TRISTEZA

En el hospital José Gregorio Hernández, mejor conocido como el Hospital de los Magallanes de Catia, hay muebles y camas viejas atravesados en medio de los pasillos de un área abandonada. Fotografía de Gabriel Méndez

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Lo más dramático del día que Daniela falleció no fue su muerte. Susana, su mamá, ya estaba preparada: había hecho las paces con la vida la noche anterior, cuando Daniela, en medio de su primera y última crisis convulsiva, apretó la mandíbula y los ojos se le fueron hacia atrás.

Daniela se fue a las 3:00 de la tarde. La hora de la misericordia de Dios. Cuenta la biblia que fue a esta hora cuando Jesús de Nazareth encomendó a su padre su propio espíritu y expiró. Susana hace hincapié en este detalle: la hora es importante, es la prueba de que la muerte de su hija era la voluntad de Dios; de que el todopoderoso escuchaba con oído atento sus plegarias cuando una noche le rogó que todo fuera rápido. La partida de Daniela –contaría su madre más tarde– fue rápida.

La tarde del lunes 4 de julio de 2016, después de la hora de la divina misericordia, la funeraria avisó que estaban por llegar a recoger el cuerpo de Daniela, y Susana bajó las escaleras hacia la morgue del Hospital JM de los Ríos, en Caracas. Susana dice que fueron «cosas de la vida». Por cosas de la vida, la puerta de madera al final de la escalera, que siempre permanece cerrada, estaba abierta. Por cosas de la vida, la cava para conservar los cadáveres, la única que funcionaba ese día en el hospital, estaba abierta. Y entonces, Susana miró.

Lo más dramático de ese día no fue la muerte. Fue el cuerpo de Daniela en la cava, apilado junto a otros dos. Tres cuerpecitos de niños compartiendo una misma cava. Uno encima del otro. Hasta el tope.

El lunes 4 de julio de 2016, pasadas las 3:00 de la tarde, habían fallecido tres niños en el hospital J.M de los Ríos, y aunque todavía no se sabía, dos más venían en camino. Dos más que ya no cabían en la única cava operativa del hospital. Dos más en riesgo de empezar a descomponerse envueltos en los vapores de un mes de julio cuya temperatura promedio fue de 31 grados centígrados en Caracas. En el Hospital JM de los Ríos no solo faltan cavas para los muertos. Cada vez más, los pacientes y sus familiares sienten que las carencias que los acosan en los centros de salud pública representan una violación a sus derechos.

En su informe anual 2015 el Programa Venezolano de Educación-Acción en Derechos Humanos (PROVEA), organización no gubernamental que promueve la defensa de los derechos humanos en Venezuela, reportó haber recibido 3.719 denuncias por deficiencias en el sistema de salud durante 2015. Casi suficiente para llenar dos veces el anfiteatro del Centro Comercial Sambil, cuya capacidad máxima es de dos mil personas.

El J.M de los Ríos no es el único. Lo acompañan decenas de otros centros de salud pública donde la medicina se ejerce con lo que hay. Según el Informe sobre la Situación del Derecho a la Salud en Venezuela, elaborado en marzo de 2016 por la Coalición de Organizaciones por el Derecho a la Salud y la Vida (CODEVIDA), conjuntamente con PROVEA, los centros de salud públicos del país presentaban para entonces 70% de escasez de insumos médico-quirúrgicos, 80% de desabastecimiento en medicinas, 50% de disminución del personal médico, y 60% de paralización de equipos de diagnóstico y tratamiento.

En otras palabras: lo que hay es poco o nada.

Fallas y carencias: el día a día de la salud venezolana
Estrella no se llama Estrella. Es un pseudónimo para proteger su identidad, una práctica esencial cuando se trata de enfermeras que se atreven a hablar sobre las deficiencias en el sistema de salud pública en Venezuela. Estrella trabaja en el Hospital Oncológico Luis Razetti, en Cotiza, un barrio en la parroquia San José de Caracas.

En este hospital, que tiene ochenta años funcionando desde su inauguración en el año 1936, hace tiempo que no se ve Epamín, un medicamento para controlar las crisis convulsivas, según relata Estrella. Tampoco hay Dipirona ni Profenid: analgésicos elementales.

De ocho bombas de oxígeno pequeñas que solían rotar por el hospital, no queda ninguna. Las grandes son imposibles de movilizar sin los ascensores que ya tienen más de cuatro meses dañados. Tampoco hay mascarillas ni gotas para nebulizar. Para los pacientes con metástasis pulmonar, respirar puede depender de qué tan rápido corran las enfermeras. Resignada, Estrella admite: «a un paciente que le da una crisis respiratoria, que Dios lo ayude. Imagínate, de aquí a que yo llegue hasta el sitio con la bomba de oxígeno que traigo de otro servicio, el paciente se muere».

Los pacientes con cáncer que reciben quimioterapia requieren que se les administre solución de suero fisiológico como parte esencial de su tratamiento. Tres o cuatro bolsas al día es la cantidad que necesitan la mayoría de los enfermos que atiende Estrella. Pero no hay suficiente suero. Una solución diaria es el máximo lujo que estas personas pueden darse, si tienen la suerte de conseguir la quimioterapia que se les recete: anteriormente, el servicio donde trabajaba Estrella trataba más de 150 pacientes oncológicos al mes; hoy, atiende entre 30 y 50. El resto se desgasta en una carrera contra la enfermedad, sudando frío, agotando sus últimas fuerzas en una peregrinación forzosa por las farmacias especializadas de Caracas. Hasta que la quimio aparezca. O hasta que pase lo peor.

Deficiencias en infraestructura y severas carencias de equipos e insumos son dos de los principales problemas que enfrenta la red pública de atención sanitaria en Venezuela. Así lo cree el doctor Gustavo Villasmil, especialista en Medicina Interna y ex secretario de salud de la Gobernación del estado Miranda, quien asegura que «en Venezuela tenemos una capacidad hospitalaria que está por debajo, en una tercera parte, de lo que estaba en el año 1962». De acuerdo con cifras levantadas por la Red de Sociedades Científicas Médicas Venezolanas, organización que agrupa a profesionales de la medicina y las ciencias en el país, el número de camas operativas en los hospitales públicos pasó de 30.964 en 2009, a 20.821 en 2014. Una reducción de más de 10 mil camas. Hasta el momento no hay cifras más actualizadas.

El especialista explica que hacen falta más de 40.000 camas de hospital en todo el país para cubrir la demanda del servicio adecuadamente. «Si se divide eso entre 1.200, que es el número de camas para el cual fue diseñado el Hospital Universitario de Caracas, da como resultado que se necesitan construir en Venezuela 33 nuevos hospitales de ese tamaño».

Según datos del censo poblacional del año 1981, Venezuela tenía para entonces 14.516.735 habitantes. La tasa de capacidad hospitalaria nacional era de 27 camas hospitalarias por cada 10 mil habitantes, de acuerdo con un informe publicado en 2002 por la Oficina de Asesoría Económica y Financiera de la Asamblea Nacional.

Para 2011, año del último censo poblacional que se ha hecho en Venezuela hasta el momento, la cifra había descendido a solo 10 camas hospitalarias por cada 10 mil habitantes, un tercio del promedio establecido por la Organización Mundial de la Salud para América Latina: 30 camas por cada 10 mil habitantes.

La realidad podría ser todavía peor. Partiendo de la cifra de 20.821 camas operativas que existían en la red de hospitales públicos en 2014 según la Memoria y Cuenta del Ministerio del Poder Popular para la Salud (MPPS), una simple división arroja que para entonces, la salud pública en Venezuela tenía una capacidad de atención de apenas 2 camas por cada 10 mil habitantes. Eso fue hace tres años.

Cuatro de cada diez camas hospitalarias en los centros de salud pública están inoperativas, según datos de la Encuesta Nacional de Hospitales 2017, publicada a mediados de marzo por la ONG Médicos por la Salud, que está integrada por médicos residentes que trabajan en hospitales públicos del país y monitorean cuál es la situación en estos centros de salud.

Según el doctor Gustavo Villasmil, todo sistema de salud pública depende de cuatro pilares para funcionar de forma efectiva: infraestructura, capital humano, tecnologías y logística de suministro, que abarca los insumos, materiales consumibles y medicamentos. Cada uno de estos pilares es imprescindible: si uno falla, el sistema entero entra en riesgo de colapso. En Venezuela, en pleno siglo XXI, los cuatro están fallando.

Para Villasmil, la salud en Venezuela atraviesa su peor momento histórico. «En las condiciones actuales, es insostenible la operación de cualquier servicio de atención médica, desde un pequeño ambulatorio hasta un hospital mucho más complejo», comenta el especialista.

«La salud en Venezuela se está cayendo por todos lados», sentencia la doctora Ciramar Navarro, médico hematólogo y jefa de la Unidad de Quimioterapia de la Clínica Briceño Rossi. «Desde lo más básico a lo más complejo. Desde profilaxis y prevención hasta medicina curativa compleja».

Mientras conversamos en su consultorio en la Unidad de Quimioterapia, las enfermeras se pasean entre los sillones de cuero donde normalmente se sientan los pacientes por varias horas para recibir sus dosis intravenosas de tratamiento oncológico. Hoy no hay un solo paciente. La mayoría canceló su cita semanal porque no habían logrado conseguir la quimioterapia que les debía suministrar el Instituto Venezolano de los Seguros Sociales (IVSS), ente encargado de la distribución de este tipo de medicamentos. Para los enfermos de esta nación en crisis, la espera es la única prescripción médica que está garantizada.

La Encuesta Nacional de Hospitales 2017 dibuja una situación crítica en todo el sector salud en Venezuela. La escasez de material médico-quirúrgico en los hospitales públicos del país ronda el 75%, mientras que en catéteres y sondas es de 76%. 89% de los equipos de rayos x en estos centros de salud no está operativo y 94% de los equipos de tomografía están dañados.

Asimismo, 78% de los hospitales públicos del país presenta inexistencia absoluta o fallas severas en el suministro de medicamentos esenciales para los pacientes, y alrededor de 97% de los servicios de laboratorio clínico registran fallas severas o permanecen cerrados.

Para este trabajo se intentó contactar al Ministerio de Salud para conocer su versión sobre el estado actual del sector salud en Venezuela, pero no obtuvimos respuesta a nuestra solicitud.

El área de terapia intensiva del Hospital JM de los Ríos está delimitada por una pared de bolsas negras de basura. Detrás de la improvisada pared, se encuentran una docena de camas apiladas, fuera de uso por su mal estado. Fotografía de Flaviana Sandoval

De los cuatro pilares que sostienen la salud en Venezuela, ninguno se salva. Para el doctor Gustavo Villasmil, la falla de uno solo marca el comienzo de lo que fácilmente puede convertirse, o ya es, una tragedia humanitaria. «Falla uno, se cae la operación. Se empieza a caer a pedazos», asegura. «Y los pedazos que primero caen son lo que pudiéramos llamar las prestaciones más complejas; valga decir, aquellas que suponen una conjunción específica, costosa y compleja de infraestructura, personal, tecnología y suministros. Por ejemplo, el manejo del cáncer en Venezuela».

Haly Hernández: ¿víctima de la política?

Haly Hernández tiene dos años y un tumor cancerígeno en el riñón izquierdo. En los hospitales de su ciudad natal, Maturín, su caso cayó en la categoría de lo que el doctor Villasmil llama «prestaciones de carácter complejo». Tal vez demasiado complejo. Después de ver el eco abdominal y la tomografía que confirmaron un diagnóstico incuestionable de un tumor de Wilms, la nefróloga que vio a Haly por primera vez supo que la niña requería atención inmediata, del tipo que solo podían darle en la capital del país.

A Haly la enviaron a Caracas el 20 de julio de 2016, con sus exámenes bajo el brazo y una orden médica para tomar una biopsia del tumor, que ya para entonces abarcaba casi el tamaño del riñón completo. El doctor Huníades Urbina, presidente de la Sociedad Venezolana de Puericultura y Pediatría y ex jefe del servicio de Urgencias del Hospital J.M de los Ríos, hizo el contacto para que el área de Cirugía Pediátrica recibiera el caso. Para el 8 de agosto en la tarde, Haly estaba acostada en su cuna de la habitación 604, en el sexto piso.

Pero una vez allí, todo pasaba despacio, excepto el tiempo, claro, que siempre es vertiginoso para el que no puede esperar. La toma de biopsia, que debía hacerse como un procedimiento quirúrgico bajo sedación, se aplazaba una y otra vez con diferentes excusas: faltaba material médico-quirúrgico, anestesiólogos, enfermeras de turno. Hasta que Gipcia Martínez, la abuela de Haly, se cansó de esperar y decidió que lo que realmente escaseaba era voluntad.

El reclamo comenzó en la oficina de la dirección del hospital, donde a Gipcia trataron de hacerle entender la situación: dado que el caso de Haly «no era una emergencia sino una cirugía electiva», había otras intervenciones más urgentes a las que se les estaba dando prioridad. Una versión que Gipcia no pudo soportar.

Entre metro y camioneticas por puesto, la abuela recorrió una Caracas que le era desconocida, rastreando entre instituciones gubernamentales alguna que pudiera prometerle una biopsia del riñón de su nieta. Tocó la puerta en la Oficina de Atención al Soberano, uno de los viceministerios adscritos al Despacho de la Presidencia que recibe y procesa solicitudes de ayuda de los ciudadanos dirigidas directamente al presidente de la República. Pasó luego por la Asamblea Nacional, donde le sugirieron llevar el caso a los medios, y finalmente, terminó en el Ministerio para la Salud.

Cuando le negaron la ayuda, les dio un ultimátum de los que solo puede dar una abuela cansada de pedir amablemente: «Si ustedes no pueden hacer nada, ya yo veré la manera de resolver. Y la manera de resolver es sacar esto por televisión o por prensa o por donde sea. Pero lo voy a sacar, porque ya no voy a seguir esperando».

El Ministerio de Salud le prometió a Gipcia enviar un funcionario especialmente para atender su caso en los próximos días. Curioso, según considera la abuela de Haly, que fuera justo después de que amenazó con llevar su historia a la luz pública. Pero para cuando el funcionario llegó al hospital J.M de los Ríos al día siguiente, una periodista, simulando ser un pariente, ya estaba allí.

Haly agarra todo lo que está a su alcance y siempre está tarareando cancioncitas. Le gustan los lentes de sol de su abuela. Espera que todos se descuiden y los recoge de la cama con un jalón furtivo. Se los pone y empieza a modelar por todo el cuarto, buscando un aval de su coquetería. Cuando alguno de los presentes le dice que se ve bella, Haly entrecierra los ojos detrás de los cristales ahumados y ríe.


Aunque por lo general se ve activa y sana, cuando las crisis de fiebre aparecen, Haly se siente débil y su único alivio es dormir durante varias horas. Fotografía de Flaviana Sandoval.

Gilipce Alcalá es una mamá joven. Tiene 20 años y al verla con Haly, es fácil pensar que se trata de su hermana mayor en lugar de su madre. Tres semanas después de que ingresaran al hospital a comienzos de agosto de 2016, conversamos sentadas en una colchoneta vieja sobre una placa de concreto elevada a medio metro del piso. Eso es la cama donde duerme Gilipce.

