委內瑞拉醫院危機 缺水斷電中的絕望與死亡

BARCELONA, Venezuela — By morning, three newborns were already dead.

委內瑞拉，巴塞羅那――上午時分，已經有三個新生兒死去了。

The day had begun with the usual hazards: chronic shortages of antibiotics, intravenous solutions, even food. Then a blackout swept over the city, shutting down the respirators in the maternity ward.

這一天是在各種慣常的危險中開始的：抗生素和靜脈注射溶液持續短缺，甚至連食品也不夠。之後全市停電，嬰兒特護病房的呼吸機無法運行。

Doctors kept aiLing infants alive by pumping air into their lungs by hand for hours. By nightfall, four more newborns had died.

幾個小時裏，醫生們徒手把空氣壓入生病嬰兒的肺，好讓他們活下去。到了夜晚，又有四個新生兒死去。

“The death of a baby is our daily bread,” said Dr. Osleidy Camejo, a surgeon in the nation’s capital, Caracas, referring to the toll from Venezuela’s collapsing hospitals.

“嬰兒死亡已經是我們家常便飯，”委內瑞拉首都加拉加斯的外科醫生奧斯萊迪絲·卡梅霍(Osleidy Camejo)說。他指的是委內瑞拉崩潰的醫院系統，導致了這樣的局面。

The economic crisis in this country has exploded into a public health emergency, claiming the lives of untold numbers of Venezuelans. It is just part of a larger unraveling here that has become so severe it has prompted President Nicolás Maduro to impose a state of emergency and has raised fears of a government collapse.

委內瑞拉的經濟危機已經爆發爲公共健康危機，目前因此喪生的委內瑞拉人數多少尚不得而知。這只是委內瑞拉更大的一場亂局的一部分，態勢愈發嚴重，委內瑞拉總統尼古拉斯·馬杜羅(Nicolás Maduro)宣佈國家進入緊急狀態，人們擔憂政府會崩潰。

Hospital wards have become crucibles where the forces tearing Venezuela apart have converged. Gloves and soap have vanished from some hospitals. Often, cancer medicines are found only on the black market. There is so little electricity that the government works only two days a week to save what energy is left.

醫院病房成了這個國家各種破壞性力量交匯的坩堝。有些醫院已經找不到手套和肥皂。通常治療癌症的藥品只能在黑市買到。委內瑞拉總是電力不足，爲了省電，政府每週只工作兩天。

At the University of the Andes Hospital in the mountain city of Mérida, there was not enough water to wash blood from the operating table. Doctors preparing for surgery cleaned their hands with bottles of seltzer water.

安第斯醫院大學坐落在山城梅里達，這裏沒有足夠的水去清洗手術檯上的血跡。準備手術的醫生們用瓶裝礦泉水洗手。

“It is like something from the 19th century,” said Dr. Christian Pino, a surgeon at the hospital.

“就像回到了19世紀，”醫院的外科醫生克里斯蒂安·皮諾(Christian Pino)說。

The figures are devastating. The rate of death among babies under a month old increased more than a hundredfold in public hospitals run by the Health Ministry, to just over 2 percent in 2015 from 0.02 percent in 2012, according to a government report provided by lawmakers.

數據是災難性的。根據議員提供的政府報告，2015年，在衛生部開設的公立醫院內，一個月以下嬰兒的死亡率達到了2%，比2012年的0.02％增加了100倍。

The rate of death among new mothers in those hospitals increased by almost five times in the same period, according to the report.

根據這份報告，同一時期這些醫院中的產婦死亡率也增加了將近五倍。

Here in the Caribbean port town of Barcelona, two premature infants died recently on the way to the main public clinic because the ambulance had no oxygen tanks. The hospital has no fully functioning X-ray or kidney dialysis machines because they broke long ago. And because there are no open beds, some patients lie on the floor in pools of their blood.

在加勒比港口城市巴塞羅那，前不久，兩個早產兒在去往市公共醫院的途中去世，因爲救護車上沒有氧氣瓶。醫院沒有能完全正常運轉的X光設備和腎透析設備，因爲它們早就壞了。因爲沒有牀位，許多病人躺在地上，躺在自己的血泊之中。

It is a battlefield clinic in a country where there is no war.

在這個沒有戰爭的國家，這裏卻如同戰地醫院。

“Some come here healthy, and they leave dead,” Dr. Leandro Pérez said, standing in the emergency room of Luis Razetti Hospital, which serves the town.

