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WSJ

Venezuela’s Health Crisis Is Crossing the Border

martes, 6 de noviembre de 2018

WSJ

By Luciana Magalhaes and Juan Forero

Contagion from Venezuela’s economic meltdown is starting to spread to neighboring countries-not financially, but literally, in the form of potentially deadly diseases carried among millions of refugees.

The collapse of Venezuela’s health system has turned what was once Latin America’s richest nation into an incubator for malaria, yellow fever, diphtheria, dengue and tuberculosis, as well as the virus that causes AIDS, medical officials in Brazil, Colombia and Venezuela told The Wall Street Journal.
The diseases, many of which had been considered all but eradicated, are now cropping up beyond Venezuela’s borders-including in this Amazon city 600 miles away.

Earlier this year, Elainy Portela watched with alarm as measles reappeared with a vengeance. Telltale red rashes covered six children near her home in Manaus, just off the highway used by Venezuelans escaping misery at home.
The highly contagious airborne disease was declared vanquished here 18 years ago. In March, the city had four possible cases. But by early October, there were nearly 1,000 people with measles here and about 2,000 total for this state, Amazonas, and in neighboring Roraima, all having originated with infected Venezuelans who crossed into Brazil, the Health Ministry said. Twelve people have died.

“I understand that Venezuelans are not coming here out of choice, but we need to think of our own protection, too,” said Ms. Portela, who worries about her 18-month-old daughter because of her penchant for hugging strangers. “It makes me scared.”

Measles is already spreading beyond the Brazilian Amazon to other Brazilian states, as well as Colombia, Peru and as far south as Argentina, according to recent Pan American Health Organization reports. Other diseases racing through communities in Venezuela are now crossing borders and raising concerns among health authorities as far away as the U.S.

“Individuals who are forced to exit the country without proper medical care can transmit a million different things, or have the potential to trigger an outbreak that no one can predict but that will eventually occur,” said Dr. Irene Bosch, a research scientist who has studied infectious diseases in Colombia and Venezuela with the U.S. National Institutes of Health. “It is a perfect storm condition for a catastrophic medical situation.”

In Venezuela, a collapsing economy that has contracted by half since 2013 has resulted in widespread hunger, power blackouts and a dearth of basic services, like water delivery. Once a leader in the Americas in disease prevention, the country has seen its public health care system deteriorate to the point where hospitals are unable to provide basic services or medicines. Health officials in many parts of Venezuela no longer offer children the full cycle of vaccinations that were once given, doctors in Venezuela say. And the government long ago scaled back campaigns to fumigate against disease-carrying mosquitoes.

The resulting spread of infectious disease inside of Venezuela has distressed doctors who have watched, powerless, as the number of people who are afflicted in that country dwarfs that of Venezuela’s neighbors.

“In Venezuela there are at least three epidemics at work, measles, diphtheria and malaria. The crisis is big,” said Dr. Alejandro Risquez, who teaches medicine at University Hospital in Caracas and is an expert on infectious diseases and vaccination programs. He noted that there are even concurrent epidemics, with people suffering from more than one contagious disease at one time.

President Nicolás Maduro and his top aides deny the health-care system is in distress and charge that critics are fabricating horror stories to justify a foreign intervention.

Doctors who have publicly exposed the state of public health have been fired and threatened with arrest. The government stopped regularly publishing health and mortality statistics in 2015, save for a rare release last year of a Health Ministry bulletin that showed that infant and maternal mortality had shot up. Calls and emails seeking elaboration from health authorities in Mr. Maduro’s government weren’t answered.

“Here there is total secrecy,” said Dr. Maria Alejandra Rosas, an infectologist and pediatrician at Central Hospital in the Venezuelan city of Valencia. “There’s a epidemiological blackout to shut us up, so the information doesn’t get out.”
The ramifications of the dire state of health services in Venezuela are readily apparent in the emergency rooms and medical posts of northern Brazil and eastern Colombia, where many of the 2.3 million Venezuelans who have fled the country since 2014 first arrived.

In Brazil’s border town of Pacaraima, population 16,000, about 180 of the roughly 700 Venezuelans who cross into the country daily line up for free vaccinations at a small health post.

Carrying their worldly belongings in garbage bags or rolling suitcases, many of the Venezuelans arrive seeking treatment. Members of indigenous Venezuelan communities are especially vulnerable and difficult to care for. Some have run from Brazilian health officials, fearful of needles and hospitals, officials said.

“They arrive malnourished, weak, and only then we discover they are sick,” said Sandra Palomino, a coordinator at a center that cares for indigenous migrants.

Javier Perez, 34, arrived from Venezuela last year with tuberculosis, but he didn’t know what his painful cough was until Brazilian doctors examined him. By that time, he had passed the disease on to his twin sons, who had been born in Brazil. One died.

“It started out like flu, with a cough and blood,” said Mr. Perez, speaking at a shelter for indigenous Venezuelans in the Roraima state capital of Boa Vista, where children with measles and chickenpox were running around.

In the border town of Cúcuta, Colombia, Yendy Pereira, 24, arrived from Venezuela with her children. Ms. Pereira’s boy, Cesar, 3, and the 4-year-old girl, Estafani, hadn’t had shots for tuberculosis and tetanus, but she knew Colombian authorities and aid groups vaccinate Venezuelans. “I told my husband, let’s do it for the kids,” she said. “The main reason was for the vaccines-that and the food for them.”

On a typical day in Cúcuta’s overtaxed main hospital, Erasmo Meoz, up to 40% of those seeking assistance in the emergency room are from Venezuela, hospital authorities say. Some have the hacking cough of tuberculosis while others come with malaria.

Increasingly, doctors see patients with HIV, like Genesis Carmen Moreno, 27. She lay on a recent afternoon on a gurney in the hospital’s crowded ER and recounted how she was brought to Colombia so she could receive the antiretroviral drugs she couldn’t get in her home city, Maracaibo. A stout 180 pounds when she had been healthy, Ms. Moreno was down to 79 pounds.

“I would have lasted a little bit more, a few days more, over there in Venezuela,” said Ms. Moreno, showing off a picture of herself before she fell ill. “I would have died because I could feel the strength leaving me.”

Doctors warn that the situation won’t be getting better soon since the exodus of Venezuelans to neighboring countries is gaining momentum. Colombia’s government estimates that anywhere from 1.8 to 4 million Venezuelans are expected to arrive in that country by 2021.

While doctors in Colombia have been grappling with infected Venezuelans, it is here in northern Brazil where the swift spread of measles has been particularly pronounced.

On a recent morning, in a small hospital in Pacaraima on the Venezuelan border, Venezuelan children and their parents, suffering from measles and malaria, sat side by side in a small waiting room while a young doctor attended them.

“We think things like this happen only in Africa,” said Dr. Jessica Almeida, while pointing to an almost skeletal Venezuelan woman who lay on a bed. She had lost more than 65 pounds, and Dr. Almeida said tests needed to be performed to determine exactly why.

The doctor also dealt with a Venezuelan baby, Valery, who had been rushed across the border with spots all over her body, a sign of measles. She cried uncontrollably while her mother tried to calm her down.
“There are many diseases where we came from,” said the mother, Katherine Bellezia, 24, who said she was considering staying in Brazil for the sake of the baby.

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