«Por lo menos yo tengo esto», dice la muchacha señalando la colchoneta. «En otros servicios he visto que lo que hay son unos muebles de goma espuma horribles y las mamás duermen ahí, en el piso».

En los pasillos de este hospital destartalado, donde los pacientes con deficiencias respiratorias suben las escaleras hasta el piso cinco, ahogándose, por falta de ascensores; donde las madres denuncian que la comida a veces viene condimentada con chiripas o vidrio; donde de las catorce máquinas de hemodiálisis que se compraron en el año 2012, hoy solo funcionan siete, y seis de ellas están operativas solo gracias a que las mamás de los pacientes pagaron el mantenimiento con su propio dinero, para que sus hijos no se quedaran con la sangre contaminada; aquí, es costumbre agradecer lo más básico. Lo que en muchos otros lugares se asume por adelantado: habrá agua, habrá luz, no tendremos que dormir en el suelo, estaremos vivos mañana.

Gilipce pasa los días desmenuzando su angustia, entre el ansia de que operen a su hija y la desesperación de que la hora de la cirugía no llega. En dos ocasiones, Haly pasó 24 horas sin comer, en un supuesto ayuno preoperatorio, pero luego de la jornada de hambre programada, le dijeron a Gilipce que la cirugía se cancelaba, sin mayores explicaciones. Cuando se le ocurrió quejarse con una enfermera, lo que se ganó fue un sonoro y desalentador: «bueno, mi amor, acostúmbrate».

Mientras esperan, Gipcia no trabaja vendiendo productos de belleza al mayor como antes. Y si no trabaja no cobra. En Caracas, sobrevive con el dinero del «potazo» que unos amigos le reúnen en Maturín, pidiendo a los transeúntes que pongan dinero en un pote para más tarde enviarle la colecta. A duras penas les alcanza y Gipcia siente el coletazo del tiempo vaciándole los bolsillos. «El tiempo de ayuda económica también es algo pesado», dice, «porque aquí tenemos que comprar comida todos los días: tres comidas».

– ¿Aquí en el hospital no les dan la comida? – le pregunto.

– No. Le dan sólo a la niña. Y además también hay que comprarle pañales.

– ¿Tampoco les dan los pañales?

– Solo dos pañales diarios.

Por su condición clínica, Haly moja cuatro o cinco pañales al día. Los tres pañales extras que usa diariamente provienen de un paquete que su abuela compró -luego de recorrer casi toda la ciudad- en el barrio de Mamera. Dado que se trata de un producto cuyo precio está regulado por el gobierno, es difícil encontrar pañales a la venta en los supermercados o farmacias. En cambio, se venden con sobreprecio en el mercado negro, donde Gipcia finalmente logró comprar.

Los dos pañales que Haly recibe del hospital son un milagro. La tarde en que Gilipce bajó a la oficina de administración a preguntar cómo podía solicitar que le dieran pañales para su hija, la encargada de turno clavó los ojos en Haly y dijo: «Pero a ella yo la veo muy bien. ¿Para qué tú necesitas los pañales?».

Han pasado casi tres semanas desde que ingresaron al hospital, y Haly sigue esperando en su cuna, con una vía incrustada en la muñeca, a que todas las demás emergencias pasen y por fin llegue su turno para entrar a quirófano. Entonces sabrán en qué estado se encuentra su enfermedad, qué tratamiento requiere, qué tanta esperanza pueden albergar.

Gilipce sabe: «mientras más grande el tumor, puede pegar en el pulmón, o extenderse al otro riñón», dice. «Ya cuando nos vinimos para acá, la doctora dijo que el tumor estaba en la línea media: la línea media es la columna; que no le falta nada para el otro riñón».

Con el tratamiento adecuado, el tumor de Wilms en niños tiene una tasa de curación de 90%, siempre y cuando todavía no se haya diseminado a otros órganos. Pero si no…

«A mí como madre, se me destrozaría todo. Que agarre el otro riñón» confiesa Gilipce. «Ya con el otro riñón agarrado, ¿qué? Ya es cruzar los brazos y decir: ‘bueno, vamos a ponerle la quimio y alargarle la vida… hasta donde ella pueda resistir’. ¿Eso es lo que ellos quieren?»

La pregunta queda en el aire cuando entra al cuarto un emisario que viene a ofrecer términos de paz y, sobre todo, a garantizar que las amenazas de Gipcia de soltar la lengua frente a un micrófono, no se materialicen. Se trata de un médico especialista II del MPPS, según lo identifica el carnet que le cuelga del cuello con un cordón rojo.

El médico empieza el diálogo con una promesa: Haly ingresará a quirófano el lunes a las 7:00 de la mañana. La primera cirugía del día.

El acuerdo de paz en boca del doctor incluye enunciados como: «a la cirugía voy a entrar yo personalmente, porque es un caso especial» y «hoy no se pudo operar porque realmente no hay la disponibilidad, y los fines de semana no operamos casos tan complejos». Gipcia arquea las cejas al enterarse de que el caso de su nieta, ahora sí, es un caso «especial» y «complejo».

Haly ingresó a quirófano según lo prometido: el lunes 22 de agosto de 2016. Fue demasiado tarde para salvarle el riñón izquierdo, que ya estaba totalmente tomado por el tumor. El médico especialista II ya lo había anticipado la tarde del viernes, mientras le examinaba el abdomen a la niña.

«Ya sabes lo que le van a hacer a tu niña, ¿verdad?», le preguntó a Gilipce. «Ese tumor generalmente abarca un riñoncito. Posiblemente le saquen el riñoncito.» Y aunque pareció que iba a terminar la frase ahí, no pudo evitar agregar un consuelo improvisado. «Pero queda con otro…»

Sí, Haly quedó con el otro riñón. El derecho. El único que tiene ahora. También quedó con una dieta especial de protección renal que debe seguir de por vida, para cuidar ese único riñón que tiene. Si tomamos los datos más recientes de la Organización Mundial de la Salud (OMS), según los cuales la esperanza de vida al nacer se ubicó en los 74.1 años en Venezuela en el 2016, significa que Haly deberá hacer dieta por los próximos 72 años. Ahora es una niña que crecerá sin comer huevos ni productos lácteos, con pocas proteínas animales, ningún enlatado y sin sal. Nunca probará unas papas fritas. Tendrá que decirle adiós para siempre a la ilusión de un perro caliente.

A Haly le prescribieron un tratamiento con quimioterapia y sesiones de radioterapia durante siete meses. Según el doctor Cono Gumina, médico gastroenterólogo y presidente de la Sociedad Anticancerosa de Venezuela, «de cada 10 pacientes a quienes se les indica un esquema de tratamiento oncológico, solamente 2 consiguen el tratamiento en su totalidad. Para los 8 restantes, el esquema queda incompleto». La niña está ahora en esta ruleta, mientras su familia reza para no caer en el grupo de los ocho desafortunados.

Una vez que el tratamiento termine, reiniciará la espera: esperar que el tumor no reaparezca, esperar que el riñón derecho sea suficiente para limpiar la sangre, esperar que en algún momento, en un futuro no tan remoto, el nombre de Haly encabece la lista de cinco mil pacientes que según el Informe sobre la Situación del Derecho a la Salud en Venezuela, de CODEVIDA y PROVEA, hoy esperan por un trasplante en Venezuela.

Gilipce soporta la espera. Lo ha hecho durante los últimos siete meses. Gipcia también aguanta, pero mira hacia atrás, y no puede evitar pensar en lo que hubiera podido ser. Recuerda esos días de agosto en los que se preguntaba: «¿qué van a esperar? ¿Qué Haly se degenere?». Todavía no entiende qué esperaban, ni por qué. Pero hizo sus apuestas el día que nos conocimos, cuando con un movimiento furtivo y veloz, me deslizó en la mano un trocito de papel doblado. «Te vas a llevar esto, yo hice una acotación ahí», murmuró, justo antes de que el médico enviado por el ministerio entrara. Más tarde, ya al resguardo de casa y sin moros en la costa, abrí el papel y leí las líneas escritas en tinta negra del puño y letra de Gipcia:

Yo presumo que toda esta situación tiene tinte político, en vista de que no me dan una respuesta concreta sobre la intervención quirúrgica de mi nieta, motivado a que quien nos hizo el enlace para el ingreso de la niña al hospital, piensa diferente a las políticas de salud del gobierno.

Difícil saber qué tan equivocada (o acertada) es la hipótesis de Gipcia. Pero sabemos dos cosas: Uno: quien hizo el enlace para que a Haly la recibieran en el hospital J.M de los Ríos fue el doctor Huníades Urbina, quien se desempeña como director del Posgrado de Medicina Crítica de la Universidad Central de Venezuela. Dos: el doctor Urbina sí piensa diferente al gobierno, y no se cansa de gritarlo a los cuatro vientos.

El J.M de Los Ríos: retrato del abandono

Cuando a mediados de 2014 el MPPS le pasó su carta de jubilación, removiéndolo de su puesto como jefe del Servicio de Urgencias del Hospital J.M de los Ríos, el doctor Urbina apareció de súbito sentado en una mesa adornada con el logotipo de un partido político de oposición, denunciando que estaba siendo víctima de una «jubilación forzosa» por haberse atrevido a hablar públicamente de las calamidades de la salud nacional.

«No es la primera vez que levanto mi voz para denunciar los atropellos y los déficits que tiene el hospital. Yo simplemente pudiera ser en este momento la cara visible de cientos de médicos que están siendo castigados en los hospitales por decir la verdad y por enfrentarse a unos directores y a un ministerio que está siendo ineficiente en la administración de las políticas de salud», dijo en aquel entonces en rueda de prensa.

El doctor Urbina salió del Servicio de Urgencias del J.M de los Ríos seis años antes de lo previsto según su edad, pero hasta hoy, parece que día a día se cumple uno de los preceptos sobre sí mismo que más le gusta repetir: «yo puedo más que ellos». Por su trabajo como director del Posgrado de Medicina Crítica de la UCV, Urbina supervisa a varios de sus estudiantes que hacen pasantías y trabajan como residentes en el hospital. Va y viene a placer entre los servicios, conoce a muchos pacientes, examina a los niños, cuenta chistes con las enfermeras, escucha los cuentos trágicos del personal de mantenimiento que no tiene con qué limpiar los baños, o con qué preparar teteros para los bebés hospitalizados. Y de vez en cuando, pasea periodistas por los pasillos del hospital, en una suerte de recorrido testimonial de la decadencia.

En 2013 un ala del piso 3 del JM de Los Ríos se incendió por una falla eléctrica. Hasta la fecha, esta área no ha sido recuperada por la administración del Hospital, a pesar de que se hicieron estudios de evaluación para presupuestar el costo de las reparaciones. Fotografía de Flaviana Sandoval.

El Hospital de Niños J.M de los Ríos fue inaugurado en 1958, con siete servicios de atención y hospitalización pediátrica en diversas áreas, 420 camas clínicas y un promedio de 30 pacientes pediátricos hospitalizados por cada servicio. 58 años después, la realidad es completamente diferente: ahora hay sólo 120 camas operativas (apenas un 30% de la cantidad original), y capacidad para hospitalizar entre 8 y 9 pacientes por cada servicio.

De los siete servicios de atención que existían inicialmente, solo cuatro siguen funcionando y están dispersos por todo el hospital, en áreas que no reúnen las condiciones mínimas para brindar una atención de calidad a los pacientes. Los otros tres tuvieron que cerrar por problemas de infraestructura, filtraciones, botes de agua, o como lo describe el doctor Urbina al referirse al antiguo servicio de Medicina 7: «porque el pupú corre por las paredes».

Medicina 7 solía ser un área de hospitalización en el cuarto piso de la torre central del hospital. Ahora, después de un bote de aguas negras que nunca se reparó, es un cementerio de camas. El piso completo está abandonado: cuartos y cuartos llenos de camas viejas, camillas oxidadas, muebles rotos, todo apilado.

Debido a un bote de aguas negras que nunca fue reparado, el área de Medicina 7, en el cuarto piso de la Torre Central del JM de los Ríos permanece clausurada y se ha convertido en un cementerio de camas. Fotografía de Gabriel Méndez.

El doctor Urbina es un imán de pacientes desesperados. Cuando lo ven por los pasillos del hospital, las mamás de los niños hospitalizados salen de los cuartos y lo abordan para hacerle preguntas, ponerle quejas o simplemente desahogarse de su eterna zozobra y compartir algo del peso angustioso que cargan. Mientras caminamos por un corredor, el doctor habla de la peregrinación que deben hacer las mamás por todos los pisos del centro de salud, buscando un baño con agua caliente para bañarse, cuando una mujer corpulenta con una bebé en brazos se asoma y dice:

– Y la plaga, doctor.

Con un gesto nos invita a entrar.

– Mire cómo está eso. ¿Usted cree que nosotros dormimos? Mire: todo eso es plaga.

El techo y las paredes están cundidos de manchitas negras: puntitos de sangre seca de los zancudos muertos pegados al concreto.

A pesar de haber sido removido de su cargo como jefe del Servicio de Urgencias del JM de los Ríos, el doctor Huníades Urbina visita el hospital regularmente para hacer seguimiento a sus estudiantes del posgrado de Medicina Crítica de la UCV. Con frecuencia las madres del Hospital acuden a él para pedirle ayuda. Fotografía de Flaviana Sandoval.

«Uno tiene que cerrar las ventanas y la calor es horrible. Ella es cardiópata» dice señalando con la cabeza a la bebé que lleva en brazos. «A ella no la favorece este ambiente. Pedí el permiso para ver si me podían dejar pasar un ventilador y me dijeron que estaba prohibido. Entonces paso la noche aquí, con un periódico, un papelito…».

La mujer hace un gesto ilustrativo mostrando cómo abanica a su hija durante las noches de calor infernal, y entonces veo su brazo, lleno de cicatrices viejas de picaduras de mosquito que nunca terminaron de sanar.

– Ustedes tienen su derecho de bajar a dirección y pedir– incita el doctor Urbina a la mujer. – Porque tienen que pelear por sus muchachos. No tengan miedo: ustedes tienen derecho a protestar y a decir las cosas.

– No, yo de verdad no tengo miedo – responde la mujer decidida-, porque es la salud de mi hija.

El doctor Urbina sabe que lo vigilan, pero tampoco tiene miedo. Es un temerario consagrado. Mientras explica que el servicio de farmacia solía estar en la planta baja del hospital, en un espacio que hoy está totalmente inundado y clausurado, se interrumpe de pronto con un silencio cortante. Mira por encima de mi hombro.

– Allá nos están mirando – dice.

Un instante de inmovilidad, y las consabidas preguntas. ¿Quién nos mira? ¿Se acercará? ¿Nos dirá algo? ¿Me van a sacar del hospital?

El doctor retoma el discurso rápidamente, como si apenas se hubiera distraído.

– A mí me persiguen. Todo el mundo pasa y me mira y le van a chismear a la directora… Pero tranquila, yo puedo más que ella.

El área de la cocina destinada para la preparación de teteros para los pacientes bebés del hospital permanece clausurada por problemas de filtraciones y falta de mantenimiento. Los teteros se preparan en un calentador portátil que puede procesar un máximo de seis teteros a la vez. Fotografía de Flaviana Sandoval.

