Opinion and Analysis: Social Programs
Venezuela's Hospitals: "Problems Are Opportunities"
The opposition-controlled parliament wants international help to tackle what it calls a humanitarian crisis in Venezuela's health service. In the first of a series of articles and videos, teleSUR's Iain Bruce visits one hospital in Caracas that is not collapsing.
After all the horror stories in the international media, it is a bit of a shock walking into the Perez de Leon II Hospital in Petare. This is one of the more violent neighbourhoods in Caracas, so security is tight. But once we identify ourselves, the security guard gives us a friendly wave through the gate. Inside the atmosphere seems calm. There are no blood stains on the floor, no patients piled on top of each other in the corridors, nobody is screaming for missing medicines, none of the life support machines appear to have collapsed because of a power cut. Everything is brightly lit. Everything is spotlessly clean. By Venezuelan standards, it is very quiet. Nurses, doctors, porters move about in a relaxed, businesslike manner.
It seems unlikely this is a show put on for our benefit. We'd had to reschedule the visit several times. When we get to the offices the press person who'd arranged our visit had left his apologies. He'd been called out and left a colleague to attend to us.
First we are taken to the intensive care unit. Only three of the 11 beds are occupied. One of the four Cuban specialists attached to the unit says this can change very quickly. “This kind of unit is very dynamic. Two days ago we had six patients here. If necessary we can activate beds in the intermediate care area and treat 15 or more at a time.” José Padilla is in the isolation bed waiting for surgery to cleanse his wounds. He has second and third-degree burns to 9 percent of his body after a high voltage cable fell on him at home. He was transferred here from a private clinic last night because his health insurance wasn't enough to cover the treatment he needed.
The head of the unit, Luisa Idrogo, tells me most of her patients are referred from the private sector for the same reason. The private insurance policies they get from their jobs run out, and the free, public hospitals like Perez de Leon take over.
Luisa says they are not currently short of any of the things José will need for his treatment. That includes the saline and other solutions used to administer many drugs. She shows me the stock room. To my untrained eye, it seems to be full of bags of solutions and other supplies, many of them made in China.
Shortages of these solutions have been one of the main arguments of Venezuela's opposition, and the various professional medical associations aligned with it, for declaring a health emergency in the country and seeking international aid. Later, the director of the hospital, Zayra Medina, tells me they did have a problem with solutions a bit over a month ago. They applied to the Venezuela-China cooperation agreement and now they are getting what they need.
More importantly, the current difficulties are teaching them to rationalize, plan and be much more rigorous in their controls. “My monthly consumption of these intravenous fluids used to be between 10,000 and 15,000.”
The common practice was to put every patient on a solution as soon as they were admitted. “But that is quite unnecessary,” she says. “Many of them are perfectly capable of eating and drinking and taking their medicine orally. So now we are prioritizing, giving them to patients with gunshot or knife wounds, diabetics, those with multiple traumas. As a result, our monthly consumption is now down to 5,700.” At the same time, the number of patients undergoing surgery and receiving intensive care has actually gone up.
Another way they have sought to overcome shortages is by developing a barter system with other hospitals in Caracas, keeping tabs on who has what and swapping where they can. Last month, Zayra Medina was briefly arrested by police detectives after she was stopped transporting boxes of medicines in her car. There have certainly been cases of corrupt doctors and hospital administrators diverting drugs onto the parallel market where they can sell them at a big profit, or siphoning them off to the private clinics where most of them also work. Medina insists that this time it was a misunderstanding. She was taking the drugs to the University Hospital where a colleague was in urgent need of them. Both the police and her staff seemed to believe her. Several of them tell me she is an inspired, and inspiring, leader.
Intensive and trauma care are the specialities here at Perez de Leon II, which was the last hospital to be opened by President Hugo Chavez, just months before his death. It took over from the Perez de Leon I hospital next door, which was run by the opposition-controlled local council. That was already in crisis and effectively stopped functioning, amid protests, four years ago.
