NEWSLETTER
In loving memory of Grandpa Felipe Carrasquel Your will be in our hearts forever. Our work at Convite, A.C. was always intended to keeping you with us, alive, whole and healthy. Now, in your name, we will work harder and we will continue to denounce that #TheStateDoesn’tCare, wherever necessary, because we DO care, and not having you around anymore saddens our souls and hearts.
TA B L E O F C O N T E N T S ANALYSIS AND INTERPRETATION OF AGGREGATE RESULTS OF MEDICINE SHORTAGE INDEX MEASUREMENTS FOR MARCH 2018
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BEHAVIOR AND EVOLUTION OF THE INDICATOR
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AGGREGATE RESULTS NATIONWIDE – MARCH 2018
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GRAPHICAL REPRESENTATION OF RESULTS BY CITY AND MORBIDITY CAUSE
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DIABETES
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HIGH BLOOD PRESSURE
ACUTE RESPIRATORY INFECTIONS (ARIS)
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DIARRHEA
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HOLY W EEK 2018 IN V ENE ZU EL A: PA RIS HIONERS H A D TO GI V E 1 U P THEIR S E V EN CH U RCHES V IS ITATION [TN] FOR A PILGRIM AGE TO 7 PH A R M ACIES OR MOR E IN S E A RCH OF MEDICINES
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1. Translator’s Note: The Seven Churches Visitation is a Roman Catholic tradition where seven churches are visited on Holy Thursday.
MONITORING THE RIGHT TO HEALTH IN VENEZUELA MARCH 2018
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ANALYSIS AND INTERPRETATION OF AGGREGATE
RESULTS OF THE FIRST TWO MEDICINE SHORTAGE INDEX
MEA SUREMENTS FOR MARCH 2018 2 Within the framework of the Monitoring the Right
affecting the Venezuelan population: high blood pressure,
to Health in Venezuela: An Approximation Based on
diabetes, diarrhea, and acute respiratory infections (ARIs).
Medicine Shortages, Preventable Deaths and Hospital Infrastructure project, Convite, A.C. has conducted a total
In
of 14 measurements (September I and II; October I and
Humanitarian Emergency, access to medicines to treat the
II; November I and II; December I and II; January I and II,
major causes of morbidity afflicting the population remains
February I and II, and March I and II) of the basic basket of
restricted at best.
Venezuela,
a
country
ravaged
by
a
Complex
active ingredients for the four major causes of morbidity
BEHAVIOR AND EVOLUTION OF THE INDICATOR The aggregate results of the fourteen measurements conducted so far are broken down below:
Upon an analysis of the behavior of the Medicine
in a country undergoing a complex humanitarian
Shortage Index based on the results obtained from each
emergency of such size and characteristics: it has been
measurement conducted to date, the following may be
deliberately caused, it is massive and systematic, it has
observed:
been inflicted by those who have the authority and the means to address it and it exceeds the State’s capacity
General Shortage Index (GSI): The GSI closed at 88.1
for action.
percent in March. This means that in seven (7) of the
In light of these results, it is impossible to deny the
fourteen (14) measurements conducted to date, the GSI
existence of a humanitarian emergency in Venezuela, as
closed just below 90 percent. These figures are devastating
well as the inability of the State to respond to this situation.
2.Survey Chronological Details: The survey consisted of two monthly measurements made between March 14-16, 2018, and March 21-23, 2018, which were the second and fourth weeks of the month, respectively, in order to detect variations that could be measured 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 NÂş 1, September 2017, available at https://goo.gl/Vrh1EJ.
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AGGREGATE RESULTS NATIONWIDE: M A R C H 2 0 1 8
3 Caracas, the city of Los Palmeros , welcomed the Holy Week with an 84.6 percent shortage of hypoglycemic agents, an 89.3 percent shortage of medicines to treat hypertension, a 90.6 percentage shortage of antidiarrheal drugs, and a 98.7 percentage shortage of drugs to treat acute respiratory infections (ARIs). The crepuscular city of Barquisimeto remains, along with Caracas, one of the cities with the worst supply of medicines to treat the morbidity causes at issue. All along the entire period, Barquisimeto has had the roughest time: the results from the survey on the availability of drugs for the four causes of morbidity aforementioned are particularly critical for all Barquisimetans. In the measurements conducted during the month of March, the group of drugs with the best supply in Barquisimeto was that of medications to treat high blood pressure. It is extremely alarming to find that the indicator for both hypoglycemic agents and medication to treat acute respiratory infections was 96.3%, which confirms the sustained trend towards 100 percent shortage. 3.Los Palmeros is a typical event of the Holy Week in Venezuela , particularly in Caracas. The tradition, which dates back to the late 17th century, evokes the biblical passage of Jesus’ entrance into Jerusalem. Palms are collected from trees, blessed, and later distributed among the believers, who braid them and fold them into crosses that they keep in their homes as a sign of faith.
