Call for Augmenting Health Services at Rumichaca

Álvaro Campo Ojeda, MS MSc, made a call for a large-scale ramping up of health services for Venezuelan migrants at Rumichaca.  He is concerned primarily about the large number of people gathered at the border crossing.

Rumichaca is located at 2900m above sea level.  Nights are above freezing, but are rather cold.  The Venezuelans are coming from a low-altitude tropical climate, and often do not have the coats and blankets that are necessary at the altitude of Rumichaca.

Professor Ojeda is worried about respiratory illnesses and the possible of enteric pathogens.

 

 

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Rumichaca – August 6, 2018

An important note to my US and European readers:
This is not intended to be a political article or polemic. I have lived for the last four years just two hours by road from the Colombian-Ecuadorian border crossing at Rumichaca. I also have an M.S. in Entomology, and, via news sources, for professional reasons, have been following the malaria situation in Venezuela since 240,613 cases were reported for 2016. This large number in a country that once was declared to have eradicated malaria from the northern and central areas caught my attention in early 2016, and I have been following the situation ever since.
Yes, I am aware that, up until now, most publicity concerning the crisis in Venezuela has come either from Spanish sources or from right-libertarian channels in the US and conservative talking heads like Sean Hannity.
To get an accurate picture of what is going on, I mostly use Colombian and Venezuelan sources written in Spanish for my research about Venezuela. I have received occasional negative comments on my Facebook posts about the Venezuelan situation from a few people on the American Left who are far removed from the situation and thus do not know what is actually happening with the collapse of Venezuela.
This post is largely based on observations and photographs taken with my own eyes and camera.

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Rumichaca

During the past five years, I have visited and crossed the 2800m (9500 ft) elevation border crossing between Colombia and Ecuador at least ten times.  The crossing is called Rumichaca and is where Rio Carchi separates Ecuador and Colombia. There is a bridge that under normal circumstances crosses a canyon, but is walkable in two to five minutes, even if you’re dragging a few pieces of luggage.

2014-2016

I‘ve been doing border crossings at this familiar border post, off and on, for the last five years.  I have crossed Rumichaca at least ten times for various reasons mostly related to tourist visits to Ecuador.  Each crossing prior to 2017 took around an hour total. I met a variety of people, mostly tourists, backpackers, and business people.  The traffic was pretty balanced in both directions with backpackers and tourists entering and leaving Colombia or Ecuador in equivalent numbers.

2017

bridge_normal

In July 2017, I met some professionally-trained Venezuelans leaving Colombia and entering Ecuador.  the average person took up to 1 hour to leave Colombia and 1 hour to enter Ecuador.   The number of people inside each Migration building at any one time was around 50, with a few outside walking between between the buildings.

2018

In February and May of this year (2018), I made this crossing.  It was a pretty routine crossing in February, although I crossed around 7:30 pm because of daytime crowds of a few hundred people.  At 7:30, the Colombian side had cleared out, and there were around 250 people on the Ecuadorian side.

Over 95% of the border traffic in 2018 consists of Venezuelans leaving Colombia and entering Ecuador.  The other small percentage consists of Ecuadorians and Colombians making long trips to the neighboring country and of miscellaneous foreign tourists leaving and entering either country.

Between February and May of this year, the number of Venezuelans crossing increased dramatically.  Also, the first measles case Ecuador experienced since 2011 occurred in April of 2017. A Venezuelan child who had recently entered Ecuador came down with measles.  Ecuador responded by installing a vaccination post for children under 15 outside border control, and also at a checkpoint 1 km south of the border town of Tulcán.  

May 2018

My May crossing this year was considerably more difficult because of longer wait time.

bridge_2

There were around a thousand people present on each side of the border.  The lines to stamp in and out were long. The average person spent one long day and evening at Rumichaca stamping out of Colombia and entering Ecuador.  The bridge between the two posts was empty except for a few moving pedestrians.

August 2018

Rumichaca_4

This August, I didn’t need to cross the border.  Instead, five Colombian friends and I went to attempt a measure of assistance for the thousands of Venezuelans we knew are crossing the border at this time.

