Braian Lozano Salinas has more surgeries than years of life, at 20, he has had 26 surgeries. He was diagnosed with neurofibromatosis, a genetic condition that causes tumors all over the body, when he was 2 years old. 

His last visit to the operating room in Hospital Oncologico Dr. Miguel Perez Carreño in Naguanagua, state of Carabobo, was an emergency. His life depended on two simultaneous surgeries to extract a tumor that was crushing his jugular vein and carotid artery (which takes blood from the heart to the brain), as well as a tumor in his eye. That was in September 2023.

Despite its seriousness, Brian’s surgery was postponed three times. While the operating room was not available for him, other patients with non-urgent surgeries were scheduled for their procedures. The difference is they had paid to be operated on.

“It works like this: you pay 80 to 100 dollars for a private appointment with the specialist and your surgery gets scheduled in the public hospital for the upcoming week. When I mentioned this to new patients that I hadn’t seen before, they replied that they were friends with a doctor who had seen them in his private practice.” That is the account of Luisana Salinas, Braian’s mother, who discovered patients being admitted for surgery without being in the waiting list or having a medical record in the hospital.

On the verge of entering the operating room, his son’s surgery was postponed. It became clear for Luisana that corruption had taken over the operating rooms of the public healthcare system. “They admitted patients at midnight, without medical records or supplies and still, they were operated on. My son has a tumor crushing the jugular and the carotid and he has been denied surgery for the third time in a row.”

Article 84 of the Constitution of the Republic, valid since 1999, sets forth that healthcare is free in Venezuela. But Braian’s experience shows that this principle doesn’t apply for patients who need to be operated on in State hospitals.

The impossibility of accessing operating rooms is repeated in hundreds of cases. Waiting times can be of three months to a year or longer in 28 to 49% of the cases of gallbladder, breast cancer, hysterectomy or prostate cancer surgeries in public hospitals. Availability of operating rooms is limited. A hospital has an average of four functioning operating rooms, although an acceptable mean would be of 10 to 15 per hospital, according to the results of the 2023 ENH (National Survey of Hospitals in Venezuela).

This feature by the team of El Pitazo and CONNECTAS discovered how the lack of functioning operating rooms, migration and health practitioners’ precarious salary conditions, combined with the shortage of supplies and medical material, has paved the way for a scheme of illegal charges to patients and their family members. Access to surgical services is granted only in exchange for these payments.

Braian’s mother had to wait because she didn’t pay for a private appointment to speed up her son’s surgery. Carmen, another patient interviewed for this feature, says that she was charged 300 dollars for her gallbladder surgery. A sports coach with a brain hemorrhage waited three months to be scheduled while he gathered the money for the cranial drill he had to rent to be used in his surgery in the public hospital. These and other cases compiled by El Pitazo, prove that cases of hospital corruption have become a widespread model in Venezuelan operating rooms, not just isolated cases.

“Shortage of functioning operating rooms explains why the so-called ‘waiting lists’ are so long and patients are forced to wait months for elective (non-essential) surgery, including oncology interventions,” explains infectologist Julio Castro, coordinator of the ENH, in a statement in January 2024. That same statement was ratified in the news letter issued by the ENH in January of this year. 

The ENH reveals that in 90% of the monitored hospitals, the staff asks surgical patients for supplies. In the last quarter of 2023, shortage of supplies in operating rooms in these health centers reached 74%.

Last January, the ENH estimated that a patient needs at least 81 dollars for basic surgical supplies, which ought to be provided by the State. That figure is the equivalent of 22.5 minimum monthly wages in Venezuela (which amounts to 130 bolivares, or 3.60 dollars at the official exchange rate in February 2024).

The situation is dire in a country in which 87.8% of the population –more than 25 million inhabitants– depend exclusively on the public healthcare system, and 87.6% don’t have health insurance in the private system, as revealed by the Fourth Follow-Up Report to the Complex Humanitarian Emergency in Venezuela of 2023 by the platform HumVenezuela. The organization calculates that 97.6% of public healthcare system users don’t have financial protection and 54.8% lack resources to cover health expenses. 

