Santiago Ortiz is lying, eyes closed, on a bed. He is no design of repose.
Above his jaundiced, distended belly, his skinny chest is pumping fast. His face twists into a pillow. An oxygen facade is strapped parsimonious opposite his mouth and nose.
Santiago is dual years aged and has strident myeloid leukaemia. What he does not have is adequate treatment.
Inside his tighten room, on a 10th building of a University Hospital of Caracas, his doctor, paediatric proprietor Joam Andrade, points to a cockroaches on a walls, and a gummy fasten holding his oxygen tube together.
But those are details. Santiago lacks medicine. “This is a third time given final year that he’s relapsed and we’ve had to acknowledge him,” Dr Andrade says.
“All we can do is try to control a pain.”
She writes in my cover what she wants to prescribe, and cannot, since there is nothing in Venezuela: “Cladribine. 5-6 ampoules. 10mg.”
Worst in a world
Plenty of countries have shop-worn or unwell health systems. Few are like a Venezuelan.
This country, that binds parliamentary elections on Sunday, has oil pot surpassing Saudi Arabia’s.
That healthy resources supposing hundreds of billions of dollars of trade benefit for Hugo Chavez, a male who, for 14 years until his genocide in 2013, ushered in and afterwards presided over a radical left Bolivarian Republic.
Under his successor, Nicolas Maduro’s rule, though, a oil cost has cratered. The IMF forecasts a country’s economy will agreement 10% this year, 6% next.
Those are a misfortune total in a world, incompatible Syria, and there’s no information for Syria.
Actually, there’s no central information from within Venezuela, since a Central Bank has stopped stating a possess mercantile figures.
So we have to rest on a IMF’s guess that acceleration in Venezuela will be 159% this year and 204% subsequent year. They are also a misfortune total in a world.
And many Venezuelans will tell we they’re a sad underestimate.
It was opposite this wreckage, in a unclothed sanatorium lecture-room, that Dr Andrade assimilated a organisation of doctors, students and heads of dialect to pronounce to me about a state of a hospital.
I had asked to pronounce to one or two. Over a march of an hour, some-more than 15 – we mislaid count – walked in, off shifts, off ward-rounds.
They waited their turns and afterwards listed their woes. No syringes. No handling equipment. Violence from patients’ relatives, mad that a sanatorium supervision had positive them of high peculiarity care.
The paediatric puncture dialect sealed for repair; a proxy site had, one tyro alloy told me, “no oxygen, no medicine for asthma, no antibiotics, no food”.
Opposition check lead
The sanatorium administration declined to comment. But a supervision insists it still has a good story to tell.
Ernesto Villegas has only stepped down from dual years as a minister, in sequence to contest in a elections as a claimant for a ruling Chavista PSUV. It is, perhaps, a dauntless move, given a far-reaching lead opinion polls are giving a antithesis coalition.
Former train motorist Nicolas Maduro won a doubtful election in 2013 to attain his coach Hugo Chavez.
His check ratings have slumped amid descending oil prices and accusations of mismanaging a economy.
Venezuela depends on oil for 96% of a unfamiliar banking trade earnings; a fall in prices has exceedingly singular a country’s ability to compensate for imports, causing shortages of simple domicile goods.
Unlike some other vegetable abounding states, Venezuela had no “rainy day” account or strait devise for falls in trade income.
Mr Maduro has indicted unfamiliar powers and speculators of waging “economic war” on Venezuela and pronounced his policies are directed during fortifying a spending energy of typical Venezuelans.
The Organisation of American States (OAS) has expressed regard about a jailing or exclusive from a choosing of a series of antithesis domestic figures.
Despite these setbacks, polls advise a antithesis could this month benefit a initial infancy in a National Assembly for 16 years.
Seated opposite a vituperation of a park unaware one of Caracas’s working-class barrios, Mr Villegas, wearing a party-embossed blue shirt, pronounced “perhaps in that sanatorium there are issues”.
But a bigger point, he said, was a immeasurable alleviation in primary health care, quite for a poorer sectors, such as a “23 de Enero” barrio, that loomed over his shoulder. “Today, thousands, millions of Venezuelans get healthcare, can practice their right to healthcare.”
But village health centres are no help, right now, for Yixember Cohen.
The 30-year-old striking engineer is station by his bed in University Hospital. His eyes are bright, his tattoos plentiful.
Mr Cohen has Marfan syndrome, a genetic commotion that means his aorta is dilating dangerously. With a grin that’s polite, apologetic and wholly incongruous, he explains his prognosis: “In my case, it’s only a timebomb. If I’m not treated, my heart will explode. Pow! Plop!”
This explosve could be defused simply adequate by surgery, and a use of a replacement, automatic valve.
But one of his doctors, who asked not to be identified, pronounced that in Mr Cohen’s case, a surgeon could not work though a finish set of valves, as he could not tell what distance he would need.
“It’s slight equipment. We’ve always had it,” he told me, a few metres divided from his patient. “But we haven’t had a finish set for some-more than a year. we don’t know when we’ll be means to import any more. Management says a finish of a year. I’m not certain we trust them.”
Mr Cohen smiles tenderly as we leave. “You have to sojourn clever when your life is on a knife-edge,” he says. “And, in any case, it’s not good for my heart, if we get upset.”
In contrast, Dr Ivan Machado says he “will not stay calm”.
He has been treating patients during University Hospital for 35 years and is now conduct of cardiology and executive of a medical school. His income is $25 (£17) a month.
But that is information Dr Machado imparts only as an aside. What matters to him is that his dialect has not been means to perform a singular heart medicine in a past 3 weeks.
“We have left from 450 open heart surgeries a year to 20. And from 1,200 cardiac catheterisations per year, it’s now during many 300.
“I’m roughly during a indicate where we have to contend we need to tighten a dialect of cardiology, since it’s not satisfactory to make us only demeanour during a patients, and see that approach they are going to die.”
He and his colleagues have looked for answers. The BBC has seen a minute sent in June, by Dr Machado and other heads of medical departments to a supervision ombudsman explaining a abyss of a predicament and suggesting “concrete steps”.
They have perceived no reply.
The same has left for a second letter, sent during a finish of October, to a conduct of a University Hospital, about Dr Machado’s inability to provide a 468-long watchful list of cardiac patients. Again, no reply, no acknowledgment.
Dr Machado looks out during a roomful of youth doctors before him. Several of them are in tears.
“We are in a charitable crisis,” he tells me. “Our nation might be wealthy, though it is poor.”