When we arrived at Rumichaca on August 6, 2018, we were stunned. Not only the areas in front of the two passport-stamping buildings were full, but the pedestrian bridge between the two countries was teeming with perhaps a thousand hardly-moving people experiencing a very slow entry into Ecuador!  

The bridge across Rio Carchi, which has been an easy walk up until now, is now packed with people. It is physically difficult for non-professional photographers or normal tourists to walk to the Ecuadorian side in the normal timeframe of a few minutes. Thus, I was only able to get pictures from two angles and was not able to take any pictures from the Ecuadorian side.

In May 2018, this bridge was an easy 2-minute walk between 1000-person crowds each on the Ecuadorian and Colombian sides.

Migrants are now spending 3 days and 2-3 cold nights at Rumichaca in order to receive the necessary stamps to continue onward to Argentina, Chile, and Peru.

Rumichaca_5

Venezuela was once a prosperous country. It was the land of beauty queens, drilling rigs, and Latin American suburbia.  During the 1990s, practically every Venezuelan woman loved makeup, hair styles, and maybe even a little nip ‘n’ tuck or a nose job.  People were very appearance-conscious and believed in upward mobility.

How that has changed.  Some people at the border wore old clothes and looked a bit scruffy, although they had gotten their hair cut and attempted to have a neat appearance under circumstance of dire poverty.  I saw faces that reminded me of people described in The Grapes of Wrath.  You could see that people had lived without basic necessities like adequate food and medicine for a year or more.  The people had experienced an economic depression that has lasted from four to seven years, depending on individual descriptions.

The Venezuelans are fleeing authoritarian rule and hyperinflation at levels that approach those of Zimbabwe’s 2005-2008 crisis or Weimar Germany in 1921-1924.  Venezuela’s current inflation rate is 40,000 percent. Prices currently double every 18 days.  Hyperinflation has destroyed the savings of the current Venezuelan emigrants such that they rarely have the money to spend on luxuries like hotel rooms.  They often bring bread and water from Venezuela to eat on the bus. Thus, they avoid buying more expensive meals in Colombia. The bread-and-water diet also reduces the need to use unsanitary bus bathrooms along the way.

The people we met have been traveling for the past three or more days in Colombia. The journey from Cucuta to Rumichaca by bus is three days if you sleep on the bus.  By bus is how most got here just a few months ago.

Now, people are also walking and riding mulas. (Flatbed trucks).  The flatbed trucks play the role of the slow freight trains that transported hobos during the Great Depression in the US.

The Venezuelans sometimes walk eight or nine hours a day until a truck comes by. The police turn a blind eye and don’t ticket the truck drivers with people on top because the truck transport alleviates the problem of hobo encampments and helps speed the Venezuelans’ journeys through Colombia toward other destinations in South America.

Portable toilets were recently installed at the border crossings.  The portalets were wisely placed across the road away from the entry areas where thousands of people now stand in line.   There are bathrooms in each passport-stamping building, but they are only adequate to serve a couple hundred people inside each building.  Until recently, these buildings only needed to serve a couple hundred or fewer people at any one time. When I crossed in 2014 and 2016, there were only 25 to 60 people in each building at any one time.  

The area near the portalets on the Colombian side was one of the only areas easily accessible to me for taking pictures of the crowd on the bridge.  

There are relatively few muscoid flies, no mosquitoes, and few other insects at Rumichaca’s altitude, so, fortunately there is little or no vector problem at Rumichaca.

All people in these pictures had already left Venezuela when the Soldados de Franela launched two drones at a military parade in Caracas on May 5th.  Nicolas Maduro falsely accused outgoing Colombian President Juan Manuel Santos of being behind the drones that were shot down by snipers at the parade.

We are a small group and had a limited amount of provisions and time.  It was clearly logistically impossible to cook arepas for 10,000 people.

For security reasons, we hid ourselves and the BBQ grill under a pedestrian bridge a half kilometer from the border activities.  

We hid under the bridge so as not to be visible to large groups of people while cooking the arepas.   We did not want to present a limited amount of provisions within sight of thousands of mostly hungry people.

Our small local group has nowhere near the capacity of international organizations.

The few hundred arepas we were able to make with the available time and supplies and the common medicines we shared were only a drop in the bucket of the food and medicine needs that were present.  For safety reasons, we were only to distribute the arepas to people walking to or from the area.