“有些人進來的時候很健康，結果卻死在這裏，”萊安德羅·佩雷茲(Leandro Pérez)醫生在鎮醫院路易斯·拉茲蒂醫院的急診室裏說。

This nation has the largest oil reserves in the world, yet the government saved little money for hard times when oil prices were high. Now that prices have collapsed — they are around a third what they were in 2014 — the consequences are casting a destructive shadow across the country. Lines for food, long a feature of life in Venezuela, now erupt into looting. The bolívar, the country’s currency, is nearly worthless.

這個國家擁有世界上最大的石油儲量，然而政府在石油價格高時卻沒有積蓄任何金錢以備不時之需。如今石油價格一落千丈，僅相當於2014年的三分之一，其結果令整個國家蒙上了毀滅性的陰影。購買食品的長隊在委內瑞拉早已屢見不鮮，現在情況惡化成了搶劫。這個國家的貨幣玻利瓦爾已經近乎一文不值。

The crisis is aggravated by a political feud between Venezuela’s leftists, who control the presidency, and their rivals in congress. The president’s opponents declared a humanitarian crisis in January, and this month passed a law that would allow Venezuela to accept international aid to prop up the health care system.

委內瑞拉政治勢力之間的夙怨進一步加劇了危機，鬥爭雙方是控制着總統職位的左派和他們在議會中的對手。1月，總統的反對者宣佈委內瑞拉正在發生人道主義災難，本月又通過一項法律，令委內瑞拉可以接受對衛生健康系統的國際援助。

“This is criminal that we can sit in a country with this much oil, and people are dying for lack of antibiotics,” says Oneida Guaipe, a lawmaker and former hospital union leader.

“在一個擁有這麼多石油的國家，人們還因爲缺乏抗生素而死，這是一種犯罪，”議員及前醫院工會領導人奧奈達·瓜伊佩(Oneida Guaipe)說。

But Mr. Maduro, who succeeded Hugo Chávez, went on television and rejected the effort, describing the move as a bid to undermine him and privatize the hospital system.

但是烏戈·韋查斯(Hugo Chávez)的繼任者馬杜羅在電視上反對這項努力，稱之爲對他本人的顛覆，以及試圖將醫療系統私有化。

“I doubt that anywhere in the world, except in Cuba, there exists a better health system than this one,” Mr. Maduro said.

“我懷疑世界上除了古巴，還有哪個國家擁有比我們更好的衛生系統，”馬杜羅說。

Late last fall, the aging pumps that supplied water to the University of the Andes Hospital exploded. They were not repaired for months.

去年秋末，安第斯大學醫院年久失修的水泵爆裂了，幾個月未能得到修理。

So without water, gloves, soap or antibiotics, a group of surgeons prepared to remove an appendix that was about to burst, even though the operating room was still covered in another patient’s blood.

於是外科醫生只能在沒有水、手套、肥皂和抗生素的情況下，爲病人切除近乎破裂的闌尾，手術室裏還殘留着上一位病人的鮮血。

Even in the capital, only two of nine operating rooms are functioning at the J. M. de los Ríos Children’s Hospital.

就連在首都的J·M·德·洛斯·里奧斯兒童醫院，九間手術室中也只有兩間能用。

“There are people dying for lack of medicine, children dying of malnutrition and others dying because there are no medical personnel,” said Dr. Yamila Battaglini, a surgeon at the hospital.

“成人因爲缺乏藥物死去，孩子們因爲營養不良死去，還有些人因爲缺乏醫護人員死去，”醫院的一位外科醫生婭米拉·巴塔利尼(Yamila Battaglini)說。

Yet even among Venezuela’s failing hospitals, Luis Razetti Hospital in Barcelona has become one of the most notorious.

然而，儘管委內瑞拉的醫院情況都在惡化，但巴塞羅那的路易斯·拉茲蒂醫院卻格外聲名狼藉。

In April, the authorities arrested its director, Aquiles Martínez, and removed him from his post. Local news reports said he was accused of stealing equipment meant for the hospital, including machines to treat people with respiratory illnesses, as well as intravenous solutions and 127 boxes of medicine.

4月，官方逮捕了院長阿基萊斯·馬丁內斯，並解除了他的職務。據本地新聞報道，他以偷竊醫院設備被起訴，包括治療呼吸系統疾病的儀器，以及靜脈注射溶液和127箱藥物。

Around 10 one recent night, Dr. Freddy Díaz walked down a hall there that had become an impromptu ward for patients who had no beds. Some clutched blood-soaked bandages and called from the floor for help. One, brought in by the police, was handcuffed to a gurney. In a supply room, cockroaches fled as the door swung open.

前不久，夜裏10點的時候，弗萊迪·迪亞茲(Freddy Díaz)醫生走進充當臨時病房的走廊，這裏沒有牀位，有些人躺在地上，抓着浸透鮮血的繃帶呼救。有個被銬在推車上的人是警察送來的。醫療用品儲藏室的門一開，蟑螂四散而去。

Dr. Díaz logged a patient’s medical data on the back of a bank statement someone had thrown in the trash.

