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'More illnesses, more deaths, more doctors leaving': Venezuela's health crisis is intensifying

PARIAGUAN, Venezuela (Reuters) - Eliannys Vivas, 9, started to get a sore throat on a Friday last month in this languid Venezuelan town where papaya trees shade poor cinder-block homes.

Five days later, Eliannys was dead, likely a victim of diphtheria, a serious bacterial infection that is fatal in 5 to 10 percent of cases and particularly lethal for children.

Her death and a wider Venezuelan outbreak of diphtheria, once a major global cause of child death but increasingly rare due to immunizations, shows how vulnerable the country is to health risks amid a major economic crisis that has sparked shortages of basic medicines and vaccines.

Eliannys' story is also one of misdiagnoses and missed signals worsened by government secrecy around the disease. Her family had never heard of diphtheria and local doctors did not immediately suspect it, despite the infection having affected hundreds of people just a few hours away in Bolivar.

After Eliannys was taken to a local hospital, doctors, thinking the disease was asthma, used a sort of inhaler on her.

But the usually chatty girl – "a little parrot," in the words of her day-laborer father — kept weakening, so doctors transferred her to a larger government hospital once an ambulance became available hours later.

An aunt of Eliannys Vivas collects money to pay a loan used for the funeral of Eliannys, who died from diphtheria, along a main street in Pariaguan, Venezuela, January 26, 2017.REUTERS/Marco Bello

At El Tigre hospital, all the devices to examine throats had broken three years ago, so no one checked her properly, according to a nursing assistant.

"They said it was asthma, asthma, asthma," said her mother, Jennifer Vivas. But as Eliannys struggled to speak, she was rushed to a third and then a fourth hospital in neighboring Bolivar state.

There, doctors discovered with horror Eliannys suffered from grossly inflamed throat membranes — the classic symptom of diphtheria.

But even the fourth hospital lacked adequate treatment for the infection, so she received only a half dose of antitoxins and no penicillin at all, according to a medical professional who treated her there.

As Eliannys' airwaves blocked up, she suffered two successive heart failures and died on Jan. 18.

"If the diphtheria diagnosis had been made earlier and she had gotten antitoxins, she would have had a chance of surviving," the source who treated her said, asking to remain anonymous because the government has banned health professionals from speaking to the media.

Diphtheria returns

Venezuela controlled diphtheria in the 1990s, but it reappeared in the vast jungle state of Bolivar in mid-2016.

At least two dozen children died last year, doctors say, and cases are now thought to have spread to a half-dozen other states.

Shortages of basic drugs and vaccines, emigration of underpaid doctors, and crumbling infrastructure have made it easier for diseases to spread, medical associations said.

A woman holds a placard in front of riot police during a rally of health-sector workers and opposition supporters, due to the shortages of basic medical supplies and against Venezuelan President Nicolas Maduro's government in Caracas, Venezuela, February 7, 2017. The placard reads, "Help us, the patients are dying." REUTERS/Carlos Garcia Rawlins

Many poor and middle-class Venezuelans also have weakened immune systems because they are no longer able to eat three meals a day or bathe regularly due to product scarcity, reduced water supply and raging inflation.

Government secrecy has compounded the problem.

"The fact people don't know (about diphtheria) helps the bacteria spread," said Caracas-based epidemiologist Julio Castro, who has been tracking the diphtheria outbreak and who showed photos sent to him of patients with thick white membranes coating their throat.

The unpopular leftist government of President Nicolas Maduro said in October there were no proven cases of diphtheria and admonished those seeking to spread "panic."

An opposition supporter wearing a costume that reads "Venezuelans starve" and "Venezuela agonizes," at a rally against Venezuelan President Nicolas Maduro's government and to commemorate the 59th anniversary of the end of the dictatorship of Marcos Perez Jimenez in Caracas, Venezuela, January 23, 2017. REUTERS/Christian Veron

It has since informed the World Health Organization of 20 confirmed diphtheria cases and five deaths, and emphasized there is a major vaccination drive under way, but has yet to provide a full national picture of the disease's effects amid a generalized clampdown on data.

The Information and Health Ministries, as well as the Venezuelan Social Security Institute, which is in charge of some drug distribution and hospitals, did not respond to multiple requests for comment about Eliannys' case and diphtheria more generally.

