This week, the first direct commercial flight between the United States and Venezuela in seven years landed in Caracas. We use that moment to dig into the collapse of Venezuela's healthcare system, one of the most severe humanitarian crises in the world.
Esta semana, el primer vuelo comercial directo entre Estados Unidos y Venezuela en siete años llegó a Caracas. Usamos ese momento para hablar del colapso del sistema de salud venezolano, una de las crisis más graves del mundo.
7 essential B1-level terms from this episode, with translations and example sentences in Spanish.
| Spanish | English | Example |
|---|---|---|
| desnutrición | malnutrition | La desnutrición afecta mucho al sistema inmunológico de los niños. |
| vacunación | vaccination | El programa de vacunación del país dejó de funcionar bien hace varios años. |
| cadena de frío | cold chain | Sin una buena cadena de frío, las vacunas se dañan y no funcionan. |
| mayor | greater / older / most important | Este es el mayor problema de salud pública en la región. |
| reservas | reserves / supplies | Venezuela tiene unas de las mayores reservas de petróleo del mundo. |
| sanción | sanction | Las sanciones hacen más difícil comprar medicamentos en otros países. |
| sistema inmunológico | immune system | Cuando una persona está desnutrida, su sistema inmunológico es más débil. |
Picture a country where hospitals run out of surgical gloves.
Where chemotherapy drugs disappear for months.
Where doctors perform operations by the light of their cell phones because the power grid has failed again.
That country is Venezuela, and a plane landed in Caracas this week that, in a quiet way, tells us something about where things stand.
Sí, y es una noticia pequeña pero importante.
Yes, and it's a small but important piece of news.
El primer vuelo comercial directo entre Estados Unidos y Venezuela en siete años llegó al aeropuerto Simón Bolívar en Caracas.
The first direct commercial flight between the United States and Venezuela in seven years arrived at Simón Bolívar airport in Caracas.
Seven years.
That gap tells you something right there.
And what I want to use this story for is not really the flight itself but the context around it, because the context is staggering.
Venezuela's public health system is, by most measures, one of the most collapsed in the Western Hemisphere.
Exacto.
Exactly.
En Venezuela, el sistema de salud tiene problemas muy serios desde hace más de diez años.
In Venezuela, the healthcare system has had very serious problems for more than ten years.
Los hospitales no tienen medicamentos, no tienen equipos modernos y muchos médicos se fueron del país.
Hospitals have no medicines, no modern equipment, and many doctors left the country.
Let's put some numbers on that, because the scale is hard to grasp.
Before the crisis deepened, Venezuela had around 66,000 doctors.
By the early 2020s, estimates suggested somewhere between 20,000 and 30,000 had emigrated.
You lose half your physicians in a decade.
That's not a setback, that's a structural collapse.
Y no solo los médicos.
And not just doctors.
También enfermeras, técnicos, farmacéuticos.
Also nurses, technicians, pharmacists.
Toda la gente que trabaja en la salud buscó una vida mejor en otro país, sobre todo en Colombia, Argentina, España y Chile.
All the people who work in healthcare looked for a better life in another country, especially in Colombia, Argentina, Spain, and Chile.
And Spain is an interesting case there, because Venezuela and Spain have that language connection, that historical bond, which made emigration easier.
Octavio, you've reported on Venezuelan immigrants arriving in Spain.
What did that look like from where you were sitting?
Sí, en Madrid fue muy visible.
Yes, in Madrid it was very visible.
Muchos venezolanos llegaron con títulos universitarios, con mucha preparación.
Many Venezuelans arrived with university degrees, highly educated.
Médicos que tuvieron que volver a estudiar porque sus títulos no eran válidos en España.
Doctors who had to study again because their credentials weren't valid in Spain.
Era una situación muy triste y también muy injusta.
It was a very sad and also very unjust situation.
A brain drain that hits the country that can least afford to lose those brains.
And the people who stayed, they're working in conditions that would be considered unacceptable in any other context.
Hay hospitales donde no hay agua corriente.
There are hospitals with no running water.
Los médicos trabajan sin electricidad durante muchas horas.
Doctors work without electricity for many hours.