We met people from Estados Anzoategui, Carabobo, Caracas, Falcón Lara, Mérida, Táchira, Trujillo, and Zulia.  All were extremely grateful for our small measure of an arepa and coffee.

Today, I estimated the total crowd at 5-12,000. Jose estimated at around 10,000.

Where from Here?

The Venezuelan migration and obviously,the situation inside Venezuela, has become a complex emergency that needs the participation of international organizations such as the International Red Cross, Medicins San Frontieres, and WHO.

The emergency includes the elements of major a d widespread medicine and meducal supply shortages, food shortages, epidemics of malaria, measles, and diphtheria.  The Venezuelan government stopped releasing the Boletin Epidemiologico in 2014, so case numbers for 2017 are WHO and PAHO estimates.

  • Malaria –
    • 406,000 cases in Venezuela in 2017 and 240,613 cases in 2016, 136,402 in 2015.
    • Cases exported to Brazil and Colombia.  Both countries also have thousands of locally-occurring cases in their own malaria foci.  Thus, distinguishing imported malaria from Venezuela versus local cases is a technically specialised task and news reports may not be as accurate as for measles that was almost eliminated from northern South America in 2011.
  • Measles –
  • Diphtheria – 1904 cases

Outgoing Colombian President Juan Manuel Santos has called repeatedly for Venezuela to open a humanitarian corridor so that direly-needed medicines, vaccines, and food can be brought into that country.

The crisis is becoming more grave as time passes.

A couple of years ago, when I only saw small numbers of well-educated migrants at Rumichaca, I thought that if only Maduro were to fall and a rational government took his place and opened the way for food and medicine shipments, that Venezuela could recover in a year or two.  That might have actually been possible, in a best-case scenario, in 2015 or 2016.

Now, with over a million and perhaps two million persons displaced,, including many in the better-educated younger cohorts, and mounting serious infrastructure and very serious water-supply problems, I see the best-case recovery scenario as lasting three to five years and costing billions of dollars in foreign aid.  In other words, a miniature Marshall Plan may be necessary. The water supply and distribution problems alone will cost billions of dollars to repair.  Additionally, Venezuela’s oil infrastructure has deteriorated, so funds won’t come quickly from oil, because investment needs to made in repairs and improvements.

The Tragic Fate of the Tropical Medicine Institute at UCV – Caracas

The botanic garden in Caracas has many plants that are dying for lack of water.  It seems the botanists and gardeners have abandoned the many once well-cared-for plants on the 14-hectare grounds.  What has actually happened is that Caracas has experienced months-long water shortages.  Also, funding for the botanic garden is very low.  Without money or water, the plants don’t receive the care they need.

Neglect wasn’t always the way at the Botanic Garden or at the Instituto de Medicina Tropical – UCV located next door.   (IMT-UCV for short).  The IMT recently had its 70th birthday, but this was not an occasion for celebration.

Both institutions were founded during the 1950s.  The Botanic Garden was known as a green oasis in the heart of Caracas.  The IMT was known for extensive research including discovering the first food-borne outbreak of Chagas’ disease.

Fast forward to now…

What has happened at the Instituto de Medicina Tropical during 2014-2018 is worse than neglect.  There has been a shocking total of 71 robberies at the IMT during the past four years.  Valentina Oropeza’s article is an important read for anyone who wants to know what has happened to the Instituto de Medicina Tropical.

The robbers have stolen obviously valuable items like computers and microscopes, but they have also stolen things that no one would normally hock at the pawn shop down the street – toilets, doors, a bathroom sink, and mouse cages.  They have stolen or let lab mice go.  They have now stripped the wiring and plumbing pipes out of the Institute.

This is either a situation of total societal breakdown, or it is deliberate indifference targeted against tropical medicine work at a time of epidemics, including 406,000 cases of malaria in 2017, in Venezuela.

The IMT-UCV is one of two major tropical medicine facilities in Venezuela.  The other was formerly known as the Direccion de Malariología and is located in Maracay.  The Maduro government is also failing to support that institution.

In future posts, I hope to discuss some of the rather noble history of these two institutions.  To do that, we need to go back to the 1950s, 1960s, and 1970s-1980s.