The only other country in the region with a significant number of confirmed diphtheria cases last year was Haiti with 33, the WHO said in December.

More illness ahead?

Doctors think diphtheria first spread from the rough-and-tumble illegal gold mines in Bolivar state, which are attracting poor Venezuelans as the minimum monthly wage languishes around $30.

After Eliannys' family was forced to start skipping dinner in December, her father, Tulio Medina, decided to work in Bolivar's yucca and yams plantation where he made more money but might have brought the infection home.

The disease has already spread to capital Caracas, where doctors say a 32-year-old mother died last year, and could yet affect more states.

Patients lie on beds in an aisle of the emergency room at the Universitary Hospital in Merida, Venezuela. Marco Bello/Reuters

With the Venezuelan pharmaceutical association estimating that roughly 85 percent of drugs are unavailable at any given time and in light of the short supply of vaccines, doctors are bracing for further increases in illnesses like malaria, pneumonia and tuberculosis.

Venezuela's rate of immunization with the pentavalent vaccine, which protects children from five major infections including diphtheria, had slipped to 78 percent between January and November 2016, according to Health Ministry figures leaked to former Health Minister José Felix Oletta and seen by Reuters.

"At this rate, we're going to see more illnesses, more deaths, more doctors leaving the country," said pediatrician Hugo Lezama, the head of Bolivar's doctors association, who himself earns only a handful of dollars a month.

"Those of us who stay are going hysterical trying to perform miracles so our patients don't die."

(By Alexandra Ulmer and Maria Ramirez; editing by Christian Plumb and Matthew Lewis)


Reporter's notebook: How a look inside Venezuela's crumbling health care system got me kicked out of the country

Our hospital source just kept repeating, “There are almost zero antibiotics, no surgical gowns, no internal sutures, no gauze, no hypertension meds, no chemotherapy. Hospitals don’t have bed sheets, food or water.”

There’s no soap. There’s no air conditioning. In short, he said, performing surgery is like practicing battlefield medicine.

We were sitting at a hotel in a country that sits atop more oil than Saudi Arabia -- Venezuela. By all rights, Venezuela should be one of the world’s wealthiest nations. But it’s not.

Just a decade ago, Venezuela was renowned for pumping out oil and 13 titles for Miss Universe and Miss World, for being a plastic surgery mecca and culinary capital. It has since become the world’s worst-performing economy, and watchdog groups say, Caracas the world’s most dangerous city.

The country is so broke that even its hospitals have ceased to function -- which was the reason we were having this late night meeting with a local resident who couldn’t take it anymore.

In order to protect members of my team, I’m not going to mention their names. Our contact told us he’d drive us through the darkened streets to the city’s struggling main hospital. As we navigated the eerily dark streets -- demarcated by hedgerows of trash, he reminded us that public hospitals in Venezuela had been militarized just days earlier.

We knew the government posted guards at the doors -- we were told to keep doctors and nurses from organizing, to prevent the influx of donations (which would have to be handed over to the military) and to keep reporters from wading into the sea of misery inside.

According to the Committee to Protect Journalists, the Venezuelan government detained scores of journalists in 2016. This has been a “clear attempt by the Venezuelan government to control the flow of information and to restrict dissent. This has been very problematic for journalists in order to report the news. Venezuela clearly ranks as one of the most repressive countries in the Western Hemisphere.” Venezuela also holds more than 2,000 political prisoners, according to the watchdog group Foro Penal.

Driving up to that hospital, we saw ghostly figures moving zombie-like in the dark. They were spilling out of the emergency room. When we parked on a darkened drive, we saw figures slumped in the shadows. We were told they were family members of those hospitalized trying to sleep in shrubbery and concrete benches.

At the hospital’s entrance, there was a desk with a security guard and a droopy-eyed cop from the National Police -- his 9 mm pistol and extended ammunition clip jutting from his hip. The officer looked like a kid to me, with a mouth full of braces, hair that was spiked and gelled and bad posture. He half-raised an eyelid when I walked past the security check, but otherwise remained statue still.

Inside, it was basically a dormitory for the dying.

We made our way to the pediatric critical care unit. There we found a 4-year-old named Jonaical with a swollen abdomen, whose mother led us to his bedside. He had been waiting for tests for two months, his mother said. In the meantime, she and the other mothers there had to provide their children and themselves with everything but the IV drips. Everything including the bedding.

