Monitoring of Access To Health in Venezuela. Newsletter N. 24 July

NEWSLETTER

JULY

2019

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MONITOREO DEL DERECHO A LA SALUD EN VENEZUELA: MEDICIÓN DEL DESABASTECIMIENTO DE MEDICINAS Y LA SITUACIÓN DE LAS ENTIDADES DE ATENCIÓN DE PERSONAS MAYORES. CONVITE, A.C. 2018 LUIS FRANCISCO CABEZAS DIRECTOR GENERAL FRANCELIA RUIZ DIRECTORA DEL PROYECTO INVESTIGACIÓN Y REDACCIÓN: YANIRETH FERNÁNDEZ, FRANCELIA RUIZ. REVISIÓN Y EDICIÓN: LUIS FRANCISCO CABEZAS, WENDY RACINES. DIAGRAMACIÓN Y DISEÑO: CAMILO ESCOBAR. EQUIPO DE LEVANTAMIENTO: DISEÑO MUESTRAL Y PROCESAMIENTO ESTADÍSTICO: MIGUEL PADRÓN EQUIPOS LOCALES DE LEVANTAMIENTO: ÁREA METROPOLITANA DE CARACAS: ALEXANDER MONSALVE SANDRA PEPE DIEGO RAMÍREZ KELLYN RUIZ BARQUISIMETO: JOSÉ RAMÓN QUERO LISSETTY PÉREZ ISABEL BRAVO AQUILES QUERO CARMEN QUIÑONES MARACAIBO: ORGANIZACIÓN MULIER ESTEFANÍA MENDOZA MAYERLING GUERRERO ALEXANDRA NAVA GAUDYS TROCONIZ LENIN ALVAREZ MÉRIDA: ORGANIZACIÓN PROMEDEHUM RIGOBERTO LOBO FRANCISCO DE JESÚS SEGOVIA ANAGABRIELA CENTENO ELVIS RIVAS

CIUDAD BOLÍVAR: ORGANIZACIÓN KAPÉ KAPÉ RAIZA GUAIPO MARY CARMEN SALAZAR ALCALA CARLOS R TORRES FLORES RANIER RAFAEL RICCIARDI PÁEZ PUERTO LA CRUZ: ORGANIZACIÓN DEFENSA EN ACCIÓN ALEJANDRA OLIVARES LUZ GUERRERO SUSANA DÍAZ MERCEDES CURIEL ZEZARINA GUEVARA VALENCIA: ORGANIZACIÓN FUNCAMAMA SOLEIR VALECILLOS YANIRA SUAREZ CARMEN BUENO ARACELYS COLMENAREZ MARIA ISABEL ALVARADO

PUERTO ORDAZ: ORGANIZACIÓN CODEHCIU MAIRIS BALZA NORKIS SALAZAR ROXANA MATHEUS ALEJANDRO HERNANDEZ ANGÉLICA SALAZAR

T A B L E

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C O N T E N T S

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ANALYSIS AND INTERPRETATION OF AGGREGATE RESULTSMEDICINE SHORTAGE INDEX

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DIABETES IN A COUNTRY FACING AN EMERGENCY

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RESULTS INDICATOR BEHAVIOR AND EVOLUTION

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GRAPHIC DEPICTION OF THE MEDICINE SHORTAGE INDEX BY MORBIDITY DIABETES HYPERTENSION ACUTE INFECTIONS OF THE RESPIRATORY TRACT: DIARRHEAL DISEASES: DEPRESSION AND PERSONALITY DISORDERS: SEIZURES:

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ON CONTRACEPTIVES SEXUAL AND REPRODUCTIVE HEALTH AT RISK

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JULY 2019 VENEZUELA #ACOUNTRYINSTATEOFEMERGENCY

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ANALYSIS AND INTERPRETATION OF AGGREGATE

RESULTSMEDICINE SHORTAGE INDEX

JULY, 2019

CHRONOLOGICAL DETAILS OF THE SURVEY Period and Frequency of Data Collection: The survey consisted of two measurements conducted in the month of July of 2019, from the 10th to the 11th and from the 29th to the 30th — which dates fall on the second week and fourth week of the month, respectively—, in order to detect variations that could be quantified and circulated regarding medicine supply protocols in pharmaceutical establishments.

For further information on the technical data sheet of the survey and other methodological details, please refer to Newsletter No. 1, September 2017, available at https://conviteblog.wordpress.com/2017/10/17/informes-de-septiembre-del-proyectomonitoreo-del-derecho-a-la-salud-en-venezuela/

DIABETES IN A COUNTRY FACING AN EMERGENCY Diabetes is a chronic disease that occurs when the pancreas does not produce enough of the hormone insulin or when the body cannot use the insulin it produces efficiently.

The effect of uncontrolled diabetes is hyperglycemia (increased blood sugar levels). Type 2 diabetes (formerly called non-insulin-dependent or adult-onset diabetes) is caused by the body’s inability to use insulin properly, often as a result of excess weight or physical inactivity.

