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Venezuela’s Once Excellent Public Hospitals in Steep Decline

July 21, 1996

CARACAS, Venezuela (AP) _ Doctors figured Tony Gonzalez had a ``50-50″ chance of surviving when he arrived at Lidice public hospital with a bullet in his head. As it turned out, he had no chance at all.

The 20-year-old was wounded in a drive-by shooting in a rough suburban neighborhood. His family rushed him to Lidice after a closer public hospital, Periferico de Catia, refused to admit him for lack of equipment and medicine.

At Lidice, doctors also decided not to operate, for the same reason. After waiting nearly an hour outside the emergency room, Gonzalez died.

His mother, wild with grief, stood in the hall screaming at the doctors for not helping her son. Police eventually escorted her out.

``If hospitals were working properly, my son ... would be alive,″ a weeping Aura Josefina Gonzalez said in a later interview.

Dr. Juan Bastida, who was in charge of Lidice’s emergency room that night, seemed numb as he confirmed the details. ``It’s rare when you can operate,″ he said. ``You feel helpless.″

Venezuela’s public hospitals were among the best in South America two decades ago when world prices for oil, the main export, boomed. Even middle-class professionals wouldn’t think twice about using them for surgery as well as routine sicknesses and emergency care.

These days, only patients with no alternative would go to one of the approximately 300 public hospitals nationwide, most of which are in difficult straits. People who can afford it go to private hospitals and clinics, where the quality of care remains good.

Financing for public hospitals has been eroded by inflation, and mismanagement linked to union featherbedding, political patronage and corruption is rampant.

At 70-bed Perez de Leon Hospital in the Caracas municipality of Sucre, the money budgeted for 1996 ran out in May. Mayor Raoul Bermudez moved his office there in June to keep it from closing.

``I found the Tower of Babel,″ Bermudez said, meaning chaos on a biblical scale.

Staff stole medicine for resale to patients, who are obliged to provide the most basic supplies, such as gauze, aspirin, surgical gloves, bedsheets and food.

Cooks, doormen, elevator operators, drivers, janitors and other support staff, many put there by political parties or unions, outnumber doctors and nurses by nearly 4-to-1. There were four gardeners and no garden.

Security was nonexistent. Gang members more than once walked in, executed wounded rivals, and walked out. Vagrants came in off the street.

Two much larger public hospitals in Caracas _ Los Magallanes and Miguel Perez Carreno _ partially shut down in May due to lack of medicine and supplies as well as broken equipment.

Dr. Serafin Alvarez, head resident at Los Magallanes, is one of many medical professionals who allege that much of the public health budget dribbles away on bribes, kickbacks and illegal contracts.

The Health Ministry does not deny the multitude of problems at public hospitals, but links them to Venezuela’s struggling economy, which has been in recession for most of the past four years.

The national budget for the 198 hospitals and 27,000 beds that the ministry manages has remained stuck at 193 billion bolivars since 1994, said Marcos Gamez, the ministry’s director of technical services.

During that time, prices soared 300 percent, the highest inflation rate in Latin America. That means the purchasing power of that stagnant budget _ now equivalent to about $410 million _ is less than a third of what it was just three years ago.

Public hospitals run by municipalities, states and the national social security system have not fared much better.

Doctors’ salaries also have plummeted.

``When I graduated from medical school 15 years ago, I was earning (the equivalent of) $1,200 a month. Now I’m a specialist and I earn $100 a month,″ said Dr. Julio Cesar Alvarez.

Eight of every 10 Venezuelans live near the poverty line and must rely on public hospitals. But going there ``means flirting with death,″ said Douglas Arias, a museum security guard.

Arias has lain on a bed at Miguel Perez Carreno hospital since April 18 with a bullet in his leg. He was shot during a stick-up at a bus stop on the way to work. He needs to have the bullet removed and then rods and plates attached to his thigh bone, which was broken in three places.

However, the state-run health insurance program is near bankruptcy and cannot buy the pieces. Nor can Arias. The $960 price tag represents nearly his entire pay for a year.

A potential solution may be giving more control to local staffs, said Dr. Rafael Ramos, who gave up part of his private practice at Caracas Clinic, a good private facility, to take charge of the emergency room at Jose Gregorio Hernandez public hospital.

In the pilot project organized by the governor of the federal district that includes Caracas, Ramos saved money, reduced waste and improved efficiency by purchasing only necessary medicine and supplies, closely supervising workers and reassigning them from superfluous jobs.

For now, though, most doctors feel adrift. They are haunted by memories of the patients they could not help like Tony Gonzalez.

Bastida said he can’t forget Mrs. Gonzalez’s piercing screams as she was ushered out of the emergency room: ``Why did you let my son die?″

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