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In order of availability to the public, Mérida was the city with the worst supply of antidiarrheal medication, with a 100 percent shortage. As for drugs to treat acute respiratory infections (ARIs) and hypoglycemic agents, the shortage in the city was a dangerous 98.1 percent for antidiarrheal agents, and a disturbing 86.4 percent for the drugs to treat ARIs. In terms of the availability of drugs to treat high blood pressure, the Andean capital was “the best stocked” with a shortage indicator of 74.7 percent.
In Maracaibo, the indicator behaved the same as in the previous month, with an 80 percent shortage for 3 of the 4 morbidity causes included in the survey. The supply of drugs to decrease glucose levels was the best in Maracaibo; yet, the shortage thereof reached 74.2 percent, whereas that of medication to treat high blood pressure was 79.6 percent, followed by the shortage of antidiarrheal medication, at 78.5 percent. But the shortage of drugs in the basic basket to treat acute respiratory infections was the worst in Maracaibo, at 92.3 percent. As for the island of Margarita, there was a not very relevant but worth mentioning reduction in the shortage index. The drugs in the shortest supply, as in the four remaining cities, were those prescribed to treat acute respiratory infections (a shortage of 94.8 percent). The shortage of hypoglycemic agents was slightly reduced, at 81.6 percent and 81.0 percent, respectively. On the other hand, in Margarita, antidiarrheal drugs were the largest available, with a 75.9 percent shortage.
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Graphic Nº 1: Behavior and Evolution of the Medicine Shortage Index by Morbidity Cause. September 2017 – March 2018.
Graphic Nº 1 shows that the General Shortage Index has ranged between 87 percent and 93 percent in the basic basket of drugs to treat the four major morbidity causes hitting the Venezuelan population, peaking at the beginning of the survey. In March, the GSI was below 90 percent, which is a slight reduction as compared against the four previous measurements (January I-II and February I-II). The stock of drugs to treat hypertension was the largest
ONCE AGAIN, WE DRAW ATTENTION TO DRUGS TO TREAT ACUTE RESPIRATORY INFECTIONS (IRAs), THE SHORTAGE INDEX OF WHICH WAS
IN EXCESS OF THE GLOBAL
S H O R TA G E I N D E X
throughout the survey, remaining below 90 percent in thirteen of the fourteen data collection periods. Once again, the supply of drugs to treat acute respiratory infections (ARIs) was the worst, closing at 96.5 percent shortage.
Nuevamente llamamos la atención
MONITORING THE RIGHT TO HEALTH IN VENEZUELA MARCH 2018
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GRAPHICAL REPRESENTATION OF RESULTS
BY CIT Y AND MORBIDIT Y CAUSE 4 DIABETES
Graphic Nº 2: Behavior and Evolution of the Medicine Shortage Index for Diabetes, by City. September 2017 – March 2018.
Graphic Nº 2 depicts the behavior and evolution of the
2017, when it reached 80.6 percent. In subsequent
shortage indicator for the group of prescription drugs
measurements, it has ranged from 71 percent to 79
for type 2 diabetes in the five cities surveyed. It can
percent, and has remained so.
be observed that, in the case of hypoglycemic agents, the General Shortage Index (GSI) has ranged almost
On the contrary, the city with the worst supply of
homogeneously from 84 percent to 91 percent, with
hypoglycemic agents and the poorest probability of
its lowest peak reaching 83.8 percent in the second
obtaining them is Barquisimeto, where the lowest that
measurement of the month of March.
the GSI has been was 87.7 during the first measurement of September 2017, and it didn’t drop below 90 percent
The city with the best stock of drugs to regulate blood
in the three following measurements, recording 96.3
sugar levels has been Maracaibo, where the indicator
percent in the month of March.
has remained below 81 percent in all measurements; it was at its highest in the first measurement of 4.This is a graphical depiction of the behavior and evolution of the shortage indicator by morbidity and city for every measurement conducted between September 2017 and March 2018.