This morbidity is perfectly manageable with appropriate medical treatment, a balanced diet, physical activity, and adequate stress management. The latter should be a must in the lives of people with diabetes and would lead to a healthy lifestyle. However, in countries such as Venezuela where “normalcy” vanishes and scenarios change drastically, medical treatment, a balanced diet, physical activity, and adequate stress management become ethereal desires or unfinished tasks that end up affecting the quality of life of diabetics.

The State justifies the increase in the number of diabetic patients and the worsening of the morbidity by arguing that people choose not to eat the right food or that people do not make appropriate choices when shopping for groceries; moreover, it labels such people as ‘sedentary’. The State also claims, via spokespersons for the health authorities, that all the healthcare centers in the country’s public health network provide diabetics with full treatment, glucometers with their test strips, and diabetic foot care through units all around the country’s territory. Nevertheless, the fact of the matter is that the shortage of test strips in the country has reached dramatic proportions since 2006.

Regarding the deficiencies in the stock of medicines at pharmacies, the State acknowledges that they exist indeed. However, it claims that they are due to people’s misuse of some drugs (e.g. metformin for weight loss) and to alleged pressures from transnational corporations that purportedly seek to position a product by forcing another to be taken off the market, thereby causing a drop in the stock or availability thereof.

1. Testimonio documentado por Convite, A.C. (2019), disponible en https://www.youtube.com/watch?v=GPFCr-GQgZo

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But the reality, as pictured by the Ministry of Health, specifically from the Non-Communicable Chronic Diseases Program, is a far cry from that which people with diabetes experience in Venezuela in their day-to-day lives.

In today’s Venezuela, a country that is plunged into a complex humanitarian emergency unprecedented in the region, poor nutrition is not precisely the result of poor food choices. Sedentarism does not necessarily occur because of laziness or lack of time. As for their medication, people do not stop taking certain active ingredients just because they are negligent or because of improper medical control. The current circumstances in the country make it impossible to take care of their health and control their pathologies as they should. The Venezuelan State significantly restricts those possibilities, as it fails to guarantee its citizens the right to health and to life.

Healthy eating has become a luxury for most Venezuelans. The price of animal protein, fruits and vegetables rise by the day to the tune of hyperinflation. Venezuelans’ low income prevents them from purchasing quality food. Since 2016, when the crisis began to show its ugliest face, people, including diabetics and the elderly, have based their diet on carbohydrates such as rice, pasta, flour, roots and tubers, which negatively affect the control and incidence of the disease.

With respect to pharmaceutical drugs, not all the active ingredients that help control diabetes are readily available and, when they are in stock in pharmacy networks or independent establishments, they are sold are unaffordable prices, which limits the possibility for people to obtain the treatment they need. The shortage of drugs has posed a true challenge for Venezuelans. Diabetics have had to cope with the crisis by resorting to extreme measures such as reducing their dose of insulin, reusing syringes, or taking drugs past their expiration date. Such is the case of Professor José Rodolfo Rico, who gives us a first-hand account of how is it to live in a country where a controllable disease such as diabetes turns deadly because of the shortage of medicines and healthy food. 1 As for the need to engage in physical activity, it is true that people could be motivated, discipline can be mastered, and habits die hard, but fear can become a difficult hurdle to overcome. And it is not just an ordinary fear: personal insecurity is one of the main factors that hinders the normal development of Venezuelans daily life. It is easy for anyone to engage in activities such as taking a long walk in a park or on the streets of one’s neighborhood, but the country’s reigning environment of violence and impunity make people feel exposed to a latent risk of aggression or attack by criminals. If the alternative is to go to safe places such as a gym, said establishments are targeted to people with a high purchasing power.

Another relevant factor is the one pertaining to the control of emotions or stress management. Venezuelans must make enormous efforts just to feel “good and cool”. When you live in a context of crisis, it is difficult to take breaks to think about ordinary things or emotionally rewarding things such as setting personal, professional, or academic goals. Most people are just struggling to do their best to survive in an overwhelming present time that they spend in basic activities such as finding food and/or affordable medicines, or getting home in a reasonable time before the dangerous night falls in a public transportation system that is utterly insufficient and deficient.

In the list of factors that determine the improvement or otherwise decompensation of diabetic patients, medical control cannot be overestimated. Diabetics are advised to, every four months, have endocrine check-ups, blood tests such as

1. A testimony documented by Convite, A.C. (2019), available at https://www.youtube.com/watch?v=GPFCr-GQgZo

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for glycosylated hemoglobin levels, and lipid profiles to evaluate results and help prevent heart disease or stroke. They also need to check their kidney function and, at least once a year, visit an ophthalmologist, a dentist, and a podiatrist.

The foregoing controls involve incurring in substantial expenses that many Venezuelans cannot afford to make in this distorted economy, where everything is dollarized except salaries. Relying on the medical care that the centers of the public health network can provide is no longer a viable option because of a mounting number of reasons that have become increasingly apparent and have been widely documented and denounced by civil society organizations, journalists, activists, political leaders, patients’ family members, and the very victims of the systematic violation of their right to health and life.

