Date: Sun, 25 Nov 2018 03:15:36 +0100
By Plableysa Ostos, Margioni Bermudez

Ciudad Guayana, Venezuela, Nov 25, 2018 (AFP) - Yoli Cabeza was sent from one hospital to another before finally giving birth to her daughter Yusmari in the corridor of a maternity ward because her contractions came quicker than medical help.   The 37-year-old was diagnosed with a high-risk pregnancy but that didn't spare her from Venezuela's medical "roulette" -- the practice of referring patients from hospital to hospital due to a lack of personnel, supplies or sanitary conditions.

Cabeza told AFP she "did the tour of every hospital in" Ciudad Guyana, the biggest town in the state of Bolivar, before returning to the place she started at, the Negra Hipolita maternity unit where "they took me in."   Incredibly, her case isn't rare in a country where many women are forced to give birth in the street because they can't get into a state medical facility.   At the beginning of November, a woman was filmed giving birth to her son squatting by a tree in front of the biggest hospital in Bolivar.   Venezuela is in the midst of an economic meltdown triggered by mismanagement and a slump in oil prices followed by US sanctions.   The United Nations says some 2.3 million people have fled Venezuela since 2015 and amongst them have been many doctors.

- Bring your own supplies -
According to a study by a dozen non-profits, some 22,000 doctors, more than half the former total, emigrated between 2012 and 2017.   Added to that, more than 6,000 nurses (74 percent of that industry's workforce) and 6,600 lab technicians have left while there's a shortage of 90 percent of necessary medicines and supplies.   Often, patients are turned away "because there are no surgical materials, no anesthesiologists. They don't even have chlorine to clean the cubicles," said Silvia Bolivar, a nurse at Concepcion Palacios, the biggest maternity unit in the capital Caracas.   Pregnant women are sometimes expected to bring their own disinfectant and garbage bags.   Venezuela has been suffering from four years of recession in which poverty is on the rise as food has become short in supply.   A caesarean section kit costs the equivalent of $100 at the black market rate while the minimum wage is 1,800 bolivars ($6) a month.   Inflation, which the International Monetary Fund predicts will reach 1.35 million percent this year has crippled the currency as United States sanctions saw foreign investment dry up.

- Surging infant mortality -
The effect on pregnant women has been devastating.   Yusmari Vargas, 24, was suffering from preeclampsia, a condition marked by high blood pressure that can develop into a more serious one that puts both the mother and baby's lives at risk.   When she arrived at the maternity unit, it was closed. The hours passed, the contractions became stronger and her baby ended up on the floor, welcomed into the world with a bump to its head.   "When he fell, they didn't even help me pick him up, there was nothing to cut the umbilical cord. It was a mess," she said.

Carolina Rojas, 22, almost lost her daughter after her caesarian section was postponed several times.   "One day there was no specialist, the next the pediatrician or the anesthesiologist didn't turn up," said Rojas.   Her daughter swallowed amniotic fluid and spent eight days in hospital after she was born.   Infant mortality rose 30 percent in 2016, with the deaths of 11,466 babies up to a year old, according to the latest Health Ministry figures.   Despite refusing to acknowledge the country's public health problems, President Nicolas Maduro launched a program to reduce the number of caesarian section births, but a year later he admitted it hadn't provided the expected results.

- 'Terrible year' - 
Suffering from post-natal pain, 32-year-old Yohanni Guarayote forced her way into the Negra Hipolita maternity unit, which locks its doors at night due to crime in the area.   She was only able to have two prenatal check-ups because she couldn't pay for a private clinic as her husband is unemployed.   "Some days the doctor didn't turn up, others there was no water, and so on," she said.   Her arms are so thin they look like a child's. During the pregnancy, she barely reached 43 kilograms (95 pounds), eating mostly sardines, yucca and squash.   "Now, I'm like a stick," she said, reclining in a sweltering room with six beds but no sheets.   She receives government subsidies but with another three children to feed, she says it's "not enough."   "This year has been terrible for pregnant women. They need to show more love to motherhood."
Date: Tue 16 Oct 2018
Source: Caraota Digital [in Spanish, trans., edited]
<http://www.caraotadigital.net/nacionales/mas-de-650-mil-casos-en-2018-federacion-medica-de-venezuela-alerto-sobre-epidemia-de-malaria/>

The president of the Medical Federation of Venezuela, Douglas Leon Natera, reported Monday [15 Oct 2018] on the significant increase in cases of malaria in the country during 2018, due to the increase in medication shortages and lack of supplies. "More than 650,000 cases of malaria have been reported [nationally as of 15 Oct 2018, which is compounded by] the fact that national hospitals have received only 6% of their needed supplies to be operational," he said in a press release.

