Witnessing the needs and acting upon it

“Growing up in Ethiopia, I hadn’t heard much about Venezuela in my life. I remember being told at school that it was one of the richest places in South America, where everything was free, but that is pretty much it. I came to learn a lot more about this country in the past few years, when it was hit by a severe political and economic crisis and when the situation eventually made the headlines internationally. So when I boarded a plane to Caracas earlier this year, I knew that the situation there was going to be different from what I had been told as a kid. I just didn’t know how critical it would be. 

I was sent to Venezuela by MSF on an assignment that was rather straightforward: I had to visit some of the organization’s medical activities in the country and to assess what were the most pressing needs in terms of water, sanitation and hygiene - my field of specialty – in an area close to our medical activities.

From Caracas, I headed straight to Bolivar state. There, MSF works in Sifontes, a mining area with close to perfect conditions for mosquitoes to reproduce. And one might be surprised by the role these small insects could play in a nation-wide crisis...

The mosquito-effect 

Fifty years ago, Venezuela was one of the leading countries in South America in the battle against malaria. But the current crisis affected Venezuela’s health system deeply. In the meantime, mining activities increased in the past few years: new mechanisms came into place to overcome the collapse of the Venezuelan economy and more people started to put their trust into gold, coltan and diamonds rather than into the overly inflated Venezuelan bolivar. In the eponymous state, the Sifontes mining area had become the epicenter of a malaria crisis.

As soon as I set foot there, I understood that this place was perfect for malaria-carrying mosquitoes to swarm: it was full of stagnant waters and hosted thousands of people living in precarious conditions (some even sleeping in hammocks under trees).

Lots of them would easily get infected by the disease. And historically, this area had always witnessed a high mobility of its population, which meant that malaria could spread quickly.

What immediately struck me was that the population in Sifontes was aware of the risks that malaria posed, they just could not necessarily afford to prevent or treat it. Indeed, bed nets to protect oneself from the mosquitoes were extremely precious. So precious in fact that I learned that up until last year, people had to spend 4 or 5 grams of gold to buy one (back then, this amount was equivalent to 150 US dollars).

When MSF started intervening in Bolivar state, in collaboration with the Ministry of Health, and distributed tens of thousands of mosquito nets for free in 2018 and early 2019, the costs of the bed nets sold on the market consequently reduced tremendously. MSF, still in partnership with local health authorities, continued with a comprehensive approach including health promotion, test and treatment of malaria cases in the area, spraying of households and specific medical care for the severe cases in its medical response.

By then, many people didn’t have to necessarily pay anymore to protect themselves from the disease. And in the space of a few months, we witnessed a drop of malaria cases in Bolivar (not only due to our action though, but also to other factors, such as the change of season).

My story could just end here, and the intervention of MSF in this Venezuelan state could easily seem like a medical success. But the truth is that a lot more must be done to reduce the risk of malaria spreading in the state and even at the scale of the country. And while the results of MSF’s intervention are important, only mentioning this would not do justice to what I witnessed on my trip. So much needs to be put in place to ensure that people living in Bolivar can be treated properly, whether they are infected by malaria or suffering from any other type of disease. 

Alarming medical situation

During my time in and around Sifontes, I visited one of medical facility in which MSF treats malaria. It was a 12-bed ambulatory catering for a population of tens of thousands of people. The place was barely functioning: when available, water was scarce, and electricity was also a huge issue.  A few weeks before I had arrived, the staff told me that they had even had to stop working for days, because a corpse was kept in an open room of the ambulatory, with no air conditioning. Nobody had the equipment to collect it and remove it properly. Waste management there was also inexistent. I could see rats going in and out the building, needles on the ground and piles of untreated medical waste just outside of the facility. 

My visit to a second hospital in Bolivar, a few days later, only confirmed my growing concern.  This time around, it was a bigger medical facility, used when smaller hospitals and healthcare centers in the region needed to “refer” cases that they did not have the capacity to treat on their own. As soon as I stepped in the hospital, I noticed that the floors hadn’t been cleaned for months. There were blood stains everywhere… There, water taps were not working at all, except for one outside the facility. Just like in the ambulatory I had previously visited, piles of medical waste (sometimes including body parts) could be seen next to the back entrance. I asked one of the doctors: “What do you do with it?" He sighed and answered: "Fifteen years ago, there used to be centralized waste management. But now, we just put it outside, with the rest of the trash.” I was shocked. Never in my life had I seen such alarming situation. It wasn’t that these people were not doing their job properly, medical and paramedical staff were doing their best to provide clinical care to the patients. But the hospital was just dysfunctional because what was needed , such as basic water provision, just wasn’t available anymore.

Water quality and waste management are usually not the first thing that comes to mind when a country is facing a political and economic crisis. But there, in a small Venezuelan region, I could see the direct impact it could have on the health of its population. In Sifontes’ mining area, health facilities were in a poor state, malaria-carrying mosquitoes were all around and the risk of water contamination was almost inevitable. Many persons I talked to were complaining of stomach pain and diarrhea and I was surprised there hadn’t been a huge outbreak yet. 

When I came back to Europe and to MSF’s headquarters, I immediately discussed with my colleagues the need to improve both the state of medical facilities and the water supply system in Bolivar.

We must always try our best to address a humanitarian situation entirely, for it to have a real impact on people’s everyday lives and to really alleviate their suffering. 

In the space of a few weeks, on top of our malaria response, we decided to increase our support in the two medical facilities I had visited and to dig boreholes for people to access safe-water in that region of Bolivar. This is a small step, but it still means something. This year, we also are expanding considerably our activities in other states of the country. And I hope that we’ll be able to do even more in the upcoming months or years. Because the people of Venezuela desperately need it.”