CARACAS, VENEZUELA — Grimacing from contractions, expectant mother Castuca Marino had more on her mind than birth pangs. She was nervous about whether she and her newborn child would make it out of the hospital alive.
Interviewed as she stood in the emergency room of Concepcion Palacios Maternity Hospital here last week, Marino had heard news reports of six infant deaths there over a 24-hour period late last month. She knew that since the beginning of February, six mothers had died in the hospital during or after childbirth.
"What are poor people going to do?" said Marino, 20, as she was being admitted to this sprawling complex where, on average, 60 babies are born a day. "I'm just hoping that there are no complications and that everything goes well."
Palacios, Venezuela's largest public maternity hospital and once the nation's beacon of neonatal care, has fallen on hard times. Half of the anesthesiologists and pediatricians on staff two years ago have quit. Basic equipment such as respirators, ultrasound monitors and incubators are either broken or scarce. Six of 12 birth rooms have been shut.
On one day last month, five newborns were crowded into one incubator, said Dr. Jesus Mendez Quijada, a psychiatrist and Palacios staff member who is a past president of the Venezuelan Medical Federation.
The deaths of the six infants "were not a case of bad luck, but the consequence of an accumulation of circumstances that have created this alarming situation," Mendez said.
He and others say the problems at Concepcion Palacios are symptoms of a variety of ills that have beset the public healthcare system under leftist firebrand President Hugo Chavez. Cases of malaria nearly doubled between 1998, the year before Chavez took office, and 2007. Incidents of dengue fever more than doubled over the same period.
Poorly paid doctors regularly demonstrate at hospitals from Puerto La Cruz in the northeast to Maracay in the industrial heartland, demanding back pay and protesting the lack of equipment and supplies. Others are leaving in droves for Spain, Australia or the Middle East, where they make 10 times the $600 monthly average salary they earn in public hospitals.
Venezuela's healthcare system was facing problems even before Chavez took office. The system has been riven with corruption, mismanagement and disorganization for decades. In addition, tropical conditions have made the country ripe for epidemics difficult for any government to control. An encephalitis outbreak in 1996 sickened 20,000 people.
But the system's current crisis comes as the country is awash in oil wealth, a windfall that critics say could be used to ease the problem. Instead, Chavez is building a parallel health program called Barrio Adentro, which features 11,000 neighborhood clinics staffed mainly by Cuban doctors.
Inaugurated nationwide in 2003, Barrio Adentro initially was so popular with the poor that it helped Chavez win a crucial 2004 referendum and hold on to power. It has brought basic healthcare to the barrios, providing free exams and medicine as well as eye operations that have saved the sight of thousands.
But the system siphons resources and equipment away from the public hospitals, which have four-fifths of the nation's 45,000 hospital beds and where the public still goes for emergency and maternity care, as well as for most major and elective surgeries.
The finances and organization of Barrio Adentro are "a black box and not transparent, so it's impossible to analyze it for efficiency," said Dr. Marino Gonzalez, professor of public policy at Simon Bolivar University in Caracas, the capital.
A lack of openness has affected other facets of public health too. After the medical establishment blamed him for an outbreak of dengue fever last summer, Chavez halted weekly publication of an epidemiology report that for 50 years had tallied occurrences of infectious diseases nationwide.
Former Health Minister Rafael Orihuela says the loss of the weekly report has deprived the government of information needed for a quick response to outbreaks of disease.
"I am not talking about a failure of the government to adopt innovations in healthcare," said Orihuela, a Chavez critic. "I am talking about a failure to maintain basic healthcare standards."
Chavez has also been accused of appointing cronies to manage public health. Efforts to arrange an interview with Minister of Popular Power for Health Jesus Mantilla, who served with Chavez in the military, were unsuccessful last week.
Politics and polarization fuel the healthcare debate. Depending on who is speaking, Venezuela is either suffering from the pangs of a new dawn in socialist healthcare or from the monumental incompetence of top-level bureaucrats.
But even government officials acknowledge the public health system in recent months has been on the verge of collapse, evidenced by problems in maternity and postnatal care.
Since the mid-1990s, the death rate of women giving birth has risen 18%, to 59 in every 100,000 deliveries, according to UNICEF. That's four times the rate in Chile. Venezuela's infant mortality rate of 18 deaths for every 1,000 live births in 2007 was down from 20.5 in 1998, but still double the rate of Chile and higher than other Latin American countries such as Colombia, Uruguay and Costa Rica.
Gonzalez, the university professor, fears that the situation could get worse because maternity hospitals such as Concepcion Palacios are having increasing difficulty finding young pediatricians to pursue neonatal specialty training due to low pay and lack of resources.
"It's not that before Chavez things were great," he said. "It's that things have deteriorated."