Two million four hundred people with diabetes are living today with no medical treatment, control, or follow-up, which worsens their morbidity, triggers chronic conditions such as blindness, and puts them at risk of heart attack, kidney failure and dialysis, diabetic foot (and amputation), stroke, and depression, just to name a few of the diseases that adversely affect diabetics to the point of leaving them disabled and at the mercy of a State that cares for nothing and no one.  

Convite. #Convite4Health

An untreated diabetic patient risks having his/her pathology worsen

Blindness.

Heart Attack Risk.

Diabetic Foot (and Amputation).

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Kidney Failure and Dialysis.

Stroke.

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RESULTS

INDICATOR BEHAVIOR AND EVOLUTION

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The shortage indexes reported in our July 2019 survey within the framework of the “Monitoring the Right to Health in Venezuela” project, which range from 21 percent and 93 percent for the basic baskets of drugs prescribed to treat the six causes of morbidity selected, are shown below. It is the opinion of Convite, A.C. that the decline in the shortage of certain pharmaceutical drugs may be attributable to the alleged growth of import markets.

Table No. 1: Behavior of the Aggregate Medicine Shortage by City and Morbidity – July 2019

Chart No. 1: Behavior of the Aggregate Medicine Shortage Nationwide – July 2019 2. For details on the historical data of all the measurements carried out since the beginning of the project, please refer to our Newsletters No. 1 to No. 11, available at disponibles en: https://conviteblog.wordpress.com/

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GR APHIC DEPIC TION OF THE MEDICINE SHORTAGE INDEX BY MORBIDIT Y DIABETES

Chart No. 3: Behavior of the Medicine Shortage Index by Morbidity. Diabetes. July 20019

The general shortage index for drugs to treat diabetes was 65 as a percentage, which means that the indicator has decreased by 11 percent so far this year. Nevertheless, the situation is far from being normal. For example, the index for the city of Barquisimeto was 90 percent, and very little has changed since January; the same applies for the Metropolitan Area of Caracas, whose medicine shortage index is in excess of 85 percent.

In the other cities surveyed, the index’s behavior has been different, for the supply of drugs has gradually increased. Among the most noticeable cases is that of the city of Puerto La Cruz, where the index in January was 98 percent and had dropped to 57 percent by July. These days, and depending on the morbidity, people have to tour fewer pharmacies searching for medicines, but their dilemma has now changed: it is no longer a matter of finding the required treatment but one of having enough money to afford to buy it, given the high costs of drugs.

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HYPERTENSION

Chart No. 4: Behavior of the Medicine Shortage Index by Morbidity: Hypertension. July 2019.

The supply of drugs to treat hypertension is still short in cities such as Barquisimeto and Puerto La Cruz, with rates in excess of 70 percent. On the other hand, the situation in cities such as Ciudad Bolívar, Valencia, Maracaibo, and Mérida is more favorable for people with high blood pressure, with shortage indicators that do not exceed 50 percent, which means that they have a greater chance of finding the right drugs to treat their disease.

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ACUTE INFECTIONS OF THE RESPIRATORY TRACT

Chart No. 5: Behavior of the Medicine Shortage Index by Morbidity: ARIs. July 2019.

Acute respiratory infections (ARIs) remain one of the morbidity causes that are hard to combat. The supply of drugs to treat said infections is still compromised, with rates of over 50 percent in all the cities surveyed.

The most alarming case is that of Barquisimeto, with 93 percent, followed by the Metropolitan Area of Caracas (MAC), with 91 percent; Puerto Ordaz and Puerto La Cruz, with over 80 percent each, and Mérida, with 74 percent, while the shortage of drugs to treat ARIs in Valencia, Maracaibo, and Ciudad Bolívar is in excess of 50 percent.

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DIARRHEAL DISEASES

Chart No. 6: Behavior of the Medicine Shortage Index by Morbidity: Diarrhea. July 2019.

As for diarrhea, the behavior of the drug shortage index in July showed that it increased slightly. People affected by this medical condition must visit several drugstores until they are able to find what they need.

The locations with the most critical shortage are Barquisimeto and the Metropolitan Area of Caracas, with a shortage of over 90 percent; Puerto Ordaz and Puerto La Cruz, with shortage rates in excess of 80 percent; MĂŠrida, with almost 74 percent shortage, and Ciudad BolĂ­var and Maracaibo, with indicators of over 60 percent. Valencia has a 58 percentage, which is the lowest shortage percentage recorded in this survey.

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DEPRESSION AND PERSONALITY DISORDERS

Chart No. 7: Behavior of the Medicine Shortage Index by Morbidity: Depression. July 2019.

Being depressed or distraught in Venezuela means torture. According to people who benefit from the humanitarian action program implemented by Convite, A.C., the anguish they feel when their health condition deteriorates is unparalleled. Although the shortage index for drugs to control this morbidity has decreased, the percentages that reflect it continue to be high: none of the cities surveyed had rates lower than 50 percent, and places such as Puerto La Cruz and Barquisimeto have a shortage of drugs to treat depression and related conditions in excess of 90 percent.

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SEIZURES

Chart No. 8: Behavior of the Medicine Shortage Index by Morbidity: Seizures. July 2019.

