Venezuelan Health Care System, Now On Life Support

The supply crisis that has plagued supermarkets and consumers for months now has hit the health care sector, with medicines, doctors and even emergency care in short supply. Plummeting oil prices are a major factor, as is the legacy of Hugo Chavez.

Lines forming outside a Caracas pharmacy in September.
Lines forming outside a Caracas pharmacy in September.
Marie Delcas

CARACAS â€" Emilia Lares, 72, has been queueing for 40 minutes in the midday sun outside the pharmacy on Altamira Square, in eastern Caracas. "I'm running low on insulin reserves," she explains, visibly distressed.

She has other sick friends in the same situation, "whether they have from hypertension, heart problems or cancer."

The woman just behind her is 24 and is worried about her birth control, which she says is becoming "more and more difficult to obtain." Condoms have long disappeared from the shelves here. According to the Venezuelan Pharmaceutical Federation, 70% of the population's medication needs are unfulfilled, as the country's health sector is plunged into crisis.

At the other end of the capital, in the working class suburb of Coche, 19-year-old Geomar is recovering from surgery. He arrived at the emergency room at dawn with two bullets in his right leg. "The ambulance that was supposed to drive him to a better-equipped hospital got here five hours late," explains Dr. Efraim Vega. "We had to amputate."

The hospital in Coche epitomizes Venezuela"s health care crisis. The blue concrete facade is partially covered in pigeon droppings. Water shortages are commonplace. The internal medicine service has closed down while pediatrics and toxicology â€" "although they're crucial here," explains Vega â€" are operating at very reduced capacities. Only surgery and traumatology are functioning at full speed. Or almost. There's a shortage of doctors in addition to everything else.

"What I'm doing is battlefield medicine," Vega says, explaining that emergency rooms are overwhelmed with gunshot injuries. On Wednesday, five vans arrived loaded with medical supplies. But how can doctors operate when anesthetics, anticoagulants and antibiotics are missing? The waiting time for an operation for a broken bone is three weeks, and it's done without an MRI or a scan. Only 55 of the hospital's 100 beds are actually operational.

Hundreds of doctors have fled the country. "There were 122 of us in my year, when we finished our studies in 2012," Vega says. "Now there's only 20 of us who are still in Venezuela." He earns 22,000 bolivars a month, which is $3,500 according to the official conversion rate but only $27 according to black market rates.

"The crisis didn't start yesterday, nor with Hugo Chávez," says Pablo Zambrano, the former president of Sector Salud, a grassroots health sector union. And Venezuela isn't an exception in Latin America either. Some of the problems can be traced to former President Chávez, who led the country from 1999 until his death in 2013 and turned the health care system into the crown jewel of his so-called Bolivarian revolution.

"Millions of Venezuelans were incorporated into a health care system from which they had hitherto been excluded," a Health Ministry worker explains of Chavez's reforms. "But they were incorporated into a health care system that was very far from being perfect."

The making of a mess

Eager to bypass public services that he considered to be inefficient and corrupt, in 2003 Chávez created his famous "Bolivarian missions," social programs directly funded by PDVSA, Venezuela's state-owned oil and gas company. The "Barrio Adentro" mission established modest health care centers managed by Cuban doctors in the heart of poor neighborhoods. Cuban doctors were welcomed with open arms in these slums that had never before had access to medical care.

But Cuban doctors could only provide basic services. The construction of comprehensive centers where they could examine, diagnose and operate was slow and disorganized. The budget for Barrio Adentro, directly siphoned from PDVSA, was left unchecked. Public hospitals in the meantime were suffering from a chronic lack of investments.

"A lot of money has been allocated to public health care over the past few years, but the lack of a coherent policy means the money vanished, swallowed up by inefficiency and corruption," Zambrano says. "Things got even worse when military commanders were named at the helm of the Health Ministry," he says.

In 2007, General Jesus Mantilla, then minister of public health, halted the publication of the country's weekly epidemiological bulletin in an effort to prevent health figures from becoming part of the political conversation. Since November 2014, the bulletin publication has once again been suspended. "Today, nobody has any access to public statistics about HIV, malaria, chickenpox or child mortality," explains Jo D’Elia, a human rights activist and public health care expert. Therefore, nobody can quantify the actual impact of the current crisis.