It wasn’t always this way. Venezuela’s public health system used to provide some of the best free health care in Latin America, beefed up by a small army of Cuban doctors.

After we had spoken to some of the mothers, our guide told us we had to move. On the way out we stopped at the packed waiting room -- full of desperate parents.

One mother kneeled by the inert form of her son, hands seemingly clasped in prayer. Suddenly loud voices broke that pieta -- an officer pointed at me. The security guard made a beeline for me. I flowed with the crowd towards the exit. But another cop had me.

The guards quickly surrounded me and told me to hand over the GoProcamera and my iPhone.

I told them I was shooting a story about sick children but they insisted we come with them.

Clearly me being a “gringo,” as they kept calling me, made them wary. After some time, I was taken outside to a supervisor’s office.

A pickup truck full of additional officers arrived. I was briefly cuffed when they found my mic pack. An officer asked which hand I wrote with -- then cuffed it. They began ordering me to sign a report that they had compiled.

I knew being cuffed was a dangerous sign and demanded a call to the U.S. Embassy. After a quick discussion, they unlocked me.

I later learned it only worked because the system is geared toward denying the detained and the arrested their rights -- meaning they could unlawfully detain someone as long as they didn’t officially “arrest them.” They ordered me onto the flatbed of a pickup and drove me 20 minutes away to police headquarters.

Along with seven cops, I was stuffed into a room. A few officers and I stood. After a couple of hours, one of them brought in a truck dipstick -- yes, the kind you use to check your oil, and began tapping it against his hand.

Yet, I think, this time being a “gringo” may have helped. Had I been a Venezuelan I might have been roughed up or worse.

The officers were obsessed with the gear, the GoPro, my phone and the mic pack. They didn’t know they could easily access the GoPro. I refused to give them access to the phone.

Unlike so many other reporters caught in similar situations, I knew I had the backing of one of the largest news organizations. I had seen the ABC News machine roll into action before on behalf of its other reporters. And I knew, implicitly, that hopefully, in a short while the company would be alerted.

The room was frigid -- because despite it being cool outside, having the AC on full blast was one of the benefits of living in a country where energy is nearly free.

What followed were hours of browbeating and intimidation -- one of the cops that had handcuffed me earlier kept miming clasping one hand over the wrist of his other hand and then wagging his finger at me. He was basically saying, "you’re going to jail."

They kept telling me, 'you are in big trouble.' They would likely have to call SEBIN -- the dreaded secret police -- unless I cooperated fully. But as morning approached their behavior began to change.

Suddenly they started talking about a deal. The ringleader of the officers began an hours-long lecture justifying bribe taking. He said that on his $30-a-month salary, corruption was the only way to survive. He had a wife and 2-year-old son. It was hard to make ends meet. He almost fell off his chair when I told him that in the U.S. there’s very little corruption in law enforcement. He also expressed shock at how infrequently (compared to his experience) American officers are gunned down.

In fact, Venezuela is one of the most dangerous countries in the world to be police officer. It’s also a place where the vast majority of officers are poor and grossly overworked. One of my guards slept outside the door folded like a laptop, another one passed out on a patch of cardboard on the floor inside the fetid bathroom.

I eventually was made to understand that the various officers concocted this together. They wanted a bribe. They said they could spring me and make all of this go away for $3,000. Then a few hours later it became $5,000 -- a huge amount of money in today’s Venezuela. The price went up because by now it was morning. I heard reveille called outside.

The first reports leaked by police to reporters about 12 hours later, said that we had been robbed and that they were helping us file a report.

They began coaching me -- giving “tips” on what to tell their higher-ups. But it turned out that even the highest ranking officers were in on it, too. At least one of those higher ranking officers even directed them to cook the official documents so that I’d seem less “suspicious.”

Again, the “crime” was trying to tell the truth about the suffering in a country these very officers kept telling us was a hellhole. It was at this point that mug shots were taken.

After an hours-long questioning by the police chief, he ordered a group picture. Assembling all the higher ranking officers and the arresting officers to mug with the “gringo." Then he handed me over to the secret police.

They were far more professional and far more terrifying. They drove me to another base, and kept me waiting for hours.

