When populism takes over the delivery of :

Sunil Daryanani

Yeovil General Hospital NHS Foundation Trust, Somerset BA21 4AT, UK and Hospital de Clínicas Caracas, Consultorio 304, Avenida Panteón, San Bernardino, Caracas 1011, Venezuela

Corresponding author: Sunil Daryanani. E-mail: [email protected]

Abstract

Adequate and modern health care is not available in Venezuela at this moment. A humanitarian crisis of post war dimensions is currently rampant and afflicting all Venezuelans alike. The delivery and availability of cancer care is severely limited and inadequate. No funding is available as populist measures, mismanagement, pillaging, corruption, lack of forethought and expertise have brought the country into severe economic collapse and political turmoil.

Keywords: health care, Venezuela, populism, cancer

(Cont.) Editorial

Published: 23/11/2017 Received: 13/07/2017 ecancer 2017, 11:ed73 https://doi.org/10.3332/ecancer.2017.ed73

Copyright: © the authors; licensee ecancermedicalscience. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

1 private medicine.Overtheyears, withfurtherandgreaterinvestmentintheprivatesectorthis managedtooutranktheothertwopublicoptions. ago patientsfavouredundergoingcomplexanddelicateprocedures inbothpublicandIVSShospitalsattendedclinicsoutpatients lano de los Seguros Sociales, IVSS) and a private health system that comprises both small and large hospitals and private offices. Over 50 years Health careinVenezuela issplitintothreesystems:apublicsystemopentoallcomers, NationalInsurancesystem(namedInstitutoVenezo- this reportcreatedalarmworldwide Furthermore, indicatorspertainingto child andmaternalmortality (grossly under-reportedas all official figuresare)hadgreatlyincreased; such asmalaria that confirmed thatconditions Bulletin Epidemiological Recently a now dismissedHealth to Minister knownfor the her allegiance political regimeauthorisedtheof publication a much delayed famine wasalreadyevident the Foodand a prizetoVenezuelaof the UnitedNationsawarded Agriculture Organization over two yearsagoonfeedinginitiativeswhen data tothepointthat misconstrued using with adataembargo) at all (or notpublished or published falsified been misused, tors haveall Over fifteen healthministershavebeennamedto head theMinistryof Health inthesealmosttwodecades.Statisticsandhealthindica care inVenezuelahealth In thelasttwodecades bonanza. economical dwindling, albeit its enormous, even furtherdespite has dwindled Health careinVenezuela exchange forfreeoilandotherprivileges. profferedrole, wasCubawhowiththegreatadmiration this, andinarathersurreptitious Behind byChavezoffered helpandassistancein of halfthecountry.the discontent and violence laws, growing and prevalent to theConstitution disrespect takeovers, repeated measures, da Silva)wonthe favour andadmirationof the western world.Unfortunatelythe world at economic large turnedits back onunconventional Lula disgraced by thenow (driven to Brazil reforms similar of social by theintroduction dramatically the landscape changing began money) ethics thaneasy (with nootherworkormoral an arrayofallies level), historic at amaximum prices (oil a fullpurse to politics, approach masses oftheVenezuelanof aforgottenfewwonthefavourgeneral backing by hisratherunconventional Blinded underprivileged. Right inthe middle of this cultural andhistoricalmélangeemergedthe figure of Hugo Chávez(1954-2013)whowithcharismaandthe Third World countryallwithina few metresofeachother. by its wealth and work opportunities. A country of multiple contrasts, it showed elementsof the First World interspersedwithelements of a the crown’ forthewholesubregion(fromMexicoto Argentina) andanenormousinfluxofimmigrantsmadethistheirnewhome,attracted was oneofbuoyancy,scenario the general backdrop this ratherincongruous Despite Venezuelaand wellbeing. wealth in the ‘jewel became ations ofpoliticiansdeliveredemptypromises,certainsocialprogrammeswereinstituted,butalas,notavailabletoalland withlimitedcover. Certain social inequalitieswereevident. A significant segment of the population lackedaccessto health care,education and housing. Gener- its proudtransformation. to returnVenezuelabut alwaysplanned abroad the slightestintentofremaining students neverharboured Postgraduate and bepartof to train abroadat aswellopportunitiesandscholarships centres of university education excellence: thiswasacountrywithnoparallel. beauty andmostlyfreehighquality perfect weatherwithnatural in theregion, democracy running position, thelongest geographical leged possible. all seemed kilometres square less thanamillion the highestoilreservesareconcentratedunderslightly Aoil price,aprivi- rising time) seemeddestinedto In forge a a country great infrastructuremannedbyawealthofhighlytrainedandcommittedindividuals. where Being bothVenezuelan bornaswelleducatedandtrainedintheVenezuelansystem morethanthirtyyearsago,thecountry(atthat the worldaregoingthroughsimilarbarbaricsituations,suchasSyria decades. Ais currentlyrampantandafflictingcrisis ofpostwardimensions humanitarian Venezuelans all alike this isnotanewproblemorcrisis.Venezuelanand healthcarehavebeenafflictedmedicine byascourgeofproblemsformorethantwo and fifty deaths arisingfrom these protestsdueto of government measures public inconformityandoppositionto late, unconstitutional unease, withmorethanahundred crisis extendingformanymonthswithriotsandgeneral medical pressandthelayofanongoing Adequate andmodernhealthcaredeliveryat this momentisnotinVenezuela.existent oravailable Despiterecentcoverageinboththe Background andpoliticalscenario [3–4]. [6]. 2 www.ecancer.org [2], andtheworldremainsexpectantparalysed. , diphtheria and , among others,wererampant. and tuberculosis, [5], diphtheria [1]. Sadly,in othercountries ecancer 2017,11 (Cont.) :ed73 -