Pharmaceutical drugs to control seizures and seizure episodes remain among the most difficult to find.

The lowest drug shortage index for the month of July was 65 percent, which means that people affected with the condition still have to make the tour of several establishments and a minimal chance of finding the medicine they need. In places such as Puerto Ordaz, the Metropolitan Area of Caracas, and Barquisimeto, the outlook for people affected by seizure crisis is gloomy, for the shortage indicator exceeds 90 percent.

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ON CONTRACEPTIVES

SEXUAL AND REPRODUCTIVE HEALTH AT RISK

Chart No. 9: Shortage Index Aggregate Nationwide, by City. The Case of Contraceptives. July 2019.

It seems as though the only way to protect oneself from sexually transmitted diseases (STDs) or from unwanted pregnancy in Venezuela is to use condoms and emergency contraceptives, a possibility that is also conditioned by the fact that the supply and availability of such products continues to be limited in the main cities of the country.

Vaginal patches and rings are nowhere to be found in the cities surveyed; intrauterine devices are rarely available, as are implantable devices. Injectable contraceptives are not easier to be obtained than before, and oral contraceptive pills can be found with less difficulty in cities such as Maracaibo and MĂŠrida.

Chart No. 10: Shortage Index Aggregate Nationwide, by City. The Case of Contraceptives. June 2019.

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#CONVITEDENOUNCES

JULY 2019 VENEZUELA #ACOUNTRYINSTATEOFEMERGENCY Regime Officials Not Pleased with the United Nations High Commissioner for Human Rights Report A few hours after the release of the long-awaited report compiled by Michelle Bachelet, Nicolás Maduro made a series of announcements on a nationwide broadcasted address. Even though he did not specifically mention the document in his message, most of the content thereof was related to the application of corrective measures in the highly sensitive topics where the High Commissioner focused and that she seriously denounced. Some of Maduro’s announcements concerning the health sector included: • Review of the status of the health system in various states in the country (Carabobo, Bolívar, Lara, Cojedes, Barinas, Apure, Portuguesa, Monagas, Mérida, Amazonas, Táchira, and Delta Amacuro) in order to “perfect” healthcare.

• Production of vaccines and insulin, in response to the “blockade imposed by the United States,” which, according to Maduro, prevents the country from purchasing medicines.

• Creation of corporation Vensalud, which will be charged with repairing and providing maintenance service to medical equipment. Vensalud was approved a contribution for 3.9 million Bolivars.

• Inauguration of a mother-children hospital in Puerto Ayacucho (state of Amazonas).

• Reactivation of the oral and maxillofacial surgery service at the Domingo Luciani Hospital.

Unfortunately, these measures are marginal amidst the chaos into which the Venezuelan health system has been plunged.

There is no such a thing as the possibility of “perfecting” something that has not even reached acceptable minimum standards or conditions of operation.

In the Report of the United Nations High Commissioner for Human Rights on the situation of human rights in the Bolivarian Republic of Venezuela, there is an entire section dedicated to the violation of the right to health. One of its fragments contains unambiguous painstaking details on the stance of the UN agencies thus far and the nightmare that the people affected by the crisis have to endure. One of the paragraphs accurately summarizes the current state of the Venezuelan public health: “Violations of the right to health result from the Government’s failure to fulfil its core obligations, which are non-derogable, even for economic reasons. Violations of core obligations were linked to the widespread lack of availability of, and access to, essential medicines and treatment, the deterioration of conditions in hospitals, clinics, and maternity clinics, insufficient provision of underlying determinants of health, including water and adequate nutrition, deterioration of immunization and preventative health programmes, and restrictions on access to sexual and reproductive health. Moreover, the failure of the Government to publish comprehensive data on public health, essential for the development and implementation of an adequate response to the health crisis facing the country, is a violation of the right to health.”

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3. Go to : https://www.ohchr.org/EN/HRBodies/HRC/RegularSessions/Session41/Documents/A_HRC_41_18_SP.docx

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#CONVITEDENOUNCES For his part, Feliciano Reyna, president of the NGO Acción Solidaria (Action for Solidarity), declared that the OHCHR instrument “puts the Maduro regime in a very disadvantageous position if he were to sit at a table with the international 4

community”. Bachelet leaves no room for doubt as to who is responsible for the current crisis in Venezuela. She dutifully documented what is happening and in a manner that advances the understanding of the gravity of the matter internationally. #Convite4Health in the #HighCommissionerReport In Convite, A.C. we strive to raise awareness on social rights for all people and demand their enforceability. We are determined to continue working to document, disseminate, and denounce the multiple, massive, systematic, and deliberate violations of human rights that the State inflicts upon Venezuelans. It is this continued individual and group effort that will mark the second consecutive year of our Drug Shortage Index survey, which we perform within the framework of the Monitoring the Right to Health in Venezuela project. The project was first implemented in five Venezuelan cities and has now expanded to eight. It is the collaborative product of our networking with allied organizations that operate in the regions included in our index. It should be mentioned that our index was quoted in the Right to Health section of the report

by High Commissioner Michelle Bachelet. More than a recognition of our work and the information it generates, it means a commitment for us to continue doing our job of defending the right to health and demanding its fulfillment and exercise, which me do under technical, methodological, and quality criteria, and using the language of rights.