迪亞茲拿過一張從垃圾堆裏撿來的銀行結算單，在背面寫下一個病人的醫療數據。

“We have run out of paper here,” he said.

“我們紙不夠用了，”他說。

On the fourth floor, one of his patients, Rosa Parucho, 68, was one of the few who had managed to get a bed, though the rotting mattress had left her back covered in sores.

在第四層，他的一位病人，68歲的羅薩·帕魯喬(Rosa Parucho)是少數弄到了牀位的人之一，儘管腐爛的牀墊讓她後背生滿了瘡。

But those were the least of her problems: Ms. Parucho, a diabetic, was unable to receive kidney dialysis because the machines were broken. An infection had spread to her feet, which were black that night. She was going into septic shock.

但這對她來說已經是小問題了，身患糖尿病的帕魯喬女士無法接受腎透析，因爲機器壞了。感染蔓延到她的腳，那天夜裏已經變成黑色。她陷入了感染性休克。

Ms. Parucho needed oxygen, but none was available. Her hands twitched and her eyes rolled into the back of her head.

帕魯喬需要氧氣，但是沒有能用的氧氣機，她雙手抽搐，兩眼翻白。

“The bacteria aren’t dying; they’re growing,” Dr. Díaz said, noting that three of the antibiotics Ms. Parucho needed had been unavailable for months.

“細菌沒有死掉，而是在繁殖，”迪亞茲醫生說，並指出帕魯喬需要的三種抗生素已經缺貨好幾個月了。

He paused. “We will have to remove her feet.”

他頓了一下。“我們得給她雙腳截肢。”

Three relatives sat reading the Old Testament before an unconscious woman. She had arrived six days before, but because a scanning machine had broken, it was days before anyone discovered the tumor occupying a quarter of her frontal lobe.

三個親戚圍着一個昏迷的女人，讀着《舊約》。她是六天前來的，但是由於掃描設備壞了，幾天之後醫生才發現腫瘤已經佔據了她前額葉的四分之一。

Samuel Castillo, 21, arrived in the emergency room needing blood. But supplies had run out. A holiday had been declared by the government to save electricity, and the blood bank took donations only on workdays. Mr. Castillo died that night.

21歲的薩繆爾·卡斯特羅(Samuel Castillo)進入急救室時需要輸血，但血液儲備已經用完。爲了省電，國家宣佈全國放假，血庫只在工作日才接受獻血。卡斯特羅當晚去世。

For the past two and a half months, the hospital has not had a way to print X-rays. So patients must use a smartphone to take a picture of their scans and take them to the proper doctor.

在過去的兩個半月裏，醫院沒有辦法打印X光片。病人必須使用智能手機拍下圖像，然後拿給醫生看。

“It looks like tuberculosis,” said an emergency room doctor looking at the scan of a lung on a cellphone. “But I can’t tell. The quality is bad.”

“像是肺結核，”急救醫生看着手機上的肺部掃描照片。“但是我說不清，照片質量太差。”

Biceña Pérez, 36, scanned the halls looking for anyone who would listen to her.

36歲的畢塞娜·佩雷茲(Biceña Pérez)掃視大廳，希望找到可以幫忙的人。

“Can someone help my father?” she asked.

“有人能幫幫我父親嗎？”她問。

Her father, José Calvo, 61, had contracted Chagas’ disease, a sickness caused by a parasite. But the medication Mr. Calvo had been prescribed ran out in his part of Venezuela that year, and he began to suffer heart failure.

她的父親，61歲的何塞·卡爾沃(José Calvo)患有寄生蟲引起的美洲錐蟲病。但是這一年，當地治療這種病所需的藥物用完了，他開始出現心臟衰竭。

Six hours after Ms. Pérez’s plea, a scream was heard in the emergency room. It was Mr. Calvo’s sister: “My darling, my darling,” she moaned. Mr. Calvo was dead.

佩雷茲的呼救已經過去了六個小時，一聲尖叫從急救室傳來，是卡爾沃的姊妹：“親愛的，親愛的，”她哭着。卡爾沃去世了。

His daughter paced the hall alone, not knowing what to do. Her hands covered her face, and then clenched into fists.

他的女兒一個人走在大廳裏，不知道該做什麼纔好，她雙手捂着臉，接着攥成了拳頭。

“Why did the director of this hospital steal that equipment?” was all she could say. “Tell me whose fault is this?”

“這家醫院的院長爲什麼要偷設備，”這是她唯一能說出口的話。“告訴我這到底是誰的錯？”