In the past six years, as Venezuela’s economy crumbled, nearly 5 million people fled. No country has borne more of the fallout than neighboring Colombia.

When Tampa Bay nonprofits organized a mission trip to provide medical care to refugees in Bogotá, the Times asked to travel with them.

This reporting trip was supported by the International Women’s Media Foundation. It was taken last December, before the coronavirus spread around the world and made conditions even worse.

At the border

CÚCUTA, Colombia — The travelers come at all hours, sometimes 30 at once. Fresh from the border, they drag bags behind them or carry nothing. They come wearing busted-up sneakers, Croc-style shoes or flip-flops. Sometimes, they come barefoot, their feet peeling and bleeding.

Martha Alarcón, the owner of a roadside kiosk, receives them with a soft smile and something to eat, usually big pots of rice with sausage and tomato sauce or arepas with cheese. When she can, she offers donated clothes, helps bandage their injuries. Sometimes, she only has cookies to offer. But she makes sure no one leaves without something in their belly.

“I know that people are hungry and thirsty,” said Alarcón, 55. “It hurts me a lot to see this happening.”

Across the world, including at the U.S.-Mexico border, refugees often meet guards and walls and hostility. But Colombians have kept their doors open. More than 1.6 million Venezuelans are estimated to have entered Colombia since 2016. They are now about 3 percent of the population, and they keep coming.

Two Tampa Bay nonprofits, Centurion Medical Missions and One More Child, saw scenes at the border and were inspired to help. They organize medical missions run by volunteer doctors, hoping to provide basic medical care to thousands of Venezuelans who are trying to start over in the capital.

At a border bridge in this busy northern city, signs remind travelers to “Take care of the little ones, don’t let them out of sight” and “Stay united with your family and you’ll be more secure.” Those without passports take the informal pathways underneath controlled by smugglers, in full view of government officials.

Venezuelan refugees cross by foot into Colombia across the Simón Bolívar bridge. [MARTHA ASENCIO-RHINE | Times]

It wasn’t that long ago that Colombians escaping their country’s violence were the ones streaming into Venezuela.

At Alarcón’s shack, Venezuelan currency, bolivares, hang above her, testaments to a country in collapse.

Once, those bills purchased beef or pork, books or sneakers. Now they flutter — worthless — in the breeze. People sometimes scribble messages on them, hoping that a sister, a friend, a husband might pass by on the same road.

At first, Alarcón remembers, only young men came. Those looking for jobs that required muscle, like bricklaying or working in fields.

In 2018, she began to see pregnant women, children and the elderly at her kiosk. People in wheelchairs, people on crutches, who’d been traveling for days.

She still sells sugarcane juice and snacks to workers on the road, like she has for the past 17 years. But now most of the profits go to feed the migrants. Outsiders sometimes bring her donations. Other times, she takes out a loan to keep afloat.

Once, a teenage mother showed up past midnight with her child, only 25 days old. “What is a little baby doing on the street at that hour?” Alarcón thought as she offered them a place to sleep.

But the girl kept walking.

Over time, Alarcón felt herself becoming more than a witness to tragedy. She listens to the stories, sometimes laughs with the travelers, tries to cheer them up so they will “lose a little bit of sadness.” They take a piece of her when they go.

She has also become an unofficial documentarian.

Martha Alarcon, 55, runs a small kiosk and offers refugees free food and drink. Some friends and neighbors have criticized her acts of kindness. But for Alarcon, “it’s very hard to see a hungry child and deny him help.” [MARTHA ASENCIO-RHINE | Times]

Her visitors record names, birthdates, hometowns and destinations in books decorated with origami made from Venezuelan bills. People sometimes leave mementos, like bracelets or photos.

I found myself living in terrible conditions without even the minimum needed to live. No clothes, no tools, no medicine, no documents. Thank god I am here …

In Venezuela we don’t have any future and that’s why my brother and I decided to leave. Because as much as we worked in Venezuela, we never had enough money … on our travels, we have met some really kind and supportive people.