Like any TV reporter I had been wearing a mic wire. It had been hooked up to the mic pack. Early on that first night, thinking a simple mea culpa and profuse apology would defuse the situation, I had stuffed it into my underwear. But now that I knew the police were handing us over to the SEBIN I feared we’d be subjected to body searches. I had to get rid of the wire. So I asked to go to one of the fetid bathrooms. I stuffed the wire down the gullet of the toilet as far as my hand would reach -- fearing that the plumbing would spit it back up. Luckily, it stayed down.

After 24 hours of detention, I was finally fed at the intelligence base. But right across from the chair where the intelligence agents has deposited me was what the agents called their “dungeon.” It was six feet from the seat I would inhabit for most of the next three days -- it was about 30 inches wide. All I saw were bony knees and hands sticking out. The men slept on mats on the floor, feet to face. The secret police required their families (in a country where food is desperately short) to provide all their meals -- so their food was stacked, stinking in the heat, in the front of the cell.

After that first day, I ate meals in a whitewashed hut next to the “dungeon.” I tried talking to the men -- but was told by our guards to be quiet and keep moving. There is no system of bail in Venezuela. I was told some of the men I saw had been languishing without trial in that dank, dark corridor for two years.

On the second day there, a commissioner reportedly in charge of spying on millions of Venezuelans came in. He didn’t introduce himself, but just started talking to me. He asked if I was CIA, or if I’d ever been a Marine.

My response: "Look at me! I’m 5-foot-8. I’m half a Marine!" They laughed.

He then asked why I was caught snooping around a “sensitive installation.”

“A hospital is a sensitive installation?” I asked.

“It is in Venezuela,” acknowledged the chief candidly, “mostly because of the political situation. There are many forces trying to destabilize this country.”

The agents had pored through my internet and Twitter history. They would come to question me every time they found something new. Perhaps as a form of intimidation, they told me they knew who my mother and father were. They got my mother right but not my father, who died in a 1990 plane crash.

They seemed most concerned by my reporting from other countries -- particularly Russia. The irony is that while I’ve covered conflict zones from Afghanistan to Iraq to Syria, in Russia I solely reported on the Olympics.

Clearly, I’m not a spy. And I think after a just a day together the secret police believed that I was who I am: a reporter for ABC News.

Like the vast majority of detainees, I was denied my right to a phone call or contact with the outside world. I was told that if they chose to keep me there indefinitely, they could easily do so. It didn’t require much imagination: since the men in the dungeon sat less than six feet away from me.

I’d heard the horror stories about hundreds of people locked away in the intelligence agency’s dungeons. That’s what they are doing right now to another American -- Joshua Holt. He’s in a jail in Caracas beneath the secret police’s headquarters dubbed "La Tumba," The Tomb.

Perhaps the most astounding thing about being a detainee of the agency whose official role is ensuring the survival of the socialist Bolivarian revolution was the class structure there. The higher ups dressed meticulously in conspicuously branded clothes -- Hugo Boss, Polo and Izod etc. The mid-level guys had brands like Jeep, and Bass Pro shops. The rank-and-file had no brand names.

As ostentatious as their clothes -- their gadgetry. High-level officials all had iPhone7s, which had just come out in the U.S. -- phones worth nearly five times the yearly salary of police.

Some of the young agents tasked with watching me confided that they signed up for the benefits. One had been a physical therapist for five years. Another had finished law school. Everyone told me they needed the perks and the food offered by being part of the elite establishment.

I spent the next 20 hours in Venezuela shuttled from Valencia to the Caracas headquarters of the SEBIN. At one point, I was cuffed for five hours -- partly because the intelligence agents refused to coordinate with the U.S. Embassy.

Finally, I was sent to the arrivals hall with an entourage of 10 officers. I took possession of my passport only when I boarded the plane. I had the clothes on my back, but unlike so many others, I had what I valued most -- my freedom.

Once I got home, I got in touch with Joshua Holt’s mother. She has never stopped fighting for him. February 19th will mark eight months since his arrest and detention.

Venezuela crisis: Caracas hospital shows sorry state of health system

"This is like a medical facility in a war zone," says Huniades Urbina-Medina, describing the Jose Manuel de Los Rios children's hospital in the Venezuelan capital, Caracas. 

"This used to be the best hospital, not just in the country, but in all of Latin America. We used to welcome patients from all over the region. And look at it now."

