CARACAS - 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 Concepción Palacios Maternity Hospital here last week, Marino had heard news reports of six infant deaths there over the course of a 24-hour period late in March. 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 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, the nation'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 in March, five newborns were crowded into one incubator, said Dr. Jesús Méndez 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," Quijada said.
The problems at Concepción Palacios are symptoms of a variety of ills plaguing the public healthcare system under leftist firebrand President Hugo Chávez, Quijada and others say.
Cases of malaria nearly doubled between 1998, the year before Chávez 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 can make 10 times the $600 monthly average salary they earn in public hospitals.
Problems in Venezuela's healthcare system did not materialize when Chávez took office. The system has been riven with corruption, mismanagement, and disorganization for decades. Tropical conditions have made the country ripe for a host of 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, Chávez 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 poor people that it helped Chávez win a crucial 2004 referendum and hold on to power. It has brought basic healthcare to the barrios, with free exams and medicine as well as eye operations that have saved the sight of thousands.
But the system siphons resources and equipment 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 Simón Bolivar University here.
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, Chávez halted weekly publication of an epidemiology report that for 50 years had tallied occurrences of infectious diseases nationwide. Former Health Minister Rafael Orihuela contends 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 Chávez critic. "I am talking about a failure to maintain basic healthcare standards."
Chávez has also been accused of appointing cronies to manage public health. Efforts to arrange an interview with Minister of Popular Power for Health Jesús Mantilla, who served with Chávez 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 monumental incompetence of top-level bureaucrats.
But even government officials admit the public health system in recent months has been on the verge of collapse, evidenced by problems in maternal and newborn care.
Since the mid-1990s, the maternal death rate of women giving birth has risen 18 percent, to 59 of 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.
"It's not that before Chávez things were great," Gonzalez said. "It's that things have deteriorated."