Eight-year-old Luisito is awaiting surgery for a brain tumor, a daunting prospect at the best of times -- but this is Venezuela, and the hospital, typically, has little medicine or functioning equipment.
A four-month-old baby shares his nine square meter (96 square feet) hospital room. She suffers from an abnormally large head, or macrocephaly, and needs a drainage valve.
The hospital doesn't have one.
The resulting fluid accumulation has left the baby girl's head the size of a basketball.
Anthony, aged seven, also shares this tight space. Following surgery, the wound on his back worsened, for lack of clean dressings either at the hospital or in local pharmacies.
The litany of avoidable suffering is repeated from one ward to the next at the J.M. de los Rios Children's Hospital in downtown Caracas. Venezuela's Pharmaceutical Federation says just 20 percent of the drugs and medical equipment needed in hospitals and pharmacies across the oil-rich state are available.
Chronic shortages of medicines as well as basic foodstuffs have been a wearying consequence of Venezuela's crippling years-long economic crisis, blamed by the international community on President Nicolas Maduro, who is seeking a second six-year term in elections on Sunday.
Medical materials can be bought over the internet, but in dollars only -- a currency inaccessible for the grandmothers of these children from families of modest means.
"We don't have dollars. We have our backs to the wall," said Maria Silva, watching over little Anthony and his spreading wound.
With better equipment, these cases could be easily treated, according to their doctor, Edgar Sotillo.
"We don't have drugs...I have patients who are suffering from hydrocephalus (a build-up of fluid on the brain) and are waiting for a valve," said Sotillo.
"We are seeing cases of chickenpox, tuberculosis, malaria, scabies. Sometimes the hospital has no water. If patients contract infections, there are no antibiotics and their situation worsens," said the doctor.
Brain tumor
Blaming his country's woes on an "economic war" being waged by the United States, the socialist Maduro has promised to fix the situation soon.
But Yuriangela, 16, has no time to wait. Suffering from lung cancer, she is waiting for her next round of chemotherapy.
Her mother, Sujer, weeps helplessly and does not know if she will be able to find the treatment her daughter needs. For chronic diseases such as cancer, nearly all -- 95 percent -- of the drugs needed for treatment are not available.
"She needs to have 17 chemo sessions," she said, adding that her family had to buy the medicine she needed abroad. "We don't have the means, but we have received help."
Next door, four-year-old Luana cuts out the letters from a printed alphabet while waiting for treatment for a brain tumor.
"For two months, we have not been able to get chemotherapy. It is the responsibility of the people who govern, who only take any notice of us when we demonstrate," said her mother, Rosa.
Demonstrations to draw attention to the plight of the health service are frequent, whether by doctors, their patients with HIV, or the disabled.
Rats and roaches
On this cancer ward, devices for medical imaging like MRI machines and radiotherapy equipment are out of order.
"We cannot operate because of the lack of equipment," one woman doctor said, speaking on condition of anonymity.
"We have had patients whose conditions improved, but subsequently, for lack of medicine, they deteriorated and died."
From broken water pipes to a single functioning elevator and rats and cockroaches in the hallways, the J.M. de los Rios hospital has a long list of problems, doctors say.
Doctor Belen Arteaga, the head of the nephrology department, earns only the monthly minimum wage of 2.5 million bolivars -- or $36 dollars at the official rate.
That's enough to buy a kilogram of meat in Venezuela, where the IMF predicts inflation will soar to new heights of more than 13,000 percent this year.
For want of antibiotics, Arteaga said she saw four children die at the hospital. Infant mortality jumped more than 30 percent in 2016 compared to 2015, the most recent official figures show.
"The doctors are leaving," Arteaga added. According to the Venezuelan Medical Society, one-third have already emigrated.
"We are witnessing a humanitarian crisis," said Huniades Urbina, head of the childcare and pediatrics society.
"These are figures from sub-Saharan Africa."