Al fondo del pasillo central de la planta baja del hospital, están dos quirófanos que permanecen cerrados desde el año 2013, cuando fueron sustituidos por los pabellones del séptimo piso, que acababan de ser inaugurados. Casi tres años después, siguen abandonados: aunque se ven equipados con camillas y algunas máquinas, las luces están apagadas y la polvareda en piso y muebles da una idea de cuánto tiempo ha transcurrido sin que alguien haya pasado una escoba por ahí.

De pie en el quicio de la puerta, el doctor Urbina suspira.

– Mira esto. Dos quirófanos sin funcionar.

– ¿Y por qué no funcionan? – le pregunto.

– Bueno, porque hay filtraciones. Porque nadie le para…

El segundo piso de la torre central del JM de los ríos también está afectado por el bote de aguas negras del área de Medicina 7. Fue igualmente clausurado y permanece abandonado. Fotografía de Gabriel Méndez.

Los quirófanos I y II del Hospital J.M de los Ríos se inauguraron en 2004, cuando Huníades Urbina aún era jefe del Servicio de Urgencias. El médico relata que la apertura de los quirófanos se hizo con bombos y platillos: hubo una transmisión especial televisada con el entonces ministro de Salud Carlos Montilla, y hasta el mismo presidente Hugo Chávez asistió para celebrar los logros de la revolución en materia de salud pública. Pero la alegría se evaporó con el primer aguacero de octubre.

«Resulta ser que esto está por debajo del nivel de la calle afuera», explica el doctor Urbina, «el nivel freático es más bajo que el de la calle y no hicieron los desagües bien. Entonces cuando llueve, esto se inunda». Durante nueve años, desde 2004 hasta 2013, el personal médico operó a cientos de pacientes en los quirófanos I y II del hospital, y sacó agua con baldes y pipotes cada vez que llovía con fuerza. En 2013, cinco de los siete quirófanos del séptimo piso, que llevaban cinco años cerrados, fueron reabiertos, y desplazaron a sus versiones viejas. Los quirófanos I y II nunca más vieron la luz del día.

Mientras tanto, en el piso siete, los quirófanos operativos alargan su último aliento. En un comunicado de prensa del 25 de julio de 2016, varias madres del hospital denunciaron que solo uno de los siete quirófanos estaba funcionando, y se tenía reservado para emergencias, debido a fallas constantes en los aires acondicionados.

El doctor Urbina afirma que alrededor del 60% de los pacientes que recibe el J.M de los Ríos padece alguna patología cuya única solución es quirúrgica. Sin quirófanos, los pacientes que necesitan una cirugía se suman al listado de víctimas de la prolongada espera. Unos cinco mil aguardan fuera del hospital, en lista de espera, añorando un cupo y rezando para que no llegue muy tarde. Otros, como José Galíndez, llevan semanas hospitalizados, esperando también, a que los quirófanos se arreglen.

Un niño que entiende la muerte

José Galíndez, de ocho años, ingresó al J.M de los Ríos en junio de 2016, con una Hidronefrosis Bilateral Grado 4, una malformación en las vías urinarias que puede derivar en problemas severos en los riñones, y cuyo único tratamiento es una serie de cirugías correctivas a lo largo de varios años. Después de 52 días hospitalizado, José sigue corriendo por los pasillos del hospital, con su vía puesta y pegada con adhesivo, mientras su mamá, Edimar Galíndez, busca cómo paliar la fatiga con algo de optimismo. «Tenemos casi dos meses esperando el cupo quirúrgico», dice. «Bueno, algún día nos meten».

La espera de José y Edimar está plagada de carencias. Faltan medicamentos. Falta dinero. Y la paciencia que todavía queda se agota poco a poco.

Reteven y Enalapril son los dos grandes dolores de cabeza de Edimar, que cada tanto recorre las farmacias adyacentes al hospital a ver si logra el milagro de conseguir estos medicamentos que su hijo necesita para aliviarse. En el J.M de los Ríos, las madres tienen prohibido dejar solos a sus niños. Los pacientes deben permanecer acompañados por un familiar en todo momento, lo que representa una enorme dificultad para muchas de las mamás que no encuentran un minuto para salir del hospital a comprar comida para ellas o medicinas para sus hijos.

La mayoría de las veces, Edimar soluciona con una serie de llamadas telefónicas: hablándole duro a su exmarido. Aunque no viven juntos desde hace más de siete años, el papá de José ayuda en lo que puede: deposita algo de dinero y de vez en cuando consigue alguno de los once medicamentos que toma su hijo. Mientras hablo con Edimar en el servicio de Urología del J.M de los Ríos, el hombre está en la calle buscando un banco Bicentenario para depositar un dinero que según Edimar, «se va a ir volando en cualquier cosita».

En el Examen Periódico Universal (EPU) de 2016, que se realizó del 31 de octubre al 11 de noviembre de 2016, en la sede del Consejo de Derechos Humanos de la Organización de las Naciones Unidas en Ginebra, Suiza, la entonces ministra de salud, Luisana Melo, aseguró que en Venezuela el acceso a la salud no está mediado por la capacidad de pago. No obstante, un estudio de la Organización Mundial de la Salud reportó que para el año 2010, los venezolanos costeaban 59% de los gastos médicos, cifra que coloca al país como el primero de América Latina con el mayor gasto del propio bolsillo para cubrir incidencias de salud.

En una protesta a las puertas el hospital el 29 de marzo de 2017, padres y representantes de algunos de los pacientes del J.M de Los Ríos denunciaron que constantemente deben costear con su propio dinero exámenes de laboratorio y rayos x, porque el hospital no garantiza estos servicios debido a fallas en la disponibilidad de insumos y reactivos, así como en el funcionamiento de los equipos de diagnóstico. Los manifestantes también reclamaron por la escasez de medicamentos y tratamientos básicos en el hospital, y aseguraron que deben conseguirlos por fuera, generalmente a precios muy elevados.

El país autosuficiente que dibujan con cifras los recuentos del Ministerio de Salud no encaja en la experiencia diaria de Edimar, para quien la situación es cada vez más crítica. «¿Cómo es posible que un medicamento que deberían tener esos niños no se consiga?», se pregunta. «Por eso es que esos niños se mueren. Este año se han muerto un poco de niñitos allá abajo en Nefrología».

El Servicio de Nefrología, en el tercer piso del hospital J.M de los Ríos, es donde los pacientes con problemas renales reciben diálisis un promedio de tres veces a la semana. En la protesta del 29 de marzo, madres denunciaron que al menos 15 niños de ese servicio adquirieron infecciones bacterianas a través de la planta de ósmosis que filtra el agua para el proceso de diálisis, y que según las denuncias no recibe mantenimiento desde agosto de 2016.


Solo siete de las catorce máquinas de diálisis del servicio de Nefrología están operativas, y funcionan de forma intermitente. Madres denuncian que al menos 15 niños se han contaminado con bacterias por la falta del mantenimiento adecuado a la maquinaria de diálisis del hospital. Fotografía de Gabriel Méndez…

Edimar todavía no tiene que lidiar con estas preocupaciones, pero si la enfermedad de José avanza al siguiente estadio, sus riñones ya no serán capaces de limpiar la sangre y tendrá que hacerse diálisis semanalmente. Todos los esfuerzos están centrados en evitar que esto ocurra pronto. Pero la escasez se interpone.

«Él tiene que tomar Alopurinol para controlar el ácido úrico y evitar que la hidronefrosis avance más rápido», explica Edimar, «pero hace rato que no consigo el medicamento. Tengo como cinco meses que no se lo doy».

En su intervención durante el Examen Periódico Universal 2016 (EPU), la ex ministra de salud, Luisana Melo, aseguró que en el país se garantiza «una distribución promedio de 9,3 medicamentos por persona». Afirmó también que en el 2015 «la red pública distribuyó 255.390.000 unidades de medicamentos y casi 33 millones de insumos médicos», según lo reseñó el portal web Runrun.es.

No obstante, según la encuesta de la ONG Convite, publicada en abril de 2016, la escasez de medicamentos de primera necesidad en las farmacias de la Gran Caracas se ubicaba virtualmente en 100%. «Un poquito menos en el municipio Sucre, donde está en 92%», apunta el doctor Gustavo Villasmil, «pero en el área metropolitana de Caracas supera de largo el 95%».

El doctor Julio Castro, médico internista infectólogo, explica que de acuerdo con la décimo novena edición de la Lista Modelo de Medicamentos Esenciales 2015 de la OMS, existen 164 medicamentos considerados indispensables para el funcionamiento mínimo de cualquier sistema de salud en el mundo. El listado incluye medicamentos para la hipertensión, antibióticos, ginecológicos, dermatológicos y medicamentos para las enfermedades neurológicas, que tienen que existir incluso si el país está en guerra. Pero según el doctor Castro, «en Venezuela, 90% de los medicamentos de la lista son difíciles de conseguir o no existen».

De acuerdo con el informe presentado por el Secretario General de la OEA, Luis Almagro, ante el Consejo Permanente, en junio de 2016, las farmacias en Venezuela solo pueden surtir 7 de cada 100 medicamentos solicitados. En un informe de octubre de 2016, la Federación Farmacéutica Venezolana (FERFAVEN) alertó sobre el cierre de 41 farmacias independientes en el país, por dificultades para cubrir su estructura de costos. Mientras que en otros países de América Latina hay una farmacia por cada 3 mil habitantes, en Venezuela la tasa es de una farmacia por cada 7 mil, asegura el informe. Según la organización, otros 3.700 de estos comercios continúan en riesgo de cerrar.

En enero de 2016, la Cámara de la Industria Farmacéutica de Venezuela reconoció una deuda de 6 mil millones de dólares con proveedores internacionales, según lo reseña el informe de OEA ante el Consejo Permanente. «Venezuela no tiene medicinas porque no las puede pagar», afirma el doctor Villasmil. «El crédito se acabó, y está muy claro que es la gente la que va a pagar. Venezuela va servir su deuda externa, pero a expensas de las divisas para alimentos y medicamentos. En consecuencia, no habrá nada qué comer, no habrá nada qué prescribir».

Además de la enfermedad de su hijo, Edimar tiene que batallar con su propia asma, que le oprime el pecho en las noches calurosas y le aprieta la garganta cuando tiene que subir por las escaleras hasta el cuarto piso porque los ascensores están parados. Los medicamentos que podría tomar para recuperar el aire tampoco los consigue. Habla con añoranza del Salbotán y el Ventide, y de los tiempos gloriosos en los que un inhalador para el asma era moneda corriente.

Pero incluso en los días de ahogo, Edimar tiene la cabeza puesta en los medicamentos de José que no encuentra. Y en los responsables del «no hay». «Aquí se han muerto muchos chamos por la negligencia médica. Médica y presidencial, porque esto es un delito», sentencia la madre. «Esto debería estar bien dotado, y no está».

Las mamás del J.M de los Ríos le apuestan todos los números a la solidaridad. Se comparten medicamentos, intercambian los pocos insumos que consiguen, se regalan pañales, y hasta pican las canillas reguladas que pueden comprar de vez en cuando en la panadería de enfrente, para que ninguna se quede con la barriga vacía.

Mientras converso con Edimar, una mamá entra al cuarto, tomada de la mano de un niñito que brinca y canturrea: «Adiós. Ya me voy de alta. Ya me voy de alta».

– ¿Tu hijo toma Urosín? – le pregunta la mujer a Edimar.

– No. Él toma es Alurón.

– ¡Ah! Yo creo que tengo. Te lo voy a dejar.

A Edimar se le ilumina el rostro.

– Oye, sí, gracias. Para ver si con eso lo ayudo a él, para que se le baje el ácido úrico. No quisiera que cayera en diálisis, porque no me gusta esa sala, es como fea, la veo como horrible.

La fealdad de la sala es lo de menos. Edimar dice que, si José entra en ciclos de diálisis, tendrá que abandonar su trabajo como cocinera para dedicarse a él, y dejará de percibir el sueldo que hasta hoy ha costeado gran parte de la salud del niño. «Si lo dializan pierdo yo», afirma, «eso va a ser grave para mí. Porque ahí sí voy a tener que dejar de trabajar, y quién sabe. Quién sabe qué hacer».

Edimar se bautizó a sí misma «la mamá mágica», porque tiene que «parir los reales todo el año». Trabaja cocinando pastas y salsas en un restaurante italiano del Centro Comercial San Ignacio en el este de Caracas, y asegura que apenas le alcanza el sueldo. «Pido prestado y después me endeudo hasta los tuétanos», dice, «toda la plata que puedes guardar la utilizas ahorita es para puro comprar comida. Con todo lo caro que está».

Para algunas mamás del J.M de los Ríos, la comida es casi un lujo. Edimar come pan con bocadillo, y a veces cambur, cuando logra tener los mil bolívares que cuesta el kilo en la avenida Vollmer, donde está ubicado el hospital. De almuerzo, le dan una comida hipo-sódica como la indicada para su hijo: cero sal, cero azúcares, todo hervido. Cuando intentó pedir que le dieran algo más condimentado, la respuesta fue clara: «dele gracias a Dios que se le está dando una comida», le dijeron.

En el tiempo que lleva en el hospital, Edimar ha bajado 10 kilos. Pesaba 85 al ingresar y ahora ronda los 75. Sin embargo, está contenta, porque un médico le dijo que para poder ser donante de riñón tenía que pesar 60 kilos, para garantizar que el riñón esté limpio y en buenas condiciones. Si la enfermedad de José avanza hasta el quinto estadio, entra en diálisis, y si resiste lo suficiente, el siguiente paso para curarlo es un trasplante de riñón. Su mamá ya se está preparando.

– Yo estoy en toda la posibilidad de hacerme mi prueba de compatibilidad y darle mi riñón a él – dice Edimar. – Que eso es lo que me gustaría, darle mi riñón a él.

– Un riñón cada uno – replica José.

– Un riñón cada uno, exacto. Hemos compartido tanto que compartir un riñón no quiere decir nada. Así de sencillo.

– Pero ¿por qué no intercambiamos de riñón?

– Porque yo te voy a dar un riñón grasoso. ¿Para que te pongas gordo como yo?

– Y yo te doy un riñón flaco para que te pongas flaca como yo.

José es un niño risueño y entre risas entiende todo. Incluso la muerte. Escucha a su mamá hablar de ella con toda naturalidad. No se inmuta cuando Edimar dice que hay niños que se mueren en las máquinas de diálisis porque no aguantan y les da un paro cardíaco. Ni siquiera pestañea al escuchar que el otro día una máquina de diálisis se paró de súbito en pleno procedimiento, y el paciente se quedó ahí, sentadito, viendo cómo su hemoglobina bajaba en picada.

José sabe incluso que sus papás no se soportan. En una de las llamadas telefónicas que Edimar recibe de su exmarido, él se atreve a insinuar que no le depositará dinero hasta el día siguiente. La mujer entra en cólera y exclama en el auricular: «yo te hago una pregunta: ¿por qué no te llegas hasta el JM?». Entre risitas, José contesta: «porque no quiere verte la cara».

Edimar, se pregunta por qué el gobierno no se esfuerza más para preservar el futuro del país: a los niños. «Ellos son unos chamos con sus discapacidades y con sus problemas patológicos» dice, «pero si tú los ayudas llegan a grandes. Pero si les cortas sus posibilidades de vida porque no hay un medicamento, no hay nada, los estás matando prácticamente. Y eso es lo que están haciendo aquí en Venezuela. Matando a los chamos».

