CARACAS, Venezuela—Leaning against a hospital wall for balance, Elena Suazo wiggled each foot into blue protective pants. Then she slipped her arms into a surgical gown and snapped on white rubber gloves, finally ready to enter the COVID-19 wing.
Suazo is not a nurse. She is a cafeteria worker at a kindergarten in Venezuela’s capital.
But she is also a loving daughter; her 76-year-old father, sick with the virus, waited inside. And in this ruined country, the only way to ensure that he received the care he needed was to do it herself -- regardless of the dangers to her own health.
“You do everything you can in the name of love,” said Suazo, 47. “If that person is your blood relative, you don’t even hesitate.”
Hospitals across the once wealthy South American nation lack enough doctors and nurses to confront the coronavirus pandemic. As thousands of trained health care workers emigrated in recent years, some hospital wings have closed. Others keep operating, but with high caseloads.
The shortage leaves families rushing to fill the void at facilities that treat the poor, like José Gregorio Hernández Hospital, which sits in the middle of a sweeping Caracas barrio. They feed patients, bathe them and change their bedsheets -- tasks normally done by trained medical professionals.
Relatives of elderly and weak patients are allowed short visits up to three times daily and are responsible for providing their own protective clothing.
Suazo finished dressing at a table near the COVID-19 entrance and looked over to a security guard. He gave her a nod of approval. Suazo tucked her bags of hot chicken soup, fresh bedsheets and cleaning supplies under her arm and ducked past the heavy sliding gate.
“I take care of him quickly, changing his clothes, feeding him, and then I leave,” Suazo said. “You can’t stay inside there long.”
This kind of thing has long been common in poor nations, places like South Sudan and Democratic Republic of Congo in sub-Saharan Africa, health experts say. But it’s only now come to Venezuela, which was once a wealthy nation, sitting atop the world’s largest oil reserves.
Critics blame 20 years of a socialist revolution launched by the late President Hugo Chávez for destroying oil production, leading to an unrelenting economic crisis. A recent round of financial sanctions exacted by Washington against President Nicolás Maduro has made life even harder.
"A kind of pandemonium"
In recent years, an estimated 5 million Venezuelans have fled the nation of 30 million. Among them are roughly 33,000 doctors -- 30% of Venezuela’s physicians, according to Dr. Douglas León Natera, president of the Federation of Venezuelan Doctors.
Care is augmented by nearly 2,000 specialists sent by socialist ally Cuba to help battle the pandemic, and by several thousand less-skilled Cuban doctors who already were here. But it’s not enough.
At least 6,000 nurses also abandoned Venezuela, said Ana Rosario Contreras, president of the Caracas Nurses College, citing a 2018 survey by the organization. The number has only grown since, she said.
Contreras said it’s common to see one nurse responsible for up to 60 patients — an impossible task. International standards call for one nurse for five or six patients.
“We’re living a kind of pandemonium,” she said. “Our salary isn’t even enough to cover the cost of public transportation to simply get to work at the hospitals.”
Health care workers interviewed by The Associated Press said doctors at public hospitals earn less than $12 a month, and nurses bring home roughly $6. Working the night shift brings a little more.
While some find additional work in upscale private clinics, one nurse said she sells auto parts on the side to support her three children. A young doctor who sells cakes when not tending to patients said she’s weighing a move for her family to Chile, where she’s confident she’ll find a job that pays an amount commensurate to her years of training.
There are other reasons to leave. Dr. Ramfis Nieto-Martinez, 54, said he uprooted his family from Venezuela six years ago, walking away from a thriving practice. Six armed men invaded the family’s home and held one of his two teenage sons for ransom, and three years later, the boys were playing soccer near their home when they witnessed a motorcycle robbery in which a man was shot dead.
“My wife told me ‘No more,’” said Nieto-Martinez. He now works in Memphis, Tennessee, but dreams daily of returning once life in Venezuela is restored to normal.
Suazo says how her father contracted the coronavirus is a mystery.
A retired foreman at a clothing factory, with a big personality and undying love for his six children and 19 grandchildren, Gavino Suazo fell at home one night two years ago and hit his head. Despite a string of surgeries, he never regained speech and has been homebound.
Then, recently, his temperature soared and his body started to tremble. Doctors diagnosed a lung infection and sent him to the COVID-19 wing at José Gregorio Hernández Hospital.
Elena Suazo moved back to her parents’ home in the hills above the hospital to help out. Her father was too weak to sit up straight in a wheelchair when he entered the hospital; Suazo immediately sought and received approval from the hospital to care for him.
Next, she needed protective gear. She had no money -- as a cafeteria worker, Suazo earns a monthly wage of less than $2 -- so her younger brother bought her one suit. Her son’s mother-in-law gave her a second, so she could go to the hospital twice a day.
At first, she had nothing to cover her feet, so she used a discarded surgical gown to sew booties to go over her sandals. Suazo hand washes the clothing and hangs each item to dry on a patio clothesline.
She and her mother cook the chicken she brings her father. Then Suazo sets out on a 20-minute walk over steep, winding roads, a twice-daily trek that she says has taken its toll. “I’ve gotten a little skinnier for walking so much,” said Suazo, who is shy and speaks softly.