MONITORING THE RIGHT TO HEALTH IN VENEZUELA MARCH 2018
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HIGH BLOOD PRESSURE
Graphic Nº 3: Behavior and Evolution of the Medicine Shortage Index for High Blood Pressure, by City. September 2017 – March 2018.
The stock of drugs to treat high blood pressure remains
medicine. In both cases, the shortage indicator has
the best throughout the survey. It recorded the highest
remained below 85 percent.
shortage index during the first measurement (92.8 percent). Most recently, it remained below 90 percent,
As for Nueva Esparta, the situation is as critical
but peaked again during the second measurement
as in Caracas and Barquisimeto. During the six
of January 2018. In March, the GSI for this type of
measurements of 2018 made so far, the indicator
medication was 84 percent and 85.1 percent for the
has remained close to 90 percent, which is short of
two measurements, respectively.
encouraging.
In terms of the cities where the survey is conducted,
Particularly during this year, the shortage of medication
the availability of drugs to treat this cause of morbidity
to treat high blood pressure was at its lowest in the
is slightly regular in Maracaibo and Mérida, which have
second measurement of March, at 81 percent.
the best stock, comparatively, of antihypertensive
MONITORING THE RIGHT TO HEALTH IN VENEZUELA MARCH 2018
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ACU TE RESPIR ATORY INFEC TIONS
(ARIS)
Graphic Nº 4: Behavior and Evolution of the Medicine Shortage Index for Acute Respiratory Infections, by City. September 2017 – March 2018.
The shortage of drugs to treat acute respiratory
shortage indicator was close to 90%. On the other
infections (ARIs) remains high in the five cities in the
hand, in Maracaibo, the shortage index of medication
survey. The General Shortage Index for this morbidity
to treat IRAs was 88 percent, whereas in the state of
cause has ranged from 93 percent to 98 percent
Nueva Esparta, it was 79.7 percent.
throughout the measurement period, which has been going on for seven months now.
The fact that the trend in the shortage of drugs to treat acute respiratory infections is towards a dangerous
In Venezuela, it is still an ordeal to get the flu. Shortage
100 percent is spine-chilling.
figures have been utterly disheartening across the survey and for the five cities under study. Only in the first measurement of September 2017, conducted during the second week of the month, the
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DIARRHEA
Graphic Nº 5: Behavior and Evolution of the Medicine Shortage Index for Diarrhea, by City. September 2017 – March 2018.
In terms of antidiarrheal medication, it is the second
In Maracaibo, which is the city with the best stock of
worst stocked group of medicines along the fourteen
medicines to treat this morbidity cause, the shortage
measurements conducted up to the month of March,
index has remained below 80 percent, peaking during
with a General Shortage Index always in excess of 85
the first and second measurements of September and
percent. It should be noted that drops in the GSI for
March, when it reached 78.5 percent. By the same token,
drugs to treat diarrhea have been recorded, at times
in five of the fourteen measurements made so far, the
marginal, at times substantial, in Maracaibo and Nueva
indicator was below 70 percent, which evidences a more
Esparta.
dynamic medication distribution scheme in Maracaibo as compared with the other cities in the survey.
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HOLY WEEK 2018 IN VENEZUELA: PARISHIONERS HAD TO GIVE UP THEIR THE SEVEN CHURCHES VISITATION FOR
A PILGRIMAGE TO 7 PHARMACIES OR MORE IN SEARCH OF MEDICINES
For Venezuelans, especially for Catholics, the Holy Week
unassisted, all under the cold gaze of a state that simply
is a special holiday commemorating the death and
does not care about the suffering of its citizens.
resurrection of Jesus Christ with different traditional religious manifestations, among which the celebration of
On the other hand, those who usually participate in the
the Eucharist, the Stations of the Cross, the Washing of the
adoration of the Nazarene had to tackle the ‘adoration’ of
Feet, the Visitation of the Seven Churches, the adoration of
the boxes with subsidized food distributed by the Local
the Nazarene, and the vigil at the Holy Sepulcher stand out.
Provisioning and Production Committees (CLAP, by its Spanish acronym) and/or call the 0800-Salud, a call-center
Some people fast on Council Friday, while others fast on
set up by the national government to distribute drugs, which
Good Friday. But this Holy Week in Venezuela unfolded
are two mechanisms that we have already denounced and
amidst the calamity of the Complex Humanitarian
questioned because the criteria of political discrimination
Emergency that has hit the nation’s life in all areas. Not even
under which they are allocated prevent access thereto to
the religious aspect is saved from this situation.
people without the ‘Carnet de la Patria’ [TN].
