By Jeremy Morgan
Latin American Herald Tribune staff

CARACAS – Opposition Metropolitan Mayor Antonio Ledezma, who’s in a bruising battle of wills with a new “head of government” directly appointed over his head by President Hugo Chávez, said Saturday that the greatest challenge the government had to overcome was a “crisis” in the state health system.

Calling on Chávez to decentralize the system and leave health facilities in the hands of state and municipal authorities, Ledezma warned that there was a great “brain drain” of talent and skills from the country, not least in the health sector.

His remarks coincided with yet another development at the Maternidad Concepción Palacios, a state birth hospital in Caracas that’s been long plagued by discontent among medical staff, who claim facilities are as inadequate as their pay.

State doctors and nurses are paid notoriously low salaries, encouraging many of them to shift into the private sector, sometimes with an eye towards emigrating with their skills.

On Friday evening, Metropolitan Health Corporation Director Nelson Ortíz announced that arrangements were being made to transfer patients from Concepción Palacios to other health centers in the capital if that were necessary.

Earlier, there had been complaints that patients were not receiving care and attention, and this led to a protest in the street outside by relatives. They claimed “irregularities” had taken place at the clinic, but didn’t go into detail about exactly what these were.

As to Ortíz’s promise to move patients elsewhere, critics claimed that there weren’t actually any ambulances to make this possible. The solution, they said, was for the responsible authorities to resolve the problems at Concepción Palacios. But, again, they didn’t specify just whom they thought those authorities actually were.

Whole swathes of the Metropolitan health service were transferred to the Health Ministry, and hence central government control, by Ledezma’s predecessor, Juan Barreto, to keep the incoming Opposition mayor from getting control of them. Barreto was then a big wheel in President Hugo Chávez’s ruling United Socialist Party of Venezuela (PSUV) but his political star has visibly dimmed in recent years.

The transfer implied, and still does, that the situation at Concepción Palacios and other health facilities in the capital is not Ledezma’s responsibility but the government’s.

This would seem to be all the more the case given that health assets and funding once run by or due to the Metropolitan authority are now managed by the new Capital District executive headed by Chávez’s nominee, Jacqueline Faría.

Either way, Ledezma rather hit the nail on the head by pointing to the difficulties plaguing a state health sector whose problems date well back before the Chávez era – but are deemed if anything to have worsened in the 10 years since the president came to power.

The fundamental problem has long been deemed to be inadequate state funding for the health system. But even at the height of the oil price bonanza, the government did not notably boost funding for the health system.

Instead, Chávez set up Barrio Adentro, a network of basic health centers in poorer districts, controversially staffed by Cuban doctors and other medical staff. But Barrio Adentro apparently isn’t working, either, again because there aren’t the funds to keep it going and many of the Cuban staff are said to have gone AWOL, heading into the private sector or defecting for richer pastures elsewhere, most notably the United States, which can offer the additional attraction of political asylum.

Chávez has accused private sector health providers of price gouging to the point of extorting money from their patients and their equally private health insurance schemes. While some critics concede that private medicine is undoubtedly expensive for the average Venezuelan, they argue that the inadequacies of the state system have inevitably prompted increasing reliance on the private sector.

The shortcomings of the state health system have been legion for years. Urban mythology or no, there’s no shortage of horror stories from patients and their relatives about the conditions encountered at state health facilities. The catalogue of complaints suggests that the stories aren’t all that far-fetched.

Hospitals are notoriously short of even the most basic medical supplies such as bandages and drugs because they cannot get dollars to pay for them. Doctors in emergency rooms reset broken bones or insert lung drain pipes without benefitting their patients with a local anaesthetic.

Apparently, that’s because there isn’t pain killer. Or, sinisterly, maybe there once was, but it’s been sold in a dark corridor for personal gain.

It’s not just drugs and anaesthetic. Patients also rely on family and friends to provide bandages, clothing and, most worrying of all, food. Otherwise, patients can literally find themselves going for days without eating – even as they’re supposed to be recovering.

There’s no hot water in the showers, the corridors are dirty and strewn with rubbish. And, unsurprisingly, demotivated staff can be notably callous and cantankerous towards their charges in what might best be described as the ultimate vicious circle.