The new hospital falls under the Venezuelan-Cuban agreement which set up the Barrio Adentro program 14 years ago, bringing primary health care to Venezuela's poorest communities for the first time. It was intended to provide this more specialist treatment to the sprawling shanty towns and low-income communities on the eastern edge of Caracas.
But it is also taking in patients from across the capital and beyond. It also benefits from an agreement with China, which supplied most of the medical equipment and ensures this is well maintained. A couple of junior doctors tell me this gives Perez de Leon II a privileged position compared with some other public hospitals. However, they say it is not as well endowed as some of the hospitals run by the military or the Social Security Institute.
I am beginning to understand that the problems and contradictions in Venezuela's health system run deeper and are more complicated than the prevailing narrative of crisis and collapse would have us believe.
Surgery: 'There's Usually an Alternative'
We move on to the surgical unit. There are four operating theatres, all in working order. At the moment, two operations are underway.
The head nurse here, Jennifer Colmenares, says they are managing on average 16 or more elective surgeries a day, as well as an average of 10 to 12 emergency operations. That's more than their target total of 24 a day. “We are not immune from the difficult situation in the country,” Jennifer admits. “We had a real problem with the disposable sheets,” she says. For a time, “we made our own out of paper.” Then they worked out that the surgical kits came with three sheets each, which weren't all being used. They began to recycle these. “A lot of it is down to the quality of the people you have in your team.”
One of the junior anesthetists, Alejandro Duran, reckons they have 70 to 75 percent of the drugs and supplies they would like. With that, they can make do. “You usually find an alternative.” Of course they always want to carry out surgery in the least invasive way possible. But Alejandro explains that if they can't perform the operation as they would really like, they resort to another technique. “It's not perfect, but it works.” He is more worried about the number of trained medical staff leaving the country. “In the long run, that could have a more serious impact.”
When the shortages really started to bite, early this year, Zayra Medina assembled the hospital's entire staff. The critical issue was surgical gauze, the swabs used to stem bleeding in any kind of surgery. They had none. Nor did any of the other hospitals run by the Health Ministry. “We all agreed this could not be a reason for stopping surgery. Then one of the hospital cleaners said she had an idea.” She was also a seamstress. “We can buy cloth and make the swabs ourselves,” she said.
The next day they rushed out and bought 50 yards of green cloth. Then everyone set to, cutting it into patches. The cleaner took them home and sewed them into makeshift surgical swabs, which they then washed and sterilized. “Three days after that meeting we were operating with homemade surgical swabs. We made 2,000 in all. And we still use them as a backup. They actually last longer.”
Something similar happened with their laser scalpels. Usually they were thrown away. One Saturday, they ran out. One of the surgeons said, “where are the used ones? We can recycle them.” They gathered them all up, but they didn't have the right machine to sterilize them. The surgeon took them to the private clinic he worked at, which did have the machine. “He brought them back, 200 of them, as good as new, which will last us for two months.”
These lessons may be useful in the future. But such improvisation is not itself a solution. Of course the price of oil means there are problems with the foreign currency needed to import drugs and medical supplies. However, Zayra Medina is sharply critical of the revolution's failure to develop domestic industry when it could. “We had 17 years when we could easily have built the factories we need to supply the health service. We didn't do it. That was a very big mistake, and we now have to speak out clearly and correct it.”
One way to fund this, in her view, would be to put an end to “the absurd situation” where huge amounts of public money go into paying public employees' private health insurance, which subsidizes the private clinics but which often isn't enough, and then the public hospitals have to sort out the mess. “PDVSA, Cantv, Corpoelec, 95 percent of them do it. It pains me to say it but they don't believe in Barrio Adentro and the public health service.” If that money were put into public hospitals, they would be far better than the private sector, argues Medina. “But that would hit some people hard in the pocket. The private insurance companies pay hefty commissions.”
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