Economic Slowdown Leads to Increased Undernutrition Rates in Venezuela On 15 July 2019, the United Nations Food and Agriculture Organization (FAO), the International Fund for Agricultural Development (IFAD), the World Health Organization (WHO), the World Food Programme (WFP), and the United Nations International Children’s Emergency Fund (UNICEF) presented the “State of Food Security and Nutrition in the World 2019” report. 5 The document underscores alarming figures that unfortunately push countries in declining growth and increased hunger away from the Sustainable Development Goals and, consequently, from the 2030 agenda. The prevalence of undernutrition (percentage of people suffering from hunger) has quadrupled in the last four years from 6.2 percent in 2012 to 21.2 percent in 2018. This increase is due to economic slowdown or downturns in several countries, especially Venezuela. The report states that inflation in the country had reached approximately 10,000,000 percent, and that real GDP growth had plummeted from minus 3.9 percent in 2014 to the minus 25 percent estimated for 2018.”

South America is home to the majority (68 percent) of the undernourished people in Latin America. The number of hungry people in Latin America and the Caribbean grew in 2018 for the third consecutive year to affect approximately 42.5 million people. According to the United Nations, 6.8 million Venezuelans do not have access to food, and Venezuela is among the 53 countries in the world with the highest number of undernourished people.

4. CARBALLO, Betzimar (July 9, 2019). “Informe de Bachelet pone en desventaja a Maduro en negociación internacional” (Bachelet Report Puts Maduro at a Disadvantage in an International Negotiation). Available at: https://www.elperiodico.com/es/internacional/20190709/maduro-exige-bachelet-rectifique-mentiras-informe-ddhh-7545502 5. Go to: :http://mppre.gob.ve/wp-content/uploads/2019/07/Carta-del-Pte.-a-Bachelet-11.07.2019-CONSIGNADA.pdf

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#CONVITEDENOUNCES #UnprecedentedMigrationRates Unheard of in the Region, Venezuela’s Migration Gate Will Reach 5 Million Forced Migrants by the End of 2019.

Approximately 500,000 Venezuelans would leave the country during the July-September quarter, a figure that could rise 6

to 1 million by the end of 2019. These estimates are from the OAS Working Group to Address the Regional Crisis Caused

by Venezuela’s Migrant and Refugee Flows. The latter number of people will add to the existing list of migrants, bringing it to a total of 5 million.

The Working Group’s Coordinator, David Smolansky, claims that this forced displacement which is expected to take place in the coming months is due to the humanitarian crisis, widespread violence, human rights violations, economic collapse, and failures in the provision of basic services. The latter causes are behind the mass exodus of Venezuelan migrants, and will remain unchanged as long as the regime of Nicolás Maduro remains in power in Venezuela.

But difficulties do not disappear when one crosses the border. Many Venezuelans have to face endless obstacles before and during their stay in a host country. A somehow discouraging example is that of Dick Gregorio Galea Brito, aged 20.

Dick Galea decided to go to Peru to help his family from there; he worked as a motorcycle- taxi driver, an activity that, far from propelling him to a better life, led to his death.

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The young Galea was stabbed with a knife to his chest and shoulder. The perpetrator of the attack was a Peruvian man who was defending his partner from the Venezuelan’s alleged verbal abuse. Dick came back home wounded because he did not receive medical attention, presumably because he was Venezuelan. Hours later, his aggressor showed up at his home searching for him and threatened to kill him, which is why he was forced to leave Peru and return to Caracas.

When the young man finally arrived in Venezuela (six days later), he did not receive the medical care that his precarious health required: although he went to several health centers, he could not be treated because they had no supplies. Finally, he was admitted to the Vargas Hospital, where the doctors decided to operate on him... but it was already too late. On July 21, he died on the operating table: he had a piece of metal in his chest that had already caused extensive damage. Dick Gregorio Galea Brito was denied the right to health both in the host country and in his native land. His death was a preventable one. He could have been saved if he had been treated as any human being deserves to be treated: with respect, dignity and without discrimination.

#HumanRightsArePeopleRights At another level, indigenous communities do not escape the painful consequences of forced migration. According to human rights activist and advisor to the NGO Provea, Mariano Alvarado, some 1,000 people from the Warao ethnic group are living in Brazil as refugees and in precarious conditions, and at least 200 of them are roaming the streets in search of a place to escape the cold because they have not been able to secure a place in the shelters. With regard to food, the activist indicates that the situation is quite critical, although he recognizes the great work that the Brazilian authorities have been

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doing in keeping united a community whose members go on, despite everything, with their customs and living traditions.

8. CARBALLO, Betzimar (July 31, 2019). “Pasando hambre y durmiendo en el piso: la terrible situación de los waraos en Brasil” (Hungry and Sleeping on the Floor: The Terrible Situation of the Warao in Brazil). Available at: https://runrun.es/noticias/385201/monitordevictimas-venezolano-herido-en-peru-murio-en-caracas/

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#CONVITEDENOUNCES Reversing Venezuela’s Deterioration: A Challenge for the Entire Latin American Region The abysmal regression that Venezuela has experienced in the last 20 years not only affects the country but the entire region. Thus, its reversal must be considered as an urgent challenge to be undertaken by all Latin American countries.