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HER2 status. treatment regimesincompleteorimpossibletoadminister. Patientswithbreastcancer couldoptfortrastuzumabwithoutknowledgeof drugs suchas5-FluorouracilorLeucovorin,basic suchasplatinumsaltsordoxorubicin,werescarceunavailable,rendering sibility ofappraisalresponseorsurgeryformetastaticdisease. Moreoftenthannotmonoclonalantibodieswereavailablebutsimple imaging (CT orMRIscans)butpatientsweregettingstate-of-the-artchemotherapyregimensforadvanced colorectalcancerwithnopos- hospitals didnot(andstilldonot)havethepossibilityof carrying outbasicimmunohistochemistrystainsontissuesamplesorproper HIV drugsand all new and expensivedrugs were dished out without much more thanahandwritten medical prescription. Public cancer Alto Costo,High-costmedicines)whichwastheenvyofmuch ofthecontinent.Monoclonalantibodies,tyrosinekinaseinhibitors,anti- In apopulistmove,Chávezpromotedandrevampedprogramme offreecancerdrugstoallVenezuelans andresidents(Medicinasde Cancer careinVenezuela minimal presenceandnostaff. firms havehadtoadaptfromVenezuelaable. Majorpharmaceutical the mostimportantmarketinLatin being America tojusthavinga Medicines arevery difficult to obtain. Essentialantibiotics,contraceptivepills,analgesics,anddrugsfor high bloodpressurearenot avail 80 timesoverthatprice[9].Disparitiesarethenorm.Itisawaytosubjugategeneralpublic. foodstuffsbasis assomebasic daily at theofficial areavailable at theunofficialother articlesareimported rate and is morethan rate which Hunger isthenormwithseveralseriousstudiesreportingat least aneightkilogrammelossamongadults[8]. Long queuesareseenona Currently, theminimumwageisUSD12amonth. The countryisinadesperatesituation. academic establishment[7]. Inflation isthehighestinworld,anddespitegovernmentwidespreadcensorship,itover700%annually. but todemonstratecontemptanddisrespectthe hordes withnootherintention paramilitary by government were ransackedandpillaged places on Earth, and furthermore impunity is the rule with lessthan5%of violent crimesinvestigated. Recently, the National Academies this, Notwithstanding the general publicis exposed to rampant crimeandviolencewhichhasmadeVenezuela oneof the most violent supplies. This isthesortofsituationwhichnooneinmostruralanddeprivedsettingswesternworldlikelytoface. in thecountry,hospital University mum. Inthelargest to offerare powerless as hospitals supplies medical sell in thecorridors vendors basic are down toamini- supplies are bare.Stocksofmedical care.Hospitals arenotabletoobtainadequate Patients withcomplexconditions and foodavailability.care provision is health standpoint, to thissituation,fromamedical Central illnesses. from common Patientsaredying last threeyears,thepaperworkandpossibilityofobtainingfundsisvirtuallyinexistentmakingforeigntravelalmost impossible. chases. Currently,and thereforeunlawful. illegal of foreigncurrencybyanyothermeansisconsidered Any furtheracquisition and forthe Venezuelanup amaximumofUSD2,500fortravelperyearand150 for use oninternetpur- many yearswereallowed nationals policies. ing countriesanditsinternalindustrialapparatushasbeenchronicallystrippeddismantledbytheChavismoerraticeconomic has forcedthedevelopmentofablackmarkettoobtainforeigncurrency. Venezuela reliesbasicallyonimportsasbefitsmostoilexport- is allowedanyforeignfundsundertheofficial exchangerateunlesstheyarechosenassympathisersoralliesofthegovernment. This For overfifteenyearsforeignexchangehasbeenunderthetightcontrolofcentralgovernment.Noentity, eitherprivateorcorporate, takeovers, asilentstalematewasreached. and hostile overt threatsofappropriation and despite outright onprivatemedicine movement) depended (i.e. Chavez´s The Chavismo circumstances. with cancerandchosetobetreatedinCubaunderverymysteriousundisclosed system whendiagnosed own medical health careinprivatehospitalsthanpublicstatehospitals.Chávezhimselfdidnotresorttohis munist/socialist adeptspreferredreceiving private healthcaresystem. attacked theprivatehealthcaresystembutashehimselfnoted,hiscom- At acertainmoment,Chavezopenly to sufferin theprocessbegan and thebatonofhealthwastakenoverby as rampantcorruption shortages andcutsaswell frombudget care. PublicandIVSShospitals specialised all thewaytohighly system withprimarycarerunning against theestablished years oftraining ‘Barrio Adentro’out doctorsafterthree churning universities new and the slums’) inside ‘Deep imply would which translated programme ‘revolutionary’be hisnew what would he corralled torule As Chavezbegan care system(the primary care systemwithaparallel health 3 www.ecancer.org ecancer 2017,11 (Cont.) :ed73 -

