Introduction

Venezuela was an economic powerhouse, with a progressive increase in gross domestic production (GDP) from 2003 – 2004. The estimated GDP per capita in 2014 was $16,000 USD, easily placing this Latin American country into a high-income status based on current definitions. However, due to government decisions, political motives and sanctions, this status no longer holds. An annual inflation of 255% was recorded in 2016; this has continued to increase, making survival very difficult for the people of Venezuela. This includes difficulty with access to health care, food items and proper amenities. This has led to a mass migration of Venezuelans into neighboring countries, including Trinidad and Tobago, for hopes of a better standard of living.

Migrant Flow

Venezuela is a Spanish-speaking country located in the continent of South America; Trinidad and Tobago form part of its northern border. The United Nations High Commissioner for Refugees has indicated that 4.6 million persons have been displaced abroad. While approximately 15,000 Venezuelan immigrants were given provisional registration during a period of amnesty, the Central Statistical Office (CSO) estimates the total number of Venezuelan immigrants, both registered and unregistered, exceeds 60,000. This number is impossible to verify given the CSO’s limited resources and the ability of the unregistered immigrants to avoid detection.  

Barriers to Health Care and the Neurosurgery Perspective

Venezuelan immigrants to Trinidad and Tobago face several obstacles with respect to health care. The current mandate provides all patients emergency treatment; however, elective procedures require fee processing. Many times these patients earn minimal salaries and are unable to pay for elective procedures. Additionally, when these patients present to the medical system, the language barrier is a great limitation, with Trinidad and Tobago being an English-speaking country. Most tertiary institutions in Trinidad and Tobago are not equipped with translators for history taking, acquiring consent for surgical procedures or daily ward round updates. This is a source of frustration for the patients and clinical staff.  

In neurosurgery departments, the incidence of developmental conditions such as hydrocephalus and spina bifida in the neonate is rising. Maternal factors surrounding these cases include a lack of prenatal care including inaccessibility to prenatal vitamins, lack of prenatal monitoring and poor maternal nutrition. All of these contribute to both maternal and neonatal morbidity and mortality. The obstetrics unit have negotiated for all Venezuelan refugees, including the undocumented, to have access to free antenatal care. This service, however, is not used by many of the refugees due to fear of deportation.  

We recently evaluated a three-week-old female infant who was presented to the outpatient clinic accompanied by her mother. The parent is exclusively Spanish-speaking from Venezuela, and with the absence of a language translator, phone applications were used to aid communication. The baby was born via an emergency lower segment Caesarean section, and there was no history of prenatal care including routine antenatal blood investigations, use of prenatal medications or antenatal ultrasounds. The infant was born with dysmorphic features, bilateral talipes equinovares and an obvious abnormality over the lumbosacral region, with the overlying skin remaining intact. Computed tomography of the spine demonstrated soft tissue protruding through a spinal defect in the lumbosacral region. These findings were consistent with spina bifida. 

What Can be Done?

With limited health care access, poor funds and language barriers, this seems like an incredible feat. We suspect this problem is not unique to Trinidad and Tobago. Steps to possibly amend the ever-growing problem will entail making awareness of free access to antenatal care, without risk of deportation to undocumented migrants. This may be achieved by facilitating collaboration with Venezuelan organizations and national health commissions to meet the needs of this population. Education to health care workers via training facilities or programs on dealing and managing an at-risk migrant population will aid in bridging the divide. Furthermore, improved communications in health care facilities with the aid of language translators, when necessary, would be invaluable to overall patient care. These small guidelines are possible steps in thwarting major developmental disorders and enhancing medical care.