After coming down with COVID-19 in December, Vinicio Sánchez visited three health centres in a single day.
At the first, a clinic in the south of Ecuadorian capital, Quito, he was told he needed oxygen but they had none left to give him. He was referred to a specialist COVID-19 centre in the north of the city, where he was fitted with an oxygen mask. As his symptoms worsened, Sánchez needed a ventilator, but the centre didn’t have the right equipment to intubate him. Transferred to a third hospital further north, he remained there for eight days until his death on Christmas Eve.
Sánchez’s wife, Mery Zapata Morales, blames his death on this dysfunctional response. “He had to go to three health centres,” she told The New Humanitarian by phone, speaking through tears. “I think this has a lot to do with the process of whether he got better or not.”
Since the beginning of the pandemic, Ecuador’s state-run public hospitals have reported massive shortages in everything from face masks to oxygen tanks to medications – doctors say this has severely disrupted patient care and led to unnecessary deaths.
“This contributes to increased mortality and frustration, because you have professionals who know what they need to do – they know the protocol – but they don't have anything to work with,” said epidemiologist and health economics expert Rodrigo Henríquez-Trujillo.
As in many other Latin American countries, corruption is partly to blame, and Henríquez-Trujillo believes many deaths could have been avoided had there been better governance.
Ecuador has been hard hit by COVID-19. Early on in the pandemic, bodies could be seen lying uncollected on the streets of the country’s largest city, Guayaquil, for days. The official toll, as of 22 August, was 31,985, but excess deaths are more than twice this figure.
Ecuador’s Attorney General’s office reported 196 healthcare-related corruption investigations in public hospitals between the start of the pandemic and November, but hasn’t updated its figures since. Alleged crimes range from embezzlement and corrupt contracts to purchasing overpriced medicines and equipment.
Several hospital managers are also being investigated for irregular procurement. Some cases involve former politicians and their families colluding with health ministry officials for contracts to sell supplies such as masks and body bags to hospitals at inflated prices.
The sons of former president Abdalá Bucaram – himself impeached on corruption charges in 1997 – allegedly ran a network in Guayaquil, selling overpriced medication and medical supplies to state-run hospitals. And a leading socialite, Daniel Salcedo Bonilla, was arrested in Peru after the small plane he was travelling in crashed as he was fleeing a probe into his alleged involvement in a hospital fraud scheme.
Meanwhile, many of the country’s elite – including Rotary Club members, well-known TikTokers, and a secret VIP list of people former president Lenín Moreno only made public after weeks of public pressure – were given vaccines before healthcare staff and other frontline workers. In February, health minister Juan Carlos Zevallos quit and moved to Miami after he sparked a public outcry by allowing his mother and her fellow care home residents to skip the vaccination queue.
Those most affected by shortages in vaccines and medical supplies have been unemployed people and low-income earners as they face greater barriers to access adequate healthcare and have been more exposed to COVID-19 due to economic pressures making them less likely to isolate. But the majority of Ecuador's population relies on the public health sector.
Ecuador is not alone
The World Health Organization and the World Bank have called on the United States to assist the region by donating excess vaccines, while experts stress that Latin American countries – including several that may not qualify otherwise due to their middle-income statuses – need better access to loans and financial aid.
Some regional governments acted early by boosting national budgets, but this also presented greater opportunities to corrupt officials looking to take advantage of the extra cash in circulation.
In Brazil – where COVID-19 has killed over 560,000 people – officials are under investigation for profiteering and misusing more than $200 million in public funds. This includes contracts for emergency field hospitals that never opened, and the buying of thousands of ventilators from China for up to $40,000 each when they were available for sale in Brazil for $16,000.
Brazilian President Jair Bolsonaro is threatened with impeachment for mismanaging the pandemic, and over allegations his political allies put pressure on health ministry officials to rush through a deal with India for Covaxin jabs at higher-than-normal prices.
In Bolivia, a former health minister is under house arrest for spending millions of dollars in public funds on 170 ventilators that failed to work properly. Meanwhile, over 830 disciplinary actions have been taken against Colombian mayors, governors, and municipal councils for misuse of public funds. And several medical practitioners were arrested in Peru in June for their alleged involvement in criminal rings that extorted families in exchange for allocating ICU beds to their critically ill loved-ones. Months earlier, a former Peruvian president and several ministers were found to have received preferential jabs in a scandal dubbed Vacunagate.
Even in the best of times, public health is one of the sectors most prone to corruption globally, according to Jonathan Cushing, head of global health at Transparency International. There are many possible entry points for corruption, he said, ranging from patients who will pay to jump lines for procedures, to senior officials colluding over public procurement of medications and supplies.
Transparency International estimates that an average of more than $500 billion a year is lost to corruption in the public health sector globally.
Cushing said reports of corruption have increased around the world since COVID-19, from expanded trafficking of counterfeit medicines in Southeast Asia to increased bribery for medical treatment in countries across Europe. In health systems that were already opaque and complex, the pandemic created a setting ripe for large-scale exploitation, he added.
“If you think back to this first wave of massive expenditures in personal protective equipment, ventilators, and now vaccines... expenditure's gone up,” said Cushing. “Where you have those big procurements, there are a lot of vulnerabilities.”
Some aid groups responding to needs amid the pandemic – including those normally focused on very different problems – have found themselves filling healthcare gaps and providing the medicines and equipment public health systems have been unable to provide.
