WMC Women Under Siege

Maternal mortality up 83% along Venezuela border as migrants flee country

Cúcuta, Colombia—Maria Daniel Castro had been vomiting all night and no one knew why.

She sat rigid in a waiting room of Cúcuta, Colombia’s main public hospital, bags under her eyes and arms folded over a jacket that just barely concealed her baby bump. It was 9 a.m. and she was alone in the fluorescent-lit room brimming with pregnant Venezuelan migrants just like her. 

Castro, five months pregnant, arrived at Erasmo Meoz University Hospital at 5 p.m. the day before with sharp pains running from her ribs to her cervix. She hoped to receive help for what she already knew was a high-risk pregnancy. Instead, she waited for 16 hours for nothing more than a quick consult. She vomited so many times throughout the night she “lost count.” 

Maria Daniel Castro, a pregnant Venezuelan mother, sits in the waiting room of Cúcuta, Colombia's main public hospital on February 7, 2019. Photo by Megan Janetsky/Women Under Siege

But in Cúcuta—a border city eclipsed by migration from Venezuela to Colombia and, more recently, a tide of violence from clashes between Venezuelan opposition and security forces—even the most extreme cases had to wait.

There was no other option.

“I imagine it will affect my baby,” she said after spending the night in the waiting room. “I spent my entire day vomiting with a fever. I don't know what could happen to it. But I haven't left, I've kept waiting, because we have to know how the baby is.”

As Venezuela spirals from rampant hyperinflation and violent political clashes, a health crisis has stricken the South American country, with its citizens unable to access food, medicine, or even basic care in their country’s hospitals. And as an exodus of more than 3 million migrants leave the country, that health crisis has begun to spill over Venezuela’s borders and into countries like Colombia, which has thus far accepted more than 1.3 million migrants. Now, with hospitals filled to the brim and aid organizations unable to keep pace, it’s the most vulnerable migrants—children, babies and pregnant women like Castro—who are being hit the hardest.

“For hours I sat here,” she said. “But thank God I'm not trying to get services in Venezuela, because there aren't any.”

Between 2017 and 2018, Erasmo Meoz experienced an 83 percent increase in maternal mortality—dying during pregnancy or 42 days after giving birth—Norberto García Romero, the hospital’s gynecological and obstetric coordinator, told Women Under Siege. Cases of syphilis in babies have shot up at a similar rate. Border zones in Colombia and Brazil have also seen spikes in infant mortality and outbreaks in previously-contained diseases like malaria, diphtheria, and measles.

A poster for vaccines hangs in front of the entrance of a Colombian medical clinic set up along the Venezuelan border for newly arrived families, mothers, and pregnant Venezuelan migrants. Photo by Megan Janetsky/Women Under Siege

The root of the problem has been a lack of basic medical services in Venezuela. In 2018, Venezuela saw a 65 percent increase in maternal mortality, and a 30 percent increase in infant mortality from the year before, when levels in pregnancy-related deaths also skyrocketed, according to a report by the University of Miami. Hospitals lacked basic nutrition, medications, laboratory, and water services, as well as supplies for surgical, intensive, and emergency care.

So, migrants cross the border to Colombia without previous checkups, without vaccinations, and in increasingly dire conditions. Instead, the women go through their pregnancy in Venezuela mostly blind and arrive at the Colombia clinics in often severe conditions.

Alejandra Leon has seen it firsthand. She runs a UNICEF-backed clinic for women and children just a stone’s throw from Cúcuta’s main border bridge where, up until last week with recent closures of border crossings, 42,000 migrants cross into Colombia every day. Still, a constant flow of patients cycles through the four short rows of blue seats in the clinic as its handful of doctors call patients into its small cluster of exam rooms. In the past month, she said, only two pregnant women had previous exams during their pregnancies. “There is a high obstetric risk because exams throughout the pregnancy are what will indicate the development of a medical problem,” she said. “With them, you can learn about what different afflictions may affect you and your baby, and then you can manage all of this. These women don't have any of that.”

For some, the extreme medical conditions stem from long-developed and untreated complications in their pregnancy; for other women, it’s from the sheer exertion of walking days to flee Venezuela, unable to afford something as simple as a bus ticket. “We talk to people who have arrived and have walked for three days,” said Edward Contresros, a doctor at the clinic. “We do the examination and have to give them liquids, vitamins, nutrients. But we’ve found that their system is already in disarray.” 

Oftentimes, that’s all they can do.

Nearly all of the pregnant women that arrive at the clinic—at least 90 percent, Contresros said —arrive with high-risk pregnancies, threatening the health or lives of the mother or fetus. Some start high-risk while others become so as the pregnancy progresses. Often, the solution to protecting the baby and the mother is regular prenatal care and consults from specialists. But those are specialists that clinics like Contresros’ and Leon’s don’t have. All they can offer is basic exams to confirm what’s wrong and refer them to Erasmo Meoz, a hospital where there are specialists, but where migrants like Castro wait for long stretches of time without aid.

“We can diagnose, but we can’t give them everything that they need,” Contresros said. “So, they continue to be at risk.”

And while international leaders have promised to deliver more and more aid supplied to border zones and Venezuela, some of which has brought with it a groundswell of violence, medical experts say their greatest need is still more specialized resources to treat those severe cases.

Maria Carrillo, an 18-year-old Venezuelan migrant, holds her five-month-old baby outside a medical clinic on the Colombia-Venezuela border on February 9, 2019. Photo by Megan Janetsky/Women Under Siege

The scarce resources they’ve found in Colombia are still vastly better than the ones they had in Venezuela, said 18-year-old parents Maria and Miguel Carrillo. The couple swaddled their five-month-old baby, Daviana, outside the clinic, Maria periodically pressing her daughter to her breast when she began crying. The family had arrived just a week before, after giving birth in Venezuela, and sought out medicine for Daviana’s fever.

In their home near Caracas, they had little-to-no medicine throughout the pregnancy and Daviana’s delivery, something that terrified Maria as she waited to give birth. “Up until this moment there was practically no help,” Maria said, as Daviana curled her fingers around the white strap of her mother’s tank top. Weeks before, they had fled their homes and families for their daughter, and despite a new kind of fear in Colombia, they also found hope in the border clinics.

Here in Colombia, she said, at least they can get help when their newborn had a fever. In Venezuela, there was nothing for her. “[I hope] for the future of my baby, I hope that she doesn't lack anything,” Maria said. “That's why we're here, so she has everything she needs. Because right now, in Venezuela, we can't get the most basic things for her.”

More articles by Category: Health, Immigration, International
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