On Monday applause was heard at the Pedro Emilio Carrillo University Hospital, in Valera, a city in the Venezuelan Andes in the west of the country. They fired the nurse Víctor Prato, 47 years old and 15 years of service. On a stretcher, inside a black bag, was the corpse of the hospital worker, who at the beginning of the month had been admitted with respiratory failure. The posthumous tribute was recorded by his colleagues in a video that circulated on social networks. His death increased the painful accounting that the health unions have done during the pandemic. There are 76 casualties in Venezuelan health personnel due to covid-19. Not all are listed in the registry. Five months after the first case was detected, only more than 35,000 infections and 297 deaths have been officially confirmed. And those of the toilets are not discriminated in the daily bulletins.
There has been no spontaneous applause in Venezuela for the doctors, that citizen tribute that from Madrid to Buenos Aires they have given to the personnel who are on the front line of the pandemic in hundreds of cities. A few weeks ago, the Government of Nicolás Maduro called for a one-minute applause session, but it was his turn to produce them. In a television broadcast from buildings of the Housing Mission built in the military zone of Fuerte Tiuna, in Caracas, an entertainer with a microphone urged people to go out onto the balconies that were mostly unlit. The gesture was answered with annoyance from the guild. They don't want applause, but the personal protective equipment they have demanded since the start of the pandemic.
The first Venezuelans killed by the virus were counted among doctors abroad, as a sign of the enormous exodus that the South American country has suffered. But within the country, the deaths of health professionals are well above the percentage recorded by Colombia, Peru, Chile or Spain, where they do not reach 1% of deaths, with significantly higher numbers of cases and total deaths. In absolute numbers, the 76 deceased in the sector counted by the health union already exceed the 65 that had been officially registered until July in Spain, which has 10 times more cases than Venezuela. "The numbers tell us that we have the highest death rate from covid-19 among health sector workers" in the region, denounced the deputy in exile and doctor José Manuel Olivares. "Doctors in Venezuela have 30 times the risk of being infected and 111 times the risk of dying from covid-19."
One suit for the guard
In Venezuela, the virus reached hospitals without a regular supply of water, soap, disinfectants, gloves, or masks, a situation that has not changed much after five months of confinement. Health personnel are now facing the exponential stage of reproduction of cases and beds, and even spaces set up for emergencies such as hotels, are already almost full of infected patients. The lack of protective equipment puts health workers in an additional dilemma.
At the beginning of July, during a guard at the José Ignacio Baldó Hospital in Caracas, a national reference center in respiratory specialties, which was designated as a sentinel for covid-19, there was only a white polypropylene suit to enter the room with 32 sick. "That day we decided to give it to the nurse so that she could administer the treatment and pray that none would decompensate because the doctors had no way to enter safely," says pulmonologist Ana Vielma, president of the Hospital's Medical Society. The cleaners were unable to clean the room that night due to lack of biosafety suit. There was also no water to do it.
# 17Ago Health personnel from the "Pedro Emilio Carrillo" University Hospital of Valera, say goodbye amid applause to the nursing professional, Víctor Prato, who lost the battle against Covid-19, after spending 2 weeks in the ICU. Video 📹 Courtesy. #Trujillo pic.twitter.com/kG279XLZdA
- Diario de Los Andes (@diariodlosandes) August 17, 2020At the beginning of the epidemic in the country, in March, the doctors at this center refused to treat these patients because they already have a high burden with other respiratory diseases in a country where tuberculosis, for example, has been on the rise for several years . They lack supplies -the staffing does not include N95 masks- and they also lack personnel, which is what concerns Vielma the most. The huge gap left by Venezuelan migration suffers in the midst of the pandemic in hospitals, where services are closed due to lack of students and most of the professional staff has had to stay at home. They are over 60 years of age and, therefore, a population at risk. "We have almost no young staff, we are left without relief," laments Vielma.
In the last decade, 40% of recently graduated doctors emigrated, according to a survey by the Doctors for Health organization. In 2018, 22,000 Venezuelan doctors had left the country, according to data from the Venezuelan Medical Federation. This week, the Government has reinforced the personnel in public centers with a new delegation of 230 Cuban doctors who have arrived in the country. At the hospital where Vielma works, until a month ago only one resident doctor was on duty in the room with the 32 patients with covid-19. With reinforcements they have managed to add one more. The center has eight intensive care beds but does not have specialists to put them to work.
Spending on asymptomatic patients
Contrary to what has been done in other countries, Maduro has insisted on the hospitalization of asymptomatic patients, with the intention of curbing the contagion. The unusual measure has generated an additional cost of the scarce protection material and the saturation of services, as criticized by epidemiologists and doctors who are in the first line of care. A good part of the doctors who have died do not belong to specialties that have had contact with patients with coronavirus. Few resources have been focused on the pandemic, neglecting other areas. Misinformation and the limited capacity to make a diagnosis, with only two PCR testing laboratories in the country, has contributed to minimizing the risk even among the doctors themselves. “At this moment we cannot know who is covid and who is not. You have to assume that all are until proven otherwise, ”says Vielma.
In another hospital in Caracas, the Clínico Universitario, each resident is assigned a biosafety suit, but in some areas they reuse them. A third-year graduate student in radiology at the end of her shift washes him with soap and bleach. The mask you receive is for the entire day, a practice that was common before the pandemic. Her service supports the diagnosis of infection. Given the lack of evidence, she says, images have become essential. She will soon begin to stand guard in the hospitalization area for covid-19. “They have told us that they are going to give us the new white suits when we are in the covid-19 area and that we will discard them after each day, although in the emergency where there are also cases I have seen that my colleagues only wear a surgical gown ”Says the 36-year-old resident, who asks to keep her name hidden for fear of retaliation.
Almost daily the platform of Doctors United for Venezuela reports one or more deaths within the union. This organization is promoting the collection of donations and funds to buy protective equipment for health personnel who have yet to face the long crest of the epidemic. For at least four years that Venezuela has been going through a serious humanitarian crisis, an extensive network of donations through non-governmental organizations has become the only care that some patients receive, part of the humanitarian aid that trickles into Venezuela and its health system already collapsed.
Recently, supplies were distributed through the Pan American Health Organization (PAHO) in hospitals in six provinces of the country, but health centers and evidence of aid are still lacking. The achievement was the product of a political agreement between the representatives of Maduro and Juan Guaidó, as head of the National Assembly and interim president recognized by more than 50 countries. To this delivery of supplies will be added others, according to what Guaidó said days ago when he authorized the transfer to PAHO of part of the money frozen abroad to buy more supplies and finally begin to pay a $ 100 bonus to health personnel who offered in March and still not concrete. A particular diligence that occurs in the midst of the pandemic and the Venezuelan institutional crisis, when the Maduro government is cornered by sanctions and the fall in oil revenues, and Guaidó's, waiting for a political transition does not have all the administrative structure to function.