The collapse of Venezuela multiplies the vulnerability of the population to the pandemic | International

A patient waits in the emergency room of the Guiria hospital, Venezuela.FEDERICO PARRA / AFP (AFP)

A week ago, the day the first case of coronavirus was reported in Venezuela, at the El Algodonal Hospital in Caracas, the surgeries were suspended for lack of face masks. They did some simple operations, because they did not have air conditioning in the operating rooms either. The lack of basic protective clothing added to the obstacles and made them suspend plans. This is one of the centers that the Venezuelan Government has cataloged as a “sentinel” along with two more in the capital and 43 throughout the country to serve confirmed cases of COVID-19.

It is the place where Dr. Marietta Rea has worked 40 years of her life. “The Algodonal has nothing, absolutely nothing. There is no evidence to do, no material to protect us. There were no masks to enter the ward, no suits or boots. There is fear with this crisis and it is natural, because there is nothing to work with, “he says with disappointment about the center that was once a reference in the country for respiratory diseases. A hospital where vaccines were once made, experimental medicine was made and performed the first heart valve transplant in the country.

Despite the recommendations of the World Health Organization (WHO), Nicolás Maduro has demanded the massive use of face masks, of any kind, including artisan ones, in stores and public transport, which are sold for one dollar (one third of the minimum wage) at the doors of Metro stations. But in hospitals, which will have the highest exposure, there is not. Some of the suspected cases of those on those two Iberia flights that started the epidemic in Venezuela, went to El Algodonal and had to be referred to other centers due to the impossibility of handling them, says Rea.

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The pandemic in Venezuela is added to a health emergency that has been warning since 2016 and that since last year has maintained humanitarian teams from the United Nations and the International Red Cross in the country. With the first 33 cases (now there are 42), the Government deployed social distancing measures that have forced the closure of schools, suspension of work activities, restriction of internal circulation and closure of flights. Even so, Venezuela has a deficiency difficult to compensate: it is the precarious state of the health system, deteriorated after years of disinvestment, which have triggered cases of controlled diseases and have also generated an accounting of preventable deaths due to electrical failures and lack of medical supplies .

The arrival of the virus in the country has also come with protests from medical personnel. It is in hospitals where there is more fear for the virus that is now ravaging Europe. “Nurses demand effective protective barriers, not something from the feeling of protection. Nurses cannot force us to work in risky conditions, because there is a principle of survival and if that is not guaranteed to health personnel in an epidemiological crisis such as this, we will not have personnel for later. We are barely in the first week ”, says Ana Rosario Contreras, president of the College of Nurses of Caracas.

In a hospital in the west of Caracas, with a donation of three rolls of disposable cloth, they began to manufacture masks this week. They do not have suspicious cases nor are they a sentinel center, but nobody has masks. “With this material we will get around 5,000”, says Daniel Hernández, union representative of the health center, who made videos with his phone in which a group of women made the simple masks. He acknowledges that there are other problems to solve in order to maintain cleanliness in a hospital without water and that these clothes will not be useful for doctors and nurses who deal directly with infected with coronavirus.

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Health unions have been monitoring the existence of gloves, face masks, soap, disinfectant, chlorine and water in hospitals on a daily basis. Every day one or the other is missing. There is soap, but there is no water. There are gloves, but no masks. The National Hospital Survey found in 2019 that 78% of the establishments had water supply failures. In some, everything is missing. “Absenteeism from work has been great these days. There is fear, there are those who are reusing the masks and also many difficulties to get to the health centers, because in addition to transport they must also wear the masks “, says Mauro Zambrano, delegate at the University Hospital of Caracas.

Gustavo Villasmil is a member of the commission of experts appointed by Juan Guaidó to deal with the epidemic. As a doctor, he assures that the measures taken by Maduro have been successful, but he assures that the time he is winning with social distancing, which should slow down contagion, it must be used at both ends of the health chain: that of the outpatient clinics and small centers that can attend to mild cases, which is totally dismantled, and in large centers adapting and expanding the country’s minimal intensive care infrastructure, where it does not 100 beds are reached with mechanical respirators.

“Monitors and mechanical ventilators are needed, the protective equipment for health personnel, since the rate of infection among doctors in China was three or four times more than that of the population. It is the time of the masks, of the gloves, of the visors, of the fans so that when the peak moment of the epidemic wave arrives, it will not hit us so hard ”.

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Waiting for evidence

Since March 13, when the first infections were reported, the growth in cases in Venezuela has been almost exponential. On Tuesday, however, there was an abrupt drop and on Wednesday they were not recorded, as announced by government spokesmen. Venezuela began its cycle with the coronavirus with 300 tests that the Pan American Health Organization delivered, exhausted in the first days.

The lack of ability to carry out all the tests, which has been key in other countries to control the epidemic, has made it difficult to have a clear view of the progress of the virus in Venezuela, as well as the brief information provided by the authorities, which does not report with regularity location, modes of infection, ages and sex of cases.

This Thursday, cases were added again and the number reached 42. The announcement was made during the reception of 4,000 diagnostic kits sent by China, which, according to Information Minister Jorge Rodríguez, will allow 320,000 tests to be carried out. Maduro also asked for more tests and medical supplies to the WHO to face the epidemic, after the International Monetary Fund denied the financing of 5 billion that he requested for the emergency, leaving behind all the criticism that Chavismo has made to the body, to the point having closed its country office in 2005.

Since 2017, the epidemiological information of Venezuela is not public and doctors and the population are blindly navigating the progress of notifiable diseases. To the censorship of this information is added the harassment of journalists by police and authorities during the coverage of the crisis and the blockade of a website launched this week by the National Assembly team to disseminate information about the virus, a sample that the political conflict in the country did not quarantine.

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