As he walks through the building, Dr Urbina-Medina points to the peeling paintwork, the exposed pipes and electricity cables.

"This isn't what a hospital should be, he says, it looks more like a building site." 

Venezuela's economic crisis has hit the country hard and the health care system is crumbling. 

As politicians argue over the rights and wrongs of recalling President Nicolas Maduro, doctors and nurses are struggling to cope.

"We don't have enough drugs to treat the sick," explains Dr Urbina-Medina as he points to the empty shelves in the hospital pharmacy.

"Five years ago, we had an average of 200 patients waiting to be operated on. At the last count, there were more than 5,500 names on the waiting list. We have nine operating rooms, but, today, only four are fully functional."

Image captionDespite his decrepit facilities, Dr Urbina-Medina is determined to stay in Venezuela

In one of the few wards that can can still be used, a young child lies listless on the bed, his mother by his side. He is called Alejandro and is 11 years old, but he looks half that age. 

He has meningitis. His oversized skull bears witness to the tell-tale signs of hydrocephaly. His eyes are gaunt, he is painfully thin.

His body cannot fight the disease. It is weakened by malnutrition. Alejandro has been here for 12 days. His mother does not know how long his ordeal will last, his agony prolonged by the shortages of medicine.

But doctors are doing all they can to keep him comfortable. 

Nutrition emergency

"Venezuela has the highest rate of teenage pregnancies in the world," says Maritza Landaeta of the Fundacion Bengoa, an NGO which works in poor communities affected by malnutrition. 

Image captionThe outpatient ward at Jose Manuel de Los Rios hospital has seen better days

"Many babies have a high chance of dying. 

"Young mothers can't find the powdered milk and basic nutrients needed to guarantee their children's wellbeing. The shops are empty. Instead of milk, children are being fed with the water used for cooking potatoes or rice. We're now seeing an increasing number of children showing symptoms of starvation," says Ms Landaeta.

She has worked in this field for close to 40 years. She is a trained paediatrician and she's never seen a situation as bad as this before. 

So who is to blame? She points a finger at the government, accused of taking measures to control the production, the distribution and the access to food. 

"It isn't working," she says, "funds are going missing, there are food shortages, the authorities aren't doing their job.

"The state has to understand that this is a nutrition emergency."

Asked if children are dying because of political mismanagement and corruption, Maritza Landaeta sighs wearily and, with an air of resignation, says: "Yes."

Deaf ears

In the heart of Caracas, behind high walls and a locked gate and almost hidden from view, there is a place of refuge for young Venezuelans hoping to escape poverty. 

The Casa Don Bosco foster home is one of 86 such institutions across the country. It welcomes about 30 children, mostly adolescents. 

"More and more children being put in foster homes because their families simply can't cope," says its director, Leonardo Rodriguez Angola, who holds up an official document. 

Image captionCasa Don Bosco is home to 30 children whose families cannot look after them

"This is a request for us to take in three brothers, aged 13, 11 and eight. They live in poverty. Their mother has four other children."

Mr Rodriguez has been pleading with the government to get more help, but his appeals have fallen on deaf ears. "When we petition the authorities, they just laugh at us," he explains. 

"Three years ago, the government created a new ministry of supreme social happiness. I thought that minister would help us. But when we went to ask for money to buy food, she replied that we had to ration what we had, adding: 'The whole country is on a diet.' The government wants to make the issue of poverty and hunger 'invisible'."

Staying on

At the Jose Manuel de Los Rios children's hospital, Dr Urbina-Medina is continuing his rounds. 

He comes across a room piled high with beds and monitors. Nothing works. Laughing, he says: "We call this our cemetery for medical equipment." 

He's putting on a brave face, but he knows that the situation is desperate. 

Huniades Urbina-Medina is four years away from retirement, he has received offers to work at other hospitals abroad. 

Has he never been tempted to leave?

His answer is emphatic: "I want to stay here, our patients need our help. Life is tough, but I won't give up!"

Inside Venezuela’s Crumbling Mental Hospitals

The state-run psychiatric hospital here in Barquisimeto, Venezuela, has long been a forgotten place, filled with forgotten people.

But with Venezuela suffering from a severe economic crisis, this mental institution has almost no drugs to control the afflictions tormenting its patients.