Scourged by the emergency and stress of finding their
Those who used to participate in the vigil of the Holy
medicines, Venezuelans had to trade the celebration
Sepulcher were forced to keep vigil over the emergency room
of the Eucharist for queues to purchase food and gas.
of hospitals instead, witnessing how their lives or those of a
They replaced the traditional Stations of the Cross with
relative are put at serious risk by the lack of quality medical
denunciations and protests against the State for the already
services and medical supplies in hospitals and facing the
unsustainable collapse in the distribution of food, medicines
consequences of the exacerbated deterioration of health
and domestic gas and in the provision of public services
care services in general.
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such as electricity, transport and solid waste collection facing them.
As for those accustomed to fasting on Council Friday or Good Friday, they probably could not differentiate these
In this religious holiday, instead of tracing the Seven
holy days from the rest, because Venezuelans are forced to
Churches Visitation, Venezuelans had to go through 7 or
fast anyway given that the monthly minimum wage is not
more pharmacies looking for medicines for themselves or
enough to eat two days in a row and, therefore, people must
for a family member, an ordeal that was made worse by the
choose which of the three daily meals they can afford to eat.
anguish of not knowing whether or not they would actually
In this context, it is the women and the elderly who are hit
find them or if they could afford them if they did, given that
the hardest by this forced fasting, as they are basically the
their exorbitant prices make them impossible to afford
first ones to refrain from having a bite when food at home
for most Venezuelans, increasingly impoverished and
is insufficient to meet the needs of the entire family group.
5.Translator’s Note: The “Carnet de la Patria” (roughly, the Motherland Card), is an ID card created by the government to track the identity and number of recipients of benefits within the framework of social and subsidized-food state programs and as a requisite for access to medication via the 0800SaludYa call center.
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During this Holy Week 2018, Venezuelans were forced to put aside their tradition to commemorate the Passion of Christ to incarnate their own passion and suffering, given that their quality of life has been
iV 53 percent of operating rooms are not functioning. V
reduced, almost destroyed, and is now limited to
21.9 percent of emergency rooms are inoperative. At the same time, 70.7 percent of ERs work intermittently.
struggling for the most basic rights such as life, health and food, which is a clear setback in terms of citizen achievements. In March, access to health for Venezuelans was in the red:
1
percent of kitchens in hospitals do not serve VI 96 food.
3
claimed the lives of more than 34 people between the
in medicines to treat the four main causes of morbidity
end of 2016 and the first quarter of 2018. It should by lack of medication or blood coagulation factors,
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according to the Venezuelan Hemophilia Association.
percent shortage of medical and surgical supplies Hospital Survey conducted by the National Assembly and the Doctors for Health NGO.
a
be noted that thirteen of these deaths were caused
There is an 88 percent shortage of drugs and a 79 in the country’s hospitals6, according to the National
risk from the lack of coagulation factor VII, which is nowhere to be found in Venezuela since 2016 and has
March closed with a shortage of more than 80 percent affecting the population.
2
The lives of about 270 hemophilia patients is at
4
The shortage of reagents in almost all laboratories in the country is becoming a risk factor for Venezuelans, and people with hemophilia are not escaping this awful reality. Hemophiliac patients are affected by
The survey also found that in the national public health
this situation in different ways. Several children have
system facilities:
been born who are suspected of having the disease and cannot be diagnosed because there is no material
i
94 percent of x-ray services and 97 percent of
II
100 percent of the laboratories in the country do
to test for it, said the president of the Venezuelan Hemophilia Association.8
tomography services are not operating.
not operate properly due to lack of reagents.
percent III 79 problems.
6.AFP (March 19, 2018).
of hospitals have water supply
5
Transplant recipients are racing against time in their struggle to preserve their organs and, consequently, their lives. From January 2018 to March 2018 alone, the Coalition of Organizations for the Right to Health and Life (CODEVIDA, by its Spanish acronym) has recorded 64 organ rejections for lack of medicines.