En algunos hospitales, los pacientes tienen que llevar sus propias sábanas y sus propios medicamentos.
In some hospitals, patients have to bring their own sheets and their own medicines.
That detail about patients bringing their own medicine is the one that stays with me.
Because what it means is that if you can't afford to buy the drug on the black market, you simply don't get treated.
The healthcare system becomes a luxury good.
Y hay enfermedades que volvieron después de muchos años.
And there are diseases that came back after many years.
La malaria, la difteria, el sarampión.
Malaria, diphtheria, measles.
Enfermedades que Venezuela casi no tenía en los años noventa, pero que regresaron porque el sistema de vacunación dejó de funcionar bien.
Diseases that Venezuela almost didn't have in the nineties, but which returned because the vaccination system stopped working properly.
The return of vaccine-preventable diseases.
That's a genuinely alarming marker, because it means the public health infrastructure has eroded to a point where populations lose herd immunity they'd built up over generations.
Malaria back in Venezuela.
In the early 2000s, cases were under 40,000 a year.
By the late 2010s, they'd climbed past 400,000.
Y eso pasó muy rápido.
And that happened very fast.
El problema no es solo político.
The problem is not only political.
Es que cuando un país no tiene dinero, la salud pública es una de las primeras cosas que sufre.
It's that when a country has no money, public health is one of the first things to suffer.
Los programas de vacunación necesitan dinero, necesitan cadena de frío, necesitan transporte.
Vaccination programs need money, they need cold chains, they need transport.
The cold chain.
Explain that for listeners who might not know the term.
Claro.
Of course.
La cadena de frío es el sistema para mantener las vacunas a la temperatura correcta desde el laboratorio hasta el paciente.
The cold chain is the system to keep vaccines at the right temperature from the laboratory to the patient.
Si hay un corte de electricidad, o si no hay camiones con refrigeración, las vacunas se dañan y ya no funcionan.
If there's a power cut, or if there are no refrigerated trucks, the vaccines are damaged and no longer work.
And Venezuela's electrical grid has been in crisis for years, with rolling blackouts that can last eight, ten, twelve hours.
You combine that with a collapsed cold chain and suddenly vaccines that work perfectly well in theory become useless in practice.
Exactamente.
Exactly.
Y también hay otro problema importante: la desnutrición.
And there's another important problem: malnutrition.
Muchos venezolanos, especialmente los niños, no tienen suficiente comida.
Many Venezuelans, especially children, don't have enough food.
Y cuando un niño está desnutrido, su sistema inmunológico es más débil y se enferma más fácilmente.
And when a child is malnourished, their immune system is weaker and they get sick more easily.
The Venezuelan Nutrition Observatory published surveys showing that something like 90 percent of Venezuelan households couldn't afford enough food to meet their caloric needs at the peak of the crisis.
Think about what that does to a population's baseline health before they even set foot in a hospital.
Y todo esto pasó en un país que tiene petróleo.
And all this happened in a country that has oil.
Venezuela tiene unas de las reservas de petróleo más grandes del mundo.
Venezuela has one of the largest oil reserves in the world.
En los años setenta y ochenta, Venezuela era un país rico con un buen sistema de salud.
In the seventies and eighties, Venezuela was a rich country with a good healthcare system.
Eso es lo que hace esta historia tan difícil.
That's what makes this story so hard.
The paradox of resource wealth.
A country sitting on the world's largest proven oil reserves, and children are dying of measles.
I covered something similar in the Niger Delta in the nineties.
The oil is there.
The money flows.
And somehow it never reaches the clinic.
Sí, es un problema clásico.
Yes, it's a classic problem.
Los economistas lo llaman la 'maldición del petróleo'.
Economists call it the 'oil curse'.
Un país depende demasiado del petróleo, no desarrolla otras industrias, y cuando el precio del petróleo baja, todo el sistema económico tiene problemas.
A country depends too much on oil, doesn't develop other industries, and when the oil price falls, the whole economic system struggles.
And in Venezuela's case the oil curse got layered on top of decades of mismanagement, then sanctions, then the pandemic.
By the time COVID hit, there were reports of Venezuelan hospitals with one ventilator for an entire regional hospital.
One.
