‘We’re Losing the Fight’: Tuberculosis Batters a Venezuela in Crisis
CARACAS, Venezuela — His family thought he just had a bad cold, nothing serious.
But Victor Martínez kept getting worse. By mid-January, he lay in a hospital ward, wasting away from tuberculosis. A month later, at his wake, stunned relatives tried to reckon with the resurgence of a disease that many Venezuelans thought had been mostly confined to the history books.
“I really don’t know what to think,” said Nileydys Yesenia Aurelia Martínez, his niece. “Even the last thing you’d imagine is happening.”
Tuberculosis, a disease that until recently seemed to be under control in Venezuela, is making an aggressive comeback, overwhelming a broken health care system ill equipped for its return, doctors and infectious disease specialists say.
The illness — like malaria, diphtheria and measles — has surged in Venezuela during a profound economic crisis that has battered almost every aspect of life and driven an exodus of Venezuelans, including many experienced doctors.
Though normally associated with the very poor, tuberculosis has begun to stalk a broader population of Venezuelans, including the middle class. Declining nutrition from food shortages and rising stress throughout the country may be weakening immune systems, doctors say, leaving people more susceptible to illness.
And with more families sinking into poverty, people have been forced to double up in increasingly crowded homes, accelerating transmission of the disease.
“Tuberculosis is the shadow of misery,” said Dr. José Félix Oletta, a former Venezuelan health minister. “If there’s a disease that is a marker of poverty, it’s tuberculosis.”
The Venezuelan government has not released health statistics since early last year, part of a sustained effort to keep the extent of the country’s decline secret.
But at two vital tuberculosis centers in Caracas, the capital, the share of new patients who tested positive for the disease increased 40 percent or more in the last year alone. Some experts fear that the death rate associated with the illness has increased as well.
“Tuberculosis is hitting us hard,” said Dr. Jacobus de Waard, the director of the tuberculosis laboratory at the Institute of Biomedicine in Caracas, the busiest public testing center in the capital.
“We’re losing the fight,” he said.
The Venezuela government’s tuberculosis prevention and control program was once among the most robust in the hemisphere, with the nation boasting one of the lowest rates of infection in Latin America, experts say.
But as the country has fallen apart under President Nicolás Maduro, who took office in 2013, the government has let the tuberculosis threat slip from its control, losing decades’ worth of gains.
Doctors have also observed the return of particularly complicated varieties of the disease, as well as more cases involving strains that are highly resistant to drug therapies.
“All these forms of tuberculosis that we forget about are starting to reappear,” Dr. de Waard said.
Experts now fear that the nation is teetering on the brink of a tuberculosis epidemic that could spill over its borders as Venezuelans flee in record numbers to escape the economic and political crisis, potentially exporting the illness with them.
And as the Venezuelan health system has fallen apart, the government’s ability to respond to epidemics has collapsed.
Some parts of the country have started to report shortfalls in tuberculosis medications in recent months, including in Bolívar, one of the states hardest hit by the illness.
Specialists said the government had recently suspended the national distribution of the antibiotics used to treat the disease, supposedly out of concern that it was disappearing into the international black market. After a three-week halt, doctors said, distribution slowly resumed, but not without interruptions in the treatment of patients.
The lack of equipment and skilled medical personnel has led some health clinics and hospitals that once had robust testing programs to shut down part or all of those programs, and some of those that remain open have documented worrisome trajectories.
From 2013-2015, about 5 percent of adult patients evaluated each year in the outpatient center and the tuberculosis clinic at Dr. José Ignacio Baldó Hospital in Caracas were found to have the disease, according to Dr. Zhenia M. Fuentes, the coordinator of the clinic. But by the last trimester of 2017, that rate had risen to about 9 percent, and then climbed even further in January, to about 14 percent, she said.
Doctors say tuberculosis infection rates in Venezuela are probably still well beneath the levels afflicting countries, mainly in sub-Saharan African and Asia, that have the worst tuberculosis epidemics.
Still, experts say, with the disintegration of Venezuela’s health system, there is little to prevent tuberculosis from spiraling out of control.
“The problem is the country doesn’t have the power to stop it,” said Dr. Julian Villalba, a Venezuelan tuberculosis expert.
All of the country’s major public hospitals are supposed to have tuberculosis testing programs, but many have been crippled or forced to close. Last year, lacking the necessary supplies, technicians at Dr. Rafael Quevedo Viloria Hospital, a major public hospital in the northwestern state of Trujillo, stopped doing a basic test in which sputum samples are stained and viewed under a microscope, said Dr. Miguel Fernández, who leads the hospital’s tuberculosis program.
Instead, patients were referred to a hospital in another city four hours away. Many could not afford the cost of public transportation and never went, Dr. Fernández said.
Of six major public hospitals in Caracas that responded to requests for information, only three were still conducting some tuberculosis tests, though not the full range required.
Pulmonologists and tuberculosis specialists praised the current director of the national tuberculosis prevention program for her efforts to keep it going, including using her own money to pay for ingredients to make test cultures.
But they said that the official, Dr. Mercedes España, was hamstrung by an apparent lack of commitment by the Maduro administration to deal with the nation’s various health crises.
“There’s an ethical rupture here,” Dr. Oletta said, accusing the government of showing more concern about its political standing than about public health. He pointed to the Maduro administration’s refusal to publicize health statistics, seemingly because it feared the political costs of more bad news.
“The result of that is more health injustice, more suffering, more illness, more death,” Dr. Oletta said.
The Maduro administration did not respond to emailed requests for interviews.
Each weekday morning, people start lining up at the door of Dr. de Waard’s tuberculosis laboratory to get tested or receive results.
“In the past, they came to rule it out,” said Dr. de Waard. “Now they come to confirm it.”
By Kirk Semple
The New York Times