October 04, 2016 - 7:50 AM
CARACAS, Venezuela - It was just a scraped knee. So 3-year-old Ashley Pacheco's parents did what parents do: They hugged her, cleaned the wound twice and thought no more of it.
Two weeks later, the little girl writhed screaming in a hospital bed. Her mother stayed day and night in the trauma unit. Her father scoured Caracas for scarce antibiotics.
They had no idea how much worse it was going to get.
If Venezuela has become dangerous for the healthy, it is now deadly for those who fall ill. After years of mismanagement and a plunge in the price of oil, the economy has stalled out. The socialist administration calls the medical crisis an invention peddled by opponents, and has refused to let in humanitarian aid.
Yet the government's own reports say that one in three people admitted to public hospitals last year died. The number of operational hospital beds has fallen by 40 per cent since 2014. And the country is running short on 85 per cent of medicines.
"I really don't know of any other country where things have deteriorated so quickly, to such an incredible extent," said Rafael Perez-Escamilla, a Yale University School of Public Health professor.
A week after her fall in mid-July, Ashley started to run a fever. At the local clinic, doctors said she would soon be on the mend. Yet the fever kept rising, and her knee was swelling.
So Maykol and Oriana Pacheco sat her between them on their motorcycle and tried three other hospitals. None had the medicine or room to take Ashley in.
The next morning, her temperature had spiked to 103 degrees. Desperate, her parents took her to a fourth hospital. When they arrived, she was whisked into emergency care.
University Hospital was filthy. The staff had run out of bleach to clean the floors. Stray dogs wandered the building, and cockroaches scuttled by on the walls. The water in the bathroom sometimes came out black.
In Ashley's room, the sink was broken, and the soap and glove dispensers were empty. Yet with the hospital so crowded that women in labour were sharing beds, her parents felt lucky she had been admitted at all.
Doctors diagnosed Ashley with a staph infection and gave her the last of the hospital's supply of vancomycin, a widely-used antibiotic.
But as night fell, she got worse. Her heart monitor line zigzagged wildly. Her breathing sounded like gasping hiccups. And her chest collapsed inward with each inhalation.
Doctors suspected bacteria had travelled to her lung, but the hospital's last X-ray machine had given out the month before. So an ambulance took Ashley to a private clinic, where the test cost the family a week's wages.
The X-ray confirmed the doctor's fears: Ashley's right lung had collapsed.
Making do with a trick from battlefield medicine, doctors slid a needle into Ashley's chest to let out the trapped air. Then they told her parents that without more antibiotic and a chest drainage machine, she wouldn't live to see the next evening.
The family frantically called around to anyone who might help. After midnight, a friend found the drainage machine at a private clinic. With it, Ashley started to breathe easier. But her leg had turned an ugly purple and swollen to the diameter of a dinner plate.
If doctors could not stop the infection, surgeons would have to amputate.
So Ashley's father joined the thousands of Venezuelans racing against personal clocks, standing in line for hours outside pharmacies.
The antibiotic vancomycin was the hardest to find. Maykol heard that a public hospital across town might have a supply. When he arrived, the pediatric unit had flooded. There was no medicine to spare.
In wet jeans, he rode to another hospital. Nothing. But as he was leaving, a man in a white coat gave him three precious vials.
In addition to medicine, Ashley now needed surgery to drain her infected knee. Only two of the hospital's 27 operating rooms were fully functional, and 150 children were waiting for a spot.
Her doctors pushed until she was booked. Two residents sterilized a used needle and injected her with anesthetic.
But the next week, the fever was inexplicably worse again, 102 degrees. Soon, she was quaking under her Dora the Explorer sheets, with a fever of 106 (41 Celsius).
Red spots spread across her still-swollen skin — the telltale sign of a heart infection. There hadn't been enough antibiotics to stop the staph bacteria from quietly spreading all this time. Without three doses of vancomycin daily for three weeks, it could ruin her heart and spread to her brain.
Maykol spent August crisscrossing Caracas in his quest to find the drug. In the meantime, five other children died on the pediatric surgery ward due to the lack of proper antibiotics.
Finally, nearly a month after she was hospitalized, Ashley's fever subsided. Her heart was scarred, and she would likely eventually need a valve replaced. Exhausted, her mother filed that information away for later.
The day before Ashley was to be released, Oriana left the 9th floor for the first time in two weeks. Doctors would not discharge Ashley until she had an ultrasound test of her leg. But only one public hospital still had a functioning machine, and the clerk there said the first slot was in November, two months away.
Perez's shoulders slumped. "This is madness," she said under her breath.
After she returned, a new doctor had more bad news: Ashley had picked up a fungal infection in her lungs. She needed a medicine that was no longer possible to find in Venezuela.
For the first time since Ashley was admitted, Maykol lost his temper.
"What do you mean she needs a medicine we can't find here?" he said. "At least tell me the name, so I can try to find it."
He spent the next days looking for ways to import the non-existent medicine. But in the end, help came from the next room over. A mother donated the medicine to Ashley. Her son had died.
In late September, doctors declared Ashley infection-free. Oriana sold the supplies the family still had to other mothers to pay for an ultrasound at a private clinic and Ashley's future treatment.
"We have nothing left," she said.
After years of putting it off, Maykol and Oriana planned to have Ashley baptized. It would be a celebration of her recovery — and a safeguard in case she fell ill again.
As Ashley and her parents left the ward, the residents and nurses shouted after the family.
They called out not "goodbye," but "good luck."
Hannah Dreier is on Twitter at https://twitter.com/hannahdreier. Her work can be found at http://bigstory.ap.org/content/hannah-dreier.
News from © The Associated Press, 2016