He also warned that "alarms are also activated" for an imminent epidemic of hepatitis and measles, a situation that occurs while most medical centers in the country continue to demand decent salaries and respect for the salary tables established in their collective contracts. "We have already completed 3 months of the professional strike, and the salary tables announced by the government so far have not been met; only doctors with more than 30 years of service are receiving 200 more bolivars [USD 20] in their monthly salary," he complained.

According to the World Health Organization (WHO), Venezuela is the country that has reported the highest increase in malaria cases in the world, according to the EFE News Agency. Officially in 2016, there were 245 000 cases and one death, whereas WHO estimated that the number of infected individuals approached at least 300,000 with 280 deaths.

However, for 2017, the WHO indicated that at least 406,000 cases were reported, a figure that is difficult to verify given that the epidemiological system of the country is precarious, but accounts for the significant increase, which is not expected to decline in 2018.  [Byline: Luis Alfredo Ledezma]
=======================
[Venezuela has experienced a huge increase in malaria cases since 2012, probably starting in Bolivar state. Lack of drugs for treatment and insufficient funding for the national control programme are the main reasons. - ProMED Mod.EP]

[HealthMap/ProMED map:
Venezuela: <http://healthmap.org/promed/p/29>]
Date: Fri 3 Aug 2018
Source: Outbreak News Today [edited]
<http://outbreaknewstoday.com/venezuela-22-states-capital-district-report-diphtheria-cases-since-2017/>

The diphtheria outbreak in Venezuela that began in July 2016 continues. A total of 1904 suspected diphtheria cases have been reported, including 164 deaths: 324 cases and 17 deaths in 2016, 1040 cases and 103 deaths in 2017, and 540 cases and 44 deaths through the halfway mark of 2018. Of note, in 2016, cases were reported in 5 states (Anzoategui, Bolivar, Delta Amacuro, Monagas, and Sucre), while in 2017 and 2018, 22 states and the Capital District have reported confirmed cases. Cases have been reported among all age groups.  In 2018, the incidence per 100,000 inhabitants was higher in those under 15 years of age than in those over 15 years of age.
======================
[In the last ProMED-mail post on diphtheria in Venezuela in May 2018 (Diphtheria - Americas (02): PAHO/WHO epidemiological update http://promedmail.org/post/20180525.5817823), 1716 suspected diphtheria cases were reported since the beginning of the outbreak in July 2016 (324 cases in 2016, 1040 in 2017, and 352 in 2018), of which 1086 were confirmed by laboratory (350) or epidemiological-link (736), and 160 died (17 in 2016, 103 in 2017, and 40 in 2018).

The cumulative case fatality rate is 14.7 per cent. There are now 188 more cases of suspected diphtheria for a total of 1904 suspected diphtheria cases reported, including 164 deaths: 324 cases and 17 deaths in 2016, 1040 cases and 103 deaths in 2017, and 540 cases and 44 deaths in the 1st half of 2018. - ProMED Mod.ML]

[HealthMap/ProMED-mail map: Venezuela: <http://healthmap.org/promed/p/29>.]
Date: Wed, 8 Aug 2018 12:06:43 +0200
By Margioni BERMÚDEZ

Caracas, Aug 8, 2018 (AFP) - Hardly anybody likes hospital food but in Venezuela, it's so awful -- monotonous, starchy diets cooked in filthy conditions, and newborns fed intravenous solution for lack of baby formula -- that experts call it an actual health risk.

Take Carla Lopez, 40, who has been hospitalized for three months to treat open wounds on her foot as a result of diabetes.   Lopez should go easy on pasta and rice -- but that's all she gets.   "I eat whatever they give me," Lopez said as she waves away flies buzzing over a plate of rice and lentils at University Hospital in Caracas. It is pretty flavorless stuff as the hospital is out of salt.   An excess of starch causes her blood sugar levels to shoot up.   Even if she were out of the hospital, she could not afford, say, a kilo (2.2 pounds) of chicken, which costs 1.5 times her monthly salary in this oil-rich but economically ravaged country saddled with runaway inflation.

Lopez says that for breakfast, she gets a kind of cornmeal patty known here as an arepa, and for lunch, it's either pasta or lentils with rice.   "In the evening, they serve you another arepa -- a small, skimpy one," said Lopez.   Back in better times, this hospital used to have different cooks for different medical problems, said nutritionist Gladys Abreu.   Now, everybody gets the same fare, and not much of it: 40 grams of rice and 25 grams of legumes.    "That is hardly enough for a small child," said one staffer in the hospital kitchen.

Another hospital employee who asked not to be named complained that garbage piles up at the facility, an imposing 11-story building that is 60 years old.    Indeed, a nearby trash bin overflows with detritus.   The National Hospital Survey, published in March by the opposition-controlled National Assembly and by an NGO called Doctors for Health, said 96 percent of Venezuela's hospitals fail to feed their patients adequately, or do not feed them at all.   The poll covered 104 state-run hospitals and 33 private ones.