Those were the words of the president of the Inter-American Development Bank (IDB), Luis Alberto Moreno, at the opening ceremony of the 60th Annual Meeting of Governors of the IDB, held in Guayaquil, Ecuador.

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Moreno stated at this important assembly that the Venezuelan population has an “income poverty rate of 94 percent.” He also praised the receptivity of the host countries, which face the arduous task of adapting their health, education, housing, and employment systems to accommodate the significant number of migrants who arrive daily in their territories.

For his part, Lenin Moreno, president of Ecuador, took the opportunity at the IDB-sponsored event to express his concern for the migratory exodus and its consequences, including the 500 million dollars that his country spends annually to attend to Venezuelan migrants. The Ecuadorian president claims that 3,000 people from Venezuela arrive to his territory every single day, and voiced his concern that “this situation is already surpassing my country’s reception capacity”.

Malnutrition Destroys the Lives of Venezuelan Children In July, the Bengoa Foundation, a Venezuelan organization specializing in food and nutrition, conducted a study (with data from 2018) that revealed that 30 percent of school-age children (between 7 and 12 years of age, approximately) examined in Caracas have chronic malnutrition, i.e. sustained deprivation of nutrients over time as reflected in the height-for-age ratio at early ages). In the state of Miranda alone, chronic malnutrition was 28.2 percent. The children in the sample surveyed had stunted growth.

Marianella Herrera, member of the board of directors of the Bengoa Foundation, who is a medical doctor herself, states that “Chronic malnutrition has a damaging component that translates into stunted growth, but also affects psychomotor and cognitive development. It compromises the development of a country in biological and human capital terms. These are people who are not going to be able to educate themselves adequately.”

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Dr. Herrera explains that chronic malnutrition has always been present in Venezuela, especially in the poorest strata of the population, but that from 2012 on, the conditions took an adverse turn and access to food has been increasingly restricted.

Consequently, acute malnutrition and chronic malnutrition began to overlap. The ravages of malnutrition are apparent from pregnancy, because mothers in such alarming conditions are unable to provide the necessary nutrients to her children.

On the other hand, malnourished children continue to arrive for consultation at the J. M. de los Ríos Hospital. Although the percentage of affected children who attend the service fell by 10 percent with respect to 2018, Dr. Ingrid Soto, pediatrician and head of the hospital’s Nutrition, Growth, and Development service, reported that the number of cases of children with wasting (extreme thinness) and swollen abdomen and limbs increased. The physician noted the stunted growth of the children assessed in the consultations.

9. EL ESTIMULO (July 17, 2019). “BID asegura que el mayor reto en América Latina es revertir el deterioro de Venezuela” (BID: The Greatest Challenge in LatAm is to Reverse Venezuela´s Deterioration). Available at: http://efectococuyo.com/principales/desnutricion-cronica-infantil-ronda-el-30-en-estados-evaluados-por-fundacion-bengoa/ 10. PINEDA, Julett (July 10, 2019). “Desnutrición crónica infantil ronda el 30% en estados evaluados por Fundación Bengoa”. (Chronic Child Malnutrition at About 30 Percent in States Surveyed by the Bengoa Foundation). Available at: http://efectococuyo.com/principales/desnutridos-de-gravedad-llegan-ninos-con-menos-de-dos-anos-a-consultas-en-el-j-m-de-los-rios/

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#CONVITEDENOUNCES Additionally, it is frequent for children to arrive for consultation at the service with anemia and parasites. Their condition is presumed to be the consequence of little or no iron intake and poor sanitation at home. Dr. Soto argues that the number of visits and consultations began to climb in May, and is of the opinion that it may be due to “diarrhea, health problems, or delays in the delivery of the food boxes distributed by the Local Supply and Production Committees (CLAP, by its Spanish 11

acronym), as reported by the parents.”

Private Health Dollarized and Within Reach of a Few Hyperinflation not only affects access to food and medicines, but also to private medical care. Rates are constantly increasing due to factors such as the use of imported supplies and expensive medical equipment that is also expensive to maintain, and medical fees are charged at the discretion of the specialists.

According to a health insurance broker, doctors’ fees range from USD 20.00 to USD 40.00 per consultation, and they are billed at the exchange rate of the day. In January 2018, “consultations were charged at USD 5.00 on average, which means that there has been an increase of 700 percent for consultations at USD 40.00 and of 300 percent for consultations at USD 20.00.”

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Surgery fees are also billed in US dollars, and estimates vary with the specialty and the area of the city where the clinic is located. “The basic cost of a surgical procedure is 2 million bolivars, and from there it raises based on the complexity of the surgery and on a daily or monthly basis due to inflation. There is no established scale among doctors. The Federation 13

intended to implement one 15 years ago, but no agreement could be reached on the matter,” said the president of the Venezuelan Medical Federation, Douglas León Natera.