I am 15 years old from Caracas … I am going to Bogotá to be a new person. A change.

One time, a man flipped through the books and saw a photo of his son. “Ah, my wife was here,” he said. He added another picture before he left.

Alarcón has already filled nine books. She likes to think she is recording history.

People tell her one day they’ll be back. In five or 10, or maybe 30 years, they’ll come with relatives and show them the books.

“It’s not so much for me, but also for their kids and grandkids, to see what their lives were like in Colombia,” Alarcón said. “Because a lot of things have happened here. Both happy and sad.”

For now, she can’t bring herself to read the books.

Esneiker Junior Castillo, 22, of Caracas, Venezuela, left, and Miguel Angel Brizuela, 21, of Bolivar, Venezuela, look up at dozens of worthless bills, which at one time would have been a fortune. [MARTHA ASENCIO-RHINE | Times]

But Alarcón knows it’s not true. Last year, she visited her uncle in San Cristobál, Venezuela, a place she had last seen years ago as a modern, tidy city. She was shocked by the changes: buildings shuttered, animals roaming the streets, people digging through garbage cans.

“They work and work, but it’s not enough to buy flour for bread. Or just a bit, but then they can’t get anything else.”

One afternoon in December, three men sat at one of Alarcón’s plastic tables, hunched over bowls of chicken soup. They had been on the road for two days and expected to spend another three walking to Bucaramanga, where they hoped to find jobs.

Carlos Martinez, 27, spread out a map given to him by the United Nations Children’s Fund. The colorful trails, decorated with cartoon figures, made it look as if their journey was one big hiking excursion.

From left, Carlos Martinez, 27, Esneiker Junior Castillo, 22, and Miguel Angel Brizuela, 21, enjoy chicken soup and Pepsi at a roadside kiosk. They stopped on their way to Bucaramanga, Colombia, where they hope to find work. [MARTHA ASENCIO-RHINE | Times]

The night before, they had slept on the road on thin sheets and cardboard and risen early in the morning to bathe in the river. They reminisced about their childhoods — the beautiful beaches, the sazón of Venezuelan cooking.

“Before, there wasn’t any sadness or poverty,” Martinez said. “We used to be chubby, all of us.”

The men carried backpacks with broken zippers. An extra T-shirt. A few cans of sausage, handed out by aid groups. Only one had a cellphone. His mother had found it for him before he left so they could keep in touch, but he hadn’t yet bought a SIM card.

Now they teased each other as they laid out their plans and flicked a 500 bolivar note across the table.

“What’s that worth now, a bus ride?”

“Not even a bus ride, man.”

How did they manage to crack a joke, with what’s ahead and what they left behind?

They could see no other way but to trust in God and their feet.

“I’m doing this for my family,” said Martinez, kissing a picture of his 3-year-old son, who has autism.

Carlos Martinez, 27, of Caracas, Venezuela, holds a framed photo of his son, which he carries in his backpack. “He’s the reason I take the risk,” Martinez said. He had crossed the border from Venezuela the day before and felt hopeful of his prospects in Colombia. [MARTHA ASENCIO-RHINE | Times]

One day, the men promised, Venezuela would recover, and they would go home.

They finished their soup, thanked Alarcón for the food and rest, and returned to the road.

BOGOTÁ — Every day, Marí Navarro rises at 4 a.m. In the darkness of the two-bedroom apartment where she lives with eight relatives, she prepares food. Her husband and two sons will soon leave to work construction jobs, and they won’t return until after dark.

When the sun comes up, her daughters-in-law usually head out with baskets of candy and snacks to sell to passing cars — a form of begging now commonly associated with Venezuelans in need.

Then she walks her grandchildren to school. It’s the one time she feels almost normal again.

