Against all odds: medical research and education in Venezuela

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Luis Azpurua

Luis Azpurua

Dr. Luis Azpurua, MD, graduated from medical school at the Universidad Central de Venezuela. He has more than 25 years of experience in the healthcare field. He is the Clinical Research & Education Director at Clinica Sanitas in Caracas and professor of Clinical and Biomedical Engineering in the Universidad Simón Bolívar. He has also coauthored the strategic planning book “De autoempleados a Empresarios. Como planificar un Centro de Salud Privado para potenciar su desarrollo.” His aim in global health is to be a catalyst to bridge the gap between knowledge and practice, spreading scientific information in the Spanish language to Latin America. @lazpuruae

Venezuela is the entrance to South America. Located in the north of the continent, bathed by the Caribbean Sea, Venezuela is one of the first places to stop when you are traveling to South America. With over 30 million people and an area of almost one million square kilometers, there are plenty of natural resources and beautiful places to visit. From gorgeous beaches to the oldest mountain chain in the world, we were blessed by Mother Nature. Our main economic activity is oil production, which represents more than 90% of our revenues.

venezmap

Venezuela

But Venezuela is facing one of the worst economic situations in its history. Since 1998, we have been ruled by the political party of Hugo Chavez. Nearly 20 years of populist government has made what was once one of the richest countries in South America into one of the poorest. We did not take advantage of the high oil prices we had in the last 10 years.

Instead of saving money from the oil production to invest in our agricultural and industrial sector in order to become a self-sustaining country, Venezuela spent its oil revenues. In 2014, oil prices plunged nearly 60%, causing us to face a daunting economical situation. There are huge debts in every corner of our economy and we have medicine and food shortages that make the political situation very unstable. On June 23rd, the Permanent Council of the Organization of American States (OAS) held a special session to discuss the situation in Venezuela.

oil prices

Oil prices over the last 20 years. Source: http://vedatos.com/stats/petroleo/ Last visited 06/15/16

In the medical arena, the conditions are no different. The public healthcare sector has collapsed. Since most medicines and supplies are imported, there is no money to purchase them and nothing to give to our population. In the private sector, the conditions are the same. Although the private sector made plans to deal with this situation, their inventories are running out. In January 2016, the Venezuelan National Assembly (Congress) made a public statement asking the President to declare a state of humanitarian health emergency in order to get help from the international community, but it went unheard. Due to these circumstances, most Venezuelan people are just trying to survive. It resembles one of the Titanic’s decks just before sinking: everybody is running around trying to escape from this tragedy.

Despite these circumstances, we are trying our best in Venezuela. Many organizations and businesses have made changes so that the crisis does not overwhelm us. We are trying to maintain a positive outlook so that we can generate creative solutions and innovate even as the crisis worsens.

The Clínica Sanitas Santa Paula is one of these innovative places. This hospital is the flagship healthcare facility of the Organización Sanitas Internacional in Venezuela. It is an 84-bed, first class structure built in 2013 with new technology, providing coverage at highest levels of care. It began activities in May 2014, and our vision is to practice first world medicine. To fulfill this vision, the Medical Research & Investigation Department was created in March 2014. Our mission is to generate knowledge through investigation and to disseminate it through teaching. Since the beginning we have focused on three main areas: education of our healthcare workforce, creating a culture of research, and involving the community with our hospital.

Clinica Sanitas Santa Paula. Caracas, Venezuela

Clinica Sanitas Santa Paula. Caracas, Venezuela

One of the areas for growth we detected when we began this journey was nursing services for patients. Most of our nurses are young and newly graduated from nursing school. Although they had the nursing skills, they struggled with bedside manner and empathy with patients. To overcome this problem, we created, along with the Human Resources Department, a Nursing Training School. In this initiative, the new nursing staff learn about our organization, our values, how to provide compassionate care to our patients, and brush up on the nursing skills. In the pilot phase, we realized that due to the staff shortages we are facing, once the nurses were working in the hospital, it was nearly impossible to bring them to the nursing school. So, we are designing virtual class modules. Nurses take these modules during their free time, wherever they are. At the end of the module they will have an online evaluation. Our goal is to constantly gauge performance and to detect areas that need reinforcement.

Basic Life Support course in the Nurses Training School

Basic Life Support course in the Nurses Training School

Our second goal in this venture is to create a culture of research. In Venezuela, research activities are not promoted. Research skills or methodologies are barely taught, from the time that students are in medical or nursing school. Students must produce a research paper in order to graduate, but once that task is completed, you don’t do any other sort of research. At the professional level, there are no incentives to do research, in either in the public or the private setting. With a heavy workload, there is no time or place for research. If you want to conduct research, you have to do it on your own, taking your own time and money to bring a project to fruition. All of these factors, coupled with a lack of data transparency, make research a hero’s endeavor.

To promote research, we are working in four areas: In February 2015, we created a Bioethics Committee, to create and standardize databases, to provide methodological and statistical support, and to give financial support to the researcher. It was created both to support research and to discuss ethical issues that will emerge in the practice of medicine. To do research, we need to have standardized data to measure what we are doing. Since we have an electronic medical record, it is easier to get data for either internal, periodic comparisons, or external comparisons, with other national or international healthcare facilities. Once the investigator has a reliable database, he could begin to develop research questions. We provide investigators with methodological and statistical support to create a research proposal. Once a research proposal is approved by the Bioethics Committee, we look for ways to finance it. Right now, because of the economic situation, this is challenging. But nevertheless, we are planting the seeds for future times. One of problems that we have faced in this phase of the project is that the investigator thinks that we will do their work. To do research, the investigator needs to have the methodology, be patient, and persevere because investigation takes time. We will support the research endeavor but the investigator is responsible for doing it.

Reaching out our community with flu vaccinations.

Reaching out our community with flu vaccinations.

Involving the community in our hospital was our third goal when we began this journey. We got in touch with them through neighborhood associations. In 2015, we assessed the community’s needs for health information and activities. We went to their homes to provide accurate information about emerging diseases, taking health literacy into account. At that time, chikungunya was spreading in the community. Right now, we are in the middle of a zika virus epidemic. In February 2016 we shared up-to-date information about the illness and how to avoid it, especially through local vector control.

We also support Fundación Sanitas, our charity sister organization, in a project to study the health status of low-income school children. We are reaching them with a multidisciplinary team at their schools to get information about their health, dental, and nutritional status. In this way, we are supporting our community, understanding that social responsibility is essential to create a healthy society.

Finally, we want to be a reference center for generating and sharing knowledge in Venezuela. To that end, we periodically give lectures and colloquiums. Our healthcare providers are invited to be lecturers. They prepare a topic of interest for our healthcare community and share their knowledge. We have also created global learning networks to keep up-to-date. Through teleconferences with Colombia, we have case discussions in orthopedics and obstetrics-gynecology. We have plans to connect many of our surgical services to surgical peers located in the United States and Latin America.

Although at the present time the situation in Venezuela makes many people think about running away, we are planting the seeds to create and sustain a first class medical center… against all odds!

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