El repique de su celular la saca de sus pensamientos. Cuando atiende la llamada, el estruendo de su voz ronca, desgastada por el asma, se escucha incluso en el pasillo. «A mí no me importa si todos los venezolanos estamos iguales: ¡estamos hablando de tu hijo, y entonces uno tiene que hacer un sacrificio por el hijo de uno!».

Médicos que huyen

Aunque a Edimar no le importe, es difícil refutar con éxito la excusa de su exmarido de que «todos los venezolanos estamos iguales». La Venezuela del presente es un país sin burbujas. No existe escape individual para nadie. Sentado en su escritorio en la Clínica Metropolitana, el doctor Gustavo Villasmil reflexiona por horas sobre esto: la colectividad del drama que hermana a los venezolanos, este episodio terminal que para él representa «el encuentro con el país que somos».

«Creo que, a la larga, este destino terrible nos alcanzó a todos», dice Villasmil. «Al barrio y a la urbanización, a las colinas y al cerro, al de la póliza de platino y al que solamente tiene seguro social si acaso. Al buhonero y al profesional. Valga decirlo: al oficialista y al de oposición. Nadie escapa a este destino».

Ni siquiera los médicos. Testigos forzosos de la decadencia de la salud pública, el sufrimiento se les pega en la piel, les nubla los ojos, traspasa los tapabocas y se cuela entre las esporas que bajan hasta los pulmones. Trabajan sin insumos, sin opciones, con el peso de vidas ajenas en las manos que les han amarrado en la espalda.

Para el doctor Huníades Urbina, los médicos en Venezuela «son unos minusválidos desde el punto de vista legal». Explica que en un caso médico legal, si un paciente sale perjudicado por la falta de insumos o equipos, el médico tratante es quien asume la responsabilidad y la condena penal, por haber atendido al enfermo sin las condiciones mínimas necesarias.

– ¿Y el médico no puede negarse a atender?

– Nos dicen que si el paciente se muere es culpa nuestra por no atenderlo. Estamos en un círculo vicioso. Si todo sale bien, se lo agradecen a José Gregorio Hernández, y si sale mal, nos abren un juicio.

En esas condiciones, muchos médicos venezolanos cuelgan sus batas blancas, o las empacan en una maleta con la esperanza de poder usarlas de nuevo en algún lugar lejano, menos hostil, como lo reportó recientemente Valentina Oropeza para el especial «Relatos del absurdo» del Instituto de Prensa y Sociedad y Connectas. Según cálculos de la Federación Médica Venezolana (FMV) a marzo de 2017, alrededor de 16 mil médicos se han ido del país en los últimos años debido a las malas condiciones de trabajo.

En mayo de 2015, en respuesta a los datos de la FMV sobre la emigración de médicos en Venezuela, el ex ministro de salud Henry Ventura desmintió que se tratara de un éxodo masivo de profesionales de salud. Aseguró que solo 320 médicos abandonaron el país entre 2009 y 2015, y dijo que la mayoría había ido a realizar estudios de posgrado, con la intención de regresar después, según lo reseñó el portal de noticias Globovisión.

En el Examen Periódico Universal (EPU) de 2016, la entonces ministra de salud Luisana Melo afirmó que en Venezuela hay un médico por cada 250 familias, además de 30.699 médicos graduados en atención primaria y 3.711 estudiantes en formación médica.

Estas cifras incluyen a los llamados Médicos Integrales Comunitarios, que han sido formados dentro de los nuevos programas educativos implementados por el gobierno venezolano, y duramente criticados por el gremio médico nacional.

En el libro «Del mal que vas a morir. Auge y tragedia de la salud en Venezuela», el doctor Gustavo Villasmil asegura que los programas de formación médica en las universidades tradicionales venezolanas presentan una diferencia de más de 1.500 horas de formación en aulas en comparación con los estudios de los médicos comunitarios.

De acuerdo con Villasmil, sobre la base de una evaluación del perfil profesional de un médico modelo, la Academia Nacional de Medicina concluyó que más del 80% de los médicos comunitarios no tiene las actitudes ni aptitudes básicas para enfrentar las complejidades de atender a un enfermo.

El doctor Huníades Urbina sostiene que los jóvenes egresados de este programa formativo no tienen los conocimientos necesarios para ejercer la profesión. «Son muchachos que engañaron o se dejaron engañar», dice, «que les enseñaron que con ponerse una bata blanca se es médico. Y no. Un médico es tener los conocimientos y la experticia que requiere tratar una patología. Son personas que no están preparadas para atender pacientes».

El programa de formación en Medicina Integral Comunitaria, un modelo importado desde la Cuba de Fidel Castro, fue muy exitoso en términos políticos. En 2005, en un encuentro en ciudad Sandino, Cuba, Castro le vendió al expresidente Chávez la idea de formar 200 mil médicos comunitarios en un período de 10 años. «Las facultades de medicina en Venezuela, en conjunto, producían en sus mejores tiempos 2 mil médicos en un año», explica Villasmil. «Es decir, llegar a la meta propuesta por Castro era una tarea que tomaría un siglo. Él, sin embargo, aseguraba que se podía lograr en una década».

Pero ni siquiera los médicos integrales comunitarios soportan las condiciones de trabajo que hoy en día tiene para ofrecer el sector salud en Venezuela. Muchos de ellos también están huyendo, o al menos lo intentan. El doctor Huníades Urbina, quien es miembro de la Academia Nacional de Medicina, relata que desde la Academia Nacional de Medicina de Colombia les enviaron una comunicación pidiendo información sobre el nivel de formación de 200 médicos integrales comunitarios venezolanos que esperan en el país vecino a que el gobierno reconozca sus títulos y les permita ejercer la profesión.

«Eso es bueno que lo digas» exclama Urbina «para que los del ministerio sepan que su misma gente los está abandonando. ¿Cuál es el socialismo que sembraron si se están yendo del país?»

Mientras tanto, los hospitales en Venezuela se van quedando desiertos. En el J.M de los Ríos había 28 anestesiólogos con entrenamiento en anestesiología pediátrica. Hoy quedan cuatro, que aparecen y desaparecen en turnos improvisados según la necesidad. De acuerdo con Urbina, el Hospital de Niños necesita cerca de 300 enfermeras para cubrir la demanda del servicio, «pero llega una y se van dos», dice. En el Hospital Oncológico Luis Razetti solo quedan tres doctores de pediatría que hacen milagros para cubrir las necesidades de los pacientes. Y según Estrella, enfermera de este centro de salud, cuando no pueden, las enfermeras hacen el papel de doctor.

Los que decidieron quedarse enfrentan el destino que nos alcanzó a todos, ganando alrededor de 32 mil bolívares, según el doctor Urbina, e inventando sobre la marcha cómo y con qué tratar a sus pacientes. «El signo espiritual que regenta mi momento actual en la profesión es la angustia», dice el doctor Villasmil. «Con ella me acuesto, con ella me levanto, con ella vivo. Esto es una cruz. Que pesa, que hace llorar, que muele, que marca, que signa la vida, incluso la vida personal y familiar, porque vivimos en esto. Esta es la vida. Es un signo muy angustioso».

Con la angustia marcada en los ojos, los médicos se pasean por los pasillos cuyas paredes están recubiertas de baldosines cuadrados pintados con dibujos coloridos. Las junturas de las baldosas acumulan una mugre de color negro, endurecida por el tiempo, que los doctores describen como «una fuente de toda clase de bacterias». Al fondo del pasillo del quinto piso, en el área de Neurocirugía, se encuentra la única sala de drenaje del hospital: un cuarto reservado para los casos más críticos de pacientes con patologías cerebrales.

Dr. Gustavo Villasmil en su consultorio en el Centro de Especialidades Médico-Odontológicas, en Petare, donde atiende a pacientes de forma gratuita. Fotografía de Gabriel Méndez.

La sala de drenaje está restringida a las visitas por razones de asepsia, para evitar que bacterias y otros microorganismos del exterior puedan dañar a los pacientes en condiciones tan delicadas que se hospedan allí. Sin embargo, el cuarto no está sellado como debería. El aire acondicionado es un armatoste dañado que sobresale de la pared exterior del edificio. Para combatir el calor, las ventanas permanecen siempre abiertas, y el aire de la calle mezclado con el humo de los autobuses que transitan por la avenida Vollmer forman corrientes contaminadas que danzan por el cuarto alrededor de Gregory Montilla.

La espera como condena

Gregory tiene 2 años y su problema viene desde el nacimiento. Nathaly Ramírez, su mamá, ya sabía, mucho antes de romper fuente y correr al hospital para dar a luz, que a su hijo le faltaba el lóbulo frontal izquierdo del cerebro. No se le formó. Y del hueco donde debería estar la parte faltante, sacó partido un líquido, mezcla de sangre y fluidos sin nombre, que se empozó ahí, a sus anchas.

Para prevenir la inflamación del cerebro, Gregory necesita cirugías periódicas que consisten en instalarle una válvula que permita la circulación del líquido acumulado en su cerebro. La primera de estas cirugías se hizo en septiembre de 2015 en el J.M de Los Ríos, cuando Gregory apenas tenía un año. Le colocaron su primera válvula cerebral y lo dieron de alta en pocos días. Pero un mes después, Gregory volvió de emergencia al hospital, con un paro respiratorio sin causa aparente. Cuando le abrieron la cabeza para retirarle la válvula y cambiarla por una nueva, el catéter, un pequeño tubo enrollado que acompaña la válvula, se había desprendido, y estaba perdido, invisible en medio de la viscosidad del cerebro.

La decisión fue dejarlo allí y esperar lo mejor. Pero lo mejor no llegó.

«Me habían dicho que no afectaba en nada», recuerda Nathaly, sentada en el pasillo del Servicio de Neurocirugía, en el quinto piso del hospital. «Que eso era una gomita que iba a nadar por el cerebro, para allá y para acá. Pero a los tres meses el niño empezó a ponerse rígido, empezó a convulsionar. Y entonces supieron que era el catéter lo que estaba afectando».

Gregory regresó al hospital para una punción de líquido cerebral, y lo que salió, según cuenta Nathaly, fue «una baba horrible y espantosa», que presagiaba infección bacteriana. Para cuando le abrieron el cráneo por segunda vez para sacarle, ahora sí, el catéter extraviado, la válvula que le habían puesto apenas tres meses antes era insalvable: estaba totalmente infectada.

Después de retirarla, los médicos iniciaron un tratamiento con antibióticos para controlar la infección cerebral y drenar el líquido infectado. Así comenzó la espera de Gregrory, que se prolongó por nueve meses, mientras la infección cedió y la mamá de Gregory logró conseguir, a través de una donación a la Fundación Prepara Familia, la válvula de presión media que necesitaba para su hijo.

Nathaly tiene una hermana en Caracas, pero no recuerda si vive en Santa Teresa o en Santa Lucía. Sabe que es «por allá lejos», que tuvo que montarse en metro, después en carro, que es horrible ir para allá. El resto de su familia está en San Cristóbal, en el estado Táchira, pero ella vino de Barinas, donde vive la familia de su esposo. Allá la está aguardando su hijo mayor, de 10 años, que espera que a finales de septiembre, su mamá lo ayude a preparar el morral para su primer día de clases en el liceo.

Le pregunto si volverá a Barinas cuando a Gregory lo den de alta.

«Mira, con ganas. Feliz estando por allá. Mucho más relajado que aquí en Caracas».

Más relajado no significa muy diferente. En Barinas, como en Caracas, Nathaly tampoco tiene trabajo. Cuenta que antes de hospitalizar a Gregory, se defendía vendiendo yogurt casero que preparaba con las sobras de la leche regulada que compraba para los teteros del niño. Eran los tiempos en que todavía se conseguía el azúcar. «Pero ahora no.», suspira Nathaly, «ya está difícil la azúcar. Ahorita no voy a poder con eso».

Nathaly quiere ser abogada. Estudió en la Misión Sucre, otro de los programas sociales de educación promovidos por el gobierno para la formación de personas de escasos recursos. Y le gustó. «Era muy bueno. Todos los profesores eran abogados. Hasta el mismo juez del pueblo nos daba clase», asegura. Pero cuando quedó embarazada de Gregory, Nathaly se olvidó de los abogados. Tenía problemas para concentrarse, hasta que, faltando un año para su graduación, dejó de ir a clases y no volvió nunca más.

Ahora lo está pensando. Podría regresar. Terminar lo inconcluso. Si tan solo su suegra, en Barinas, no trabajara. Entonces podría cuidar a Gregory mientras ella, recién egresada, ejerce la abogacía. Ganaría mejor. La salud de Gregory estaría garantizada. Todos estos pensamientos cruzan su mente mientras espera que la Misión Sucre le dé respuesta a su solicitud de retomar los estudios poco a poco: presentar un proyecto de tesis de grado, ir sacando las materias rezagadas de una en una. Todavía no le han dicho nada. Ella espera, fantaseando despierta en los pasillos del hospital.

Gregory fue dado de alta en septiembre de 2016. No tenía rastro de infección, estaba recién operado y con una válvula nueva. Nathaly estaba feliz. Llegó a Barinas a tiempo para preparar la lonchera del primer día de liceo de su primogénito. Y entonces, a sólo dos días de haber llegado a casa, Gregory convulsionó.

Nathaly lo llevó de emergencia al Hospital de Barinas, donde se descubrió que en el cerebro del niño se había alojado una nueva bacteria. El cultivo que le hicieron reveló que se trata de una bacteria que se adquiere únicamente a través de heridas abiertas; no es susceptible de contagiarse por el aire o el contacto. Gregory se infectó en algún momento mientras la herida en su cabeza todavía estaba abierta; lo más probable es que haya sido mientras estaba en el Hospital de Niños.

Con una nueva infección, la válvula cerebral que recién le habían instalado se infectó también. Los médicos del Hospital de Barinas tuvieron que retirarla, y empezar un tratamiento con antibióticos para controlar la infección y preparar a Gregory para una nueva cirugía, que requerirá una nueva válvula. Otra vez la búsqueda. Otra vez la angustia.

Nathaly no va a ser abogado. Al menos no por ahora. Está dedicada a cuidar a su hijo; sentada al lado de la cama, vigilando su sueño, abanicándolo con un papel para disipar el calor humedecido de los llanos venezolanos. Lo hará durante el tiempo que sea necesario. Todo lo demás, hasta ella misma, puede esperar.

En Venezuela, la política de salud pública por excelencia parece ser la espera. La muerte también espera. Agazapada en los rincones de los quirófanos sin aire acondicionado; al pie de la cama de cada niño que no consigue quimioterapia; junto a cada máquina de diálisis que funciona a medias; a espaldas de cada médico que debe operar sin los insumos adecuados para evitar un juicio criminal por mala praxis. La muerte aguarda con los brazos abiertos, llama a los niños con voz queda: a Haly, a José, a Gregory, a todos los demás, cuyos nombres no conocemos. Seguirá llamando a los que vengan. Se contentará con cada caja de pastillas que no aparece, con las bombas de oxígeno dañadas, con cada pedacito de vidrio en la comida de un niño. La escasez, la precariedad, la desidia, son sus victorias.