Encuesta Nacional de Hospitales constató que falta 88% de medicamentos (National Hospital Survey Verified an 88 Percent
Shorgage of Medicines). Available at El Nacional’s website: http://www.el-nacional.com/noticias/crisis-humanitaria/encuesta-nacional-hospitalesconstato-que-faltan-medicamentos_227478 7.Altuve, A. (February 17, 2018). Mueren tres pacientes hemofílicos por falta de factores de coagulación (Three Hemophilic Patients Die for Lack of Blood Coagulation Factors. Available at El Pitazo website https://elpitazo.com/salud/mueren-tres-pacientes-hemofilicos-por-falta-de-factores-de-coagulacion/ 8.Pineda Sleinan, J. (. (February 1, 2018). . Pacientes hemofílicos sin examines ni transfusiones por escasez de reactivos (Hemophilic Patients Without Tests or Blood Transfusions Due to Lack of Reagents). Available at Efecto Cocuyo website : http://efectococuyo.com/principales/pacientes-hemofilicossin-examenes-ni-transfusiones-por-escasez-de-reactivos
MONITORING THE RIGHT TO HEALTH IN VENEZUELA MARCH 2018
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6 7
A
Marta Solórzano and Luz Marina Fuentes were victims of the shortage of immunosuppressant drugs and lost both
Without reagents for serology, people with HIV cannot be tested for the status of the virus in their
their organs and their lives. In Convite A.C. we denounce
bodies. The situation is further complicated by the
that Marta and Luz were also killed by the State.
fact that it is not possible to make new diagnoses.
b
One month after the Inter-American Commission on Human Rights granted precautionary measures in favor
With the outbreak of epidemics such as malaria, hepatitis, tuberculosis and, more recently, dengue
of the patients of the Nephrology Unit of the J.M. de
fever, the lack of reagents can be a potential death
Los Ríos Hospital, the Venezuelan State has not taken
sentence, given the impossibility of getting a timely
concrete action to meet the needs of the patients; in fact,
diagnosis.
no representative of the State has commented on the measures to be taken. In the meantime, the lives of the children remain threatened.
A
In light of the above, the mothers of the patients of the J.M. de Los Ríos Hospital took to the streets on March 20
Grandpa Felipe Carrasquel, a patient with chronic obstructive pulmonary disease (COPD), diabetes and hypertension, whose testimony on how the shortage of medicines affected him was collected by Convite
to protest for the poor condition of the hospital and for
A.C. in November 2017 , died in a context of a complex
the State’s failure to act and solve the terrible situation
humanitarian emergency. The death of Grandpa Felipe is
that the children and their hospitalized relatives are
a death that could have been perfectly avoided had he had
enduring, denouncing that:
i II
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the medicines to treat his diseases in a timely manner. The whole context of the Complex Humanitarian Emergency
The Hematology Unit and the area where children should receive chemotherapy treatment have no
that we have documented was nothing but a death sentence for him. During his testimony, he told us how the shortage
air conditioning equipment operating.
of medicines and food had impaired the quality of life and,
The Hematology Unit is paralyzed.
helpless because, in order to stay alive, he needed specific
as a result, his health had deteriorated. He said he felt doses of his medication in a timely manner. Grandpa Felipe
supply of pediatric and adult lines in the III The Hemodialysis Unit is intermittent. “Medications such as Paricalcitol, an important drug for the management of metabolic disease, have been lacking for more than a year.”
8
9
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The shortage of reagents significantly complicates the already dark panorama of access to healthcare in Venezuela, because it makes it impossible for laboratories
did not get his treatment on time or, when he was lucky to get it, the drugs were too expensive and he couldn’t afford them: like most of the elderly people in Venezuela, Grandpa Carrasquel only had his old age pension to make it through the month and it was not enough (and is not enough for anyone) for him to purchase neither food for his diet nor the treatment he needed. Grandpa Felipe was also killed by the State.
to screen for diseases such as hepatitis C or HIV. 9.Reporte Proiuris. (March 21, 2018). El Estado desacata medidas de la CIDH y niños del J.M. de Los Ríos siguen en peligro de muerte (The State Ignores Precautionary Measures from the Inter-American Commission on Human Rights and Children in J.M. de Los Ríos Hospital Are In Danger of Dying). Availableat Prouiris website Proiuris: http://proiuris.org/?p=48550 10.Carrasquel,
F.
(February,
2018).
#AlEstadoNoLeDuele Caso de Felipe Carrasquel (C. A.C. Entrevistador
(#TheStateDoesn’tCare The Case of Felipe Carrasquel (C. A.C. Interviewer). Available at https://www.youtube.com/ watch?v=O2BpLu1TMjk
MONITORING THE RIGHT TO HEALTH IN VENEZUELA MARCH 2018
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