Controls on exchange rates and prices have become a tourniquet with plummeting oil prices and depletion of foreign currency reserves in recent months. So pharmacies and hospitals are now being hit by the same supply crisis that has affected supermarkets for months now.

Shortages are also affecting the private sector, which lacks material, medicine and staff. "Because some of the labor agreements in the public sector, often old ones, had granted employees private insurance, the state decided in 2012 to sign a comprehensive contract with private hospitals," D’Elia explains. "This agreement, which concerns more than 8 million workers, poses a clear principle issue. And it's a threat for the private sector, given that the government is a really bad payer."

It turns out that the ills affecting Venezuela's public health care â€" improvisation, corruption and denial of reality â€" are the same as those of the Bolivarian revolution.

Keep up with the world. Break out of the bubble.
Sign up to our expressly international daily newsletter!

The Food Truck, A Sign That The White And Wealthy Are Moving In

In San Diego, California, a researcher tracked how in the city's low-income neighborhoods that have traditionally lacked dining options, when interesting eateries arrive the gentrification of white, affluent and college-educated people has begun.

Balboa Park Spring Fling Food Truck festival

San Diego Food Trucks via Facebook
Pascale Joassart-Marcelli

SAN DIEGO — Everybody, it seems, welcomes the arrival of new restaurants, cafés, food trucks and farmers markets.

What could be the downside of fresh veggies, homemade empanadas and a pop-up restaurant specializing in banh mis?

But when they appear in unexpected places – think inner-city areas populated by immigrants – they're often the first salvo in a broader effort to rebrand and remake the community. As a result, these neighborhoods can quickly become unaffordable and unrecognizable to longtime residents.

An appetite for gentrification

I live in San Diego, where I teach courses on urban and food geographies and conduct research on the relationship between food and ethnicity in urban contexts.

In recent years, I started to notice a pattern playing out in the city's low-income neighborhoods that have traditionally lacked food options. More ethnic restaurants, street vendors, community gardens and farmers markets were cropping up. These, in turn, spurred growing numbers of white, affluent and college-educated people to venture into areas they had long avoided.

This observation inspired me to write a book, titled The $16 Taco, about how food – including what's seen as "ethnic," "authentic" or "alternative" – often serves as a spearhead for gentrification.

Take City Heights, a large multi-ethnic San Diego neighborhood where successive waves of refugees from places as far away as Vietnam and Somalia have resettled. In 2016, a dusty vacant lot on the busiest boulevard was converted into an outdoor international marketplace called Fair@44. There, food vendors gather in semi-permanent stalls to sell pupusas, lechon (roasted pig), single-sourced cold-brewed coffee, cupcakes and tamarind raspado (crushed ice) to neighborhood residents, along with tourists and visitors from other parts of the city.

Informal street vendors are casualties.

A public-private partnership called the City Heights Community Development Corporation, together with several nonprofits, launched the initiative to increase "access to healthy and culturally appropriate food" and serve as "a business incubator for local micro-entrepreneurs," including immigrants and refugees who live in the neighborhood.

On paper, this all sounds great.

But just a few blocks outside the gates, informal street vendors – who have long sold goods such as fruit, tamales and ice cream to residents who can't easily access supermarkets – now face heightened harassment. They've become causalities in a citywide crackdown on sidewalk vending spurred by complaints from business owners and residents in more affluent areas.

This isn't just happening in San Diego. The same tensions have been playing out in rapidly gentrifying areas like Los Angeles' Boyle Heights neighborhood, Chicago's Pilsen neighborhood, New York's Queens borough and East Austin, Texas.

In all of these places, because "ethnic," "authentic" and "exotic" foods are seen as cultural assets, they've become magnets for development.

Food vendor at outdoor international marketplace called Fair@44.

Fairat44 via Instagram

A call for food justice

Cities and neighborhoods have long sought to attract educated and affluent residents – people whom sociologist Richard Florida dubbed "the creative class." The thinking goes that these newcomers will spend their dollars and presumably contribute to economic growth and job creation.

