Sunday, November 27, 2016

Venezuela, A Failing State

The medical student told me to use his name. He said he didn’t care. “Maduro is a donkey,” he said. “An asshole.” He meant Nicolás Maduro, the President of Venezuela. We were passing through the wards of a large public hospital in Valencia, a city of roughly a million people, a hundred miles west of Caracas. The hallways were dim and stifling, thick with a frightening stench. Some were full of patients waiting silently in long lines outside exam rooms. Others were dark and deserted, with the overhead lighting ripped out. The medical student, lithe and light-haired, kept us moving, peering through swinging doors, conferring with colleagues in blue scrubs.

We ducked into a room stuffed with rusted bed frames and dirty plastic barrels, where in a corner a thin young man was propped on a bed without sheets. He watched us weakly. A young woman in a pink T-shirt stood beside him, rigid with surprise. The medical student gently asked if they would answer my questions. The young man nodded. His name was Nestor. He was twenty-one. This was his wife, Grace. Three weeks earlier, he had been ambushed on his motorbike and shot three times, in the chest and the left arm. “They were going to shoot me again, but one of the malandros”—bad guys—“said I was already dead. They took my motorbike.” Nestor spoke slowly, his voice uninflected. His skin was waxy. The wounds to his arm and chest were uncovered, half healed, dark with dried blood. There was a saline drip in his right arm and, at the foot of his bed, an improvised contraption, made from twine and an old one-litre plastic bottle, whose purpose I couldn’t figure out.

Did the hospital provide the saline?

No. Grace brought it. She also brought food, water, and, when she could find them, bandages, pain medication, antibiotics. These things were available only on the black market, at high prices, and Grace’s job, in a warehouse, paid less than a dollar a day.

“The hospital doesn’t even give water,” the medical student said. He was watching the hallway. He studied Nestor briefly. “The lungs fill with liquid after someone is shot in the thorax,” he told me. “We usually take the bullet out if we can. But, either way, the wounds need to be drained.”

Were the police investigating the robbery?

Nestor looked down. The naïveté of the question left it beneath reply. Venezuela has, by various measures, the world’s highest violent-crime rate. Less than two per cent of reported crimes are prosecuted.

We had to go, the medical student said. Grace and Nestor thanked us, though we had done nothing for them. The medical student was worried about what he called “spies.” He had smuggled me into the hospital through a broken back door. The regular entrances to the hospital were all manned by uniformed personnel with rifles—National Guard, mostly, but also police, both local and national, and other, less identifiable militia. Hospitals in Caracas were even more tightly secured. Why were hospitals so heavily guarded? Nobody threatened to invade them. The guards had orders, it was said, to keep out journalists. Exposés had embarrassed the government.

Most of the elevators were out of order, so we took the stairs. At night, the medical student said, these stairwells were dangerous—unlit and prowled by muggers. But how could muggers get past the guards? “They work together,” he said. “They share.” He took me down a grimy corridor to a heavy door, which he cracked open. Beyond it, I could see a gleaming, brightly lit hallway with freshly painted light-blue walls and a polished white tile floor. “This is the area they show visitors,” he whispered. He peered at me to make sure I understood. Got it: Potemkin General. We hurried away.

I was introduced to a surgeon, who took me outside to speak. We stood under a tin roof, near piles of garbage and a deserted loading dock. The surgeon was bearded, heavyset, nervous. He looked exhausted. He did not want me to know his name, let alone use it. “We have no basic trauma tools,” he said. “Sutures, gloves, pins, plates.” He ran down a list of unavailable medications, including ciprofloxacin, an all-purpose antibiotic, and clindamycin, a cheap antibiotic. The doctors lost surgical patients because they had no adrenaline. They could still do some types of blood tests, but they could no longer test for hepatitis or H.I.V./aids. The electricity supply was a problem. At one stage, the operating room had been closed for a week. The waiting list for surgery was now three months. In Maracaibo, a major city farther west, surgeons had been reduced to operating by cell-phone flashlight.

The surgeon headed back inside. Doctors had been fired, I knew, for talking to reporters, even for simply filing complaints about hospital conditions. The government did not want to know. There were private clinics to which high officials and Venezuelans with dollars took themselves and their families. Those who could went abroad.

