Español“Once and for all, the government must understand that we are in a state of emergency,” says Cristino García, executive director of the Venezuelan Association of Hospitals and Clinics, in reference to the medical sector in Venezuela. The economic crisis, generated by strict exchange controls, has not only affected supermarkets, but also private and public health institutions across the country.
This statement comes just a few days after President Nicolas Maduro proudly claimed in a New York Times op-ed that his government has “created flagship universal health care and education programs, free to [Venezuelan] citizens nationwide.”
During a radio interview conducted today, García said that “scintigraphic skeletal studies, for detecting the spread of metastatic tumors, can no longer be performed, because the country has run out of radio-pharmaceuticals. There is no radioactive iodine either, which is used to detect tumors in the thyroid and parathyroid glands.” Doctors have begun to advise their patients to travel to Colombia to get these kinds of tests.
“We are sending patients that require the tests to Colombia, at least those who have the means to travel. I know three patients that have gone during the last three weeks. Not everyone can afford it, though, as one must have the financial means to stay there for about a month,” said the director. He added that the drugs and supplies needed to diagnose breast cancer cannot be found, neither in pharmacies nor medical centers.
No Foreign Currency, No Drugs
Strict exchange controls have become an obstacle to obtaining foreign currency, and therefore, to importing medical supplies and equipment. “86.4 percent of medical and surgical materials used in Venezuela are imported,” says García. Shortages have suddenly appeared in the inventories of medical centers: of 239 regular-use materials, 194 are completely absent.
By February 27, García had already reported that private medical centers no longer had reagents for detecting diseases such as syphilis, HIV, and hepatitis, as well as drugs for heart disease, needles, probes and catheters. According to the director, “Insulin, an extremely important drug for diabetic patients, is nearly depleted in all clinics affiliated with the association, and several of them have already run out of it.”
Obstacles for imports have also affected access to spare parts for medical equipment. There is a list for patients around the country in need of radiotherapy treatments, because of 21 linear accelerators nationwide (special equipment used for this treatment), only three are operating.
“There is no way to buy the spare parts. Venezuelan suppliers owe US$500 million to importers,” García says.
Manufacturers of medical equipment no longer extend any credit to distributors in Venezuela, because they know that payment is not guaranteed. The main reason is that the government has not approved the settlement of foreign currency for this sector.
“In 2013, the government had to liquidate $300,000 per month for the health sector, but we have only been assigned $97,000 so far this year; that’s the reason for the shortages,” García explains.
In the presence of shortages, medical centers have had no choice but to prioritize surgeries, in an effort to optimize inventories. The director of the association explains that in clinics, 80 percent of elective surgeries are suspended in order to save supplies for emergencies.
Cuba to the Rescue
José Manuel Olivares, a resident oncologist at the University Hospital of Caracas and member of Doctors for Health, says there is no doubt about the shortage of medical supplies. “However, only emergency patients, physicians, and staff hear about it.” The physician opines that at present “we can’t win the battle with death without supplies.”
Olivares also condemns that the hospital receives oncological drugs from Cuba, since these lack national or international certification. They “are highly toxic for patients,” he explains, “so we will start to see side effects within the next five years. Also, the lack of supplies makes us discard the use of high-quality drugs, substituting other methods for them, and that can cause the early relapse of patients undergoing treatment.”
Despite Olivares’s concerns, some patients still travel to Cuba to receive treatment they cannot get here. That is the case for 10 patients with thyroid cancer who were transferred to the island this week, according to Marjorie Chaparro, a member of the Venezuelan Society of Nuclear Medicine.
No Reply from the Government
Regarding strategies proposed by the medical sector to solve the shortage problem, García says that “last year in May, we submitted a cost-structure proposal to the government, and we are still waiting for an answer.” For García, the solution is very simple: the government must pay importers, so that purchases of supplies may resume.
Yesterday, the Venezuelan Pharmaceutical Federation also denounced the lack of approvals for permits issued by the Ministry of Health. These are a prerequisite for obtaining foreign currency from the government, so their absence further prevents the import of medical supplies and equipment.
The medical sector must also deal with problems associated with current labor legislation, specifically with the application of Providence 294. This regulates and caps the prices of services, along with the central government’s compensation of clinics and foreign providers, and well below market price.