José García, executive secretary of Caritas Ecuador, said the Christian aid group has been forced to channel resources into things like personal protective equipment, food, and medicines for over 600,000 people in need since the start of the pandemic.
He said local Caritas offices in some areas have opened small pharmacies and medical clinics for those who can’t access the overburdened public healthcare system or afford private care. As a result, they have had to pause other long-term projects such as agricultural development and training programmes.
“We are not suffering from [just] one pandemic. We have other pandemics that within the context of this [COVID-19] pandemic have worsened and multiplied” García said, listing issues from unemployment and violence to environmental crises and state corruption.
“How terrible,” he added, “that so many political appointees have enriched themselves with the people's resources.”
Not just COVID-19
Ana María Gómez J., a specialist in internal medicine who has a private practice in Quito, believes Ecuador’s current healthcare crisis is far more down to money going in the wrong directions than just the extra demand because of the pandemic.
“It was because something did not work,” Gómez told The New Humanitarian. “It was not only a lack of management, [not] only a lack of doctors, but many things were not done because resources were diverted.”
In June, medical staff and patients held demonstrations outside two state-run hospitals in Quito, and cancer patients rallied in front of hospitals in Guayaquil, protesting the lack of medications causing delays in operations and treatment for chronic illnesses.
In some cases, according to Henríquez-Trujillo, shortages have caused price inflation of up to 800 percent, putting them even further out of reach.
The New Humanitarian spoke to several Ecuadorians angry at the long delays. Isabel Juela’s husband had recently had to undergo his brain surgery at a private clinic because the state-run hospital in Quito delayed the procedure for months due to a lack of anaesthetics. The family now owes the doctors $15,600 for the surgery.
Lucila Lara was at the Eugenio Espero Public Hospital in Quito, visiting her brother who needs a metal plate implant after being electrocuted and suffering severe burns to his head. Two months on, the operation has yet to be scheduled as the hospital says it lacks the funds to purchase the plate and the medications needed to carry out the procedure.
“What are we going to do?” Lara asked. “If it's really expensive, how are we going to pay for it outside [at a private clinic]?”
As Ecuador’s COVID-19 outbreak intensified last year, Gómez – who referred to the rise in untreated illnesses as a co-pandemic – said she started receiving a stream of new patients with fewer resources, desperate for treatment they could no longer receive in state-run hospitals.
“These patients who tell me, ‘I have no attention in the public [hospital], I come to you, whatever it costs me.’ It’s horrible,” Gómez said. “The right to health has not been guaranteed during the pandemic.”
Amid the COVID-19-related corruption accusations, Moreno – president until May 2021 – insisted his government had worked hard to combat graft prevalent during the previous administration of Rafael Correa, noting he had asked two vice presidents to step down.
Earlier budgetary cuts had already debilitated the health system. Between 2017 and 2019, spending in public health fell 35 percent per year and thousands of medical staff were laid off. The government cut over $200 million more from the healthcare budget in May 2020, despite the acute situation generated by the pandemic. That same month, Moreno signed a decree to increase transparency in procurement and “put a stop to corruption in the purchase of medicines and supplies in the health system”. Yet reports of corruption continued to emerge.
Meanwhile, Moreno’s administration struggled to roll out vaccinations. After Zevallos left as health minister, it was revealed that the country had no vaccination plan, which the president defended by saying it “existed in the minister’s mind”.
Since taking office, President Guillermo Lasso has promised to fully vaccinate nine million people – roughly half of Ecuador’s population – by September. As of 15 August, less than 40 percent of the adult population had been fully vaccinated.
Assistance continues to flow into Ecuador in spite of the corruption scandals. Earlier this year, the International Development Bank extended loans for social and health projects in the country worth $263 million. It's unclear how this money is being used. The IDB didn’t respond to questions about whether it evaluates corruption levels before donating to governments, pointing instead to its accountability page, which outlines its anti-fraud processes.
The Pan American Health Organization, meanwhile, said the assistance it provides is determined by a country’s epidemiological situation and level of need, based on a thorough needs assessment. It didn’t say if corruption and mismanagement of supplies are taken into consideration, only that PAHO “follows strict protocols to ensure that any supplies and assistance provided reaches those that need it the most”.
Ecuador’s new government has so far responded to this public health crisis by sending officials to visit hospitals across the country to evaluate the situation.
In June, Vice President Alfredo Borrero called the conditions “deplorable” and proclaimed: “Healthcare is sick.” He promised to fully stock hospitals and improve their condition, but is yet to reveal how the government will do so.
Neither the interior ministry nor the health ministry responded to requests for comment on the corruption scandals in state hospitals by the time of publication.
Germán Rodas Chaves, coordinator of the National Anticorruption Commission, or CNA – an independent watchdog – said what's really needed are structural changes: stronger anti-corruption laws, special units within the judicial system dedicated to tackling corruption, protections for whistleblowers, and better education to understand the impacts of corruption.
The CNA has long analysed hospital contracts, and warned officials how mafia rings operate, including bribes for hospital contracts, avoiding the public bidding system, and selling overpriced medicines and hospital supplies. It submitted these investigations to healthcare officials, the Comptroller General’s office, and the District Attorney’s office in 2019, but none of the institutions ever responded, Rodas Chaves said.
“The corruption mafias are not two or three years old,” Rodas Chaves told The New Humanitarian. “They have been established in healthcare in the country for more than 10 years.”
Edited by Paula Dupraz-Dobias and Abby Seiff.