Daniela ya no tiene que esperar. Su madre Susana, en cambio, sumó a su propia espera la de muchos. Nunca abandonó del todo el Hospital de Niños después del 4 de julio. Continúa yendo cada martes, y cada día adicional que puede. Habla con las mamás de los pequeños que aún siguen hospitalizados, recibe sus quejas y denuncias, sale a la calle a contar lo que pasa puertas adentro del centro de salud.

Los motivos que la llevaron a quedarse en el hospital después de la muerte de su hija los explica a motu propio con toda naturalidad; como contando un anexo más de su historia personal. «Yo no puedo sencillamente porque Daniela no está, voltearme y dejarlo así» dice. «No puedo. Recuerdo que el día que Daniela falleció, una mamá que no estaba en el hospital me mandó un mensaje y me dijo: ‘amiga, usted se ha hecho una familia en el JM, así que cuente con nosotras’. Y uno no le da la espalda a la familia».

Desde el principio, Susana estaba decidida a contar lo que pasaba dentro del Hospital de Niños. La primera vez que la vi en una reunión de la Comisión de Asuntos Sociales de la Asamblea Nacional en julio de 2016, dijo tajante: «mi hija no necesita que yo haga más nada por ella. Ya ella está bien, ya no le duele nada. Ya no hay que pincharla, ya no hay que hacerle nada. Pero hay un montón de niños en el hospital que sí necesitan que se haga algo. Alguien tiene que hablar. No puede ser que se siga negando una realidad que se lleva a los niños todos los días».

Susana está convencida de que sigue los pasos de su hija. Cuenta que durante su estadía en el hospital, Daniela decía que quería ser hada. «Yo le preguntaba: Daniela, ¿pero hada? Y ella respondía: sí, porque yo quiero darles regalos a los niños», relata, y añade que en algún momento durante su hospitalización, Daniela agregó otro deseo a su lista: ahora quería ser hada o doctora.

– ¿Por qué?- pregunta Susana en voz alta, y se responde- Porque ella quería darle regalos a los niños y curar a los que están enfermos.

El huerto de Daniela

En su tiempo libre, Susana se dedica a sembrar. Siembra en el jardín de su apartamento en la planta baja de un edificio en Caricuao, que desde hace varios años se convirtió en un pequeño huerto con muchas plantas diferentes. «Tenemos espinacas, cebollín, unas zanahorias que todavía no tienen tamaño, pero ya pronto deben estar listas para sacar», dice. «Tenemos una mata de lechoza. Hemos tenido tomates en algunas épocas, pero el tomate es muy delicado. Él da su carga y después eventualmente se muere y volvemos a sembrar».

A Daniela le encantaba sembrar. Salía todos los fines de semana al jardín y uno de sus juegos favoritos era regar las caraotas sobre la cama de su mamá para seleccionar cuáles iba a sembrar y cuáles no. «Incluso cuando no podía caminar, la sacábamos en el coche, y ella regaba cualquier semilla», recuerda Susana.

Daniela sembró una mata de parchita que hoy en día les da parchitas a todos los habitantes del edificio, que cada mañana bajan a recoger las que cayeron, para hacer jugo. La niña también tiraba en la tierra semillas de auyama y melón, que todavía no han dado frutos. Pero las caraotas que sembró antes de su última hospitalización ya florecieron.

Susana Álvarez, madre de Daniela, que falleció el 4 de julio de 2016 en el JM de Los Ríos. En el huerto en el jardín de la planta baja de su edificio en Cariacuao, Susana siembra matas de lechoza, parchita, tomate, caraotas, espinacas y zanahorias, junto a la casita de juguete donde Daniela solía jugar con su papá. Fotografía de Gabriel Méndez.

En el huerto, entre las orquídeas, las matas de navidad que crecen hasta el primer piso del edificio, y un cactus que dos veces al año da un grupo de siete u ocho flores blancas que solo viven durante una noche, Daniela fue feliz. Su mamá la recuerda siempre risueña, siempre cantando, tratando de bailar inclusive cuando le costaba trabajo caminar.

«Siempre tratamos de que Daniela no se deprimiera», dice Susana, «de que tuviera una vida de niña lo más normal posible. Y creo que todas las mamás que estamos en el hospital hacemos eso. Todas intentamos que, a pesar de lo dura que sea la situación, a pesar de lo difícil que la estemos pasando, ellos sigan siendo niños. Creo que todas nos esforzamos por eso. Porque su vida sea lo más parecida a la vida normal de un niño».

Edimar, la mamá de José Galíndez, guarda un secreto a voces: la normalidad es su mayor objeto de deseo. Una fantasía que siente ajena, casi prohibida. Para no dejarla ir, puede implantarla en la vida de los otros, como un anhelo. Puede decirme, con un rastro de burla amarga en la voz:

– ¿Qué te parece el horror? ¿La vida patética de cada una de nosotras? Me imagino que tú llegas a tu casa y te desintoxicas, ¿no? Agarras y pones una canción bien bonita y piensas: voy a olvidarme de toda esta locura…

Un instante de meditación fugaz. De silencio. – ¿Olvidarme?

http://prodavinci.com/2017/05/04/actualidad/el-hospital-de-los-ninos-por-flaviana-sandoval-y-gabriel-mendez/

– Flaviana Sandoval – 14-6-2017

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  202. Having a getaway can be quite a fun encounter, so long as you are ready for it properly. In this article, you will certainly be provided with important ideas to aid ensure that your getaway is satisfying. Start using these ideas the very next time that you might be vacationing. When you are traveling around the world with limited funds, look at consuming flights rather than trains for your spots. While trains are perhaps the better standard function of travel for backpackers, a lot of airlines offer low cost routes which can be much cheaper than train tickets. By doing this, you may visit much more spots with out contributing to your finances. For any getaway, experienced travellers will package some outfits they may thoroughly clean their selves with bare minimum work. In addition effortlessly-cleanable outfits lessen the total amount of apparel a traveler has got to take alongside, they could offer a secure protection web in case of unexpected delays. Clothes that may be rinsed and dried out in a resort drain can be a godsend on an unpredicted layover. In the event you journey a great deal for operate, the ceaseless modify of venue and planes may be strenuous. Turn it into a bit much easier on yourself by usually asking for a similar seating when you book your flight («9A, please, or correct within the wing.») Basically, on the wing is an excellent area for the reason that airplane tends to be most solidly anchored and less vulnerable to shake. Like that, you will really feel as if you’re being placed in «your» seat on the same airplane back and forth, and you’ll also be comfortable with employed in that particular position (window in your remaining, and so forth.) Possessing earplugs useful while on a trip can save your rest and sanity! Be it in the aeroplane or even in your accommodation, the use of earplugs will enable you to shut out a minimum of fifty percent of the disturbances that will give you a head ache, stop you from getting to sleep, or else emphasize traveling inside a bad way. Also, they are inexpensive so take lots. If you’re going on a vacation cruise, load a highlighter in your suitcases! There are lots of activities which are on through the cruise and quite often you’ll obtain a good very little e-newsletter that particulars what’s occurring and where. You can utilize your highlighter to label those for you to do, and save yourself some severe headaches. If you’re vacationing in a hotel and you like coffee, don’t utilize the plain tap water making it. Instead, acquire some ice-cubes through the ice unit and placed it inside the coffeemaker the evening just before to dissolve. The ice devices use filtered normal water so you’ll get better flavored espresso! When traveling exceeding 1 kid, consider pre-packaging each and every child’s clothes right into a sizeable fridge case. These hand bags could be tagged with every working day, hence the children can simply discover the clothing they’re likely to put on. This helps prevent them from needing to unpack the entire travel suitcase every morning, plus reduces the risk of products being overlooked in the home. Now that you’ve obtained a number of the fundamentals on travelling, tell your employer you are taking a vacation, get your plane solution, fishing boat admission or whatever signifies you intend on using and go! Always be safe whether or not touring on your own or otherwise. Require directions and help if you want it. Most people will not likely mouthful. Above all, Since It was explained at the beginning with this article, the easiest way for the holiday to visit effortlessly is that you can be equipped for it. Take advantage of the suggest that this article has given to you to make sure that your getaway goes effortlessly. Remember to have fun although away!

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  204. Occasionally, the drive traveling occurs when you notice an alluring snapshot inside a newspaper, or keep in mind an before getaway you had taken. As soon as it comes up, you begin to think about the possibilities: a warm, bright and sunny devote the to the south even though the cool winter winds are coming, possibly. Then it is time and energy to get started producing plans. This article contains some good tips to help you out on your following travel excursion. Only package the clothes you need. Sometimes, it does not pay out to become above-equipped. Many people package far too many garments after they vacation. This really is a dilemma. It can be specifically a challenge when they inadvertently lose the totes that contained them. Consider packing versatile outfits you could re-dress in. Safeguard your fluids from spilling when you journey with a selfmade jar stopper. Just before screwing the limit on your traveling-measured toiletries, deal with the best by using a little component of plastic material pulled from a plastic-type buying travelling bag. This will each safeguard your outfits from the liquid and maintain the liquid within its container. To bring everything that you need on your vacation, you should have reputable suitcases. When your baggage is aged or cannot consist of everything that you need, you need to go purchase new travel luggage. Tend not to wait to get expensive suitcases. The product quality assures that your particular items will be shielded and good travel luggage must last you for years. Try using bubble cover when packaging. You will discover a good reason points get sent by mail in bubble cover. It maintains vulnerable things safe. If you journey, your travel luggage passes through an operation nearly the same as simply being delivered through the postal support. Bubble wrap isn’t challenging to locate and is a superb choice when packing breakable possessions. Okay, not all trip is perfect for exciting and sport, and not every the ideas that are pointed out on this page will affect your ideas. Even so, if you make a note to try out several of the previously mentioned tips, you will be on the right path to owning more pleasant vacationing experience, regardless of whether your trip is designed for business, household or pleasure.

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  208. Discretion travel is an excellent experience which everybody must have within their life. Even business traveling can be done pleasurable. There are some facets of vacation that will detract through your enjoyment. After the guidance on this page may possibly assist you in getting most from any vacation that you may require or want to take. Use the ATM to have paying cash in your local currency. Banking institutions generally get access to excellent swap rates. This could preserve a large amount of money for you more than some time. When considering vacationing, it is important to think about best method of journey. Touring by automobile can provide a lot more sights and possibilities for part trips. Touring by train can offer an opportunity to unwind and obtain some operate done once they desired. Aircraft can include floor fast but don’t permit a lot movements and one are unable to get off the aircraft in flight. Every single method of vacation has it’s individual positives and negatives that need considering. When visiting with a street trip, make sure you bring a handbag along with you for trash can. Even those who don’t normally take in in a car will in the course of lengthy road trips, specifically if you don’t want to stop to eat and increase the a chance to your trip. A garbage travelling bag may help you keep your clutter and clutter as low as possible. To plan the very best vacation probable, choose your lodgings properly ahead of time. Make price reviews for many of your respective preferred type of lodgings and price range sufficient money to purchase your chosen. Then in case your initially option is not available, you’ll have at least two options from which to choose. Should you not look after your system your skin will never ever look its greatest. A balanced diet with plenty of healthy food items will enable you to feel great and look great. You need to consume plenty of fruits, greens, grain and lean necessary protein. Consume great to help you feel good. Using this array of ideas in your strategy, vacationing might be a wind, not just a discomfort. These are generally basic concepts, but basic operates is surely an extremely successful protective. Basic perception is all that you should keep a vacation experience optimistic and exciting, regardless if you’re venturing way off the outdone path.

  209. Travelling can be strange at times. From time to time, journey can be a basic basic need, when at in other cases, it a form of recreational and entertainment. Then, needless to say, often times it is actually each. Getting guidance on traveling, despite your basis for doing it, helps. This article will explain to you some valuable hints to make sure you expertise vacationing is as great as it could often be. When staying at a hotel that provides an electronic digital alarm system time clock, check out both time and the alarm system when you first get there. It is a frequent prank to pre-set the alarm system to very early instances, or perhaps to fiddle using the time displayed on the time. Late at night when you visit your bed, you might not realize your time clock is half an hour speedy or sluggish. Prior to making on a trip, it is vital to be sure that all of your documents is up to particular date. Including identification such as your driver’s certification and passport, any needed immunization or health-related records, and credit rating or financial institution credit cards. In this way you will not come upon any troubles when you make buys or on your moves relating to non-corresponding ID. Keep a picture log of your dearest jammed dog When you are traveling with kids, are actually excellent memories plus an awesome souvenir if you take images of your own child along with the filled wildlife doing enjoyable stuff through the entire trip. In your house, you are able to acquire each of the photographs and then make them right into a image venture publication to remember your journey. If you’re far out and about and find that you’ve left your telephone battery charger at home, contact the top workplace of your hotel and explain the situation. Most lodges save the abandoned or neglected chargers which can be still left in hotel rooms in case your phone is a fairly popular version, it could help save from having to pay 50 money for a battery charger that you just use only for a couple of time. Should you not deal with your whole body your skin layer will never appearance its finest. A healthy diet plan with lots of nutritious foods will allow you to feel good and look fantastic. You ought to consume a lot of fresh fruits, veggies, whole grains and lean proteins. Eat very good so you can feel good. As you have seen, there are numerous of methods to minimize the stress of planning your vacation and simplifying the logistics. Take advantage of any or many of these ideas when organizing your upcoming holiday. As an alternative to simply being anxious, you will have the time and energy to really appreciate your trip.

  210. One of the greatest sport routines is travel. The cabability to check out the globe and discover new sights has turned into a desire for countless individuals throughout the world. This information is intended to present you travel tips to assist you to chose the correct spot and get the most from your practical experience. When you are traveling, you can stay away from hassle and lower journey potential risks by blending in. Don’t use expensive precious jewelry or spot-specific designer brand names that symbol you as a traveler. Instead, attempt to outfit like the residents do, and don’t highlight oneself. Nearby-owned organizations and accommodations are a lot less likely to be a target for terrorists and pickpockets equally. When traveling, generally be prepared to have issues stolen. Make move forward photocopies of all of your significant paperwork. You may also publish digital tests of such papers for easy accessibility while traveling. The local United states embassy can assist you in getting in touch with these at home who can wire you urgent money or assistance in replacing your passport, however, not a lot in addition. Set a spending budget for the travel expedition prior to your departure. It is so simple to overspend when you are in the center of a vacation higher so you aren’t taking into consideration the realities or outcomes of the money you happen to be paying. Figuring out a spending budget ahead of time and sticking with it is going to make sure that you is able to afford to consider future getaways. When having a air travel, you must not think that your flight can offer every little thing that you desire, no matter the length of the airline flight. As a consequence of cutbacks, several airlines will not supply bedroom pillows, covers or headphones, so provide your personal in the event you make use of them. You must also want to provide a couple of air travel approved treats coupled in case the air travel foods are a flop. Traveling doesn’t really need to be expensive when you build a spending budget before leaving. Whether you wish to do a cross-land road trip or check out a European country, traveling may be entertaining and academic. Remember the suggestions in this post to keep risk-free and get the most from your hard earned dollars once you travel.

