VENEZUELA: Practicar la medicina en medio del caos.

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When the Venezuelan infectious disease specialist Oscar Noya started his career almost four decades ago, he treated about 20 patients with malaria a year. Last year the number was 3500. He expects the number to be higher this year. In the past five years economic policy has left his formerly upper middle income country beset by poverty, violence, corruption, hyperinflation, and chronic scarcity of basic goods, leading to a humanitarian disaster.

Recently, a patient visited Noya with textbook symptoms for malaria: high fever, tremor, and chills. The young man, small and wiry with an odd indifferent look, had a good idea of what was ailing him—he’d already had many bouts of malaria in his lifetime. He was Noya’s third patient of the day to show malaria symptoms. In the dark and windowless waiting room, 10 other patients sat in silence.



“Before, it was one patient a month, or two at most,” Noya told The BMJ during a break. “Now it can be 50 a day.” 
Noya usually sees 15 to 30 patients or more a day in his small office in the Tropical Medicine Institute of Venezuela’s Central University in Caracas, most of them with malaria. A large painting of his mentor, former Venezuelan health minister Arnoldo Gabaldón, sees all.(...)


In the midst of the western hemisphere’s worst economic crisis in recent history, the health system that used to provide Noya’s patients with affordable care and access to drugs has crumbled. Around 22 000 physicians left between 2012 and 2017,1 leaving many hospitals with vacancies that were never filled. There are not enough medicines, and those that can be found are unaffordable.

“Malaria is just one indicator,” Noya laments. “We have epidemics of a large number of diseases, which means the entire health system has collapsed.”

Dr. Oscar Noya

Noya’s working day lasts from 7 am to 5 pm. He doesn’t accept money from his patients, who have little or none. He himself is living off savings. His own hospital salary of $20 (£15; €18) a month—when he gets it—couldn’t support him.

The economic crisis forces children and adults to work in rural areas where there is much standing water that serves as breeding grounds for mosquitoes, and catching malaria isn’t hard. 

Patients come to El Clínico from other parts of Venezuela because there’s a shortage of drugs nationwide, says Noya, as he carefully counts out 21 tablets of the combination treatment artemether with lumefantrine.

Drought of drugs

The cost of a full round of treatment, when available, is just a couple of US dollars. Most of the drugs Noya prescribes today are provided by international organisations, not the state. “We had to resort to donations to continue working,” Noya explains. Even so, they’re running out of the chloroquine they prescribe to pregnant women with malaria.

Drug shortages began in 2014. Last year his institute spent five months without any drugs at all. On days when Noya has no antimalarials for his patients he can only tell them to go home and rest. “This is what angers me most,” he says.

The Federation of Venezuelan Pharmacies, a trade group, estimates that only 15-20% of the necessary drugs are available in the country. Daily medicines to treat diabetes or hypertension are almost impossible to find. Antibiotics are practically non-existent. And the drugs that are available are prohibitively costly. Some treatments can surpass the monthly minimum wage of 18 000 bolivars, the equivalent of $4.50.

For more than three years President Nicolás Maduro has denied the existence of a humanitarian crisis and blocked foreign aid. In early April the Red Cross was able to deliver its first shipment of humanitarian medical aid: power generators, 5000 L of distilled water, and three surgery equipment kits.

Noya’s ability to do research has changed dramatically. His laboratory lacks supplies ranging from diagnostic tests to ordinary paper. 
The rooms are full of empty chairs, as colleagues and students have joined three million other Venezuelan emigrants fleeing hunger, disease, and crime. The laboratory is a graveyard of damaged equipment: the people who could repair them have left. The postgraduate programme Noya led has closed for lack of funding.

More than half of the university’s staff have gone. “We are living with a very serious brain drain,” Noya says. “This is the problem that worries us most: the staff are leaving, and we can’t train new people. It’s a chain of events that makes it difficult for us to continue doing research.”

Noya’s hospital is typical. Syringes, needles, gloves, and sewing thread are not available across the country. The National Hospital Survey found that all public hospitals experience shortages. Half have damaged x-ray equipment. In 95% the tomographs don’t work. And operating rooms are closed in 53% of hospitals. (Más)