The walk to the city park is about 2 miles through rough neighborhoods and takes 45 minutes on foot with three small children in tow. [MARTHA ASENCIO-RHINE | Times]

Often, her stomach grumbles. She skips meals to have more to give the children.

In Venezuela, Navarro came of age at a time when the country was pouring the profits of the oil industry into public services. She grew up in a family of professionals and was used to filling up the grocery cart at the supermarket and traveling for vacation — once even to Colombia.

“For those in my time, the quality of our childhood was spectacular,” she said.

But the socialist government’s largesse papered over holes. When oil prices plummeted, inflation rose so high, most families couldn’t afford diapers. Grocery stores emptied, schools shrank, hospitals became death traps and people looked for a way out.

Navarro’s family was not so rich or well-connected that they could fly to a place like the United States and start over, nor so destitute that they couldn’t scrape together money for bus rides to Bogotá. Navarro’s husband is Colombian, which helped ease the transition. They send money back to a daughter and two granddaughters still in Venezuela.

It’s safer for cousins Rodrigo Arias, 2, and Miah Arias, 4, to play inside their apartment. [MARTHA ASENCIO-RHINE | Times]

In Bogotá, the family felt lucky to afford an apartment, even in a neighborhood where they feel unsafe walking to the playground. It’s better than the run-down hotel room they crammed into when they first arrived.

Navarro’s apartment back home is exactly how she left it. All her furniture, kitchen supplies and clothes, waiting for her return.

Mari Navarro and her daughter-in-law, Emily González, 22, leave the house to take the children to the park. [MARTHA ASENCIO-RHINE | Times]

Her grandkids are the reason they stay in Colombia. Here, at least, the schools are still running, and they can earn enough to feed the kids fruit and heaping plates of rice and chicken.

***

Navarro, like many of her countrymen, left Venezuela when it became a matter of life or death.

Her mother, a diabetic, needed insulin, which had become impossibly expensive. So three years ago, Navarro began to travel to Colombia, where she could earn money and send medicine back home.

Eventually, her mother’s skin became so dry, her feet tore open. By then, Venezuela’s hospitals had long run out of basic medical supplies. Navarro’s family scrambled to buy everything for her mother’s treatment on the black market: the alcohol, the antibiotics, the medical tools. It still wasn’t enough.

When her kidneys began to fail, the doctors said they needed albumin injections to treat her. But it was only sold in American dollars and her family had none — so Navarro could only watch as her 76-year-old mother’s body filled with liquid and her heart stopped beating.

News networks were reporting the skyrocketing rate of child mortality in Venezuela. At the schools, few teachers remained, and children were fainting for lack of food.

Her sons and their families joined her in Bogotá.

***

In Colombia, Navarro and her family live with new uncertainties. There are so many more expenses. They weren’t used to paying for services like electricity, which had been covered by the Venezuelan government. In Bogotá, she noticed that most of her neighbors live in perpetual debt.

“Even a glass of water that you drink every day, here you fight for it all,” she said.

The medical crisis that pushed Navarro, now 50, to leave Venezuela haunts her. In Colombia, Venezuelans are locked out of the public health care system, except in emergencies. The government says the influx of refugees has strained its resources.

Navarro’s 4-year-old granddaughter, Miah, has been suffering from angry rashes for months, but they couldn’t afford to take her to a private doctor. Recently, Diego, her 7-year-old grandson, crashed his bike. His ankle got stuck in the wheel, splitting it open.

They rushed to the emergency room, where doctors stitched him up. But weeks later, when the wound continued to fester, she couldn’t get any medicine. A local shop advised her to apply calendula leaves to Diego’s wound. It seemed to reduce the inflammation, but the boy just couldn’t sit still and the wound kept reopening.

Then she heard about an opportunity. One week in December, some American doctors were offering medical consultations. So she bundled up the children and took them to the red-light district, where Venezuelan sex workers in skin-tight clothes blinked in the morning sun.