As is the case with other patients, Braian’s parents had to buy an extensive list of supplies at the request of the hospital. They also asked for help and received donations on TikTok, Instagram and X to get it done. However, the money they spent failed to be a guarantee for their son’s surgery.  

The third time that their son was taken out of the scheduled surgery to make room for patients who allegedly had paid for private appointments to have surgery in the hospital, Luisana took to social media. She bemoaned the situation to Attorney General Tarek William Saab. Her video, recorded in the health center, became viral the day it was posted. The hospital’s director, Pedro Salinas, reached out to her 48 hours later. “He said to me: ‘Mrs. Luisana, you have no idea the damage you've caused me with that video’. So I replied: What about the damage done to my son?”.

Braian had surgery on October 18, 2023. When he was released from the hospital, staff refused to give Luisana the files and medical records pertaining to Braian’s surgery, all of which she had requested. This was the aftermath of an inquiry by the Public Ministry on the irregularities of inappropriate charges in the operating rooms at the hospital in Naguanagua that had been exposed by Luisana.

Before leaving the hospital, two prosecutors asked Luisana to record a new video thanking the authorities for his son’s surgery. She accepted, even though she made it clear that her son required two major surgeries and only got one. The tumor that compromised his right eye vision was not extracted. 

Regarding the pending surgery, Braian’s parents have run out of resources. They have more questions than answers: “How many doctors do I have to report for my son to be cared for? I have to do this again to get his eye surgery?”, Luisana wonders. She posted another video in February this year asking the authorities for help. As of the deadline of this  investigation, her request had not been answered. 

In the end, the director of Hospital Oncologico Dr. Miguel Perez Carreño in Naguanagua, was removed. Luisana has tried to contact the prosecutors to get to know the details of the judicial investigation, to no avail. “The prosecutors vanished. There is no ongoing investigation. Unfortunately, I have to post on social media because that is what seems to bother them the most. That is how it works here in Venezuela.”

CHARGES OVER THE RIGHT TO HEALTH

Maracaibo is the second most populated city in the country and the capital of the state of Zulia. There, patients are also charged fees to use operating rooms at public hospitals. Carmen Huerta, a 33-year-old woman, took four months to collect the money she was charged to have gallbladder surgery at Hospital Universitario de Maracaibo. 

In October 2023, doctors found several gallstones in an appointment. After her diagnosis, a man wearing hospital ID approached her and told her that she could have her surgery in a week if she paid in dollars. “He told me to write down a list of 12 things I had to take with me if I wanted to get surgery, and pay, because otherwise the waiting list was endless, he also said that if one of my gallstones moved I could have bile spillage and that it was dangerous.” 

Four months later, in February 2024, she was able to collect 250 of the 300 dollars to get the surgery, which was now urgent due to the risk of bile spillage. “I got there and I had a bout of pain, I promised the man (who was the doctor’s contact in the hospital) that I would get the rest of the money for the next day. I was admitted and put on a stretcher, and they told me I would have surgery the next day. The pain was unbearable,” she explains.

Lying in her hospital bed, she recalled everything she had to do to collect the money. She took on additional classes in the school she works at with children aged 9 to 12, where she makes a mere 20 dollars a week – enough for food for her mother and her two daughters. She took out a loan, sold her kitchenware, bought a hair dryer and started offering hairdressing services to her acquaintances; she also cleaned homes and babysat kids in her community to get the extra money.

Money in hand, she arrived at the hospital and was taken to her room, where she waited for her surgery. She was there for only 12 hours. At 3 AM, a nurse and a doctor asked her to leave because an emergency had been brought in and her surgery needed to be rescheduled. “I begged them not to kick me out, that I would pay the rest of the money the next morning. But they kicked me out of the hospital anyway.” 

Outside, carrying her small bag of belongings with toiletries and the supplies, Carmen had to wait in the dark for the day to dawn. She couldn’t go home, she had to walk across the city because there was no public transportation at that hour, and it was dangerous. She wept in front of the hospital. “I couldn’t tell if my tears were out of pain or injustice, or because of the nurse and doctor’s faces when they kicked me out,” she regrets.

