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Latin America

Empty shelves: A day at a Venezuelan pharmacy

"We don't have that" are the words most uttered at Venezuelan pharmacies these days. Medicines for chronic illnesses are the hardest to find.
15 Feb 2017 – 11:20 AM EST
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It's 10 a.m. and there's a constant flow of people entering the Ferrenquín Pharmacy in central Caracas. They go directly to the back, where two pharmacists and eight assistants tell eight out of every 10 clients that they don't have the medicines they are looking for.

“Do you have Adalat Oroz?” asks one heavy-set woman, wearing a blue blouse that shows an ample cleavage.


"Something for the gallbladder?” asks an elderly woman with an anguished face.


“Bactron is an antibiotic, right? Do you know where I can find it?” says a bearded man in his 60s.

No idea, says one of the assistants.

The pharmacy's two phones never stop ringing, as people all over Venezuela call looking for certain medicines. They get the same answer as most of the others. We don't have it.

Shortages affected 85 percent of all medicines in Venezuela in April of this year, according to the Pharmaceutical Federation of Venezuelan. The number climbed to 95 percent for medicines for chronic diseases such as hypertension and diabetes. And 65 percent of the medicines defined as essential by the World Health Organization cannot be found in Venezuela. They include drugs to fight infections and bacteria, like antibiotics.

The Venezuelan Psychiatry Society also reported that the availability of psychiatric drugs in the South American country has fallen by 70 percent. Out of 20 drugs for depression, only one can be found, and then not regularly.

Pharmacy administrator Eneida Logart is asked if she has Keppra, used to treat convulsions. She checks her shelves, even though she knows that medicine is among the most scarce. She has seen the consequences at her own drug store.

“They come in saying, 'Doctor! Doctor!' And when you look they are already on the floor, convulsing. What can you do? Help them, just put something in their mouth so they don't bite their tongue and call the fire department. And they have to go on that way, wandering around to the other pharmacies.”

Some clients unload their frustrations on the drug store's staff. They get mad or they cry. The pharmacists and their assistants say they have learned to calm down the clients, to explain that it's not their fault that they don't have some medicine and then ask them to return or call back a few days later to check on whether the medicine has arrived.

The pharmacists have no idea when hard-to-find medicines will arrive, but the clients often accuse them of hiding or hoarding them, and sometimes have attacked them verbally and even physically.

The opposition majority in the Venezuelan parliament approved a special law in May to address the health crisis, but it was declared unconstitutional by the Supreme Court, dominated by supporters of the late President Hugo Chavez. His successor, Nicolas Maduro, argued that the law would have allowed a “foreign intervention” because it implied accepting assistance from other countries.

Five months earlier, the Maduro government had launched a “National Medicines Production Plan” to guarantee “the distribution of more than 333 million units of generic pharmaceuticals to all of the country's pharmacies during the first quarter of the year.” The plan failed, and the government decreed a state of emergency in May that gave Maduro the power to take extraordinary measures to deal with any crisis.

Cardiovascular diseases have been the top cause of deaths in Venezuela since 2013, accounting for 29.44 percent of deaths, according to statistics from the Health Ministry published by the Venezuelan Cardiology Society.

Prices from a decade ago

Logart moves easily between the shelves. She has worked at Ferrenquín for 17 years, and now manages the pharmacy. She blames the shortages on government controls on prices, which at times are below the cost of production. That's why manufacturers stop making them.

“It's been years of price controls, and they've never been adjusted. Aspirin is set at three bolivares,” or about .004 US cents, said Logart. “That's why there's none in the market.”

The prices of most medicines were fixed in December 2003, and have not been adjusted since even though inflation hit 180 percent in 2015 alone.

While a cup of coffee with milk costs about 600 bolivares, the official price of a box of Phenobarbital is just over five bolivares. At the Ferrenquín pharmacy, an energy drink costs 450 bolivares, but the government mandates a box of aspirin be sold for no more than three bolivares.

The International Monetary Fund has estimated that inflation in Venezuela will surpass 700 percent by the end of this year, and will continue to be the highest in the world. The country's minimum salary was set in September at 22,576.50 bolivares – roughly $22.57.

Logart believes that along with the price controls, the shortages are the result of many pharmaceutical manufacturers shutting down because of government tight controls on the foreign currencies they need to import raw materials.

Health Minister Luisana Melo said in July that Venezuelan manufacturers are still producing medicines, that the country is still importing the medicines that cannot be produced locally, and that six state enterprises and 45 private companies are cooperating to overcome the dependence on imports.

Melo added that the country will always have to import 25 percent of the pharmaceuticals it needs, especially high-cost medicines for diseases like cancer and HIV.

If they don't have it, they make do

The pharmacy worker in charge of preparing special formulas says clients are asking for those kinds of medicines to replace standard medicines they cannot find. But they are limited to relatively minor diseases such as skin infections, scabies and fungus.

The formulas and lotions are made in a small room at the back of the drug store. The preparation table is covered with instruments for measuring and mixing, and scales for weighing the materials. On one wall are shelves with more than 50 containers of materials, all carefully labeled.

“We are using adults' antibiotic pills to make suspensions for children,” said Long art. “But they are make-do preparations. They last one week, maximum.”

Closed at night, for security

There are pharmacies in Caracas that look like prisons. In neighborhoods like the Altagracia, Acacias or El Paraiso, pharmacy workers stand behind metal bars to protect themselves from criminals.

There are no bars at Ferrenquín, but the pharmacy stopped working night hours five years ago. Clients had to stand at the night window, easy prey for robbers. The pharmacy now closes at 7 pm.

“That's the crisis have now. These are medicines that people cannot afford to stop taking,” said Logart. “In Venezuela, we are at God's mercy.”