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C O N F I D E N T I A L SECTION 01 OF 04 CARACAS 001551

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E.O. 12958: DECL: 2019/12/14
TAGS: ECON ELAB HURI PGOV VE
SUBJECT: VENEZUELA'S MEDICAL SYSTEM IN DISARRAY AS GBRV SHIFTS
RESOURCES TO BARRIO ADENTRO

REF: CARACAS 1374; CARACAS 1256

CLASSIFIED BY: DUDDY, AMBASSADOR, DOS, AMB; REASON: 1.4(B), (D)

¶1. (C) SUMMARY: Venezuelan doctors have accused the Venezuelan
Government (GBRV) of politicizing health care at the expense of the
health of Venezuelans. In recent months, protests have paralyzed
hospitals across Venezuela as doctors and patients have complained
of shortages of medical supplies, delays in hospital renovations
and unpaid wages and benefits. Observers describe public hospitals
as increasingly dangerous places where underpaid, undersupplied,
and understaffed doctors struggle to provide medical services to
Venezuela's poor. Critics say that the GBRV has created a parallel
medical system-"Barrio Adentro"-that has sucked resources away from
the traditional hospital network and reduced the overall quality of
medical services. The GBRV has suspended doctors for speaking out
about the crisis while giving former military officers and
community councils a greater role in hospital administration. On
November 29, President Chavez announced plans to eliminate a
government health care benefit that pays for public workers to
receive health care at private clinics, a move that would place
even greater strain on already overburdened public hospitals. END
SUMMARY.



HOSPTIAL CRISIS SPREADS ACROSS THE COUNTRY



¶2. (SBU) In recent months, newspapers across Venezuela have
carried daily reports of a growing crisis in the public hospitals.
On November 30, for example, "Notitarde" published reports of a
vigil by patients and doctors to protest shortages of medicines and
supplies at the Enrique Tejera Hospital; on December 1, Ciudad
Guayana's "Correo del Caroni" covered the "technical closure" of
the Negra Hipolita Maternity Ward after the breakdown of the air
conditioning system raised concerns that the heat would increase
bacteria levels in the incubators for newborn babies; and on
December 4, the daily "El Universal" reported that doctors in
Merida had shut down the University Hospital of Los Andes (HULA)
due to medical supply shortages, pronouncing the hospital "dead."



DOCTORS PROTEST DETERIORATION OF PUBLIC HOSPITALS



¶3. (SBU) On November 18, in a development representative of the
breakdown of public hospitals across the country, the Jesus Yerena
de Lidice Hospital shut down after 140 physicians announced their
mass resignation. Lidice is one of the two largest and most
important public hospitals in the impoverished Catia municipality
of Caracas; it serves a poor and marginalized community that
otherwise has little access to health care.



¶4. (SBU) For over three months, Lidice's patients and doctors have
protested shortages of medical supplies, delays in the renovation
of hospital wards, and unpaid wages and benefits. But the conflict
escalated on November 16, when the Health Ministry suspended four
of Lidice's doctors after charging them with inciting protests
among the patients. Lidice's doctors resigned en masse after the
Health Ministry refused to reinstate the four suspended doctors and
resume negotiations over salary payments and benefits owed since
¶2007. The resignations paralyzed Lidice, leaving only two
doctors-an internal specialist and a surgeon-to care for the
remaining patients.



¶5. (SBU) Although Lidice reopened on November 20 after the Health
and Labor Ministry agreed to reinstate the four suspended
physicians and resume negotiations over other demands, the

CARACAS 00001551 002 OF 004


emergency pediatrics unit and maternity ward remain closed for
renovation. The maternity ward of the Lidice hospital-considered
the second most important in Caracas for many years-has now been
closed for two years, while Catia's other major public hospital,
Los Magallanes Jose Gregorio Hernandez, has been partially closed
for over a year while awaiting renovation.



