Original art by @modográfico

It rang in the middle of the night. Half-asleep, I grabbed my phone, vaguely aware that whatever was on the other side couldn’t be good. A call at four in the morning never is.

Unknown number. Ugh. I hit the little green icon.

“There’s been an accident!” It took a while for it to register. The woman’s voice was disturbed, frustrated and scared. “We have no power and one of the victims is being brought here!”

“Who is this?” I asked, fearing the worst.

It was the Medical Director of an IVSS hospital. I’d never talked to her before, but it was a plea for help.

“Slow down, what’s the emergency?”

The driver on a car accident, a man in his late 20s, got caught on the wreckage of the burning vehicle until firefighters and medical responders pulled him out. He got to the hospital with over 60% of his body burned, badly, still alive but hanging by a thread.

In this situation, the last thing you want to see is an ER darker than the darkest black, cut by little shards of light coming from cell phones. I was not given his name. It was the description of a faceless victim.

“We have no electricity” cried the voice on the phone, “the generator won’t turn on and the back-up is stuck! What do we do?”

“Wait up a bit, maybe it’s just a flick in the grid and you’ll get power again soon” I said.

“We haven’t gotten any power in more than 72 hours. We can’t work like this and this young man is going to die.”

These generators are supposed to be back-up, but it’s Venezuela: they’re on all the time. After two years of service around the clock, the engine gave up.

“Who is this?”

I grabbed my landline and called a group of colleagues who live 20 minutes from the hospital. They got there in 15, ran to the generator and began doing what they could.

It was pointless. These generators are supposed to be back-up, but it’s Venezuela: they’re on all the time. After two years of service around the clock, the engine gave up.

Half an hour later, the Director approached my team. “Go home guys. The patient is dead.”

The official report: a man died in the ICU due to his injuries.

The reality: doctors couldn’t even see their hands in front of their faces. The man died suffering on a bed, waiting for an ambulance. The family was never told the grim truth.

The New Dark Ages

My job is to keep hospital generators running. I’m supposed to go around the country arranging maintenance visits at IVSS medical facilities, so the backup generators don’t break down and people die in the dark, like this guy in the inner country. I deal with big hospitals, mid-sized hospitals, little hospitals. With generators as big as power stations and small as suitcases. I’ve seen it all.

My advice: don’t have emergencies at night. It’s a game of roulette. Some hospitals are dark carcasses where medical professionals pace around aimlessly; without electricity there’s no lights, no elevators and no medical equipment.

Almost half of the IVSS hospitals nationwide rely solely on generators. Even the ones nominally on the grid end up running them around the clock, since the CORPOELEC service is so unreliable. Most generators are designed to work like this, but not without maintenance. Orders from “on high” are to run the generators full time, but they don’t do any maintenance on them, so roughly 15% are broken, another 20% in dire need of maintenance with almost two years of delay. For the rest, it’s funny: either the maintenance work is half-assed (because the State expects contractors and private companies to absorb the added expenses), or are in Caracas, where the IVSS engineer can visit and Nicolás himself does his press conferences – the capital is considered a priority and the rest of Venezuela is attended with leftovers.

Juking the Stats

For years, IVSS – the creaking old Venezuelan Social Security Hospital Administration – was run by Lieutenant Colonel Carlos Rotondaro. Late last year, he was replaced by Luis Salerfi López Chejade, a pharmacist. What do they have in common? Neither is known for taking bad news calmly.

The administrative culture at IVSS is screwed up beyond words. Administrators are under enormous pressure to show results, so they juke the stats: forged documents, falsified data and inaccurate results are the norm, not the exception. According to Dr. Huníades Urbina Medina, president of the Venezuelan Society of Childcare and Pediatrics, “in some hospitals, the clinical diagnosis of malnutrition has been banned.”

In Caracas the IVSS engineer can visit and Nicolás himself does his press conferences – the capital is considered a priority and the rest of Venezuela is attended with leftovers.

The code of Omertà is ruthlessly enforced. Opening your mouth and getting fired is only the beginning of your troubles. You might get cut off from CLAPs deliveries, from misión benefits or you might get a visit from your friendly neighborhood colectivo. Leak any embarrassing information about the state of IVSS hospitals and what you set off isn’t reform: it’s a witch hunt and certain, dire retribution. Last year, when Antonieta Caporale, Minister of Health, released the official epidemiological bulletin, she got fired publicly in the middle of a cadena by the Head of the State.

When images of the Domingo Luciani hospital leaked, IVSS’s flagship hospital, showing ghostly kids with ribs popping out of their rib cages, it was Twitter and word-of-mouth what leaked the truth. On a technical visit, I had a messed-up encounter; the shirts we use are the same color as the IVSS people. Looking at the malnourished children that morning, a “This is worse than I thought” escaped my mouth.

“You have no idea how bad it is” a nurse told me, as she passed me by. “For every kid reported daily in dangerous malnutrition, there are at least 8 more unreported.”

Everything is done so administrators can keep up appearances.

In the IVSS J.M. De Los Ríos hospital, the number of infants with malnutrition tripled, reaching about 110 cases according to Ingrid Soto, Chief of the Service for Nutrition, Growth and Development. Meanwhile, the INN (Instituto Nacional de Nutricion) showed none. This is in Caracas; how many cases are we talking about when we look at the rest of the country?

How many more families have gotten the “we did all we could” treatment, while their relatives agonized in the dark?

The government is engaged in a far-reaching conspiracy to suppress the true scale of the health crisis. The entire health system – from outpatient clinics to hospitals – has been turned into a restricted military zone to keep journalists, NGO activists and anyone else who may be looking to verify the true extent of the crisis out and quiet.

Changeover

When presidency of the IVSS changed hands last winter, our already crippled hospital system went from technical paralysis to complete stop. An epic “quítate tu pa’ ponerme yo” went down.

Luis Salerfi, the new director, pushed out all the Rotondaro people, to put his cronies in. Any order given by the previous administration was cancelled and activities were suspended until further notice. It’s now late January 2018, and the situation hasn’t changed. The new boss refuses to receive or sign orders, documents or contracts if they are not delivered to his house or office at the Ministry of Health, slowing down an already delicate process.

I see the results in the system I know intimately. For nearly four months, there’s been basically no maintenance on the overburdened generators hospitals depend on. How many more families have gotten the “we did all we could” treatment, while their relatives agonized in the dark?

Warehouses

The solution for a least half of these problems is gathering dust at IVSS Warehouses. I’ve seen them. Stacked in neat rows, organized at leisure and lazily recorded, IVSS has at least 60 medical beds, 30 dialysis machines, top of the line X-Rays equipment, artificial lungs, blood purifiers and gallons of antiseptic iodine. None of it can be moved without the IVSS President’s say so. And the order never seems to come.

Meanwhile, Maduro’s favorite, Delcy Rodriguez, faced an international reporter with the words “there’s no crisis in Venezuela”, ignoring how the supply of hospital beds went from 47,000 to 18,000 in less than six months.

Malaria takes a hold inside the territory, hospitals work with less than 5% of supplies and medicines, as Caritas Venezuela, breaking under the fence of military silence, reports that, in parishes at risk, 11.4% of children under 5 are suffering from acute malnutrition.

And the numbers keep piling up.