Venezuela: Fighting malaria and failing health system in Bolivar
When one thinks of a nation going through a severe political and economic crisis, the first thing that comes to mind is probably not gold. But in Bolivar, Venezuela’s biggest state, illegal gold mining has been booming for years and the yellow metal has become a motivation for many Venezuelans to head towards the south of the country, as a last chance to make a living before potentially returning home or fleeing to Brazil. Doctors Without Borders/Médecins Sans Frontières (MSF) has been present in various cities including Caracas, Sucre and Bolivar in Venezuela since 2015.
Luis Henrique Ripa, comes straight from the Venezuelan capital of Caracas. He left his family behind to come work as a miner in Las Claritas, a small town located in the municipality of Sifontes, in Bolivar state. “This is the second time I come here”, he says when one asks him if he has previously visited the area. “To be fully honest, I don’t really like it, but the opportunity is too tempting. The very first day I arrived, I found gold. Some people look for months before finding anything. But it just took me a day and I took it as a sign. Being here is an adventure, and what you get is worth it.” The fact that Luis is now bedridden, with a large cast covering most of his right leg doesn’t seem to make him change his mind about his journey. The man keeps on smiling and tries to forget his pain. Earlier that week, he broke his leg after a 11-meter free fall inside a gold mine. Luis asks a local doctor when an ambulance will come pick him up. His injuries are too severe to be handled at the local ambulatory he’s at now, he will have to be transferred to a hospital to be properly treated.
Laying in the bed beside him is another young man called Yordan Pentoja. Yordan did not fall, he fell ill. The 27-year-old is also being cared for at the ambulatory for a severe form of malaria. He says he has been diagnosed with the disease about a dozen of times since he started working in the mine, over a year and a half ago. “Malaria is like a plague around here. I have so many friends and colleagues who have had it that I stopped counting”, he sights. He closes his eyes and adds: “I came to the ambulatory this morning because I started to feel terrible. My head and my stomach hurt like hell.”
The prevalence and danger of malaria
Fifty years ago, Venezuela was often presented as one of the leading countries in South America in the battle against malaria. Though the disease was not fully eradicated by then, efforts had been done to decrease drastically the number of cases in the country. But in recent years, malaria has made a major come back in Venezuela. Indeed, in 2019, it ranked as the most affected nation in Latin America, with over 320 000 diagnosticated cases.
“You see, this place is where everything started. Or where everything ended, it all depends how you look at it”, explains Yorvis Ascarnio, an inspector of public health who works for the National Malaria program in Bolivar. There, in the municipality of Sifontes, malaria has become endemic. “When the economic crisis hit Venezuela, it hit people in Sifontes very hard too. At first, we started having less and less medicines in our stock. We soon had to choose to whom to give the few medicines we had, we could focus only on severe cases. And it was the same situation in other ambulatories and diagnostic points… I have been working in this area for the past twelve years. I’ve seen the highs and lows of this place. But this period was extremely hard for us.”
In 2016, MSF started intervening in Bolivar, to provide support to the National Malaria Program, in collaboration with the Ministry of Health. Since then, the organization has been supporting various diagnostic points in Bolivar and assisting with the provision of adequate treatment for malaria patients. A year ago, MSF has also been working with the Malaria Institute in Carúpano, in Sucre state, increasing its capacity to tackle malaria in the country.
“In Bolivar, we also help with what we call vector control: we fumigate houses and distribute mosquito nets to the population, to diminish the risk of infection” explains Josué Nonato, a MSF health promoter. “And my job, as a Health Promoter, is to explain to people how to identify the symptoms of malaria and what to do when they start to feel sick, to make sure they can be treated before the disease gets too severe”.
In 2019, MSF informed over 55,000 people throughout health promotion sessions in the area. The organization also treated over 85,000 people for malaria, distributed over 65,000 mosquito nets, sprayed 530 households and overall helped carry out over 250,000 malaria diagnostic tests. Since then, the number of malaria cases has decreased by approximately 40% in the municipality of Sifontes. To reach these objectives, MSF’ strategy has been to get as close to the people who might be impacted by malaria as possible. That’s why most of the diagnostic and treatment points the organization supervises in partnership with the National Malaria Program are located directly inside the mines.
“We went from sometimes up to 200 people queuing in front of the diagnostic points and many people who were infected with malaria who had to go directly to the ambulatory because there was no treatment available to a situation a bit more manageable now”, comments Monserrat Barrios, MSF Bioanalyst, in charge of training new microscope technicians at diagnostic points.
MSF increases presence in 2020
This year, MSF also supports the local ambulatory in Las Claritas, called Santo Domingo. Initially built for a population of 20,000, it now has to serve the needs of over 75,000 people who have come to live in the area in the past few years. MSF has been providing malaria prevention, diagnostic and treatment there, but is increasing its support to cover other diseases and health needs.
Fanny A. Castro, MSF medical activity manager, explains: “We know other departments also need help to cope with the number of patients, including those suffering from non-communicable diseases or in case they need to take care of emergencies and referrals to a hospital. We are focusing more on sexual and reproductive health, for instance, with services such as family planning and deliveries. We overall want to make a difference and to increase the population’s chances to access health services. We have also installed a functioning water supply and waste management around the facility, which considerably improves the quality of care provided.”
However, health needs go well beyond Las Claritas and the municipality of Sifontes, Venezuela’s economic crisis has deeply impacted the health system in general and it is felt almost everywhere. MSF tries to answer the most pressing needs in different states of Venezuela, and in Bolivar, the organization will also soon begin to support one of the state’s regional hospitals which today is barely functional, in a city called Tumeremo.
In one of the abandoned hallways of this hospital, a newborn’s cry is heard. Alicia Jimenez, an indigenous woman from Bolivar, just gave birth to her tenth child with the help of one of the facility’s remaining midwives. She had to travel by boat and car to reach the hospital, but she says that despite the difficulty of the journey and the current poor conditions of the building, she’s still blessed with this new addition to her family. In 2020, MSF will intensify its efforts to tackle malaria in Venezuela, but also intends to facilitate and ease access to health services, in Tumeremo and other places across the country.