For those of us who have been following the deteriorating socioeconomic situation in Venezuela, it is alarming to see the extent of deterioration in the quality of life of Venezuelans over the past 3-4 years.
This is a country that was once the world’s largest oil exporter, rich in natural beauty, ecological diversity, natural resources and beautiful, friendly, resourceful people.
Venezuela is experiencing a major humanitarian crisis at present, the economic collapse giving rise to food shortages, a rapidly deteriorating health care and education system, hyperinflation and almost complete depletion of foreign reserves.
The IMF predicts Venezuela’s inflation rate will reach 1 million % by the end of 2018 (1,000% 2017,112% 2015).

Venezuelan children wait in a food distribution long queue in Caracas, Venezula, on 23 November 2017. Venezuel people lives between the alert, crisis and humanitarian emergency indexes, with a clear negative trend. (Photo by Alvaro Fuente/NurPhoto via Getty Images)

In order to function, grow and prosper, a society requires certain basics such as good access to food and clean water, an adequate health care and educational system, security and a stable economic and political environment.
Venezuela over the last 5 years plus has had none of the above…

The socioeconomic impact of this meltdown is reflected in some of the following statistics:

• Food Shortages: 90% of the population lives below the the poverty line (WHO)
• Average Venezuelan has lost 24 lbs in the past year
• “61% went to bed hungry in 2017”
• Health Care Meltdown: 85% medicines either impossible or difficult to find in 2017
• Hospitals reporting less than 10% of needed medicines and medical supplies available, radiology and lab services markedly diminished or shut down completely
  A recent national survey of 40 hospitals showed a 1/3 of hospital beds were non functioning, 50% of ERs don’t have vital medicines and 95% of CT scans and 51% of X-ray machines were not working
• Increased outbreaks of infectious diseases such as diphtheria, measles, HIV, malaria and TB (highest in 40 years)
• Reduced access/availability of vaccines…potency concerns
• Acute and chronic malnutrition, especially in children
• 300,000 children at risk of malnutrition related death(OAS)
• Acute and chronic diarrhea related to poor water
• Brain Drain: >13,000 doctors and more nurses have left Venezuela over the past 4 years along with many others
• Human migration: > 2.3 million people (7% pop) have left since 2015
• Colombia, Peru, USA, Spain, Chile, Panama, Brazil…(UN)
• Crime: world’s 2nd highest homicide rate 57/100,000 (Canada 1.68/100,000)
  insecurity, robbery(40%) extortion 
• Education meltdown: poor salaries, electricity blackouts, fuel shortages, teacher migration 
• Economics: reduced economic output x 50% over past 4 years
• Tourism meltdown: reduced to almost zero

I recently visited Venezuela to see how accurate were many of these reports .

I talked with many people working on the front line of health services in particular.

I visited a number of city hospitals and a rural health centre.

I talked with patients, family doctors, hospital and public health specialists, nurses, ambulance drivers, teachers and some people on the street.

I saw an 8 year old boy that looked barely 4 years old with marasmus…a condition related to severe general chronic malnutrition and more associated with the severe famines of Sub Saharan Africa in the 1980s.

I saw lots of examples of empty hospital beds, not because of lack of patients but because of lack of medicines, medical and surgical supplies, malfunctioning equipment, power outages and compromised water supplies.

I saw a number of basic X-ray machines not working because the wires had been cut to sell, equipment had broken down and no replacement parts available.

I saw an ER that had to survive without adrenaline for one week.

I saw many patients waiting on cots in ER for admission…some of these patients had active TB and were putting other patients and staff also at risk without any isolation options.

I saw a psychiatric ward that resembled some of the old Stalin Gulag prison camps.

I talked with a very competent head surgeon who was demoted because he reported to the Health Ministry that the mortality of patient’s admitted to the hospital had increased from 5% to an alarming 20% because of the lack of medicines and diagnostic tests.
The Ministry of Health blamed him on the alarming increase in patient mortality and demoted him.

I talked with the medical director of a city hospital who was on a salary of $9 US / month and often the payment was delayed by 2-3 months He was a well-trained medical specialist and hospital administrator.

Most of the people I met both medical and non-medical ate one meal per day…Usually a thin “arepa” which is a corn pancake traditional in Venezuela.
Rarely can people afford meat or vegetables.

My impression is rural people have a little better access to food than urban dwellers…still rarely get to eat meat.

Rural dwellers tend to have even less access to medicines, medical supplies and medical staff.

My impression is people have a significant protein and micronutrient deficient diet.
There is still significant amount of food available in Venezuela but as a result of spiraling inflation it is not affordable for most I saw fridges with 1-2 carrots or potatoes.
People’s diet is high in carbohydrate and low in protein, fat and micronutrients.
As a result, some people look healthier than they really are…similar to what I have seen on the Tibetan plateau.

I heard of cases of patient’s being kept alive with manual pumps because ventilators were faulty or power outages.

These are very difficult conditions for patients and staff.

It’s amazing how those medical staff who have stayed keep going every day in such conditions…a testament to their commitment to their people and country.

Not all medical and nursing graduates stay.
An alarming 50% of recent graduates from one medical school I visited, have already left the country, even before internship.
No doubt similar statistics in nursing and other medical professions.
Who can blame them, working is such circumstances.

I saw an astronomical lack of appropriate medicines and diagnostic equipment at primary, secondary and tertiary care facilities.
Many infections are treated on the blind without access to diagnostic tests, often with an inferior and sometimes inappropriate antibiotic because that’s all that’s available.

It’s not surprising that we are seeing such an increase in infectious diseases across the country.
This has the potential to markedly increase multi drug resistant organisms across Venezuela, it’s neighbouring countries and the world.
The mass migration of >2.3 million people out of Venezuela in the past 3 years accentuates this risk.

As a result of the complete breakdown in the health care system, one cannot rely on current health statistics and numbers.

My impression is the prevalence of many diseases and multi drug resistant infectious disease especially is underestimated and underreported to Venezuelan citizens, the WHO and the rest of the world.

The consequences of a broken health care system and economy is having a huge impact on Venezuelans, their neighbours and most likely the rest of the world.

Venezuelan President Maduro was quoted at the UN in September 2018 saying “Venezuela is a victim of world media attacks designed to construct a supposed humanitarian crisis so as to justify a military intervention.”

Up to recently he has refused to acknowledge a crisis and has refused to accept international humanitarian aid.

The Lima Group is a multilateral group of neighbouring Latin American countries and Canada, established in August 2017 to work towards a peaceful solution to the current Venezuelan crisis.
It works towards release of political prisoners, offers humanitarian aid, calls for free elections and promoting restoration of democracy in Venezuela.

Within the past 2 weeks there has been a glimmer of hope!
The United Nations recently announced it would provide $9.2 million to Venezuela from its Central Emergency Response Fund to go to UN agencies within Venezuela.

Maduro has recently invited Michelle Bachelet (former Chilean president and now head of the UN’s Office of High Commissioner for Human Rights) to visit Venezuela.

Venezuelan’s secretive central bank which has refused to share financial information for a long time is reportedly preparing new data for the IMF .

Hopefully this is grounds for a spark of cautious optimism in a country that has such huge potential and has endured so much more darkness than light for so long.

The world needs to pay more attention to the plight of Venezuelans and keep pressure on the Maduro regime to admit there is a crisis, accept international humanitarian aid and start working towards a democracy where people can live in a secure, less corrupt state, where there is good access to nutrition, health care and education and the opportunity for its citizens and country to thrive once again.

Bill Hanlon MD