At the hospital, Suazo takes a seat on a bench outside with others waiting for security guards to call her name for her turn to go inside. They share stories while waiting, some sitting outside all day.
Venezuela’s decline has left its mark on José Gregorio Hernández Hospital, a 47-year-old, nine-story building of exposed concrete. The paint is peeling and the elevators often fail. Garbage piles up outside and a pack of dogs roam the grounds. Just a couple hundred beds remain in use.
Hospital administrators denied requests by The Associated Press to enter.
But family members say the overworked hospital staffers keep the COVID-19 wing clean. The doctors and nurses are kind, they say, but there are simply too few of them. Three or four nurses typically work in the wing with 31 beds for coronavirus patients, and workers said that the same number of doctors oversee this wing and other emergency visits.
Throughout the day, relatives deliver food; security guards posted at a desk on the street take it inside to patients. Relatives of the weakest patients dress in protective gear to care for them.
After a visit with her grandmother, Yessenia Suriel, a 30-year-old secretary, peels off a white full-body, biohazard suit, revealing jeans and a white shirt soaked with sweat. Many patients in her grandmother’s wing don’t have anyone to bring food or bathe them, Suriel said.
“You feel bad and want to help them,” she said. “With the little time I’m given inside, I can’t help everybody.”
Lizmary Moreno, 23, an unemployed waitress, said the risk is worth it to see her 70-year-old grandmother, battling pneumonia, light up when she appears at her bedside. “Ay, my darling, you’ve arrived,” her grandmother says.
One day, hospital officials refused to let her enter because there were holes in her protective gear after repeated washes. Moreno panicked. She pleaded with relatives to help her find a replacement, fearing she’d miss even one visit with her fragile grandmother.
The outfit she was wearing on this day also was threadbare. “I’m afraid to go inside,” she said. “I’m having trouble breathing. Maybe it’s just my nerves.”
A lack of PPE for doctors, nurses
Relatives going into the COVID-19 wing put themselves at significant risk.
“In an ideal world you wouldn’t want that,” said Dr. Paul B. Spiegel, director of the Center for Humanitarian Health at Johns Hopkins Bloomberg School of Public Health. “If that person’s not going to get food and water or medicine, then what do you do? It’s not unique. It’s just very sad.”
Officials in Venezuela report roughly 800 deaths from coronavirus among more than 90,000 cases throughout the country. That’s likely a gross undercount, as many fearful of the broken health care system choose rather to stay home.
An alarming 231 Venezuelan doctors, nurses and other health care workers have died of the coronavirus nationwide, reported United Doctors of Venezuela, a non-governmental group that lobbies for adequate medical supplies and labor conditions.
Seven doctors including one nurse died of the virus during one three-day period in October, the group reported. They blame it on a lack of protective supplies.
“In some hospitals authorities have tried to get doctors or the medical teams, nurses, to use and reuse what’s already been used,” said Natera, president of Federation of Venezuelan Doctors.
Workers at José Gregorio Hernández Hospital say they’ve been spared deaths, though the virus apparently has swept through its staff.
The hospital’s director was quarantined after showing classic symptoms. Three nurses interviewed by the AP said they fell ill, along with several of their relatives. Two security guards at the COVID-19 entrance say they fought through symptoms; they borrow protective clothing from other hospital workers.
Dr. Wilfredo Sifontes, who oversees the hospital’s emergency services including its coronavirus wing, described having a fever, cough and feeling sick. Though he oversees testing kits, he himself was never tested and continued to clock in. He dismissed the threat of the coronavirus, comparing it to a “common flu” that’s sparked needless panic.
Relatives entering the coronavirus wing he oversees know what they’re getting into, he said. They “are told about the risk to themselves and others,” Sifontes said. “They assume responsibility.”
Standing in sharp contrast is Peréz de León II Hospital, a medical center treating COVID-19 patients in another tough neighborhood of Caracas called Petare. It’s also a state hospital and offers free COVID-19 care but under the auspices of the international humanitarian group Doctors Without Borders in agreement with Venezuela’s Health Ministry.
The wing is staffed with 120 doctors, nurses and technicians who care for 36 patients, including six in intensive care connected to respirators and under sedation.
The rooms have running water and air conditioning. Staff follow a rigorous protocol for protective clothing and hand washing—with the most attention given to taking off the gear after each shift to avoid contamination. Psychologists on staff call to update family members—who are not allowed into the tightly controlled wing.
Hospitals like this one are few in Venezuela. Some private clinics in Caracas operate at international standards. They’re available only to the wealthy, or to patients with insurance willing to pay $2,500 a day or more -- more than 1,250 times the monthly minimum wage that most Venezuelans earn.
José Gregorio Hernández Hospital was pretty much the only option for Gavino Suazo. And his daughter’s care made his stay tolerable.
Arriving at his bedside, she changed his diaper, gave him a sponge bath and replaced his bedsheet with a pink-and-yellow one she’d brought. She spoon-fed him soup.
“He can’t do these things by himself alone,” she said.
She did the work willingly. “I had the good fortune of having a good mother and a good father,” Suazo said. “They always looked after us.”
After nearly two weeks, doctors told Suazo her father was healthy enough to be discharged. She could arrange for the short car ride up the hill to their home.
As they left the hospital grounds, they passed relatives of those still battling the virus, waited to be let inside.