  211. Many people tend not to take advantage of possessing the chance to traveling because there are so many specifics to think about. Discovering the most effective methods to touring is going to help you in starting the numerous doors that happen to be given to you, from traveling to so many fantastic areas around the globe. To essentially get yourself a sense of your location travelling, follow the local people. Many best holiday destinations begin to feel totally general and touristy. By wondering about and getting exactly where those who reside there spend time, you will get an even more authentic feel for the area, so when an added bonus, avoid the selling price markups that cause problems for vacationer very hot areas. Go on a great book along with you to read through when traveling. Should you usually have one thing interesting to do, you may be less likely to get disappointed or bored to tears throughout layovers and other time delays that happen to be outside your handle. Invest in a new label which you have been planning to study so that you have one thing to enjoy. When you have intends to traveling, the most important planning for you to do is make a check-list of all you need from toiletries to extra content articles of clothing. Before you leave, ensure that every one of these products are loaded as most likely when you forget about something, the present retailers accessible to you will overcharge for easy things such as tooth paste or shampoo. Whenever you journey, will not overpack. The much less things you bring, the unlikely you will be to forget about one thing. Consider just a few boots, since they put pointless bodyweight to your luggage. Hopefully, these tips have presented you some thing of value – or at least – something helpful to mull around. Above all else, it is very important keep risk-free while traveling. In addition to that, try and just press the strain away and have fun. Take pleasure in!

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  220. Touring can be something most of us do every now and then. It is often required for equally company and pleasure. Producing travelling less difficult is really a aim that many of us have. In this post we shall go over a few tips for producing your upcoming journey expertise a simpler a single. Load up lightly when traveling. Individuals always usually load up a lot more than is important, and find yourself using only about 50 of the items they consider. Go with a handful of items that one could wear several times, and try to synchronize every little thing. When you forget to pack a particular object, you will probably find something correct at your vacation spot. When you are traveling to a new area, attempt your best to appear just like you belong there: In no way permit any individual see that you are currently misplaced. Examining your chart during the sidewalk is actually a certain-fireplace free gift, as is asking for instructions. Bear in mind, new arrivals are perfect concentrates on for pickpockets and muggers. Seek out discount rates for your travel preparations. Getting a vacation provides you endless places to spend less in. In from the flight, for the hire car, to a jogging trip from the metropolis, discount rates are all around. Search the internet using deals and view what offers are available to you through your bank cards and memberships. In countries that you just visit, be familiar with the ethnic look at how inquiries have been answered. In many places, specifically India and Asia, it might be regarded as extremely impolite to inform someone who you don’t know the response to their concern. Other folks could merely answer «of course» for any concern inquired in British. Take note of doubtful body terminology. With any luck , you may have now created on your own and check-list or even to-do list about touring. The advice set forth right here should last nicely in the foreseeable future as you travel may it be for enterprise or perhaps for satisfaction. Having a trip must be exciting and fun and now it might be with this information and facts.

  221. By using our information, these days you will learn many excellent secrets to using a productive vacation. Apply the details to the planned destination to enjoy developing a unique practical experience. These guidelines will help you conserve time and money with little to no just work at all. Only load up the clothes you will require. Occasionally, it will not pay out to become around-ready. A lot of people load up too many clothing after they journey. This is a issue. It is especially a challenge when they unintentionally lose the totes that contained them. Consider packaging multi-purpose garments that one could re-use. Check out federal holiday seasons. Before you routine your international traveling, verify a schedule to ascertain if you will find any holidays throughout your stay in another country and what it means in terms of business and diner closings. It may well have an impact on what is open up or offered to do. You will probably find you might have a great deal or possibilities or, it can be every day of sleep to the local people – that means a day squandered for you personally – so you have nothing to do. When traveling, don’t forget about that you can vacation by coach to numerous places in Northern and Latin America. It might be significantly less pricey than traveling by air and it is normally lower-anxiety for your tourists. Touring by shuttle has misplaced much of its preconception recently, with a lot of firms purchasing new vehicles and in many cases using the services of guards to ride together. Understanding what to take with you on a journey might be hard and you could frequently forget significant things. Put one hour besides, to sit down a couple of days just before your vacation and compile a long list of points you need to take with you. Produce a second list of issues that you might will need, but you are ok without the need of if you have only only a little space. Creating listings, helps to ensure that you won’t overlook crucial things. Travel could be a gray-your hair inducing celebration or else undertaken with some provision. It could also be a good fun and fulfilling expertise. In case you are affected person and organized you can most certainly have the getaway of your life. This information has hopefully presented some insight regarding being structured and affected individual.

  222. Vacationing could be unusual at times. From time to time, traveling can be a basic necessity, when at other times, it a type of recreational and sport. Then, needless to say, occasionally it really is the two. Getting information on touring, no matter your cause of doing it, is useful. This information will reveal to you some helpful suggestions to make sure you experience vacationing is just like it might come to be. When picking a spot to travel to, there is no far better source of information than the usual fellow traveler. Other tourists with a similar needs and strategies, can tell you what spots are should-recognizes and what locations you should try to avoid. No guide book can replace the initial-hands experience of somebody else or family members. Pack an additional travelling bag for messy garments. Nobody wants to pack their dirty unmentionables in with all of their great things. Load a compact, collapsible case to bring along messy clothing in for the return trip. Alternatively, provide a rubbish bag. You can wrap unclean outfits within the trash travelling bag to keep them separate from everything else. Should you don’t desire to be around youngsters when you find yourself on a break new choices are being available for you! Cruise lines are significantly giving «men and women-only» cruise trips, that offer tired mother and father and childless lovers the ability to vacation without having the children. These travels are getting to be well-liked for cruise lines and so are anticipated to be seen more often in other places at the same time. When you are traveling in remote regions by auto there may not be a efficiency cease at every mile marker. While you are going with young children, specifically, this can be very problematic. Get together a page so that you can drape it on the available doorways of your own vehicle to present them some semblance of privacy if you want to make that unexpected emergency pit cease on the side of the path. By no means place your house address on your travel luggage. When submitting the data greeting card on your own travel luggage, make use of organization tackle alternatively. If you do not possess a business address, let it rest empty. If you happen to abandon your suitcases somewhere, only give your contact info on the motel or flight personnel. Vacations needs to be exciting, not another way to obtain tenderness. The tips in this article will help you get through the irritating areas of touring, and appreciate every one of the finest elements of it alternatively. No person ought to have to invest their trip worrying. Get pleasure from your holiday, and have a good time!

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  229. Travelling could be a unique and gratifying experience for yourself if you take good thing about it. Learning to strategy travels is not that tough, however it does require some research so that you don’t end up receiving dropped or dropping cash on some thing you don’t require. This list of suggestions need to make you a more intelligent tourist. If vacationing by oxygen, it is essential to think before hand. Normally it takes considerable time to achieve an air-port that can be found in an important city, because of spot and visitors. Do all of your current loading your day prior to. Purchase entirely good to go the night time prior to your journey. One of many most detrimental approaches to start up a vacation is usually to miss your flight. When you are traveling to your peculiar area, generally be aware of your surroundings. Both, really active and extremely peaceful streets, can have added threat. Visitors who are busy gawking on the scenery may change to find their finances gone. Constantly determine who seems to be around you and take notice, if you think like an individual could be adhering to you. Should your cellular phone will never deal with great distance from the place you would like to journey to, it could be an intelligent idea to get a telephone cards just before departing. A telephone cards will make telephone calls significantly less expensive and make sure that you don’t inadvertently make any high-priced long distance calls. Deliver a vacant h2o package. Everyone knows that getting a whole bottle of water by means of safety is a big no-no. Should you don’t desire to be stuck paying a premium for bottled beverages soon after protection, take along your personal unfilled bottle to fill up at the water water fountain. In case the regular faucet water is below fascinating to you, take a single serve packet of consume mixture to include in the package. Unless you take care of your body your epidermis will in no way appearance its finest. A balanced diet regime with plenty of healthy foods will assist you to feel good and appear wonderful. You should try to eat a lot of many fruits, vegetables, whole grain products and low fat necessary protein. Consume excellent so that you can feel good. With this assortment of recommendations in your collection, touring will certainly be a breeze, not a discomfort. These are typically simple suggestions, but easy works is definitely an extremely powerful precautionary. Easy feeling is all you need to have a travel practical experience positive and enjoyable, regardless if you’re going way off of the defeated keep track of.

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  236. We constantly carry vacationing as an excellent chance to go to new spots and to make new friends. And though it may be interesting and fulfilling, it could also be incredibly stress filled if you’re not properly planned for it. Check out this report and browse high on some vacation details that you need to really know about. If you’re going with kids, it’s tempting to allow them track by helping cover their their particular mp3 gamers, but consider taking alongside some guides on Compact disk. Possessing anything literate and interesting for the family to hear is not merely enjoyable and interesting, but provides a common expertise that each loved one may take forwards with them into existence («Hey there, bear in mind once i was 15, and we listened to Black color Elegance on the right way to Maine?»). It’s the things which fond thoughts are created. When traveling by air, always have a package water helpful. Consuming lots of fluids will make sure that your system remains hydrated throughout the airline flight. The atmosphere in the cabin is quite free of moisture, enjoying chaos together with your body. Don’t replacement alcohol or caffeinated drinks for drinking water, as this will make lack of fluids worse. To protect yourself from any difficult confrontations, perform a little research when you are visiting an overseas land. Including looking up normal key phrases such as «thanks,» «how much» and «how have you been.» You need to browse around for regular customs of the country, such as motions, to enable you to prevent offending a person with expressions or system words that appear typical for you. Whenever you journey to a foreign region, keep important information and facts together with you. Include the brand and make contact with details of where by you will end up keeping yourself in addition to that of your embassy or consulate in the united states you happen to be traveling to. Should you experience trouble or troubles abroad, this can be the first point of get in touch with. They’ll assist you should you come upon any problems. If you’re having a cruise, load a highlighter within your baggage! There are lots of routines which are on throughout the cruise trip and more often than not you’ll obtain a wonderful tiny newsletter that information what’s going on and in which. You can use your highlighter to tag those you should do, and stay away from some headaches. If you’re remaining in a motel and also you like caffeine, don’t make use of the faucet water to make it. Instead, acquire some ice from the ice cubes machine and set it inside the coffee brewer the evening well before to melt. The an ice pack models use filtered drinking water so you’ll improve sampling espresso! When you are traveling using more than one particular little one, take into account pre-loading every child’s clothing in to a big freezer travelling bag. These totes may be tagged with each working day, therefore the youngsters can readily discover the clothing they’re going to wear. This prevents them from being forced to unpack the entire luggage each morning, as well as reduces the possibility of items getting overlooked in your house. Seeing that you’ve acquired a number of the basics on vacationing, educate your manager you take a holiday, buy your aircraft solution, vessel admission or no matter what means you intend on consuming and go! Always be safe whether or not vacationing by yourself or not. Demand instructions and assist if you need it. Most people will never mouthful. First and foremost, You are going on vacation to have exciting, but having a good time should never mean permitting your safeguard down. While we have reviewed on this page, staying harmless should be your priority when you are traveling. Trying to keep several simple security suggestions convenient can provide assurance, and make your vacation more pleasant too.

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  242. We usually maintain vacationing as this great ability to check out new spots as well as make new friends. And even though it is exciting and gratifying, it is also unbelievably demanding if you’re not properly organized for it. Look at this report and study up on some traveling information and facts that you need to truly know about. When you journey, it’s vital that you cease for the cheddar cheese along with the large-time monuments. What which means could this be: Check out Mt. Rushmore, sure. However, you must end with the Jolly Green Large Statue in Minnesota and have your picture used. You should actually go view the Corn Palace in Mitchell, SD, and Wall surface Medicine. These areas are kitschy, and that’s the reason why they’re vital. America is the two a place of fantastic attractiveness and excellent silliness, and both needs to be celebrated from the visitor. Creating a buddy of the concierge can certainly make your stay at any resort a significantly safer and wiser expertise. This person needs to be greeted and tipped like your life is dependent upon it. The concierge has a wealth of facts about where you can eat, play, relax, store, and can also get you of any combine you could find your self in when not even close to residence. The greater you intend, the less expensive the airline flight ought to be for yourself. Try to strategy your travels beforehand and finances how much cash you would like to pay for journeys and motel, in addition to, how much you would like to invest in leisure time activities. Preparing your vacation ahead of time, really helps to handle your hard earned dollars appropriately and guarantees you will have a better time. When traveling internationally, you should know what forms of insurance coverage credit card banks provide you. You might be currently included for cancelled air travel which get billed to the credit card. You should do your research just before making. If you’re taking a vacation cruise, load a highlighter with your baggage! There are lots of activities who go on throughout the vacation cruise and usually you’ll get yourself a good very little e-zine that information what’s occurring and where. You should use your highlighter to symbol which of them for you to do, and save yourself some head aches. If you’re remaining in a motel so you like coffee, don’t take advantage of the tap water so it will be. Rather, get some ice cubes from the ice-cubes machine and placed it inside the coffee brewer the evening before to melt. The ice cubes equipment use filtered h2o so you’ll get better sampling caffeine! When traveling using more than 1 kid, think about pre-preparing every child’s apparel in a sizeable freezer handbag. These luggage might be branded with each time, hence the little ones can simply get the apparel they’re gonna dress in. This stops them from needing to unpack the full travel suitcase in the morning, and in addition reduces the chance of things simply being neglected at home. Now that you’ve obtained some of the basic principles on vacationing, tell your boss you are taking a holiday, buy your aircraft admission, fishing boat ticket or whichever indicates you intend on getting and go! Remember to always be secure whether or not vacationing on your own or not. Demand directions and aid if you require it. Many people will not bite. Above all, Soaring can be a well-liked, yet somewhat challenging way to traveling. It is often the quickest and easiest strategy to attain a spot. It is also usually the most puzzling and stress filled way to journey. When we have discussed nevertheless, your upcoming flight doesn’t must be a «hard» process. Examining the guidelines we now have provided will help to make your up coming air travel simpler, and more satisfying, too.

  243. Traveling can be a significant trouble if you are unprepared or haven’t shopped around for the best deal. You could potentially turn out paying out out of the nasal area for the flight seat tickets when you can have become them for half the cost. This post will present you with some travelling pointers. Once you vacation, it’s essential to quit to the cheeses plus the major-time monuments. What that means could this be: Head to Mt. Rushmore, sure. However, you need to cease in the Jolly Eco-friendly Giant Sculpture in Minnesota and obtain your picture used. You should really go begin to see the Corn Palace in Mitchell, SD, and Wall Medicine. These places are kitschy, and that’s the key reason why they’re crucial. The usa is equally a spot of great elegance and wonderful silliness, and each needs to be celebrated by the traveler. When you know that you will have got a lengthy layover in a town, check what there may be to accomplish beforehand. A 3 hour or so layover in Washington D.C. can easily turn into a speedy excursion in the Washington Shopping mall or a long stay in Minneapolis could become a fast purchasing visit to the Shopping mall of United states! Prior to traveling, be sure to check the estimated weather conditions for the spot. You don’t wish to be saddled with outright winter clothing throughout a warmth influx or only shorts and reservoir-shirts in a blizzard. Getting new clothes during holiday may well not only be expensive, but you possibly will not have space inside your travel luggage to consider almost everything home along! Acquire clothespins alongside the next time you traveling. While not on the normal journey checklist, a few clothespins can confirm very beneficial. If you’re going on a vacation cruise, load a highlighter in your baggage! There are tons of pursuits who go on through the cruise and more often than not you’ll have a wonderful tiny newsletter that details what’s occurring and where. You can use your highlighter to label those you wish to do, and save yourself some migraines. If you’re remaining in a motel and also you like coffee, don’t utilize the tap water to make it. Instead, find some good ice-cubes from the ice unit and placed it from the coffee brewer the night just before to burn. The ice-cubes equipment use filtered normal water so you’ll get better tasting gourmet coffee! When traveling with over one child, consider pre-packaging each and every child’s clothes right into a huge fridge handbag. These hand bags could be labeled with each day time, and so the little ones can easily find the clothing they’re going to use. This prevents them from being forced to unpack the complete luggage each morning, and also reduces the possibility of items simply being forgotten in the home. Seeing that you’ve got a number of the essentials on traveling, inform your boss you are taking a getaway, obtain your aeroplane solution, fishing boat admission or whichever means you plan on taking and go! Remember to always be safe whether touring by itself or otherwise. Request guidelines and help if you need it. A lot of people will not likely bite. Above all, You are going on a break to possess enjoyable, but having a good time must not mean allowing your shield straight down. Since we have reviewed in the following paragraphs, remaining safe should always be your main concern when you are traveling. Trying to keep a couple of basic protection suggestions useful can provide reassurance, and then make your journey more pleasurable as well.

