Elisabeth Daza and José Mireles are frontline medical workers in Caracas. Daza is a resident doctor at the Angel Vicente Ochoa Ambulatory in the working class “Cementerio” barrio in Caracas. Mireles, a third-year medical student at the Hugo Chávez University of Health Sciences, is the Regional Secretary of the Venezuelan University Student Federation and President of his university’s student center. Last year we interviewed both Daza and Mireles about Venezuela’s then successful strategy against Covid-19. In this interview, we learn about Venezuela’s healthcare system – which was deficient before the pandemic and now further weakened by sanctions – and about the vaccination process underway.
[See Part I of the interview here.]
Beyond the impact of the sanctions, which we examined in part I of this interview, there are also structural problems in the healthcare system. What are the weaknesses and strengths that you encounter on a daily basis during the pandemic?
Mireles: In the context of the pandemic, one problem that we face is the lack of primary, secondary, and tertiary care in the public healthcare system. This kind of attention cannot be left aside in a pandemic, since the consequences are rapid, cumulative, and will end up impacting the development of Covid-19 itself.
Additionally, the government must really deliver all the support it can to the healthcare system. It must be prioritized. This includes increasing the salaries of medical personnel. Our work is essential, but it is also exhausting and very dangerous... Yet the government does not guarantee minimum working conditions or job stability. In fact, the salary of healthcare professionals is around five dollars a month.
This leads to demoralization and job desertion: a significant number of qualified personnel have migrated to the private sector, which offers much better pay, or simply left the country since doctors are offered better salaries and greater job stability abroad.
Some, however, remain in the system because of their vocation... And while the numbers are much lower than what is needed, these people are very committed. Nonetheless, in spite of the great sacrifices of the medical personnel, care is poor for the most vulnerable, who have no option but to go to public hospitals.
At the moment, one problem we are facing is the lack of PPE [Personal Protection Equipment]. In the best of cases, doctors and nurses receive biosecurity material every two weeks. Others do not even receive them at all and are forced to acquire them in private pharmacies at exorbitantly high prices.
Finally, a serious problem within the health system is the availability of beds, intensive care units, mechanical or assisted ventilation equipment, and medical equipment in general. Additionally, the existing medical equipment is in poor condition due to lack of maintenance.
However, the problem with the equipment and the medical infrastructure precedes the Bolivarian Process. The situation wasn’t fully corrected in the past twenty years. Then the crisis and the sanctions came down hard on us. There was no adequate planning, and today we are paying the consequences.
In a pandemic, these problems multiply. Severe Covid-19 patients must be connected to mechanical ventilators, but these are very scarce. Problems have emerged even in countries with a robust healthcare system, but the situation here is much more critical because the lack of long-term planning ran up against the sanctions. This, of course, means that there is a higher mortality rate.
In an attempt to counteract the shortage in medical equipment, the Ministry of Science and Technology and CAVIM [Compañía Anónima Venezolana de Industrias Militares, Venezuela’s military industry company] activated a research center to develop artificial respirators based on manual ventilation balloons. This prototype could help us save some lives, but what we really needed are mechanical ventilators.
In view of this situation – as President Maduro and Health Minister Carlos Alvarado have stated – we must focus on prevention. Our country has many limitations in terms of its health system. The key focus now should be prevention.
Daza: The Poliedro of Caracas, which is the epicenter for treatment of Covid-19 cases, is a good case in point, because what happens there is sometimes pertinent to other healthcare facilities. As José mentioned, the greatest weakness is the lack of medical personnel. While the Poliedro should be staffed with twenty doctors at any time, there are times when there are only four or five. That puts the doctors, and the healthcare personnel in general, in a very difficult situation.
Currently, at the Poliedro de Caracas, there are approximately 400 hospitalized patients. There, between 200 and 300 chest X-rays are performed every day, and about 300 people get rapid testing daily. Depending on the patient's symptomatology, X-rays, and beds available, it is decided whether or not to admit the patient.
At the moment, the number of positive cases arriving at the Poliedro is higher than the number of patients being discharged, so not all patients can be admitted.
Many families have been forced to care for their sick ones at home. Others, whose loved ones were admitted into a hospital, have to purchase the medicines, which are very expensive. Can you tell us more about this?
Mireles: When Covid-19 arrived in Venezuela, the government announced that we had the resources to attend the pandemic, which we considered irresponsible. It was evident that the availability of beds and intensive care units, already insufficient before the pandemic, would be short when Covid-19 descended on us.
As medical personnel and left militants of the Bolivarian Process, we must reflect critically on the enormous limitations of the public healthcare system. We are facing a serious health crisis, it is multifactorial, and the Venezuelan government is no doubt in part responsible.
We are overwhelmed. I know of health centers where 400 patients arrive every day. However, the lack of tests, medical supplies and personnel prevents most patients from being admitted.
Faced with this situation, many families are forced to care for their loved ones at home and purchase medicines and medical supplies on their own. On top of that, treatments are very expensive because pharmacies are speculating with prices, and the government does not intervene. In some cases, the medicines needed can range from $500 to $1,000, which is simply inaccessible for the majority of Venezuelans.
Additionally, some hospitals don’t have a full supply of medicines and basic implements, which makes for a dramatic situation. As it is, with an understaffed system short on beds, intensive care units, and supplies, many families are intentionally choosing to care for their relatives at home.
