By Allison Walton, MD.
All photos taken by Dr. Walton.
The Venezuelan migrant crisis is ultimately a tale of corruption, greed, and shortsightedness, but also of compassion, advocacy, and worldwide self-reflection that has sprouted in response – and that I am hopeful will sprout anywhere in the world when we witness a humanitarian crisis. I’ve just returned home from volunteering in Cucuta, Colombia, with MedGlobal.
The Venezuelan infrastructure and government have completely collapsed. This once-prosperous nation now has few to no public services, jobs, food, medications, and no paper. The annual inflation rate was 1,300,000% as of last winter. The Venezuelan currency is almost worthless, in fact, people are making bills into art, such as earrings, purses, wallets, and used as a canvas for paintings, and sold for the equivalent of 5-20 US dollars.
There is a critical food shortage and widespread malnutrition, with the average Venezuelan adult having lost 20 pounds in the past several years. As you might imagine, the nutritional crisis for children and infants is even more devastating and often fatal. Maternal and child mortality have jumped by 50-75% in the past few years.
The Venezuelan medical system used to be one of the best in Latin America. Over the past several years, many hospitals have shut their doors completely and pharmacies have no medications to stock and instead fill their shelves with water bottles. One-half of Venezuelan physicians have left the country so far. Vaccine-preventable diseases, which were believed to be eradicated 5 years ago, are resurging, including measles and diphtheria. The incidence of other infectious and communicable diseases such as malaria, tuberculosis, hepatitis A, and HIV have also jumped dramatically.
One of my translators in Cucuta explained that when his young daughter was born in Venezuela. He was given a list of supplies to obtain and he had to go purchase everything for prior to the delivery of his daughter. Everything from IV fluids, antibiotics, medications, gauze, surgical gloves, and obstetrical surgical tools, everything had to be bought by the individual and brought to the hospital. Fortunately, he was able to obtain most of the supplies, and his wife and daughter are doing well. Unfortunately, not all Venezuelans are able to get the medical care and supplies they need, and about one-third of people admitted to Venezuelan public hospitals will die there.
There is literally no paper in Venezuela – one patient showed me a prescription from home, written on a random scrap of paper and stamped with the Venezuelan physician’s name.
About one-fourth of Venezuela’s population have fled these dire conditions, making their way into neighboring South American nations, most of them heading to Colombia. The Colombian social services and health care systems were strained already, and now with the enormous influx of Venezuelans – many of them children, infants, and young women – the Colombian healthcare system is cracking.
MedGlobal’s local staff in Cucuta made it a point to help me learn about the background of the Venezuelan crisis and showed me a lot of the public health data collected. They also introduced me to various social services and partner NGO’s. We spent half a day visiting the Puente Simon Bolivar, and the border zone on the Colombian side. Approximately 25,000 people cross the bridge every day, though many ultimately return to Venezuela, entering Colombia to purchase food and medications to bring back to their home country.
The local Catholic diocese established a shelter and food kitchen, where about 4,000 migrants per day get a hot meal. There are several other organizations that have established medical and some social/legal services, including the UNHCR and Red Cross.
MedGlobal has partnered with IPS Medcare de Colombia S.A.S., a public/free clinic staffed by a Colombian physician from 6am – 11am, and then a different Colombian physician from 11am – 6pm. Both of the physicians working there right now are just out of medical school and I’m told that this is somewhat like their residency, part of a required 2-year public service prior to going into any specialty.
MedGlobal physicians have their own exam room within the Medcare clinic, and a patient panel to see each day. My patients were mostly pediatrics and referrals from emergency rooms or other clinics, where there was no medication to treat their condition. Many patients told me about going to an emergency room in Colombia and being told this is not an emergency and sent away, or getting a handful of tests and inadequate treatments, and they were coming to us hoping to get more answers and in need of treatment.
The Medcare clinic has a formulary list of medications we can prescribe, and the patients can pick up those medications at no cost from a nearby pharmacy. We also do have a list of laboratory studies we can order, which will be drawn at the clinic in the early mornings, each day. With the MedGlobal/Medcare clinical practice relationship beginning only two months ago, there are growing pains and improvements to be made and the medical record system is undergoing changes. MedGlobal is also hoping to establish another clinic site within the border zone.
Beyond the medications, we can prescribe and list of laboratory studies we can order within the current MedGlobal/Medcare/Colombian government’s practice agreement, there isn’t much more we can do at this time. We are not able to perform any procedures, including injections such as IV/IM steroids or antibiotics. There are no in-house imaging studies available. The MedGlobal and Medcare staff, nurses, and physicians are all doing everything we can with the limited resources we have.
Patients had traveled from as far as the capital of Caracas, sometimes by foot, to try to get services here in Cucuta. The Colombian medical system wasn’t doing great beforehand and is now crushed under the influx of Venezuelans, including many children and pregnant women.
I saw a young man who had pneumonia and sepsis. In the US, he certainly would have been admitted here and would have gotten 30cc/kg IV fluids and trended lactate levels, would have had imaging and supplemental oxygen and respiratory treatments, but all I could do was give him antibiotics and some education on pulmonary hygiene, and hope I treated him before he became critically ill. He already went to a local emergency room that morning and was sent here for the free antibiotics.
I saw a teenage girl with horrible mastoiditis, after reporting a severe ear infection 2 years ago. There was purulence coming from her external auditory canal and a fistula with purulence above the pinna. She needed an ENT surgeon and possibly a neurosurgeon. She would have been admitted to hospital immediately as well, but here I had to prescribe her a very prolonged course of oral antibiotics and advise that her mother continue to try getting her seen at a hospital in Colombia, hoping she would finally be admitted.
I saw a 2-month-old infant who was only 800g above his birth weight and looked like a tiny porcelain skeleton. He was critically dehydrated and malnourished and needed to be admitted to a hospital immediately. Even while I was telling the clinic staff that this infant is going to die, I knew there wasn’t much we could do. The head nurse at the clinic called a local hospital and asked them to help, and we sent them over – I don’t know what happened to him.
For most of its citizens, Venezuela was a prosperous, progressive, growing nation less than a decade ago. One of my adult patients was a nurse by training who is now homeless in Cucuta, and one was a structural engineer who now works at a sandwich shop in Cucuta and lives in a one-room apartment with two other families. They were living a normal middle-class life, just like many of you in the US, and they never imagined this would happen to them.
One of many lessons I took away from my time in Cucuta, however, was that his can happen to any nation at any time. As we have been seeing in vivid colors recently, outrageous corruption among the people in power can and does happen anywhere, including in the US. Frighteningly, a familiar refrain has been coming from some in the Venezuelan government recently — that this is a “fake” crisis, and as such, they will not allow humanitarian aid into Venezuela.
This is a very real crisis. Please, come and see it for yourself. Please educate yourself and others about how it happened.
And please do not close your eyes to the myriad other humanitarian crises ongoing in this world, several of which MedGlobal is helping with by actively sending personnel, supplies, and education.