CARACAS, Venezuela — In the crowded waiting room of the Vargas de Caracas hospital, the walls are decorated with peppy pro-government slogans: “It’s only possible with socialism.”
But the Zika epidemic has struck as the socialist-ruled country is spiraling into economic chaos and the public health system has been stripped of many basic tools of modern medicine. Hospital patients get wheeled past closets overflowing with trash. Stray dogs wander the hospital grounds. Doctors perform surgery without sutures and gauze.
“Little by little, medical care is disappearing,” one doctor said.
Lisseth Salas arrived at Vargas de Caracas in a state of partial paralysis, suffering from Guillain-Barré syndrome, which has been linked to Zika. Two other hospitals had denied her service — one because it had no neurologists, another because she wasn’t in the military. As she has recovered, Salas has lacked the immunoglobulin treatment her doctors would prefer to use.
“We haven’t had absolutely any of it all year,” said Sabrina Maldera, an internal medicine resident at the hospital. “We’re trying to treat patients with our hands tied.”
In the Latin American fight against the Zika virus, Venezuela stands apart. While other nations bombard their airwaves with public-service warnings about mosquitoes and publish tallies of new cases, Venezuela has played down the epidemic and choked off information about its spread. For more than a year, President Nicolás Maduro’s government has refused to release its weekly epidemiological bulletin, just as it has hidden statistics on inflation and the homicide rate.
Public health experts and doctors believe that the government is dramatically lowballing the Zika toll, which officially stands at around 5,000 cases. Some independent experts estimate that there have been more than half a million cases of the mosquito-borne disease, which would give Venezuela the second-largest Zika total behind Brazil. The government has acknowledged 255 cases of the rare Guillain-Barré syndrome since Zika arrived last year, more than twice the number in neighboring Colombia. The Venezuelan government has reported three Zika-related deaths, although it has not provided details.
Former health minister José Félix Oletta said Venezuela is still in the “ascent phase of the epidemic wave.”
“Venezuela is showing the perfect scenario for how not to do things, in health,” said Oletta, who is part of an independent medical network that estimates there have been 412,000 Zika cases. “If you don’t establish good communications, the first thing that grows isn’t the epidemic, it’s the fear, the panic.”
Health experts believe that Zika arrived in this oil-producing country sometime last year, crossing the porous Amazonian border with Brazil. The Aedes mosquito that carries the virus is common here: Venezuela has suffered outbreaks in recent years of dengue and chikungunya, viruses that are also spread by the insect. Unlike Brazil, Venezuela so far has not seen a spike in cases of microcephaly, a birth defect that results in a baby having an unusually small head and can cause seizures and developmental delays. But doctors say such cases could hit as soon as April, when mothers infected by Zika over the summer start giving birth.
Last month, Venezuela’s new opposition-controlled National Assembly declared that the health system, with its shortages of medicine and equipment, had created a humanitarian crisis.
“The system isn’t prepared,” said José Manuel Olivares, an oncologist and opposition lawmaker who heads the health commission in the National Assembly.
Public hospitals in Caracas look worn and disheveled, with graffiti-tagged walls and broken windows. As crowds look on, relatives hoist their wounded out of cars and carry them on blood-stained stretchers or roll them in dented wheelchairs past soldiers guarding the doors.
The ninth floor of the University Clinic hospital, one of the country’s largest, has become a makeshift pediatric ward, because the air conditioners broke last fall on the floor designed to treat children. Doctors there say they have shortages of lab tubes, catheters, inhalation masks, X-rays, suction hoses and antibiotics. The hospital last week was treating 12 Guillain-Barré patients, more than at any time that doctors could remember. Two patients have already died. “This is totally unusual,” said one doctor, who spoke on the condition of anonymity for fear of retribution. “Every day new Guillain-Barré cases are coming in.”
Most of these patients get treated by plasmapheresis, a blood-filtering process akin to dialysis that involves being hooked to a machine for several hours over the course of a week. The hospital had to ration its immunoglobulin because there was not enough for all the patients. Starting in the late 1990s, Venezuela produced its own immunoglobulin, at a company called Quimbiotec. But that company ceased production last year as the country’s economic crisis worsened, compounded by falling oil prices and the government’s price and currency controls. The government now imports the substance.
Former health minister Rafael Orihuela, who like Oletta served before Maduro’s socialist-inspired party came to power in 1999, said Venezuela has fewer than 300 hospital beds in functioning intensive-care units. He expects the Zika outbreak could cause 3,000 Guillain-Barré cases.
“This is a true problem,” he said.
Even for a normal case of Zika, which can involve a mild fever, a rash and joint pain, doctors say they are hamstrung. Many hospitals and pharmacies lack basic acetaminophen, the pain reliever sold in medications such as Tylenol. Residents have to scour the black market for scarce materials such as mosquito nets or repellant. Women who might fear getting pregnant during a time of microcephaly risk can’t find birth control at pharmacies.
“How do we do family planning if there is no birth control or condoms?” asked Oletta, the former health minister. “The solution will be abortion.” But abortion is illegal in Venezuela in most cases.
The Zika outbreak has exposed in the public health sector the kinds of stories of misinformation, scarcity and government mismanagement seen in other parts of Venezuelan life.
“It’s a microcosm of the whole country,” David Smilde, a professor of sociology at Tulane University who has researched Venezuela for two decades. “You have a government that doesn’t value transparency. You have a medical system in collapse.”
“It’s like a worst-case scenario,” added Smilde, who contracted Zika himself while in the country in January.
Freddy Ceballos, president of the Venezuelan Pharmaceutical Federation, said pharmacies lack 80 percent of their normal products.
“The situation is exceedingly grave,” he said. “It has to be the president of the republic who assumes responsibility for these problems.”
There is some mosquito fumigation in the capital, but residents say municipal officials are now rationing it, targeting houses with confirmed Zika cases. Thousands of doctors have left the country, seeking better wages and services. One young doctor said he earned 32,000 bolivares a month, about $30 at the current black-market exchange rate.
“We’re not prepared for any type of emergency. We can’t even handle normal medical problems,” the doctor said, speaking on the condition of anonymity because he was not authorized to give an interview. “This is like Africa here now. This is the real Third World.”
Julio Castro, an infectious-disease specialist at the Central University of Venezuela, has resorted to using social networks to try to understand the scope of the Zika outbreak, because of the absence of official statistics. He has graphed Google searches for Zika and is planning a Twitter campaign with a Zika hashtag to try to understand the geographic breakdown of the sickness.
“It’s unconscionable that we have the type of health system we have right now,” he said.
Salas, a 36-year-old supervisor of the maintenance staff at the private clinic where Castro has an office, was familiar with the country’s medical shortages. She was on the subway home from work one night last month when she noticed a rash on her forearms. By the time she reached her apartment, it had spread across her torso.
Over the following week, a period in which most Zika victims would recover from their mild symptoms, her condition deteriorated: She suffered burning pain in her back and head, the right side of her face and body became paralyzed, and soon she was unable to walk and speak. The fact that her sister-in-law worked in the Health Ministry helped her gain admittance to the Vargas de Caracas hospital for treatment of her Guillain-Barré, she said.
“The pain was very unpleasant, strong. I was crying,” she said, the bruises still evident on her chest where blood was removed in her treatment. “Thank God they were able to help me here.”
A couple of beds down, Tatiana de Oro, a 37-year-old maid, had made less of a recovery from the same ailment, her face still drooping from paralysis.
“Nothing has ever happened to me like this,” she said, having trouble forming her words. “This disease is truly horrible.”