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Venezuela

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 — 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 — "although they're crucial here," explains Vega — 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 — improvisation, corruption and denial of reality — are the same as those of the Bolivarian revolution.

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Geopolitics

Smaller Allies Matter: Afghanistan Offers Hard Lessons For Ukraine's Future

Despite controversies at home, Nordic countries were heavily involved in the NATO-led war in Afghanistan. As the Ukraine war grinds on, lessons from that conflict are more relevant than ever.

Photo of Finnish Defence Forces in Afghanistan

Finnish Defence Forces in Afghanistan

Johannes Jauhiainen

-Analysis-

HELSINKI — In May 2021, the Taliban took back power in Afghanistan after 20 years of international presence, astronomical sums of development aid and casualties on all warring sides.

As Kabul fell, a chaotic evacuation prompted comparisons to the fall of Saigon — and most of the attention was on the U.S., which had led the original war to unseat the Taliban after 9/11 and remained by far the largest foreign force on the ground. Yet, the fall of Kabul was also a tumultuous and troubling experience for a number of other smaller foreign countries who had been presented for years in Afghanistan.

In an interview at the time, Antti Kaikkonen, the Finnish Minister of Defense, tried to explain what went wrong during the evacuation.

Stay up-to-date with the latest on the Russia-Ukraine war, with our exclusive international coverage.

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“Originally we anticipated that the smaller countries would withdraw before the Americans. Then it became clear that getting people to the airport had become more difficult," Kaikkonen said. "So we decided last night to bring home our last soldiers who were helping with the evacuation.”

During the 20-year-long Afghan war, the foreign troop presence included many countries:Finland committed around 2,500 soldiers,Sweden 8,000,Denmark 12,000 and Norway 9,000. And in the nearly two years since the end of the war, Finland,Belgium and theNetherlands have commissioned investigations into their engagements in Afghanistan.

As the number of fragile or failed states around the world increases, it’s important to understand how to best organize international development aid and the security of such countries. Twenty years of international engagement in Afghanistan offers valuable lessons.

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