Y los datos del COVID en Venezuela son difíciles de saber porque el gobierno no publicó información completa.
And the COVID data in Venezuela is hard to know because the government didn't publish complete information.
Muchos expertos creen que las cifras reales de muertos fueron mucho más altas que las cifras oficiales.
Many experts believe the real death figures were much higher than the official numbers.
That opacity around health data is itself a health problem.
Because you can't respond to a crisis you refuse to measure accurately.
I think about Amartya Sen's observation that famines don't happen in democracies with free presses.
The same logic applies here.
When you suppress health data, you can't build the international response that could save lives.
Y eso conecta con el vuelo de esta semana.
And that connects to this week's flight.
El primer vuelo directo entre Estados Unidos y Venezuela en siete años significa que las relaciones entre los dos países mejoraron un poco.
The first direct flight between the United States and Venezuela in seven years means relations between the two countries improved a little.
Y eso puede ser importante para la ayuda humanitaria y para la salud.
And that could be important for humanitarian aid and for health.
Let's hold on that connection for a second, because it's worth unpacking.
The U.S.
sanctions regime on Venezuela has been extensive and controversial.
Supporters say it pressures the Maduro government.
Critics argue it functions as a collective punishment that falls hardest on the most vulnerable.
Where do you come down on that, Octavio?
Mira, es complicado.
Look, it's complicated.
Las sanciones no crearon el problema.
The sanctions didn't create the problem.
Los problemas en Venezuela empezaron mucho antes.
The problems in Venezuela started much earlier.
Pero sí es verdad que las sanciones hacen más difícil comprar medicamentos y equipos médicos.
But it is true that sanctions make it harder to buy medicines and medical equipment.
El problema es que el gobierno de Maduro usa eso como una excusa.
The problem is that Maduro's government uses that as an excuse.
That's the dilemma with targeted sanctions.
They're rarely as targeted as advertised.
And the healthcare sector, which is supposed to be exempted under humanitarian carve-outs, still ends up affected because banks won't process transactions they think might be sanctions-adjacent.
Risk aversion in the financial system becomes a secondary sanction nobody voted for.
Exacto.
Exactly.
Y en Venezuela hay organizaciones humanitarias, hay médicos valientes, hay enfermeras que trabajan sin dinero porque quieren ayudar a su gente.
And in Venezuela there are humanitarian organizations, there are brave doctors, there are nurses who work without pay because they want to help their people.
Pero es muy difícil enviarles dinero o materiales desde fuera del país.
But it's very hard to send them money or materials from outside the country.
So back to the flight.
If that flight signals a partial thaw, even a cautious one, what does that actually mean in practical health terms?
More aid access?
Easier movement of medical supplies?
Posiblemente.
Possibly.
Pero también hay otra cosa importante: cuando hay vuelos directos, es más fácil para los médicos venezolanos que viven en Estados Unidos regresar temporalmente para trabajar en Venezuela.
But there's also something else important: when there are direct flights, it's easier for Venezuelan doctors living in the United States to return temporarily to work in Venezuela.
Muchos quieren ayudar pero los viajes son muy difíciles y caros.
Many want to help but the journeys are very difficult and expensive.
That's a dimension I hadn't thought through.
The diaspora as a potential healthcare resource for the country they left.
There are programs in other crisis contexts, Cuba being the ironic nearby example, where physicians from abroad come back for rotations.
If a thaw in US-Venezuela relations makes that logistics chain work better, that's a concrete health outcome.
Y también hay otro elemento.
And there's another element.
Venezuela tiene una población de refugiados muy grande fuera del país.
Venezuela has a very large refugee population outside the country.
Más de siete millones de venezolanos viven fuera de Venezuela ahora.
More than seven million Venezuelans live outside Venezuela now.
Eso es una crisis humanitaria comparable a Siria.
That is a humanitarian crisis comparable to Syria.
Seven million.
And the majority went overland through Colombia, Ecuador, Peru.
I remember talking to Colombian health officials back when the migration peaked.
They were completely overwhelmed.
They were dealing with populations arriving malnourished, without vaccination records, with untreated chronic conditions.
The Venezuelan health crisis essentially exported itself across South America.
Sí, y eso es algo que la gente no comprende bien.