  244. You could be within the place of having to worry concerning how to map out the next journey properly. It could look like an inconvenience, nevertheless it shouldn’t be. The following tips can help you prepare for your forthcoming getaway in the most efficient way possible. Leave any useful items you don’t need to have at home when traveling. Belongings attract consideration and improve your chance of becoming a sufferer of robbery. When traveling to your strange town, constantly know about your surroundings. Equally, extremely active and really peaceful roadways, can have extra chance. Travelers who definitely are active gawking in the points of interest may possibly turn around to locate their budget removed. Constantly check to see who is near you and take notice, if you feel like an individual could be adhering to you. If you are planning to travel looking for outfits while abroad, analysis that area’s measuring method. Garment dimensions fluctuate tremendously from nation to nation. They also vary tremendously from company to company. Nevertheless, a simple expertise in their outfits measurements can help you enter the ballpark so far as locating a sizing that matches you goes. Deliver an empty h2o container. We all know that delivering a full jar water by way of stability is an important no-no. When you don’t wish to be stuck paying out a premium for bottled liquids after security, bring along your own personal vacant jar to complete with a water water fountain. In case the plain tap water is less than attractive to you, take an individual assist package of drink mix to include in the package. If you do not care for your system your skin will never ever appearance its best. A balanced diet regime with lots of nutritious foods will allow you to feel happy and check fantastic. You must consume plenty of fresh fruits, greens, whole grain products and lean protein. Consume great to help you feel happy. As was reviewed at first in the article, knowing the ins and outs of exactly how the air carrier business operates can save you a ton of money when booking journeys. Implement the recommendation from this article and you’ll be on your way to preserving a lot of cash with less costly flight tickets.

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  247. Sometimes, the need to travel arises once you see an attractive photo inside a magazine, or remember an previously getaway you got. When it occurs, you begin to think about the possibilities: a comfortable, bright and sunny spot in the south even though the cold winter months wind are coming, perhaps. Then it is time and energy to begin making agreements. This short article features some very nice guidelines to help you out on your following vacation excursion. To spend less when reserving flight flights, look at the circular-trip costs — even when you simply want to take flight one method to a spot. As a result of unique air travel insurance policies, occasionally it’s less expensive to get a circular escape to your required locale rather than take flight one of many ways. No less than if this occurs, you save cash by buying the round-vacation passes anyway and merely not use the give back flight rear. Find out about national getaways. Before you decide to timetable your international traveling, check out a work schedule to see if you can find any vacations during your continue to be in foreign countries and what which means in terms of company and restaurant closings. It may affect precisely what is available or accessible to do. You could find you might have a great deal or choices or, it can be every day of relaxation for that locals – which means each day misused for you personally – bringing you nothing to do. By going on the net you can accessibility a great deal of info in relation to where the initial one is vacationing and about the region one is moving. Researching community destinations can help one particular map out their vacation prior to it even commences. Using a prepare into position and knowledge in the area can lead to a much more pleasant encounter. Use bubble place when loading. There exists a good reason points get sent by mail in bubble cover. It keeps breakable physical objects very safe. Whenever you traveling, your travel luggage goes through an operation very similar to becoming delivered using the postal services. Bubble cover isn’t difficult to locate and is an excellent choice when preparing breakable valuables. Like everything else, the industry of touring is vast and it has a whole lot information accessible. Sometimes, it merely requires just a little hint regarding how to start by using it so that you can begin your own personal expertise. With a little luck, you received that through the earlier mentioned ideas.

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  258. For most vacationing is really a delight, but preparing the journey is overwhelming and stress filled. It could be annoying and monotonous to make sure things are buy for any getaway. Check this out article to learn how to prepare a getaway and revel in it. If you get to a new hotel, permit the boiling water run within the shower for a little while. Even nicest of accommodations may be somewhat filthy. Permitting the water manage can help get rid of spores how the normal cleaning up might have skipped. You aren’t spending money on the liquid monthly bill in the room anyways. When you are traveling, it is important to ensure your air travel will meet your requirements. Different airlines maintain diverse niches. Some are low-cost, some provide exceptional assistance, plus some focus on much more places than the others. Before you decide to reserve any trip by aircraft, study various airlines very first. It will save you a headache. When preparing, ensure you break up your valuable items. In case you are packaging several bags to get a journey, spread your higher priced items out between the two. Generally stay away from adding all of your belongings in just one bag just in case this bag is misplaced or stolen. Shedding just one single bag remains to be dreadful but may well not damage your vacation. Browse the fine print on all traveling purchases you will be making. This means you will always get dealt with pretty. By way of example, often airlines try and let you know they could not make positive changes to airline flight, however contract often claims that they may. Firms make an effort to cover this information on your part since they want even more of your money. Be a ready buyer so that businesses will not be able to take advantage of you. Make the luggage easy to place. Spot large vibrant stickers and pictures all over your baggage, to ensure that if you area it coming through, you already know for sure it is your own property. This assists to not only get your case, but in addition to eradicate the distress which comes when you unintentionally seize one which isn’t your own property. When you read through previous, travelling is more enjoyable than about to vacation. You have learned how to very easily plan your next vacation, and you could now increase the odds that your vacation is going to be successful. Keep this advice in mind to ensure that your trip will stay on track.

  259. Many individuals will not take advantage of getting the opportunity to journey simply because there are numerous particulars to consider. Discovering the best ways to travelling will help you in opening up the countless doorways that happen to be made available to you, from going to a lot of great spots worldwide. Have you thought about travelling overseas? You should carry onto your touring strategies for some time and head to a greater distance and faraway lands. As opposed to using two journeys each year you can manage continue on one journey to get a season. Just be sure you keep an eye out for deals because you might get a really good offer on resort and trip passes. If you are planning a getaway in another country, it is essential to be sure to get the necessary vaccinations beforehand. When you are in the preparation stages of your journey, make a note of any shots which can be necessary or suggested. Failing to do so could leave you wide open for harmful exotic ailments that could wreck your holiday, or more serious, wreck your health. Even if you are going for a long airline flight, provide your very own comfort materials and don’t count on air travel workers to supply them. Bring anything you have to stay entertained and comfortable. Don’t overlook to bring along a few snacks to make sure you possess some foods that you just take pleasure in during the air travel. When you travel, tend not to overpack. The a lot fewer things you take, the unlikely you might be to neglect some thing. Consider only some shoes, while they add pointless bodyweight in your bags. Since you’ve finished reading this article, hopefully that you simply now comprehend some of the finer points of traveling. Ideally, you may soak up this information and employ it intelligently, to be able to depart your worries powering and get the exhilaration you seek, in your following vacation to many unique location.

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  268. A holiday can ease the soul by leaving you restored, rejuvenated, and invigorated. Regardless if you are just now starting to prepare your next getaway, or are only searching for travel ideas and recommendations, it really is our believe that this short article will be of help to you when you program your next vacation! Whenever you get to a new hotel, enable the boiling water work within the bath for any short while. Even best of accommodations may be considerably filthy. Permitting the hot h2o manage can help eliminate spores that the standard cleaning up could have neglected. You aren’t purchasing water costs within the room anyhow. Before choosing a traveling guidebook, search online. A great deal of the info offered in costly guidebooks is also online. You can print out this data and take it along, saving both funds and excess weight in your baggage. This process also permits you to choose which components of info are crucial for yourself, and merely carry these. Vacationing with a team? Work to undermine on where you can eat and where to go. If you decide to be selfish, the other group will resent you for leading to them to get a terrible time. By diminishing, everybody is satisfied at some time and you are required to try to expertise new things. If you’ve actually traveled with children you’ve undoubtedly been inquired far too many instances how much more it is. One way of resolving this is to buy each of the young children a roadmap and instruct them how to study it. They’ll be occupied, and you’ll be training them a expertise that they can use most of their day-to-day lives! When you are traveling to a new city, attempt your greatest to search as if you should be there: By no means allow anybody see you are misplaced. Looking at your road map in the center of the sidewalk can be a sure-blaze free gift, as is also asking for directions. Bear in mind, new arrivals are great focuses on for pickpockets and muggers. If you’re staying in a accommodation and you like gourmet coffee, don’t make use of the faucet water so it will be. As an alternative, get some good ice through the ice-cubes device and place it from the coffee brewer the night time before to dissolve. The ice-cubes models use filtered drinking water so you’ll get better sampling gourmet coffee! When traveling with more than a single child, take into account pre-packing each child’s garments into a sizeable freezer bag. These totes could be branded with every day, and so the children can simply discover the apparel they’re going to dress in. This stops them from needing to unpack the entire luggage every morning, plus decreases the chance of goods becoming forgotten in your own home. Seeing that you’ve obtained a number of the basics on traveling, educate your boss you take a getaway, buy your plane admission, boat solution or whichever implies you plan on taking and go! Remember to always be safe no matter if vacationing on your own or not. Request recommendations and help if you need it. Many people will not likely bite. Above all, As was reported at the start of this article, befriending locals is a great idea when going to a overseas country. Natives can take you places that you might not or else see just sticking to tours. Apply the recommendation from this report the very next time you travel, and you will make sure you enjoy an exclusive as well as other experience out of your standard traveling plans.

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  272. When you’re intending to abandon the security of your respective familiarized property for parts not known, the very last things you need to concern yourself with are causing yourself problems that could have been effortlessly eliminated or losing out on possibilities. Check out this selection of suggestions and turn into as journey-knowledgeable as possible. When you are traveling, if you need to work with a open public pc for anything at all, whether it’s to check on your email, your Facebook or myspace, or perhaps your bank account, be sure to log out! Don’t just near the web browser as if you may do on your own personal computer, make sure you go through the log out switch. This will likely prevent other people from using your data. It might be valuable when traveling to put together a large group of relatives and buddies traveling with. In the huge class, you might be much less vunerable to thieves concentrating on lone vacationers who appear like ‘easy pickings.’ You will additionally have the extra added bonus of expressing your vacation using the ones you happen to be close to. Make the luggage vibrant and apparent. Avoid having hand bags that are 1 matte coloration and merge with the other pieces of baggage within the international airport. Possessing unusual-searching baggage can make your case much easier to area and may deter thieves from stealing it in a active airport terminal. If you intend on flying with children, make sure you stop usually in the way there and again. Explain them in specifics where you are proceeding, and the way long it should take to visit there. Put together some activities to keep them hectic through the getaway, such as coloring books. Make your baggage simple to place. Position huge brilliant peel off stickers and photos all over your luggage, so that when you location it approaching by means of, you know for certain it is actually yours. It will help not only to locate your bag, but in addition to eradicate the humiliation that comes once you by accident seize one which isn’t your own. It is a wonderful big planet to learn. You can find locations for a myriad of tastes. Wherever you want to go, you will discover a great place just waiting around for you.

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  274. If you are considering taking a trip and merely do not know how to start, you possess appear on the right position. Adventure is exciting but to make sure your vacation plans go off without a hitch, you will probably find the recommendations and tips in this article convenient. So listen up! Should you be a woman travelling in another country, make sure that your bag is properly shut or zipped. If it is probable, use a travelling bag that is not effortlessly launched, or one which has a complicated clasp. In overseas nations, many select-pocketers focus on naive travelers which are not mindful making use of their luggage. Points can be plucked from the handbag within seconds. Protect your travelling bag to maintain your private items secure. Setting up a good friend from the concierge can certainly make your stop at any accommodation a much more secure and more intelligent experience. This individual must be greeted and tipped much like your lifestyle depends on it. The concierge has a great deal of information on where to consume, play, relax, retail outlet, and will also have you associated with a combine you can definitely find your self in when far from residence. If you are vacationing internationally, ensure that you know and obey all the nearby legal guidelines. The embassies and consulates could only enable you to so much. Should you devote a criminal offense on international garden soil, according to unfamiliar regulation, your government will be unable to override those laws and you should send on the consequence of that country’s regulations. Acquiring vacation insurance plan must be a top priority for your impending trip. Unpredicted crashes, vacation hiccups and even climate anomalies, can affect at any moment in your vacation. Guarding yourself with insurance policy can relieve most of the misery associated with these kinds of incidences and give you some assurance. Mentioned previously at first with this article, the Caribbean island destinations are a very popular travel location. Brilliant blue oceans and white-colored sandy seashores attract several travelers all throughout the year. Implement the advice from this report to help you determine which isle is the perfect suit for your upcoming traveling destination.

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  323. Regardless of whether you possess arranged a vacation away from town, from the state, or perhaps out of your nation, there is a good chance that you will gain benefit from the helpful suggestions seen in this collection of handpicked vacation ideas. From packaging your hand bags to buying souvenirs, appreciate these tips. If you intend on touring, remember to schedule dependable animal care beforehand. For those who have a small puppy, you can find dog-pleasant flights and hotels and provide him coupled. Huge canines, kitties, and wildlife with medical conditions should have a reliable pet-sitter that one could believe in. Your furry buddies will be happy! Get neighborhood food list online while you are vacationing. You will find typically a great number of eating places positioned close to accommodations. When you have an internet connection your location staying, make use of it to look them up on the web. Usually you will find choices on his or her websites. There are also directions and appropriate reviews. Provide a handbag-of-fun for the little ones. Make sure to have plenty of products to help keep your little ones interested right through the air travel. There’s practically nothing a whole lot worse than an, «Are we there however,» 10 minutes in a a few-hour or so air travel. Greeting card games, specific coloring books, and puzzles work well and, provided you can afford to pay for a single, grab a portable video clip gamer. The hours of amusement value are worth the charge. Your luggage can actually consider you lower on a trip. Carefully look at your clothing choices. There’s absolutely no reason to adopt one half of everything you own! Acquire clothes that you could quickly wash in a washroom kitchen sink, or maybe in a pail in the event the circumstance so needs. Help make your choices combine, so a number of things will be used several products in distinct permutations. Do not broadcast the place of your respective pocket. Be secretive about where you stand retaining your cash and treasured information and facts. Being aware of where it is could give pickpockets a good edge. Never ever set your finances inside your back again budget. If you are in the habit of the process crack it. Your rear budget is incredibly simple to grab from. Are you prepared to organize your after that getaway? Recall, there are more aspects to consider when you are traveling.