PUBLIC HOSPITALS ARE DANGEROUS, UNDERSUPPLIED, AND UNDERSTAFFED



¶6. (C) During a private meeting on November 10,
XXXXXXXXXXXX, a health reporter for the "El Universal"
newspaper, described the public hospitals as increasingly dangerous
places, where underpaid, undersupplied, and understaffed doctors
work in unsanitary conditions to provide medical services to
Venezuela's poor. Due to shortages of basic medical supplies,
doctors ask patients to purchase their own needles, disinfectants
and gauze. XXXXXXXXXXXX told EmbOffs that doctors sometimes dress wounds
with the same dirty bandages. Other patients are told to bring
their own X-rays from private clinics. As in many areas of
Caracas, public hospitals suffer from water shortages, forcing
doctors to postpone important operations. In some of the older
public hospitals, the plumbing systems cannot pump water above the
first few floors of the building.



¶7. (C) XXXXXXXXXXXX estimated that medical residents in public hospitals
make an average of 2,000 bolivars (BsF) per month (USD 930 at the
official rate of 2.15 BsF to the dollar). According to XXXXXXXXXXXX, over
fifty percent of the resident doctors move to the capital from
other parts of the country, and their salary is barely enough to
cover rent in Caracas, where an austere apartment in a dangerous
neighbourhood can easily cost 1,800 bolivars per month.
Consequently, many doctors have left the public hospitals in search
of other jobs, while some of the most qualified have left the
country to earn better salaries abroad. In a December 4 press
report, the Venezuelan Medical Federation (FMV) estimated that the
public hospitals are understaffed by 43 percent.



¶8. (C) Crime has further contributed to the flight of doctors from
the public sector. XXXXXXXXXXXX said that criminals go to the public
hospitals to rob, steal, and even kill patients. The emergency
room in Hospital Vargas is only open for twelve hours-between seven
in the morning and seven at night-because of security concerns. In
October, a shootout in the emergency room of the Los Magallanes de
Catia hospital killed two people. Although the Ministry of Health
has promised to send more guards to protect the hospitals, in many
cases the additional security has not arrived.



SEE NO EVIL, HEAR NO EVIL, SPEAK NO EVIL



¶9. (C) On November 17, XXXXXXXXXXXX told EconOff that the GBRV has
suspended doctors to discourage them from speaking out about the
health care crisis. Last year four doctors were suspended when
they exposed the accidental death of six babies in a maternity
ward. According to XXXXXXXXXXXX, the GBRV has limited the role of the
resident doctors in hospital management and transferred authority
to local community councils. XXXXXXXXXXXX said that community council
members meet with hospital directors to discuss renovation
proposals. On November 10, the director for the Vargas Hospital of
Caracas, Francisco Hernandez, told the press that he had to present
the hospital's renovation proposals to the community councils
before sending them to the Health Ministry and President Chavez for
approval.

CARACAS 00001551 003 OF 004


BARRIO ADENTRO DRAINS RESOURCES FROM PUBLIC HOSPITALS



¶10. (C) XXXXXXXXXXXX told EmbOffs that the quality of health care in the
public hospitals has deteriorated as the GBRV has redirected
resources to "Barrio Adentro," a program staffed by the Cuban
Government that provides free medical services in poor areas (Ref
A). Although "Barrio Adentro" has translated into political gains
for President Chavez, its medical impact is questionable, despite
having received massive government investment (Note: The GBRV spent
approximately USD 5.6 billion on Cuban medical assistance,
training, medicines, vaccines, and other services in 2008,
according to one estimate. See Ref A for further analysis of
Barrio Adentro. End Note.). While Chavez has acknowledged a
"crisis" in "Barrio Adentro" and announced a sweeping campaign to
revitalize the program, neither President Chavez nor his ministers
have announced new plans for additional investment in the
traditional public hospital system.



