Doctors here say the need for patients to source their care privately, or to purchase their own medical supplies for use in bare-bones public hospitals, is leaving untold numbers of poor Venezuelans to die during the pandemic. But the Fuenteses, aided financially by a family member now living in the United States, were able to buy oxygen tanks, IV drips, saline solution, needles and other costly supplies, then hire nurses to provide 24-hour care at home.

Like other Latin Americans in the middle and upper classes, they paid for doctors to make house calls. They even bought lifesaving courses of remdesivir, sourced from a burgeoning local black market for coronavirus drugs, at $140 per dose. After a total outlay of $20,000 in three weeks — a sum equal to 1,667 years worth of salary at Venezuela’s minimum wage — two ill family members have recovered. A third remains hooked up to oxygen and under 24-hour care, his condition gradually improving.

“If you don’t have money, you don’t have a chance,” said Belinda Fuentes, a 44-year old fitness instructor in New York who emptied her life savings to help her parents and older brother.

For thousands in Latin America, where the richest 1 percent earn 21 percent of the region’s income, double the average in the industrialized world, survival in a worsening pandemic is boiling down to economics.

“Sometimes, it’s just about the cost of oxygen, which some health services do not have enough of,” said Ciro Ugarte, director of health emergencies at the Pan American Health Organization. “Families are having to buy it and bring it to hospitals. If they don’t have the money, in severe cases, their family member will probably die.”

In Brazil, the epicenter of the region’s coronavirus crisis, cases are still surging, overburdening a health-care system skewed to serve the rich. Of the 45,848 intensive care beds in Brazil, slightly more than half are in costly private hospitals that serve a quarter of the population.

During Mexico’s punishing second coronavirus wave in January, more than 50 percent of covid-19 patients admitted to hospitals run by the Mexican Social Security Institute, the nation’s largest public health network, subsequently died. The rate in better-funded private hospitals was 20 percent, according to an analysis commissioned by the World Health Organization and released last week by the Institute for Global Health Sciences at the University of California at San Francisco.

Private hospitals in Latin America, where care can cost upward of $2,000 a day, remain largely the purview of the very rich. Home care is emerging as a less expensive alternative, even as it drains the resources of a middle class devastated by pandemic-related job losses.

Dario Morales, a 36-year-old flight attendant in Peru, said his mother was infected in February. His stepfather, also diagnosed with the coronavirus, had died days earlier at a public hospital in the coastal city of Trujillo.

To avoid that fate, his mother pleaded with him to pay for home care. The bill for 10 days of oxygen, specialized drugs and in-home care from nurses and doctors: a financially crippling $2,800. He managed to cover it by giving up his apartment and moving in with friends.

“If we took her to a public hospital, it would have been, ‘Oh sorry, we don’t have space,’” Morales said. “Even if they did find a bed, she’d get no attention because there are too many patients and too few doctors and nurses.”

In Venezuela, a broken socialist state, the public health-care system has been so weakened that its citizens bear the highest out-of-pocket health-care costs in Latin America. Venezuelans cover 63 percent of their health expenditures on average, according to WHO and Organization for Economic Cooperation and Development data — nearly double the rate in Chile, and more than four times that of Argentina.

Public hospitals are so underequipped and underfunded that one survey found that 92 percent of X-ray machines did not work and 68 percent of facilities lacked consistent running water. Patients routinely supply their own oxygen, needles, antibiotics and saline solution.

After sidestepping the worst of the pandemic last year, Venezuela ended strict lockdowns in December and has now witnessed a terrible surge. Official data from President Maduro’s opaque authoritarian government show roughly 183,000 infected and 1,900 dead. But those numbers, doctors say, do not begin to capture the true extent of the outbreak.

“If you got sick today, I have nowhere to put you,” said Julio Castro, an infectious-diseases specialist and adviser to the Venezuelan opposition on the coronavirus response. “For a year we have warned that things could get worse, and now the worst is happening.”

The pandemic has exacerbated scarcities of medical supplies and drugs, fueling a proliferation of WhatsApp chat rooms filled with private vendors offering oxygen concentrators for $5,000 and oxygen tanks for $500. Those are sums accessible only to the small and disappearing middle class and wealthy elites, leaving thousands of Venezuelans in need to turn to social media or GoFundMe sites.

In what once was South America’s richest nation per capita, years of corruption and mismanagement and falling oil prices have fueled deeper inequality. The rich and connected buy imported foods and lavish cars and belong to elegant country clubs. The extreme poor — 79.3 percent of the nation, according to a survey by Andres Bello Catholic University in Caracas — live in squalor, often in violent slums, and lack adequate food. Many have lost weight from what some call “the Maduro diet.”

Venezuela has secured precious few vaccine doses, and has reserved them for emergency responders and the elderly. Still, some elites have managed to access them. One wealthy Venezuelan said he had obtained the Russian Sputnik V vaccine through a personal local contact. The man, who spoke on the condition of anonymity out of fear of government retribution, said he had purchased vaccinations for himself and several staff members from the Domingo Luciani Hospital in Caracas at $200 a dose.

“If you have the money to pay, you can talk to the [nurse] on the floor and get what you need,” he said.

For the poorest Venezuelans, meanwhile, the cost of the pandemic is fatally high.

Marilin Mijares came down with the covid-19 symptoms of cough, exhaustion and difficulty breathing two weeks ago. Her daughter Marialber Cabrera, a 35-year old who resells used goods in the northern state of Aragua, said she pleaded with the staff at two public hospitals to admit her.

“They were both at full capacity,” Cabrera said. “There was no room.”

Even if a bed became free, she was told, the family would have to provide the supplies — medical gloves ($15 a box), masks ($10 a box), an oxygen tank ($100) and refills ($50 each). For Cabrera’s father, a security guard who earns $6 a month, the cost was unimaginably high.

Cabrera’s grandmother had caught the virus and recovered, so they began a similar treatment for her mother at home: a combination of vitamins and ibuprofen purchased with donations from neighbors and extended family. But her mother’s symptoms worsened. When her breathing became extremely labored, Cabrara began begging private suppliers.

“I told them over the phone that we didn’t have any money and that my mom really needed oxygen,” she said, her voice breaking. “They just said, ´There is nothing we can do for you if you can’t pay.’”

Her family began a grim vigil, trying to comfort her mother as her condition deteriorated.

“The last time I saw her, she asked me to give her a shower,” Cabrera said. “She told me she loved me and that her love was unconditional and forever.”

The next morning, Cabrera was in line at a public hospital attempting to arrange an X-ray appointment for her mother when her father called. Mijares had started to “suffocate.”

“My dad was crying, saying she couldn’t breathe,” Cabrera said. “My neighbors helped my father put her in a car. She died there. She couldn’t breathe.”

“If she had had oxygen, my mother would still be alive,” she said. “What we are living is horrible.”

Now, both she and her father have come down with symptoms.

“Everything is in God’s hands now,” she said.

Mary Beth Sheridan in Mexico City and Terrence McCoy in Madison, Wis., contributed to this report.

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Source: Washington Post