“I’ve seen public hospitals in Chile and Argentina,” the medical student said. “They’re clean, fine, efficient, like they used to be here. We’re going backward. All because of this government!”

Public health in Venezuela is, in fact, getting rapidly worse. In 1961, Venezuela was the first country declared free of malaria. Now its robust malaria-­prevention program has collapsed, and there are more than a hundred thousand cases of malaria yearly. Other diseases and ailments long vanquished have also returned—malnutrition, diphtheria, plague. The government releases few statistics, but it is estimated that one out of every three patients admitted to a public hospital today dies there. State mental hospitals, lacking both food and medications, have been reduced to putting emaciated, untreated patients out on the streets.

We circled the hospital grounds, following a tin-roofed walkway. It was a dim, greasy day, raining lightly. We came upon a long, narrow encampment: families who had strung hammocks between the posts of the walkway or laid mattresses on the concrete, out of the rain. There were bags, baskets, baby strollers. People seemed to be camped long term.

A dark-skinned man in a hammock said that he had been there for three months. His four-year-old son was in the hospital with a low blood-platelet count. “Viral infection,” the medical student told me. “Maybe Zika, or dengue. If he gets the right meds, he’ll survive.” He asked the man, whose name was José, about blood tests. José said that he had raised the forty dollars for the tests, partly by begging on buses, after losing his job. Now he needed money for medicines, none of which the pharmacies had in stock. “We must buy from the mafia,” he said. He meant the black market, but not just the ubiquitous profiteers known as bacha­queros. The medical student understood. Some of the security forces that were deployed, or self-­deployed, to the hospital were in the medical-­supply business.

The overstaffed entrances—all the military and police uniforms and firepower—began to make more sense. Cops and soldiers, militares, were notoriously underpaid. There was money to be made here. We talked to other families camped on the walkway, and on concrete benches under an awning closer to the hospital buildings. Some people were surprisingly outspoken. They denounced the prices charged for examinations (in a system of supposedly free health care), the corruption, the intimidation, the outrageous prices for sterile gauze, saline, food (when there was food), and medications. Some militares had the nerve to accuse the families of profiteering, and to seize their hard-won supplies when they tried to enter the hospital. These were items that, often, they had bought from other militares, who had looted them from pharmacies, or from shipments meant for hospitals. The worst actors were the colectivos, gangs of barrio toughs armed by the government and deputized as “defenders of the revolution.” Their main activity, as runaway inflation and food rationing gripped the country, was shaking down and monitoring their neighborhoods, but they found opportunities around hospitals and seemingly answered to no one. (Some colectivos could trace their descent to urban guerrillas from the sixties who had never disarmed.)

A young woman in a wheelchair had been shot in the leg in a robbery, and was unable to get the pain reliever she needed. But that wasn’t why she was out here. She was looking after her mother, who was in the hospital. The young woman taught primary school, and her students came to school hungry, and she had some choice things to say about President Maduro. Use my name, she said. She wasn’t afraid. But I didn’t want to put more than her first name in my notes. If guards or the colectivos saw my notebooks, they might be seized.

The revolution being defended is usually known, in Venezuela, as Chavismo, for its chief protagonist, Hugo Chávez, who was the country’s President from 1999 until his death, in 2013. For decades, the country had been ruled by two centrist parties that took turns winning elections but were increasingly out of touch with voters. A move to impose fiscal austerity was rejected, in 1989, with a mass revolt and countrywide looting—a paroxysm known as the Caracazo—which was put down by the Army at a cost of hundreds, perhaps thousands, of lives. Chávez was an Army lieutenant colonel, from a humble background—his parents were village schoolteachers. He crashed the national stage in 1992, by leading a military-coup attempt. The coup failed, and Chávez went to jail, but his televised declarations of noble intent caught the imaginations of many Venezuelans. He offered a charismatic alternative to the corrupt, sclerotic status quo. After his release, he headed a small leftist party and easily won the Presidency.

by William Finnegan, New Yorker |  Read more:
Image: Oscar B. Castillo