Editorial 10. References cancer patientsaresomeofitsmajorvictims. averted if a solidhealthcaresystem with its overseers hadbeeninplace. crisis isenormous and The deathtollof the currenthumanitarian of theVenezuelansplight The desperate have been that could one crisis and induced as apolitically and reported to bepublicised needs be solidandnotsubmittedtofrailtymismanagement. care isarightofall.Healthsystemsshould The accesstopropermedical like this. Many lessonscouldbelearntfromthisandnoothercountryorsociety intheworldshouldeverhaveto go throughanything happened. offeredcare. ofhealth standard system withareasonable medical anadequate not have that should experiment This isthesortofsocial be afewyearsuntilVenezuelansgovernment, itwill based there beaturntodemocratic Even inthebestofcircumstances,should are Conclusion with dignityasweknowit. A humanitariancrisisisbeingignoredandbasichumanrightsareviolated. Cancer careinVenezuelaincompatible care toadegree to treatmentandend-of-life to diagnosis from prevention disjointed is severely any ongoingcrises. are notavailable.Despitetheevidence,governmentanditsofficials continuetoadvertiseandreportthatallisnormalblatantlydeny Patients areresortingtoalternativeornaturalremediesreligioninsomecasesforcomfortastreatments,medicalsuppliesandprocedures Cancer patientsaremoreoftenthannothavingtostoptreatmentorbuyimporttheirmedicationsatunmanageablecoststhem[10]. and currentlycompanieshavehadtoabsorbmultimilliondebtsstopimports. overarching giant that marketing strategies hadnootheroptionthanto place productsdirectlywiththe government. Paymentwasdelayed their othermarketingallies. andneglected sold alltheirimportstothegovernment companies Pharmaceutical The statebecamesuchan 4. 9. 7. 6. 5. 3. 2. 1. 8. uk T (2017) TK Burki weight statusinperi-urbanVenezuela JNutr142 1343–1349 J etal(2012) Bernal Venezuela 2016 Landaeta-Jiménez M Goihman M(2017) Fraser B(2017)DatarevealstateofVenezuelan healthsystemLancet3892095 Malar J16273–291 Recht Jetal(2017) (In Spanish. Abstract inEnglish) Herrera M(2016)Conflictodeinterésointeresesenconflicto,transparencialaobtenciónyanálisisdatoscientíficos http://www.fao.org/venezuela/noticias/detail-events/en/c/346201/ Sahloul E Bello RJetal(2017)Venezuela’s health-carecrisis et al(2016)Cancercareattimesofcrisisandwar:theSyrianexample Ongoing drugsshortageinVenezuela andeffectsoncancercare http://www.ovsalud.org/publicaciones/alimentacion/ An assaulttotheNationalacademiesofVenezuela ClinDermatol Children live, feel, and respond to experiences of food insecurity thatcompromisetheirdevelopmentand Childrenlive,feel,andrespondtoexperiences MalariainBrazil,Colombia, Peru andVenezuela: currentchallengesin controlandelimination et al(2016)ENCOVI:Encuesta nacional decondicionesvida(inSpanish). Accessed on October 24th 2017 An Venez Nutr 29 18–30 Lancet390551 4 www.ecancer.org JGlobalOncol LancetOncol 35(3)340 18578 3338–345 ecancer 2017,11 :ed73

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