At the invitation of doctors, reporters from The New York Times visited six psychiatric wards across the country. All reported shortages of medicine, even food.

The one here, El Pampero Hospital, hasn’t employed a psychiatrist in two years. It has running water for only a few hours a day, and food is scarce. Omar Mendoza, pictured above, is one of many undernourished patients. He lost half his weight this summer and is down to about 75 pounds.

The glue that keeps this hospital in order — the sedatives, tranquilizers and medications — is nearly all gone. In courtyards, women who are functional while medicated are now curled on the floor hallucinating, crying, screaming, rocking back and forth for hours.

The doctors and nurses here are aghast at what is taking place, caught between anger and feelings of helplessness.

The nursing staff debates daily: Who gets the few remaining pills? Who is the most unstable, or suffering the most? They reduce doses, doling out pills into small metal cups with the fluidity of Las Vegas casino dealers.

El Pampero also suffers from shortages of basic personal-care and cleaning supplies. There is no soap, no shampoo, no toothpaste, no toilet paper. Patients relieve themselves in the common areas and patio area, and clean themselves only with water.

Nurses fear that patients in the men’s ward are more likely to become violent when they are unmedicated. Two of the men in this photograph murdered members of their families before their schizophrenia was diagnosed. One decapitated his mother, and the other stabbed his stepfather.

We found Cleofila Carillo crying softly under a mosquito net. The morning before, her unmedicated bunkmate had leapt on top of her, beaten her, bitten off her nose and eaten it. Doctors said she needed full reconstructive surgery, but because of the shortages, they did not have the medical supplies to perform it. All they could do was apply a bandage.

Without sedatives, nurses say, they must restrain patients or lock them in isolation cells to keep them from harming themselves. That is what happened to Raul Martínez, who was suffering a psychotic episode. A nurse tied him to a gurney.

Patients eat three times a day, but there is never enough food from the government. Members of the hospital staff solicit donations during their time off. Medical records show that over half of the patients in the men’s ward are underweight.

Patricia Couto
In Venezuelan hospital, newborns in cardboard boxes

Photos released by Venezuela's opposition this week show a dramatically different scene than you'd expect to see in a hospital nursery.

The images show newborn babies in cardboard boxes, lined up on a counter.

A hospital employee took the photos, according to the opposition group that released them.

The images purportedly were taken at the government-run Domingo Guzmán Lander Hospital in the coastal city of Barcelona, about 315 kilometers (195 miles) east of Caracas. CNN has not been able to independently verify the authenticity of the photos and it is unclear when they were taken. 

Mesa de la Unidad Democratica, the coalition of opposition organizations that released the images, says the scene is another sign of a crisis hitting the country's health care system. 

Authorities are investigating, according to the government official who runs the institute that oversees the Barcelona hospital and others across the country.

"We in no way justify the actions taken," Venezuelan Social Security Institute President Carlos Rotondaro said on Twitter Tuesday.

But he also defended the health care system.

"Our hospitals take care of hundreds of patients, despite what some media are hiding. We recognize the failures and continue," he wrote.

The government hospital system later tweeted what officials said were current photos and a video showing plastic hospital bassinets in the nursery.

Since January, officials said, the hospital has delivered more than 4,000 babies. 

Venezuela is battling an economic crisis, and many Venezuelans are fed up with widespread shortages of basic goods and medical supplies, factory shutdowns and blackouts. Protests over the government have been raging for months, culminating in a push to recall President Nicolas Maduro

In May, the opposition-controlled National Assembly declared that Venezuela was suffering a national humanitarian health crisis. The next month, a group of doctors speaking in the National Assembly decried shortages of medicines and supplies.

Venezuela's health care crisis 03:31

"Getting sick in Venezuela is synonymous with death," Dr. Cristian Pino told lawmakers at the time.

According to statistics released by the Venezuelan Pharmaceutical Federation in June, the country is facing a shortage of more than 80% of the medicines doctors need. And more than 13,000 doctors -- about 20% of the country's medical workforce, have left the country in recent years due to the collapse of the health sector. 

The government denies there is a health care crisis and says Maduro's administration has opened more than 2,000 urgent care facilities throughout the country. The President also accuses the opposition of plotting to privatize the national health care system.

CNN's Julia Jones, Michael Roa, Euan McKirdy, Paula Newton and Flora Charner contributed to this report.