In September 2018, Maria Paula Toledo got her first monthly paycheck from the Venezuelan Ministry of Health for her work as a doctor at a rural clinic in Venezuela, outside the city of Maracaibo. It was the equivalent of about $1.50 — enough to buy a regular pizza, she says, but with no extra toppings.
A year later, she's doing slightly better – her current monthly salary is worth about $2.50 – thanks to adjustments to her wages as the government bumped up the national minimum wage.
The minimum wage now stands at $1.68 per month – that's 40,000 bolívares based on the Central Bank's official rate in Venezuela of 23,675 bolívares per U.S. dollar. And while medical workers can earn more than that in private practice, if they work for a public institution, they're lucky to get that minimum figure along with some small bonuses.
But for Toledo, it's still not enough to make ends meet – even with an additional food stipend and extra money from night shifts. She can't afford a place of her own, so she lives with her mother, who also helps cover her expenses. Shop owners near her hospital give her free food. And even though her patients at the municipal clinic don't have to pay her directly, sometimes they give her a small amount of cash to help her pay for her bus tickets.
And it's no surprise that the minimum wage is vastly insufficient. In Venezuela, a worker needs at least $146.41 dollars a month to pay for the basic food basket to feed a family of four, according to the think tank Center of Documentation and Analysis for Workers, CENDA in Spanish, which has been studying the economy since 1976.
Despite her economic struggles, Toledo is not thinking about leaving Venezuela. "I'm not going anywhere," says the 26-year-old. "I love my country, and I feel useful here."
But a lot of doctors have left the troubled country.
According to the World Health Organization, there were 66,138 doctors in Venezuela in 2014. Douglas León Natera, president of the Venezuelan Doctors Federations, estimates that nearly half of them have left during a press conference on August 24.
In addition, he says that about half of all medical staff – aides, nurses and others — in public hospitals have migrated. León Natera says their incomes were "miserable."
Other officials tell a similar story. Hania Salazar, head of the local Union of Nurses, says that in Zulia, the largest state in the country with some 3.7 million residents, half of the 4.000 nurses employed by the government have either migrated or moved to another occupation with better income.
And the medical workers must cope not only with insufficient wages but with difficult working conditions. Toledo recalls helping to deliver a baby nine months ago without any gloves (the clinic ran out), with no air-conditioning (the system had broken down) and surrounded by insects.
"Our integrity as doctors is destroyed," she says, drinking a cup of hot chocolate in a coffee shop in Maracaibo, capitol of Zulia, the most populous state in Venezuela.
The exodus of doctors has taken a toll on the country's health. A report from the United Nation's Office of the High Commissioner for Human Rights says that the migration of hundreds of doctors is part of the reason that diseases that were once under control, like diphtheria and measles, have spread again.
"The situation regarding the right to health in Venezuela is dire. Interviewees consistently described a healthcare infrastructure that has been declining for years, hallmarked by "an exodus of doctors and nurses, unsanitary conditions, and severe shortages in basic medical equipment, supplies and medicines."
"Families of patients have to provide all necessities, including water, gloves, and syringes. Reports point to shortages of 60 to 100 percent of essential drugs in four of Venezuela's major cities, including Caracas," says the U.N. report.
Michelle Bachelet, U.N. High Commissioner for Human Rights, will update the report next Monday, September 9, for the Human Rights Council in Geneva, Switzerland.
As for health-care workers who remain, many moonlight to meet expenses.
Freddy Alaña, a 56-year-old doctor who leads the medical services unit for employees of the University of Zulia, says that even with a combination of public and private money, he earns only half of what he used to in his early years as a doctor around 1998 to 2000. His two jobs in public institutions pay about $12 a month combined; he boosts his income with private consultations.
Yasmely Marín, a 43-year-old doctor from the same university unit, supplements his income by working as an anti-stress masseur and as a paramedic at a private company that provides home health care and other medical services.
Twin brothers Ivan and Jose López, are also juggling various jobs. They have been members of the nursing staff at the University Hospital of Maracaibo since 2017 but have not received a salary because they are also studying at the university to become specialists in intensive care.
The López brothers pay their bills by taking care of elderly patients at their homes. "It's been a daily struggle. That's a way for us to survive, economically speaking," Ivan declares. The twins plan to work for the hospital, where they'll each earn about $6 a month – the equivalent of what they make "on a single [8 or 12 hour] shift in private care," says Jose.
They have little time to rest, going from a hospital shift to a shift at a patient's home. Sometimes, they don't set foot in their own house for three to four days.
But both are willing to stay in Venezuela. "We're working for love of the art, as we say here. If we don't do it, who else is going to?" asks Jose.
His brother, Ivan, agrees. "We're going to support our hospital for as long as we can," he says.
Some medical workers turn to other means to survive.
Yusmary Pirela, a 37-year-old nurse who also works under Dr. Alaña's guidance, travels every weekend to the Colombian border, 78 miles away from Maracaibo, to sell clothes from her own wardrobe and from her friends as well as napkins and other items to earn extra money.
She knows the road is dangerous. Thieves robbed the bus she was on earlier this year, taking her purse and some of the clothes. She saved her passport by hiding it between her legs.
Then she treated a male passenger who was bleeding heavily after being hit on the head with a gun during the robbery.
But she's determined to stay. "As long as there is food [at home]," Pirela says, "I'm staying. I'm dying here."
Gustavo Ocando Alex is a freelance writer in Venezuela who has contributed to BBC World News and the Miami Herald.