Yes, and that's something people don't understand well.
Una crisis de salud en un país no se queda en ese país.
A health crisis in one country doesn't stay in that country.
Las enfermedades, la malnutrición, los problemas mentales, todo eso viaja con las personas.
Diseases, malnutrition, mental health problems, all of that travels with people.
La salud pública es un tema global.
Public health is a global issue.
Which is the core argument for why the international community should care about Venezuelan healthcare even from a purely self-interested perspective.
What happens inside those borders doesn't stay inside those borders.
We learned that with Ebola, we learned it with COVID.
Venezuela is a slower-moving version of the same lesson.
Y para terminar con esta parte, quiero decir algo sobre los médicos venezolanos que se quedaron.
And to close this part, I want to say something about the Venezuelan doctors who stayed.
Son personas increíbles.
They are incredible people.
Trabajan sin materiales, sin electricidad, sin dinero suficiente.
They work without materials, without electricity, without enough money.
Muchos ganan menos de veinte dólares al mes.
Many earn less than twenty dollars a month.
Es una dedicación extraordinaria.
It's an extraordinary dedication.
Less than twenty dollars a month.
For a physician.
You know, I've spent time in conflict zones, in places with genuinely wrecked infrastructure, and I've met people doing impossible work under impossible conditions.
It's always the same profile: not heroic in the movie sense, just people showing up.
Day after day.
Because what else do you do.
Oye, Fletcher, quiero preguntarte algo.
Hey, Fletcher, I want to ask you something.
Antes dijiste que Venezuela tiene unas de las reservas de petróleo 'más grandes'.
Before you said Venezuela has some of the 'largest' oil reserves.
En español usamos 'más grandes' para comparar cosas, pero también usamos 'mayores'.
In Spanish we use 'más grandes' to compare things, but we also use 'mayores'.
¿Sabes cuándo usar cada uno?
Do you know when to use each one?
Honestly?
No.
I assumed they were interchangeable.
Are they not?
No exactamente.
Not exactly.
'Más grande' habla del tamaño físico, del espacio.
'Más grande' talks about physical size, space.
'Mayor' habla de importancia, de cantidad o de edad.
'Mayor' talks about importance, quantity, or age.
Entonces decimos 'la reserva más grande del mundo' para el espacio, pero 'la mayor reserva del mundo' para la importancia o la cantidad.
So we say 'la reserva más grande del mundo' for physical space, but 'la mayor reserva del mundo' for importance or quantity.
Por ejemplo: 'Madrid es más grande que Valencia' pero 'Madrid tiene el mayor número de museos en España'.
For example: 'Madrid is bigger than Valencia' but 'Madrid has the greatest number of museums in Spain'.
So 'mayor' is closer to 'greatest' in English, not 'largest'.
That's actually a distinction English blurs constantly.
We say 'the biggest problem' when we might really mean 'the most significant problem'.
Spanish is more precise about it.
Exacto.
Exactly.
Y 'mayor' también significa 'older' cuando hablamos de personas.
And 'mayor' also means 'older' when we talk about people.
Mi hermano mayor tiene cincuenta años.
My older brother is fifty years old.
O 'el mayor problema', que es el problema más importante, no el más físicamente grande.
Or 'el mayor problema', which is the most important problem, not the physically largest one.
Es una palabra con mucho trabajo.
It's a word that does a lot of work.
A word doing a lot of work.
I like that.
So if I wanted to say 'the greatest healthcare crisis in the region', that would be 'la mayor crisis de salud de la región'.
Not 'la crisis de salud más grande'.
Perfecto.
Perfect.
Ves, quizás no vas a decir que estás embarazado cuando hablas de reservas de petróleo, pero con 'mayor' y 'más grande' puedes sonar muy natural.
See, maybe you won't say you're pregnant when talking about oil reserves, but with 'mayor' and 'más grande' you can sound very natural.
Buen trabajo, Fletcher.
Good work, Fletcher.
The embarazado reference.
Every single episode.
I want it on record that I have vastly improved since that incident.
Vastly.
Anyway.
Venezuela, a flight, a health system in pieces, and a word that does double duty.
Not a bad hour's work.