The Concepción Palacios Maternity Hospital: A Delivery Room for Calamities As if it were not enough that 75 percent of the hospital’s bed are inoperative, that there is a shortage of medical and cleaning supplies, and that its staff is harassed, poorly paid or simply absent, the 4 elevators of Concepción Palacios Maternity Hospital are currently out of order. The first two elevators broke last year, while the third one stopped working at 14

the beginning of 2019, and the fourth one became inoperative on July 2.

Women in labor, mothers with newborns, recently operated women, etc., are moved between the different areas of the hospital up and down the stairs or in the waste elevator, where toxic waste, garbage and material with fluids and secretions, among other contaminant agents, are transported.

The surgical service of the hospital is located on the eighth floor. Unfortunately, it had to be evacuated because it has no elevator. According to the maternity hospital’s staff, the recovery room is collapsed. The medical personnel and workers are very concerned, have not received a clear solution to the problem, and fear that the hospital will be completely shut down.

11. PINEDA, Julett (July 12, 2019). “Desnutridos de gravedad llegan niños con menos de dos años a consultas en el J.M. de los Ríos” (Seriously Malnourished Under 2 Arrive for Consultation at the J.M. de los Ríos). Available at : http://efectococuyo.com/principales/desnutridos-de-gravedad-llegan-ninos-con-menos-de-dos-anos-a-consultas-en-el-j-m-de-los-rios/ 12. CAMACARO, Zulay (July 12, 2019). “Suben hasta 700% tarifas de consultas médicas” (Medical Fees Increase Up To 700 Percent for Consultations). Available at: http://www.2001.com. ve/en-la-agenda/210366/suben-hasta-700--tarifas-de-consultas-medicas.html 13. Idem 14. PINEDA, Julett (July 9, 2019). “Por el ascensor de la basura trasladan a pacientes en la Maternidad Concepción Palacios” (Patients at Concepción Palacios Maternity Transported Through Waste Elevators). Available at: http://efectococuyo.com/salud/por-el-ascensor-de-la-basura-trasladan-a-pacientes-en-la-maternidad-concepcion-palacios/

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#CONVITEDENOUNCES The health crisis affects all hospitals alike, and no matter how hard the patients and staff of the healthcare centers try, it is not possible for them to find a solution to so many difficulties. Just like the maternity hospital, the Luis Razetti Cancer Hospital is in precarious conditions. Cancer patients there, moved by their need to continue to receive treatment, volunteer to fix the damaged medical equipment that can be repaired (some are beyond repair); unfortunately, costs keep increasing and they are not able to raise the necessary funds to do the job.”

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The J. M. de los Ríos Children’s Hospital Mourns Again This time it is 10-year-old Eliander Bandres, a patient of the Nephrology unit at the hospital. He suffered chronic kidney disease and had not been hospitalized for some time. Last Tuesday July 9, however, he went directly into the emergency room with pain in the abdomen and skin lesions. He was immediately admitted to the hospitalization area and, according to the ONG Prepara Familia, the kid died on Thursday 11 from septic shock (generalized severe infection) that spread from 16

the tip of his hemodialysis catheter.

Unfortunately, between January 2 and July 11, 2019, four girls and twelve boys passed away at the children’s hospital in Caracas in the midst of the worst health crisis Venezuela has ever experienced.

Unassisted Kidney Failure Patients 17

Operation of the dialysis unit of the Pastor Oropeza Hospital in Barquisimeto, in the state of Lara, came to a halt on Tuesday, July 16. The osmosis plant broke down and without it the artificial kidneys or hemodialysis units do not work at all, which leaves people who need them to clear the toxins that accumulate in the blood unassisted.

Patients with kidney failure need to be dialyzed three times a week, every other day, for four hours. Unfortunately, that is not a possibility in the Pastor Oropeza Hospital. The situation had long been coming. The unit began to fail on April for lack of maintenance, lack of supplies, and interruptions in the water supply service. But the necessary corrective measures were simply not taken and the dialysis unit became inoperative.

No Light at the End of the Health Tunnel in Venezuela Hospitals, outpatient clinics, dialysis units, among other healthcare facilities, were once again operationally stretched after a third national blackout on the afternoon of Monday, July 22. In the capital city, hospitals like the J. M. de los Ríos, the Clínico Universitario (HCU) and the José María Vargas Hospital only opened their doors to treat “strict emergencies”.

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Scheduled surgeries were suspended. No damages were reported, and the power plants operated just fine.

Regarding the supply of safe running water, the conditions were dire in public healthcare centers. The HCU and the Vargas did not have access to water and received none through water cistern trucks. The NGO Doctors for Health monitored the situation and reported on the operation of power plants in 13 hospitals in eight states in the country. The NGO reported no deaths that could be associated with the blackout in the hospitals they survey.