  324. Despite the fact that supposed to have been a relaxing and calming activity, traveling can often be needlessly nerve-racking and fraught with disaster. Your getaway can certainly find yourself a nightmare once you don’t plan properly. Make use of the suggestions on this page to offer the very best vacation experience. Select a bistro around your hotel if you are planning to keep more than over night. While many lodges have restaurants built in, these kinds of eateries will likely be unfortunate, general affairs providing very little to keep in mind. By locating a neighborhood diner inside effortless traveling length you will get access to a small amount of neighborhood shade. When choosing an flight, it’s essential to get more than simply the cost of the solution into account. Plenty of airlines charge dollars for checked luggage now, and several charge other too much hidden costs. Just before ‘shelling your hard earned money’ for what appears like a cheap solution, perform a little research. When you are traveling to inadequate countries around the world or countries rich in offense rates, maintain your valuables from eyesight. Don’t put on a digicam more than your arm or even a affordable view on the wrist should you don’t would like to draw in the attention of criminals and beggars. Carry a shoulder blades bag for most of these items as an alternative. Should you be touring upon an expanded getaway, anticipate performing washing laundry as you go. You should not make an effort to bring greater than a week’s amount of apparel along at any one time. More than that may become too bulky to simply carry from location to location undertaking laundry washing inside the drain is much easier. Check out prices directly together with your resort or air travel company to economize on your own journey. Though it is usually little, some google search web sites give a payment to their charges. To protect yourself from the charge, look into the air carrier website specifically or supply the accommodation a phone call for their costs. You will typically find that the costs are reduced whenever you reserve specifically. Seeing that you’ve armed oneself with a few information and information, you’re willing to enterprise within a calm and well informed manner. Continue to be warn, and simultaneously make sure you experience the knowledge of meeting new people and embracing new cultures. Attempt these guidelines and you will rest assured and relish the journey.

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  327. Just about everyone likes touring, but most do not get delight in get yourself ready for the getaway. Preparing all of the myriad information connected with a trip could be both confusing and mind-boggling. Please read on for several tips about planning a vacation you may enjoy. In order to avoid trauma or illness from wrecking your vacation, make certain your health insurance coverage applies when you are away from home – specially if you are intending a trip in another country. If you find out that you will be not included, don’t be concerned. Consult with your local travel agent or on the web for getaway insurance plan. Use a lot of plastic when packing. Placing your clothes, toiletries, as well as other items in clear plastic luggage is definitely a wise method to load up when traveling. Not only does it allow you to coordinate, furthermore, it will keep your possessions secure. If the case needs to be open to the weather around the tarmac, the valuables in your bag will stay dried out. When traveling to warm regions, remember to keep your messy laundry in the shut bag. Hotels and properties in warm elements around the world aren’t as bug-resistant since many American citizen residences. Filthy washing will draw in pesky insects, especially ants, meaning that garments which was just unclean, is currently entirely unwearable for the rest of the trip. Have a picture record of any dearest filled animal When traveling with youngsters, are excellent remembrances along with an awesome memento by using pictures of your own child and also the packed animal carrying out enjoyable stuff during the entire journey. In your own home, you can acquire all of the photos and then make them into a photo experience publication to consider your vacation. When you are traveling with over a single little one, think about pre-packaging every child’s clothing into a huge freezer travelling bag. These luggage might be tagged with every time, and so the youngsters can simply get the clothes they’re likely to put on. This stops them from being forced to unpack the complete baggage in the morning, and in addition lowers the chance of products becoming forgotten in your house. As was talked about at first of the write-up, knowing the ins and outs of just how the airline industry functions could help you save a ton of money when scheduling flights. Apply the recommendations using this report and you’ll be soon on your way preserving a ton of money with less expensive flight passes.

  328. Whether your organization goes away from home or you are looking for an unforgettable getaway, you may benefit from these useful recommendations on travel. Although journey has tended to become faster and cheaper with time, there exists nevertheless a major difference between the charges you have as being an unprepared visitor versus being a nicely-educated one particular. Make sure you have a container water along with you. Regardless of whether you locate on your own in the wilderness or even in a busy metropolis, possessing a package of water on the person at all times is never a poor thought. These are typically particularly an easy task to always keep useful if you carry a bag. Search for savings for all your travel arrangements. Going for a getaway gives you limitless areas to economize in. In everything from the air travel, on the leasing car, into a jogging tour of your town, discount rates are readily available. Search the internet benefiting from bundles and check what discounts are for sale to you through your a credit card and memberships. When traveling to an alternative metropolis, try out the best to search as if you should be there: In no way let anyone see you are misplaced. Checking your road map in the middle of the sidewalk can be a sure-blaze free gift, as is looking for recommendations. Remember, new arrivals are good concentrates on for pickpockets and muggers. International journey can be quite enjoyable. On the aircraft airline flight in your destination, bring along a term book and then try to study a couple of words in the language from the culture where you may be spending some time. You do not have to become fluent from the terminology and lots of local people will probably be pleased which you made an effort to find out a bit of their words. Tend not to be timid about errors. A lot of people will enjoy you tried to discover a bit concerning their tradition. Check prices directly along with your accommodation or air carrier organization to economize on the trip. Though it is usually modest, some online search engine websites put in a payment on their costs. In order to avoid the charge, examine the air travel web site straight or provide the resort a telephone call for their prices. You can expect to usually discover that the costs are lower if you reserve straight. Hopefully, these guidelines have provided you with many extremely beneficial info, along with presented you a way to arrange every one of the opinions and information you could have presently experienced on vacationing. Maintaining the following tips under consideration once you start vacationing can help you take pleasure in more of your holiday.

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  353. Touring can be a much loved interest of people around the globe. Understanding new civilizations and achieving new experience are a few issues that one could enjoy whilst you traveling. They are some great suggestions to help you out together with your journey strategies. Take clothing that is ideal for journey. This means items you could clean and dried out inside the hotel, and that won’t wrinkle from simply being air-dehydrated. Also, recall that you could get garments along the way, and it will most likely become more appropriate towards the climate and traditions from the place. If you are intending on paying a great deal of cash on your holiday or trip, take into account making an investment a small sum more on traveling insurance policy. It is going to ensure that you are safeguarded when your journey must be canceled because of individual disease, natural catastrophe, or any other uncontrollable activities. Have a delighted attitude while on a trip. Things could possibly get somewhat tense at airport terminals. Tempers operate higher. The people who work there frequently find it difficult of issues. Maintaining a good attitude about yourself, at the very least outwardly, will probably enhance your experience. A poor frame of mind will hardly ever allow you to get anywhere. Shield your liquids from spilling when you journey having a homemade jar stopper. Prior to screwing the limit on your vacation-size toiletries, include the very best by using a small piece of plastic-type pulled from a plastic-type material store shopping handbag. This will likely equally safeguard your garments from your liquefied and maintain the fluid on the inside its container. Do you experience feeling well informed with your vacation contingency prepare? Do you have a modified prepare? Could you now add stuff that assist both you and your spending budget? Do you want so if an urgent situation or unanticipated situation arises? With help from the aforementioned tips, with a little luck you possess good quality techniques to these queries now.

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  355. Choosing how and where to travel can present several tough concerns and problems, even going to the most knowledgeable international tourist. This informative article represents a few confident-blaze approaches to publication hotels, program outings, perform business meetings on the streets, and customarily make the most of your sojourns away from land. Correct preparation is key, so pack the basics, but don’t more than-pack. The greater number of you pack, the more you might have to hold, shell out extreme travel luggage service fees for and after that maintain. Limit the number of shoes you have as they possibly can take up a lot of room and so are the biggest stuff you will end up taking. Be respectful and affected individual to security checkpoints and customs officers. In most cases, these are available for your safety. Otherwise, getting annoyed still won’t help you overcome any quicker. In reality, making a bother in the safety checkpoint is nearly usually a admission towards the show lane for that added lookup. Require time daily to relieve anxiety while on a trip or travelling and you will appreciate oneself because of it when you are getting back home. With all the current mayhem, jet-delay, hanging out and also other enthusiasm of journey is available a whole lot of stress in your thoughts and the body. As soon as most vacation trips have ended, a different one is necessary to recover so consuming a few momemts on a daily basis to revitalize will make it simpler that you can curriculum vitae your standard daily life when it’s all over. While you are travelling internationally, attempt looking for mementos in uncommon areas. It is now increasingly hard to find gifts that have been produced on the spot you might be browsing. Try looking in supermarkets, stationery shops and equipment merchants. You will discover items that individuals in the region in fact use and the packaging will likely be exclusive for your location. When traveling by atmosphere, there is no lengthier any explanation to hold another toiletries case. All your liquids and gels will need to match a Ziplock case no matter. That bag will already be covered, and will also be smaller sized and lighter in weight than any bag chosen for your task. A great trip calls for great preparing to ensure everyone enjoys their selves. These are simply ideas that may make your following holiday a little bit more trouble-totally free. When you program the next adventure, perform a little research and prepare your itinerary properly. Continue to keep many of these journey suggestions in mind, and savor the next getaway.

  356. Vacation is something that we all in get pleasure from. Actually in many cases once we are travelling we think about it to be a holiday. The greater number of details you have the more fun your touring experience will be. This post will supply numerous distinct touring recommendations to be able available the utmost advantage out of your vacation. Should you be traveling with young children, a backpack or another case packed with new and intriguing games and actions is a good idea. Make sure that these are generally points they are certainly not generally allowed to play with, or special stuff for journeys only. It is going to give them anything to enjoy and they can be amused longer. When you are travelling on a budget, take advantage of the in-space facilities in order to cook your very own foods. The coffee machine which is typically offered in the most affordable hotel rooms can double as a popular plate. You can heating basic h2o in the carafe for ramen or soups, or make use of the hot plate by itself to make bacon. When you are traveling, usually be ready to have things stolen. Make improve photocopies of all of your current essential documents. You can even upload electrical scans of these papers for quick entry while traveling. Your local Us embassy can help you in getting in touch with these in your own home who can wire you crisis funds or assistance in replacing your passport, but not very much else. To help you revive tension, you should go on a holiday from work. Going on an annual getaway provides you with one thing to function tough for and it will surely give you a gentle after the tunnel. It is essential to reward yourself and there is absolutely no far better incentive when compared to a trip! There are several insurance plan choices when you are traveling. Once you book a trip, you must make a decision, to start with, what type of vacationer you happen to be and your hunger for risk, then select which plan or insurance policies you should buy to pay contingencies on your own getaway. The earlier you will make these insurance policy choices following arranging, the less cash you may pay out and the more options you will have. You may purchase vacation cancellation insurance coverage, a favorite option insurance policy towards loss of your travel luggage insurance plan towards health care crisis situations or perhaps climate contingency insurance. Visiting new spots should be enjoyable, not nerve-racking. These suggestions can help take the worries away from your travel and let you have a good time. Regardless of where you’re heading or how you’re acquiring there, the following tips will help make your holiday a little easier and a little more fun.

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  381. Are you presently prepared to improve your camping out understanding? Camping out will provide you with the opportunity reveal a gratifying knowledge of all of your loved ones. In order to get the most pleasurable practical experience, heed the tips from the post beneath. A great multi-objective tool should be element of your camping outdoors products. There are two forms to create. Initially is definitely the noticed/hammer/axe 3-in-1 tool to use for fire wood and other chores. Other is the regular multi-function device with a number of resources into it just like a can opener, tweezers, scissors, as well as a blade. Get only photos and leave only footprints. Which is the rule of thumb when camping out. Only use natural solutions that you require and never depart any remnants that you simply were camping outdoors once you depart. Pick-up all rubbish, extinguish and protect any flame pits, bury all human being squander, and then make the location where you camped appearance just as it did when you thought it was. Introduce yourselves with other families camping out inside your immediate area, as a method to be sociable and a lot more apt to support each other out. If yet another crew shows up soon after you’ve create, offer you to help because of their tent or equipment. If some thing should go awry during the trip for anybody, it’s much better to demand help from somebody who was polite adequate introducing themselves. Bring items for ‘Smores. ‘Smores are an integral part of any camping outdoors getaway. Merely load graham crackers, chocolates, and marshmallows. Toast the marshmallows, make it the stuffing to your graham cracker/delicious chocolate sandwich. When you have a ‘Smore, you can expect to want ‘some more’–bring ample for everyone to have at least a couple of them! If you are considering camping out, and also you are new to the action, you then should never begin alone. It could be rather dangerous if you don’t know what you really are performing, so it is essential to bring along a skilled friend to help you discover the ropes. As you now know about some of the best tips you can find about camping, you are moving toward enjoying the in the open air with your loved ones. Make use of the suggestions so you may not find yourself within a unpleasant vacation that you simply hope you can get away from.

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  385. Foregoing a 5 various-celebrity resort for that traditional entertainment of camping outdoors can certainly make for the remarkable trip for the whole family members, your SO or all by yourself! Look into the suggestions in the following article that will allow you to help make the absolute the majority of your outdoor camping vacation! When you are camping with a public camping area, make sure you package shower boots for all with your celebration. Not simply will they shield the feet from your bacteria in the shower area floor, however they are just the thing for individuals nighttime works for the bushes when you should employ the restroom. They could be aged flip flops, Crocs, or perhaps slide-ons. Find out your new equipment before heading camping out. The exercise does definitely support. Nobody wants to arrive at the campground, only to find that they don’t know how to use anything or setup their particular tent. Practice along with your new equipment prior to deciding to possibly set foot about the camping site. With camping out, will come the campfire. Be sure your campfire is a wide open room and considerably enough from remember to brush or shrubs which means you don’t operate the chance of a stray kindle getting them on blaze. Surrounds the fireplace with rocks to keep it contained. Most significantly, by no means depart any campfire unattended. If you need to depart for any excuse, be sure the campfire is extinguished fully. Guarantee the tent is an satisfactory sizing for anybody that may be together with you. You ought to have no issue getting to sleep and getting throughout the nights when outdoor camping. If you are looking at outdoor camping, so you are a novice to the action, you then should never start out alone. It may be rather hazardous if you don’t know what you are carrying out, so you should take along a highly skilled buddy that will help you find out the ropes. As soon as you more about camping out, it is possible to actually loosen up and have fun whenever you head out into the outdoors. As with every exercise, the greater you understand, the greater number of successful your camping out trips will likely be. Remember the ideas you might have read in this article to enable you to take pleasure in all your camping outdoors journeys.

  386. No matter if you’re planning an unique vacation or taking a spur from the minute jaunt, sometimes, it’s the small details that may be the figuring out component about how a lot you enjoy your time and effort out of the house. The information on this page will help you program the perfect retreat. Leave all unnecessary valuable items in the home. You take the hazards of getting everything thieved of your stuff if you do take valuables along. In case you are going to a location which has a water-limitation on all beverages you might be packing, purchase pub shampoos and tooth powder. Truth be told, you can actually locate bar hair shampoo and toothpaste available in powder type online. These things are an easy way to acquire close to liquefied-restrictions. When you are traveling in nations with hazardous faucet water, recall other ways which you may be exposed. Shut the mouth while u