Sickness and shortages rise as Venezuela crumbles
CARACAS, Venezuela: The wheezing bus pulled in late from the slums, so Carmen Hernandez was practically jogging toward the clinic now. It had opened 20 minutes ago, and she needed to be early. Late meant lines, and the 49-year- old mother of five couldn’t wait. She was wasting away. Her high cheekbones were protruding more, and the headaches were getting worse. A fearless tough talker, she didn’t flinch at the crackle of gunfire on her street. But this was different. She’d dropped eight pounds in four weeks. She was scared.
“I should be at the clinic already,” she said, her voice on edge.
That would be the state infectious disease clinic, where a doctor in July had said the words that meant Venezuela’s chronic shortages had finally ensnared her. With the economy collapsing, many things were hard to find. But this was her Viraday, the HIV drug keeping her alive.
“We have none left,” the doctor had told her. “Try again in August.”
So an hour after first light one August morning, she was doing just that. Her eyebrows furrowed as she approached the clinic’s black gates.
Doctors inside were struggling to cope with a surging HIV/ AIDS crisis that experts fear could become the worst in Latin America in years. In a country where a six-pack of condoms - which can prevent transmission - costs almost a full day’s minimum wage, the number of newly infected patients was jumping. Surging prices and shortages of medicines and food, meanwhile, were hitting those already infected, with increasingly devastating consequences.
“Hola, mi amor,” a grinning guard at the gate said, sizing up Hernandez. She couldn’t afford breakfast, but she had managed blue eye shadow and a dash of fuchsia on her lips that matched her skintight leggings. His smirk said he knew she was not from around here - a middleclass district. This woman was pure Catia, one of the capital’s toughest slums.
“What are you looking for today, my love?” he said.
She took a second, hugging herself in a knockoff Adidas jacket that hid the loose skin from her rapid weight loss. “Viraday,” she said. “I need Viraday.” Already living with the world’s highest inflation rate and an increasingly repressive government, Venezuelans are facing an imploding health system.
During the 14-year rule of
We used to have about one or two HIV patients a day; now we have four and five, up to 25 a week. We’ve had too many patients die because we can’t offer treatment.
President Hugo Chavez, a charismatic socialist who died in 2013, oil-rich Venezuela was praised by health experts for its HIV prevention programmes and free treatment. But the national health system is now buckling as years of government mismanagement and corruption, coupled with lower oil prices, have plunged the economy into chaos. Authorities import many drugs, including antiretrovirals, at discounted rates via the Pan American Health Organisation. But the local currency is in free fall, putting those cut-rate drugs, as well as basic imported medical supplies such as needles and saline, increasingly out of reach.
Amid the cascading medical crises is the spike in complications from HIV/AIDS. Free HIV tests have been mostly unavailable since November. Pinched by costs, prevention programmes offering free condoms ceased last year. Amid pill shortages, otherwise healthy carriers like Hernandez are going weeks, sometimes months, without anti-retroviral drugs.
As a result, Caracas’ largest hospitals are now scrambling to cope with an influx of both newly infected and deteriorating HIV patients, their emaciated bodies evoking the distressing images that defined the virus in the 1980s.
“We used to have about one or two HIV patients a day; now we have four and five, up to 25 a week,” said Maria Eugenia Landaeta, head of infectious diseases at Caracas University Hospital, one of the capital’s largest medical centers. “We’ve had too many patients die because we can’t offer treatment.” “It is,” she said, “a nightmare.” According to statistics from the United Nation’s AIDS agency, based on information from Venezuela’s health ministry, the number of AIDS-related deaths in the country surged 25 per cent to 2,500 between 2010 and 2016, even as they fell 12 per cent on average across Latin America. Many Venezuelan medical experts believe the numbers could be even higher.
The number of newly diagnosed infections in Venezuela fell slightly during the same period, easing to 6,500 from 7,000 annually, according to the figures.
But shortages of medication, the lack of tests and the disintegrating economy, experts say, appear to be sharply worsening the HIV crisis now, making the country an outlier in a region that is generally making gains against the virus.
Severe shortages of HIV drugs go back to at least April, doctors say. But before July, the state clinic Hernandez counts on had regularly supplied her with the combination drug Viraday, known as Atripla in the United States. Its powerful compounds act against the enzymes that causes the HIV infection to spread.
“When they told me they ran out, I left, sat down on the street and cried,” Hernandez said. “I couldn’t stop. People passed by and stared.”
Venezuela’s health ministry did not respond to repeated calls and written requests for comment. The government of Nicolas Maduro, Chavez’s anointed successor, has routinely rejected offers of international humanitarian aid. Nonprofit groups say Venezuelan authorities have refused even small-scale help.
Jesus Aguais, founder of AID for AIDS International, said his non-profit used to have a permit to bring up to US$ 2 million ( RM9 million) worth of HIV drugs into Venezuela annually. Without citing a reason, the government abruptly refused to renew its license in 2014, he said.
“We send drugs to 42 countries,” said Aguais. “What is happening in Venezuela hasn’t happened anywhere else.”
The AIDS patients at Caracas University Hospital are a vision that haunts Hernandez. Last year, she went to the facility for lab work.
“I remember an extremely skinny one in a wheelchair,” she said. “It affected me.”
Today, some of the hospital’s hallways are darkened by burned- out bulbs; one hallway has a caved-in floor. On a recent day, the 14 beds reserved for HIV patients in the infectious disease ward were filled. So the spillover went to internal medicine, a 150bed unit that was 40 per cent occupied with patients suffering from HIV/AIDS complications.
In one large ward, AIDS patients, some wasting and shrivelled, languished in their beds. The stench of diarrhea floated in the halls; there was little medication to treat it. If patients need IV dips or many antibiotics, they have to buy them.
Many can’t afford it. A destitute 31-year- old AIDS patient, a hairdresser who had been splitting his anti-retroviral pills in half to make them last, laid in a fetal position in his bed.
Skipping doses or taking insufficient amounts of the medication for weeks, doctors say, can increase the virus’ tolerance of HIV drugs, allowing it to spread.
The young man’s feet were scaly and white, a sign of dehydration. His mouth hung open, his eyes wide in their jutting sockets.
Lacking the right antibiotic to treat him or IVs to rehydrate his rail-thin body, his doctor prescribed an antacid and a plastic bottle for drinking tap water. The complication: The hospital’s water supply, doctors said, had been contaminated by bacteria.
“We can discharge them, which is often safer for them,” said David Flora, a medical resident in the ward.
“Or we can watch them die. Those are really our choices.” — WP-Bloomberg
Maria Eugenia Landaeta, head of infectious diseases at Caracas University Hospital