15.5NEDA, Julett (18 de julio de 2019). “Paralizadas diálisis en el Pastor Oropeza de Barquisimeto por avería de la planta de ósmosis”. Disponible en: http://efectococuyo.com/salud/ paralizadas-dialisis-en-el-pastor-oropeza-de-barquisimeto-por-averia-de-la-planta-de-osmosis/ 16. PINEDA, Julett (23 de julio de 2019). “Suspenden cirugías electivas en el J.M. de los Ríos y el Clínico Universitario tras megaapagón”. Disponible en : : http://efectococuyo.com/ principales/suspenden-cirugias-electivas-en-el-j-m-de-los-rios-y-el-clinico-univesitario-tras-megaapagon/ 17. PINEDA, Julett (23 de julio de 2019). “Megaapagón paralizó unidades de diálisis en distintas regiones del país”. Disponible en: http://efectococuyo.com/principales/megaapagon-paralizounidades-de-dialisis-en-distintas-regiones-del-pais/ 18. PINEDA, Julett (July 23, 2019). “Suspenden cirugías electivas en el J.M. de los Ríos y el Clínico Universitario tras megaapagón”. (Elective Surgeries Suspended at the J. M. de Los Ríos and the Clínico Universitario After Mega Blackout). Available at: http://efectococuyo.com/principales/suspenden-cirugias-electivas-en-el-j-m-de-los-rios-y-el-clinico-univesitariotras-megaapagon/

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#CONVITEDENOUNCES As for people with kidney failure, they generally face difficulties to receive their therapy, but their situation grows worse in emergency contexts because very few dialysis units are able to respond to contingencies. For example, in the Metropolitan Area of Caracas, the Riverside Center (located in the municipality of Chacao) and the Rómulo Gallegos Nephrology Center (located in the municipality of Sucre) were forced to reschedule the hemodialysis sessions that had been set for the afternoon of Monday 22 because they did not have power or water. The state of Lara was one of the most affected because not only were dialysis treatments suspended during the nationwide blackout: on Tuesday 23, the dialysis units located in La Pastora, El Ángel, and Barquisimeto, did not provide the service. Lara was one of the 15 Venezuelan states where power 19

was not restored after the blackout.

The Emergency Facilitates the Rise of Illegal Businesses Surrounding Health as a Right The Dominican police reported on the dismantling of a criminal gang that exported adulterated drugs manufactured in a clandestine laboratory located in the Santiago Oeste Municipal District, province of Santiago, northern Dominican Republic. The agents in charge of the investigation stated that the organization organized a company under the name of 20

Proqualt to sell adulterated medicines.

The criminal network was made up of two Dominicans and seven Venezuelans. As reported by the international media, medical and surgical equipment, including 22,381 boxes, 10,000 bottles, and 6,676 vials with medicines were seized during the search, all intended for export without the sanitary, industrial, and export permits issued by the Ministry of Public Health and the General Customs Directorate of the Dominican Republic.

In the meantime, within our own borders, two female employees were arrested in the state of Bolivar for selling blood, plasma, medicines and other supplies from the Ruíz y Páez University Hospital. The women, aged 36 and 43, respectively, asked for foreign currency, gold, or bolivars in cash in exchange for the material. They were captured by the Scientific, Criminal, and Forensic Investigations Corps (CICPC, by its Spanish acronym) division in the state aforementioned and are 21

under the Public Prosecutor’s Office on organized crime charges.

#ConviteXLaSalud present in the #InformeDeLaAlta In Convite we work on the visibility and enforceability of social rights for all people, that’s why we are determined to continue working to document, disseminate and denounce the multiple, massive, systematic and deliberate human rights violations to which the State submits to Venezuelans. In this continue doing and doing with others, we will soon arrive at our second consecutive year by raising the Shortage Index of Medicines within the framework of the Right to Health Monitoring project in Venezuela, first in five, and currently in eight cities of Venezuela, through networking with allied organizations that make life in the localities included in our index. Index that was cited in the section on the right to health of the discharge report Commissioner, Michele Bachelet, what more than a recognition of our work and the inputs generated from it, It is a commitment, to continue doing our work of defense and enforceability of the right to health, with criteria technical, methodological and quality, and with rights language.

19. PINEDA, Julett (July 23, 2019). “Megaapagón paralizó unidades de diálisis en distintas regiones del país” (Mega Blackout Stopped Dialysis Units in Several Regions in the Country).

Available at: http://efectococuyo.com/principales/megaapagon-paralizo-unidades-de-dialisis-en-distintas-regiones-del-pais/ 20. PERALTA, Marcelo (July 20, 2019). “Apresan venezolanos al desmantelar laboratorio farmacéutico clandestino en Santiago Oeste” (Venezuelans Arrested After Dismantling of Clandestine Pharmaceutical Labortory in Santiago Oeste). Available at: :http://diarioglobalrd.blogspot.com/2019/07/apresan-venezolanos-al-desmantelar.html?m=1 21. EDG Writers´Desk. (June 28, 2019) “Detenidas trabajadoras del Hospital Ruiz y Páez por vender insumos médicos en oro” (Ruiz y Páez Hospital Workers Detained for Selling Medical Supplies in Exchange for Cash). Available at: https://www.eldiariodeguayana.com.ve/detenidas-trabajadoras-del-hospital-ruiz-y-paez-por-vender-insumos-medicos-en-oro/

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