 

What Will Be Required in the Future in Administration of Venezuelan Health?

In addition to the obvious shipments of medicines for a myriad of conditions, large administrative changes will be needed to restore the Venezuelan health system.

The current situation involves an extremely “horizontal” system based on primary health clinics – Barrio Adentro.  The Chavistas have also placed many political appointees in place of trained and educated specialists in the various health fields.  Many specialists and other educated people have emigrated and are no longer in Venezuela.

How can Venezuela’s health system recover from this situation?  The recovery will obviously be difficult, but a few measures for a new government to take are clear:

  • In hiring new personnel, screen out loyal Chavistas and personnel from the Maduro administration.
  • Hire based on actual qualifications.
  • Chavismo has left an unfortunate unproductive and negative attitude among many people.  In hiring, seek people who have positive and productive mindsets.
  • Cooperate with international organizations that will probably be present in the recovery.
  • Cooperate with business and industry, while also maintaining a regulatory regime to prevent the high health costs that are typical of the United States. Consider a model more similar to the health systems in other Latin American countries or similar to the pre-Chavismo system in Venezuela.
  • Consider restoring some of the now-disbanded former structures that were successful in past years.  I am thinking especially of the MSAS (Ministerio de Sanidad y Asistencia Social) that was once led by Arnoldo Gabaldón.  The MSAS was fused with another ministry (Ministry of the Family) in 1999 and underwent a process of decentralization .
  • The basic result of this administrative change was that the public health function of the MSAS was diluted and two things happened:
    • Change in focus toward social programs and away from actual public health programs.
    • Extreme decentralization and focus on primary health care (Barrio Adentro) and away from any vertical, nationwide efforts.  As an example, vaccination programs have suffered greatly in the past 18 years.
  • The disastrous result of these changes in Venezuela’s health administration is now visible.  Epidemics of measles, diphtheria, malaria, and massive medicine shortages.

 

Consciousness-Raising About Venezuela

Over the past year, the crisis in Venezuela has grown in scope.

A year ago, for me, a year ago, the exodus from Venezuela and problems inside Venezuela were a reading topic.  The vector-borne disease situation in Venezuela revived my interest in the field in which I did my degree – Entomology.

Entomology had been largely dormant for me because of some rather bitter although not extreme experiences from the early 1990s that were related to Caregiving for my mother and the conflict between that and my work in Entomology.  My point here is not to discuss those experiences, other than to say that the recent report from the National Academy of Sciences has largely vindicated my feelings about these experiences.

For several months, I took actions both personally and on social media to promote and defend the rights of Caregivers.  As the number of actions I took increased, I felt more reconciliation with my former career.  The capstone of that reconciliation was the NAS report mentioned above.

I sure am glad now that I did this!!  The Venezuelan exodus has now become a topic of daily conversation.  Today, I heard from a good friend about a group of nine Venezuelans he saw by a rural roadside.  They were trying to catch a ride to Ecuador.

The situation now affects travel plans.  It makes formerly-easy border crossings in Latin America difficult.

And, I know that Entomology, or perhaps the lack of expertise thereof, is a piece in the puzzle in the crisis.  Of course, the overall roots of Venezuela’s problems are political.

Nevertheless, the following question needs to be asked:

How did the country with one of the world’s best vector-borne disease control programs in the 1930s-1970s fall so far?  What are the proximate causes?

And, interest in that question is why I registered a new domain name today, vzvectors.com.

 

 

 

 

On the Road Again

During the upcoming week, I will be riding the buses once again in southern Colombia. I have a paperwork-related errand that I need to accomplish in Cali.

Meanwhile, I will be observing and talking with the people whom I meet on the way.

 

Ruth Sponsler

M.S. Entomology

406,000 Cases

That thing about the 400,000 cases mentioned above? It’s been validated by the World Health Organization.

That number has been widely reported, including by Reuters, Al Jazeera, and Crux.

Personal Note:

I recently met some Venezuelan refugees. I did not take pictures, because I respect people’s right to privacy, especially when they come from a dictatorship.  The people I met were from Caracas, Miranda, and Trujillo, which are locations affected by food and medicine shortages, but not by malaria.