- Intravenous solution as milk -
At the Concepcion Palacios maternity clinic, also in Caracas, doctors stopped providing formula for newborns because there was no money for it.   Parents can provide their own, but one mother, Yereercis Olivar, who just gave birth to her second child, cannot afford formula.   She could not nurse the baby, either, because they were separated to protect the child from the chicken pox that Olivar came down with while pregnant. It has left her skin covered in blisters.   Olivar was desperate, so she started trying to extract milk from her breasts with a syringe.

It took three days for that excruciating method to kick in and provide milk.   During that time, the baby lived "only on serum" -- the kind used in intravenous solutions to keep adults hydrated. It was fed to the child from a baby bottle.    Baby formula, like so many basic goods in Venezuela, is available only on the black market and a can of it costs around 50 million bolivars, or $15. That is nine times the average monthly salary.

The hospital survey said 66 percent of Venezuela's maternity wards have no formula to give to babies.   The decline into hellish health care conditions has been swift in recent years, said Olivar, whose first child was born at the same hospital in 2016. It was better back then: she could not nurse her child, but there was baby formula.   Now, "there are cockroaches in the area where they prepare the baby bottles," said Silvia Bolivar, a nurse with 25 years on the job.    From holes in the walls and ceiling, water leaks and rodents scamper, she added.   The health ministry ignored a request from AFP for comment on this story.

- Patients going hungry -
On the sixth floor where she is being treated, Olivar says she has heard nurses protesting for the past six weeks to demand better pay and working conditions.   Posters on the wall say nurses also want better food for sick people.   President Nicolas Maduro said the crisis in Venezuela's hospitals has been aggravated by US sanctions against his government. 

He says this punishment prevents the country from buying medical equipment and medicines, 80 percent of which are in short supply, according to labour unions.   "It is hard when patients come to us, trembling and on the verge of fainting, to say they are hungry," said nurse Bolivar.   At the maternity clinic, the baby bottles smell bad. There is no soap to wash them and the sterilization machine is broken.   Dark mold covers containers of rice and pasta that is fed to mothers.

Both there and at the University Hospital, the floors and bathrooms are dirty. There is no disinfectant. Cleaning is done with water and rags.   Lopez, the lady with complications from diabetes, does not know how much longer she must remain in her decrepit hospital room, which is furnished with broken chairs. Her foot is not getting any better.   But it's not all gloom: her hospital roommate gave her a bouquet of sunflowers to brighten things up.
Date: Sun 15 Jul 2018
Source: Merco Press [edited]
<http://en.mercopress.com/2018/07/15/measles-strikes-yanomami-tribes-in-brazil-and-venezuela>

Researchers have urged the governments of Brazil and Venezuela to offer emergency medical attention and protect the Yanomamis. Brazilian health authorities have reported 67 cases of measles, including one baby dead among Yanomami natives on the Venezuelan border, and labelled the situation as "catastrophic". The situation is by no means under control.

Of the total number of people infected with measles, 60 are Venezuelans, said Manoel Pereira, technical manager of the programme of immunization and immuno-preventable diseases of the Special Sanitary District of the Yanomami of Brazil. Authorities are investigating another 9 cases for suspected measles. So far, the only recorded death among the Indians is that of a 9 month old Brazilian baby, Pereira said in a telephone interview with a French news agency.

The disease is attacking especially indigenous Sanuma, a subgroup of the Yanomami ethnic group living in the border region. An estimated 3873 indigenous people live in the area with the largest number of reported cases.

Sarah Shenker, a senior researcher at the human rights organization Survival International, said deaths were also reported on the Venezuelan side, which also appear to be measles-related. "This outbreak could be catastrophic for the Yanomami," the researcher added, urging "the Venezuelan and Brazilian governments to offer emergency medical attention to prevent more deaths and protect the Yanomami lands from invaders to guarantee their survival."

The cases were recorded between March and June 2018. Although this Saturday marks 34 days without notifications, Pereira stressed that this does not mean that the situation is under control.
====================
[See ProMED-mail. Measles update (41): Americas, Europe, Pacific http://promedmail.org/post/20180709.5895186 for a discussion on the Yanomami tribe. The Sanuma, also referred to as Sanema, Sanima Tsanuma, Guaika, Samatari, Samatali, Xamatari and Chirichano in the literature, are an indigenous people of Brazil and Venezuela. They are related to the Yanomami. They number about 1500 and live on both sides of the border [Wikipedia].

Measles presents a potentially catastrophic threat to these indigenous people. It is critical that the Brazilian and Venezuelan governments provide vaccinations immediately and medical care to protect them. - ProMED Mod.LK]

[HealthMap/ProMED-mail map of Venezuela:
<http://healthmap.org/promed/p/29>]
More ...