical Equipment. But in 2014, the cash-strapped government provided less than $200 million—a sharp drop from 2010, when the sector imported $807 million.

Last March, the Central Bank said that there was a 50% scarcity of medicines; it has since stopped publishing such data. The Venezuelan Pharmaceutical Federation, which represents the pharmaceutical sector, estimates that as much as 70% of all medicines are in short supply or unavailable.

Doctors and administrators at public hospitals say life-and-death operations—to unclog an aorta, for instance—have plummeted. Compounding the problem is a lack of staff. Hospital officials say up to half of medical school graduates, who earn less than $50 a month at the country’s black market rate, are fleeing the country.

At the University Hospital, a symbol of the health-care system since its opening in 1956 and the first hospital here to carry out cardiac surgery, doctors performed as many as 40 open-heart surgeries a month a decade ago. Last year, that average had fallen to about seven each month. Heart catheterizations, another common procedure at big hospitals, have fallen from 1,200 annually to about 100.

“How can we treat a patient when we can’t operate, or even give them a drug to take care of the pain?” said Dr. Ivan Machado, a veteran cardiologist at the hospital.

The human toll of the hospital’s plight is underscored by Carmen Quiñones, 51. In early December doctors at a private clinic discovered she had an abdominal aneurysm, bleeding in the lower part of the aorta, the major blood vessel that supplies blood to the body.

She was rushed to the University Hospital’s emergency room and told she needed a small tube called an aortic prosthesis to repair the rupture.

But the hospital, dry of resources, informed the family that it would be up to them to procure the necessary supplies—including the aortic prosthesis. By the next day, they had found one, which was donated by a doctor at a private hospital who knew the family.

While the prosthesis was successfully implanted, another complication arose during the operation. Doctors discovered another aneurysm, requiring a second surgery and a second prosthesis. The family failed to find another.

“I’ll operate, but what am I going to put in her?” Dr. Durand told Jhon Jairo Perez, Mrs. Quiñones’s 24-year-old son.

Without surgery, she began to worsen and by Dec. 26 was slurring words and losing consciousness. The blood was seeping from the weakened artery into her lungs, two doctors who treated her said, but the hospital didn’t have extra stocks to replace what she was losing.

“She bled to death,” said Dr. Durand. “We didn’t have a prosthesis. No blood. It was very hard to help her.”

The situation marks a sharp departure from the golden era, from the 1950s to the 1970s, when Venezuela was Latin America’s richest nation. Immigrants from Europe flocked here and the state built model health facilities. Things began to go south during a long period of low oil prices, government mismanagement and a debt crisis in the 1980s that dried up funding.

A few years after Mr. Chávez took power in 1999, he struck a deal with Cuba to import thousands of Cuban doctors in exchange for oil. The medics fanned out to impoverished barrios, offering consultations and basic care. The Barrio Adentro program was popular and was credited with helping Mr. Chávez survive a recall referendum in 2004.

Despite an unprecedented oil boom, gross fiscal mismanagement—on the part of government and all of its ministries—slowly bled the public health-care system dry of funding. According to the World Health Organization, in 2012, the last year for which data is available, the share of state spending on health, at 6%, and health spending as a percentage of annual economic output, at 2%, were lower in Venezuela than in all other major economies in Latin America.

In recent months, officials have spoken infrequently about health care—even as doctors and patients have staged protests outside hospitals.

Instead, some officials in President Nicolás Maduro’s government have lashed out at doctors and the directors of medical associations who have criticized health care—calling them traitors and greedy capitalists who don’t really care about the sick. In September of last year, Mr. Maduro, his former interior minister and local officials in Aragua state—all from the ruling party—went so far as to brand some doctors conspirators.

Mr. Maduro singled out one leading doctor, Angel Sarmiento, calling him a terrorist on national television and ordering his arrest. The doctor, who had told the press that eight deaths in a single public hospital were possibly linked to the same pathogen, has been in hiding since.

In early February, the president of the association representing private clinics, Carlos Rosales, was brought in for questioning by the intelligence service after he released information to the press about large numbers of hospitals unable to perform surgeries for lack of any supplies. He was released after a few hours. The intelligence service didn’t respond to requests for comment.

With so many lives hanging in the balance, even bureaucrats can’t shift the spotlight away from patients like Armando Delgado. Mr. Delgado, a 53-year-old mechanic, had a tumor in his neck that was successfully reduced with chemotherapy a year ago. His oncologist then recommended radiation therapy to finish off the cancer, which was to begin 21 days later.

Mr. Delgado has instead waited nearly 11 months. The one radiation therapy machine near his home of San Cristobal, in western Venezuela, was frequently out of service, a casualty of overuse. The tumor grew back.

“We probably won’t be able to cure him. He responded well to chemo, but the time has passed for radiotherapy,” said Dr. Stella Rivas, his oncologist, after Mr. Delgado stopped by for a recent visit.

After the visit, Mr. Delgado fought back tears. “I am scared, I’ll tell you,” he said.

Some people, desperate for medication, have gone to remarkable lengths to obtain them.

Gisela Duarte, 51, a retired state employee who suffers from diabetes, a heart condition, hypertension and high blood pressure, says she spends most of her day calling pharmacies nationwide. She recently found that a pharmacy had insulin. But it was five hours away by bus, in the town of Coro.

“I told them, ‘I’ll get there,’ and I did by noon,” she said, recounting how she urged a clerk at the store to keep the medication for her. Yet the battle for more drugs continues. “The problem is if I don’t take the medicine then later things will get worse. I could have a heart attack.”

Others take to social media, counting on well-known personalities, like Marianella Salazar, a columnist and radio show host with nearly 500,000 followers. She often sends out tweets, like a recent one reading: “URGENT, the drug CARDIOXANE is needed for a chemotherapy.” She then listed a phone number for donors to call.

Belen Fagundez, 40, a Caracas teacher who was diagnosed with breast cancer, couldn’t locate cyclophosphamide, a chemotherapy drug her doctors planned to use. Tweets and posts on Facebook, some of them put up by people she barely knew, led strangers to send the drugs she needed from neighboring Colombia.

“Social media saved my life,” Ms. Fagundez said. “I still can’t believe the luck I had.”

At the University Hospital here in Caracas, those who are feverishly trying to get the care they need praise the dedication of doctors but say the health system itself only brings torment.

Arturo Caivet, 65, was another patient in the cardiovascular ward who was discharged in November due to lack of supplies. Mr. Caivet’s heart, slowed by a calcified aorta, was beating very slowly and his body was shutting down.

His only hope was to go from pharmacy to medical equipment company to buy a dozen key products need for his operation, including a heart valve. He spent his life savings. In early February doctors at the University Hospital operated successfully.

“It was a lot of luck,” he said a week later. “It’s like coming up for air. You say, ‘Life, life.’ ”