Handsome and with neatly slicked hair, Victor Gonzales looks like he belongs more in a boy band than among the dirt-clad miners around El Callao.
Originally from Caracas, the 25-year-old made the journey to the mining town in Bolívar state with his wife five months before IRIN encountered him in August.
“You can’t live in the city anymore; there's no cash, that’s why so many people are coming to the mines. If not, they are leaving the country,” he says. But behind his meek smile, Victor is carrying a daily burden that is preventing him from working each day: malaria.
Alongside Nigeria, South Sudan, and Yemen, Venezuela is one of four countries worldwide that has seen an alarming increase in cases of the mosquito-borne disease.
The World Health Organization raised the alarm in April after a report found that cases of the malaria had jumped 69 percent in 2017 from the previous year. In October, the president of the Venezuelan Medical Federation said the number so far in 2018 was more than 650,000 – if confirmed that would represent an additional 60 percent increase on 2017, with several months still to go.
(Source: WHO, PAHO, Federación Médica de Venezuela)
In the Sifontes municipality, next to El Callao, the towns of Las Claritas and Tumeremo, where illegal mining thrives, have the highest number of reported cases in the country. As far back as 2013, 60 percent of Venezuela’s malaria cases were found in Sifontes.
Last year, the estimate for the whole country was 406,000 cases, five times higher than 2013. Now, hospitals in Caracas, which has long had a very low number of cases, are seeing a rapid increase in patients sick with the disease, and most come from mines in Bolívar state.
“I have already been sick for six days,” says Victor. “Because I sleep in the mine I got infected. This is the fourth time in five months I have had it.”
‘Survival of the fittest’
Away from the scant food shelves and despondent queues seen throughout many of Venezuela’s major cities, El Callao, on the country’s eastern frontier with Guyana, is booming.
“Here in El Callao, thank God, we don’t suffer this crisis; we are blessed with the richness of gold,” says Alberto Garcia, one of the many Venezuelans to have flocked here.
El Callao is Venezuela’s gold capital, and it never sleeps. Gold dealers operate a 24-hour service seven days a week and Garcia is one of them, getting in on the rush. Having arrived two years ago from the city of Valencia, he managed to get connected fast and now works as a buyer. He is one of the lucky ones.
Along the side-street where Garcia works, Syrian, Israeli, and Iranian flags can be seen draped inside shop windows. “People from all over the world are here in El Callao,” says Garcia. “It’s a very profitable place.”
Like Garcia, dealers buy gold from local miners then sell it outside the country. Despite this operation being illegal, the transactions take place in broad daylight in front of the authorities.
But this thriving economy comes at a price: a conflict between the military and local mafias is raging, the mining has brought widespread environmental devastation, and the malaria epidemic is threatening to engulf the entire region. “Here in El Callao,” says Garcia, “it’s survival of the fittest.”
A rapid resurgence
Venezuela was once internationally celebrated for its robust eradication programme. The country waged a vigorous campaign in the 1930s against the virus, which was considered to be endemic.
Led by physician Arnoldo Gabaldón, a nationwide prevention programme using the insecticide DDT was launched throughout the 1940s. By 1955, 10 years after the programme started, the rate was lowered to one per 100,000 people, and in 1961 the WHO declared malaria eradicated from 68 percent of a malaria zone that included two thirds of the country.
Today, it's a different story.
Foreign imposed sanctions are tightening against the government of Nicolás Maduro, who still downplays the severity of the malaria problem. The means to counter the growing epidemic remain slim as money runs out and years of import controls have caused a lack of mosquito nets and other preventative equipment.
After years of wild spending that pumped money into Cuban-style health missions for the poor, the public healthcare system has been neglected for years and is in deep crisis.
Other factors that have helped malaria’s spread include the breakdown of water-pumping systems that increased breeding grounds for mosquitoes, the end of the fumigation programme, and internal migration within Venezuela to affected areas.
Plasmodium vivax is the most common of the three species of the malaria-carrying parasite that circulate in the area.
Medicine shortages and a lack of prevention programmes have serious consequences for those infected.
Victor wakes up at around 5am to join the queue at the Juan German Hospital. Each day from dawn until dusk the hospital car park fills with families, couples, and single men of all ages, most of them wear their mining boots.
Despite the prospect of free medicine, there is no guarantee a day's wait outside the hospital will get you treatment. Medicine shortages are so acute now that self-treatment options are becoming increasingly common. Children as young as four can be seen among the miners who lie out sick across the tarmac.
Health workers say that even in the smaller clinics they can receive up to 200 new patients daily. Age, a delay in seeking treatment, and self-treatment prior to professional care all affect the number of the parasites in the blood.
Plasmodium vivax is particularly difficult to treat, as it can lie dormant in the liver for months, in some cases years. The medicine Primaquine should be taken for 14 days to treat vivax; but low supplies and unpredictable delivery leave many patients unable to complete the full treatment. Stories of patients in desperate need of cash selling their prescriptions, only to relapse a few weeks later, are also common.
With plasmodium falciparum – the deadliest of the three types of malaria in the area – also prevalent, dozens of people reportedly die each month in El Callao. Obtaining statistics on exact numbers is very difficult due to the reluctance to release reliable data. At Juan German Hospital on one August day, an old Cadillac serving as a mortuary vehicle came and went several times.
A short walk from Juan German Hospital, the medicines needed to treat malaria are easily bought on the black market along with the plastic strips used for the blood smear microscopy examinations.
Primaquine and Chloroquine pills taken from the hospital are sold on the black market for up to two grams of gold on the street corners. Five Venezuelan military personnel guard the hospital doors, but medicines always find a way out.
“Everyone knows who is profiting from the blackmarket trade here, the mafias and the army work together,” says Victor. For miners like Victor who are too sick to work and therefore to pay black market prices, it’s an agonising wait to receive medicine from the hospital.
Despite recent government efforts to dispel the criminal networks that have long reigned in Venezuela´s wildcat mines, little on the ground changes. Military generals lay claim to freshly captured mines and mafias are replaced with new armed groups. An effective response to the malaria epidemic seems to fall behind the long list of priorities in present-day Venezuela.