Food, it seems, has become the perfect lure.

It's uncontroversial and has broad appeal. It taps into the American Dream and appeals to the multicultural values of many educated, wealthy foodies. Small food businesses, with their relatively low cost of entry, have been a cornerstone of ethnic entrepreneurship in American cities. And initiatives like farmers markets and street fairs don't require much in the way of public investment; instead, they rely on entrepreneurs and community-based organizations to do the heavy lifting.

In City Heights, the Community Development Corporation hosted its first annual City Heights Street Food Festival in 2019 to "get people together around table and food stalls to celebrate another year of community building." Other recent events have included African Restaurant Week, Dia de Los Muertos, New Year Lunar Festival, Soul Food Fest and Brazilian Carnival, all of which rely on food and drink to attract visitors and support local businesses.

Meanwhile, initiatives such as the New Roots Community Farm and the City Heights Farmers' Market have been launched by nonprofits with philanthropic support in the name of "food justice," with the goal of reducing racial disparities in access to healthy food and empowering residents – projects that are particularly appealing to highly educated people who value diversity and democracy.

Upending an existing foodscape

In media coverage of changing foodscapes in low-income neighborhoods like City Heights, you'll rarely find any complaints.

San Diego Magazine's neighborhood guide for City Heights, for example, emphasizes its "claim to authentic international eats, along with live music venues, craft beer, coffee, and outdoor fun." It recommends several ethnic restaurants and warns readers not to be fooled by appearances.

Longtime residents find themselves forced to compete against the "urban food machine"

But that doesn't mean objections don't exist.

Many longtime residents and small-business owners – mostly people of color and immigrants – have, for decades, lived, worked and struggled to feed their families in these neighborhoods. To do so, they've run convenience stores, opened ethnic restaurants, sold food in parks and alleys and created spaces to grow their own food.

All represent strategies to meet community needs in a place mostly ignored by mainstream retailers.

So what happens when new competitors come to town?

Food vendor at outdoor international marketplace called Fair@44.

Fairat44 via Instagram

Starting at a disadvantage

As I document in my book, these ethnic food businesses, because of a lack of financial and technical support, often struggle to compete with new enterprises that feature fresh façades, celebrity chefs, flashy marketing, bogus claims of authenticity and disproportionate media attention. Furthermore, following the arrival of more-affluent residents, existing ones find it increasingly difficult to stay.

My analysis of real estate ads for properties listed in City Heights and other gentrifying San Diego neighborhoods found that access to restaurants, cafés, farmers markets and outdoor dining is a common selling point. The listings I studied from 2019 often enticed potential buyers with lines like "shop at the local farmers' market," "join food truck festivals" and "participate in community food drives!"

San Diego Magazine's home buyer guide for the same year identified City Heights as an "up-and-coming neighborhood," attributing its appeal to its diverse population and eclectic "culinary landscape," including several restaurants and Fair@44.

When I see that City Heights' home prices rose 58% over the past three years, I'm not surprised.

Going up against the urban food machine

Longtime residents find themselves forced to compete against what I call the "urban food machine," a play on sociologist Harvey Molotch's "urban growth machine" – a term he coined more than 50 years ago to explain how cities were being shaped by a loose coalition of powerful elites who sought to profit off urban growth.

I argue that investors and developers use food as a tool for achieving the same ends.

When their work is done, what's left is a rather insipid and tasteless neighborhood, where foodscapes become more of a marketable mishmash of cultures than an ethnic enclave that's evolved organically to meet the needs of residents. The distinctions of time and place start to blur: An "ethnic food district" in San Diego looks no different than one in Chicago or Austin.

Meanwhile, the routines and rhythms of everyday life have changed so much that longtime residents no longer feel like they belong. Their stories and culture reduced to a selling point, they're forced to either recede to the shadows or leave altogether.

It's hard to see how that's a form of inclusion or empowerment.The Conversation


Pascale Joassart-Marcelli is a Professor of Geography and Director, Urban Studies and Food Studies Programs at San Diego State University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Keep up with the world. Break out of the bubble.
Sign up to our expressly international daily newsletter!