¶11. (C) On October 5, the President of the Venezuelan Medical
Federation (FMV) XXXXXXXXXXXX told EmbOffs that
the health care problem is primarily political.
According to XXXXXXXXXXXX, the GBRV has focused resources on the
development of a parallel medical system-"Barrio Adentro" -that has
sucked investment away from the hospitals and the traditional
medical infrastructure to the detriment of the health of
Venezuelans. At the same time, the GBRV has appointed military
professionals with no medical background to important positions in
the Ministry of Health. XXXXXXXXXXXX said that there is "anarchy" in the
Ministry of Health, pointing out that the GBRV has released health
statistics just four times in the last 14 months. FMV Vice
XXXXXXXXXXXX added that vaccination rates have
decreased dramatically over the past several years.



¶12. (C) While the GBRV has prioritized "Barrio Adentro" over the
traditional medical system, Venezuelans seem to prefer public
hospitals or private clinics. On October 9, XXXXXXXXXXXX
told EmbOffs that the majority of Venezuelans
continue to receive medical care in public hospitals or private
clinics rather than "Barrio Adentro." XXXXXXXXXXXX cited a 2006 study
by a team of European Union analysts that measured the use of
health services by sector (i.e., public hospitals, private clinics,
or "Barrio Adentro") and confirmed that poorer Venezuelans were
more likely to receive medical care in public hospitals than
"Barrio Adentro."



CHAVEZ THREATENS TO ELIMINATE PRIVATE HEALTH INSURANCE BENEFIT



¶13. (SBU) On November 29, in a move that further illustrated GBRV
efforts to strengthen "Barrio Adentro" as an alternative to the
traditional medical system, Chavez announced his intention to
eliminate the hospitalization, surgery, and maternity (HCM) benefit
that public sector employees use to pay for health care at private
clinics. During a broadcast of the "Hello, President" radio and
television program, Chavez said that the HCM benefit supported the
"bourgeoisie" owners of private clinics and that public employees
should instead use "Barrio Adentro's" network of Integral
Diagnostic Centers. In press reports the following day, public
employees in the petroleum, iron, steel, and aluminum sectors
protested the announcement (Note: According to one press report,
sixty percent of the 12 million Venezuelans with health insurance
work in the public sector. End Note.). Critics pointed out that
the private clinics offer medical services that "Barrio Adentro"

CARACAS 00001551 004 OF 004


does not provide, and that the public hospitals do not have the
capacity to absorb a massive influx of new patients from the
private clinics. On September 23, deputies for the pro-Chavez
United Socialist Party of Venezuela (PSUV) told EmbOffs that
changes to the medical insurance system would be imposed
progressively given the sensitivity of the issue (Ref B).



COMMENT



¶14. (C) The quality of health care in Venezuela has declined as
the GBRV has shifted resources from the traditional medical system
to "Barrio Adentro." Resource-starved public hospitals are
beginning to show the effects of years of neglect. Mismanagement
has increased as military officers and community council
members-usually with little previous experience in health care-have
assumed a greater role in the administration of public hospitals.
At the same time, the hospitals suffer from the same problems that
plague the rest of Venezuelan society, including the deterioration
of infrastructure, an increase in crime, and the flight of the
professional class. Despite these issues, President Chavez and
other members of his cabinet have not publicly acknowledged the
deterioration of the public hospitals or announced any new plans to
revitalize them. To the extent that President Chavez has
acknowledged Venezuela's health care crisis, the GBRV has looked to
"Barrio Adentro" and Cuba-and not the public hospitals-as the
solution.



¶15. (C) Meanwhile, "Barrio Adentro" has not proven to be a viable
substitute for the public hospitals despite massive GBRV attention
and investment. Indeed, the evidence suggests that all classes of
Venezuelans continue to prefer public hospitals to "Barrio
Adentro," even as the quality of medical services in the former has
deteriorated. The popular preference for public hospitals means
that the traditional medical system must treat a growing number of
patients with dwindling resources, a problem that will only
intensify if the GBRV decides to eliminate the health care benefit
for public employees, forcing them out of the private clinics and
into the public hospitals. Another possible consequence is the
risk that the GBRV will look to expropriate private sector medical
facilities.
DUDDY