Daza: Indeed, there are positive cases [of Covid] that cannot be admitted due to the bed shortage in the sentinel and field hospitals. Since we are facing this harsh reality, it is very important now to establish a clear triage protocol to define which cases should be admitted and which could be treated at home.
My personal criterion as a physician is that if the patient has mild symptoms, if he or she can comply with the treatment, and if the family can activate biosecurity measures, then home isolation is a good option. It is better for the patient and more effective for the health system.
As it is, there are several modalities of care: in sentinel hospitals, in field hospitals such as the Poliedro, and at home. In the case of the Poliedro, which is the one that I know best, the government provides most of the treatments free of charge, although there is difficulty in getting medications such as Azithromycin and Levofloxacin for patients with bacterial infections.
I should add that right now, in the outpatient public clinic where I work, we are seeing many patients arrive with mild or moderate symptomatology. These people are not admitted or referred to other places. Instead, we advise their families as to how to provide care and how to isolate the patient. In fact, all the health centers are dealing with and advising Covid-19 patients at the moment, from pediatrics to obstetrics, from gynecology to surgery.
This brings me back to the subject of the information campaign. It is necessary for the population to have information on what is the profile of the patient who requires hospitalization, what are the warning symptoms, how to comply with the treatment, the biosecurity and isolation measures for those treating loved ones at home, etc. A large and effective information campaign for the entire country is a must.
Turning now to the subject of vaccination, approximately how many doses and what vaccines have arrived in Venezuela? How is the vaccination process being carried out?
Mireles: So far about 1.2 million doses have arrived here, between the Russian Sputnik V and the Chinese Sinopharm. A very limited number of the Cuban Soberana II (in the clinical trial phase) also arrived in Venezuela.
Additionally, and this could be important, there is likely to be a cooperation agreement between Cuba and Venezuela, which would bring the production of the Cuban Abdalá vaccine to Venezuelan labs.
However, as healthcare personnel, one of our main concerns now is the slow deployment of the vaccination process. The process began with the immunization of people in public offices, some military personnel, and part of the healthcare personnel. However, not all medical personnel have been vaccinated so far. We are very concerned about this. Other countries such as Argentina vaccinated medical professionals first… That, of course, makes sense since we are the ones on the frontline!
That is why health care workers and medical students are promoting a campaign for immediate vaccination. And I should add something here: the fact that some medical personnel are not immunized represents a risk not only for us but for patients as well. Medical staff must be prioritized.
As for the campaign to vaccinate the elderly, it began a while back, but it is very slow. That also causes concern in the healthcare community.
We would like to understand what is really happening with Sputnik V. Months ago, the government announced the acquisition of ten million Sputnik V doses from the Russian Federation. So far less than one million have arrived.
In short, we recognize the impact of the sanctions, which we adamantly denounce, but we also demand more transparency, and again, we call for the immediate vaccination of all healthcare personnel. Further, it is necessary to speed up the vaccination process for the elderly and those who are more vulnerable due to their medical conditions.
How is the process of acquiring vaccines through COVAX coming along?
Mireles: COVAX is the mechanism designed by the World Health Organization for the acquisition of the vaccine by the world's poorest countries.
The process of acquiring the vaccine through COVAX has generated a lot of controversy in Venezuela, since there are no official communications on the matter, and the information delivered through state channels is contradictory. At first, it was reported that Venezuela would receive AstraZeneca. Then the government announced that it was rejecting the vaccine because of the side effects it can produce.
At other times, when it comes to purchasing vaccine doses, the government points to the difficulties it is facing due to the sanctions. However, negotiations with the WHO are ongoing, and the Venezuelan government recently announced a payment to the COVAX program.
The COVAX issue has generated a public debate between the sector of the Venezuelan right-wing which promotes the sanctions, and the government. The sector led by former MP Juán Guaidó, who hijacked Venezuela's resources in complicity with US imperialism, pursues blackmail politics by voicing its “willingness” to facilitate the process to purchase COVAX mechanism vaccines: they are engaged in a political swindle that helps no one.
Right now the situation regarding COVAX is difficult to untangle since the negotiation and procurement process has not been made public. In fact, this opacity does not only concern the vaccines that would come through COVAX, but also the government’s negotiations with Russia, China, and Cuba to acquire the vaccine.
The truth is that right now we have no concrete information about vaccine procurement and about the implementation of a full national vaccination plan. Nor do we have a timeline or a road map, and this generates anxiety in the medical community and the population at large.
The Organization of Health Sciences students in Caracas, of which I am a spokesperson, demands transparency and better planning. Also, since the pandemic has taken us to the frontline, we demand to be vaccinated. Through our collective pressure, we managed to get some sixty percent of the students vaccinated, but the process came to a halt and no explanation was given. We demand that one hundred percent of the healthcare staff be vaccinated.
As medical students, and largely due to the shortage of doctors, the situation puts us in the epicenter of the pandemic. We are happy to be there. We have a calling and we are learning, but the state has the obligation to provide immunization to us.
Of course, our hope is that by the end of 2021 Venezuela’s population will be fully immunized. As I mentioned before, the government announced its acquisition of ten million Sputnik V vaccines. Additionally, it would seem like another 12 million are being negotiated through COVAX. If we add the Cuban and Chinese jabs and design a good and transparent roadmap, this should be possible.