Hospital Universitario de Maracaibo, from where Carmen was thrown out, is the largest in the state of Zulia, and it has 11 operating rooms. However, only five of them are functioning, as stated by the president of the Nurses Association of that region, Hania Salazar, in November 2023.  

An ER doctor at that hospital was on call the day of Carmen’s surgery. He had a single pair of gloves (bought with his money) to examine patients. “It’s impossible not to ask patients to bring their own supplies, at least in cases of emergency,” he said. The doctor refrained from speaking about the charges for surgery. This feature has decided to protect the identities of several sources, out of fear of reprisals from the government of Nicolas Maduro.

The shortage of supplies and equipment in health centers is typical of the complex humanitarian emergency in Venezuela (acknowledged by international organizations since 2016), and to make matters worse, staff is underpaid. This factor may drive corruption within hospitals, says Douglas Leon Natera, president of the Venezuelan Medical Federation (FMV). Health practitioners in State-run institutions are expecting the renewal of the collective contracting scheme that establishes improvements in payment and social security for the sector since 2003.  

In the last decade, doctors and nurses have led protests to decry the devaluation of their salaries: In 2020, a hospital employee earned a monthly salary ranging between 15 and 30 dollars. 

In March of 2022, the executive branch set the minimum salary at the equivalent of 30 dollars, but with the devaluation of bolivares, the country’s legal tender, they lost purchasing power. In January of 2024, Nicolas Maduro issued a decree to increase bonuses to 100 dollars per month for public officials, including the healthcare sector. In May that year, he passed another increase of 30 dollars. Still, the salary of State doctors remains low in comparison with other countries in the region. The compensation of a Venezuelan doctor is equivalent to a fourth of the minimum wage of a Colombian employee.

Five sources in the field of healthcare: two union leaders, a nurse, a former director of a hospital, and a traumatologist (who asked to keep their names confidential for security reasons) stated that inappropriate charges, especially in surgical services, have been fueled by low salaries. 

Inappropriate charges became more conspicuous in public hospitals in Venezuela following the COVID-19 pandemic, according to testimonies collected by El Pitazo in three cities: San Cristobal, Acarigua and Caracas. “My sister was admitted with COVID to Hospital Clinico Universitario de Caracas. We paid for the supplies, and for a nurse to care for her and guarantee she did get her medication. We were not the only ones. There were around ten patients in the COVID area, and they all had paid,” recalls Mariela Perez, whose sister Maritza was hospitalized for a month and died of COVID in 2021.

Even though national legislation forbids this type of practice, the business of inappropriate charges in public hospitals hasn’t stopped growing since the pandemic – to the point in which it opens or closes the doors of operating rooms.

Articles 20 and 122 of the Medical Deontology Code, mandatory in Venezuela, explicitly forbid any sort of negotiation or payment in exchange for services in the public healthcare system or transfers to private hospitals. Likewise, the Anti-Corruption Law (in place since 2003, and amended in 2022) sets forth penalties of two to six years in jail for officials who abuse their powers as means to get money or bribes. This regulation applies for employees of organizations incorporated with public funds, i.e., hospitals. 

Two doctors and a nurse working in hospitals of the District Capital and the state of Falcon, explained that in public health centers, small groups come together to organize networks to make money with the operating room and scheduled surgeries. Patients may be contacted in private practice appointments or in hospitals. 

In the meantime, Carmen is waiting for her surgery to be scheduled. She hopes her right to health prevails, despite not having the money to pay for it. She spent the money she had saved to treat a fungus on her mother’s skin, and in other emergencies with her daughters. 

But Carmen’s pain persists. “In order to prevent pain, I don’t take deep breaths. Some nights I pace around the house because I can’t take it. I keep an eye on the color of my urine, as the doctor said. And I keep trying to collect the 300 dollars. I have even thought about selling my home.” Carmen lives in a popular sector that doesn’t have all of the utilities, and her house could sell for 1,000 dollars.