Mari Navarro waits at a popup clinic organized by Tampa Bay nonprofits, Centurion Medical Missions and One More Child. Navarro had come so two of her grandchildren could be seen by doctors. [MARTHA ASENCIO-RHINE | Times]

In the exam room, doctors immediately recognized that Miah had a mixture of scabies and allergies. That could be cleared up with cream and allergy medicine. Then Dr. Ronald Figueredo, a wound specialist from Tampa, hoisted Diego up on a cot to examine his ankle.

“I think that he needs like an antibiotic or something,” Navarro offered. “I’ve been cleaning it with blue soap every day.”

The doctors agreed. Antibiotics and an anti-inflammatory cream would quickly clear the infection.

“If we don’t treat it, it can grow and it could give him a fever, and he could get really sick,” Dr. Yalda Hazrat explained to Navarro, with the help of a translator.

Navarro nodded. “Exactly,” she said. “I studied nursing, but in Venezuela.”

After they picked up the medicine, Navarro held Miah and Diego’s hands and walked toward the bus. Diego was already bouncing around, full of energy. “The children adapt,” she thought.

By day two, people lined up outside the clinic, hoping to get a consult. Most were women and children. [MARTHA ASENCIO-RHINE | Times]

At the clinic

The makeshift clinic inside of a daycare, with its Christmas cutout decorations and plastic dividers, was a far cry from Figueredo’s usual offices. He works at modern hospitals run by AdventHealth in Tampa and Carrollwood.

Here there were no scanners, no lab work available, no assistants keeping track of a patient’s medical history. At best, the doctors’ brief trip could offer short-term solutions and a break from worry and stress.

“Sometimes, it’s a priority to sit down and laugh with a patient,” Figueredo said.

The trip was the first organized in Bogotá by two Tampa Bay nonprofits, Centurion Medical Missions and One More Child. They hoped to fill some of the gap in medical services and offer hope for refugees trying to start over in Colombia. Over four days, doctors and residents, mostly students and alumni from St. George’s University in Grenada, would treat almost 1,000 patients, most of them children. In 2020, they had wanted to return six more times.

Women and children wait in the makeshift waiting room inside one of the city’s daycare centers, which agreed to host the clinic for a couple of days. [MARTHA ASENCIO-RHINE | Times]

Figueredo, originally from Paraguay, joined the trip as a way to give back. His life had taken him from growing up in a country with unreliable hospitals to working in state-of-the-art facilities in Tampa. “It’s easy to forget where you came from,” he said.

Outside, a line of patients snaked down the street. In the waiting room, a catalog of ailments told the story of crisis and displacement: malnourished children who subsisted on candy and snacks, and families suffering from scabies and parasites because they slept crammed together in one-room hostels that rented for $2.50 a night. People who cried because they couldn’t find medicine they needed to survive or simply hadn’t seen a doctor in years and were relieved to hear their children were doing OK.

Downstairs, the doctors had set up a small pharmacy. Anti-parasitics, pain medication and topical steroids were in stock. But by the end of the first day, the group was already running out of children’s Tylenol and vitamins.

Figueredo — who went by a nickname, Fig — worked with the tools he had. He liked to put patients at ease by clowning around and saw his job here as part medical adviser, part counselor. It was an attitude he had learned growing up in Paraguay, where doctors sometimes acted like family. He reassured crying children as he patted them with his stethoscope and teased young mothers, asking questions about their lives and sharing details of his own.

A woman came in concerned that her son wasn’t eating enough.

“One of my sons never wants to eat, either,” he said, rolling his eyes dramatically. “Kids are all different. Don’t worry too much, unless he is getting sick.” She left with a smile on her face.

It felt good to fix problems that had a simple solution.

The doctors check in with each other at the end of a busy day. From left: Chelsea Hoenes, Yalda Hazrat, Ronald Figueredo and Nathalie Briones. They saw every patient waiting for care. [MARTHA ASENCIO-RHINE | Times]

Other cases had no easy answers.

Jose Legorio Borges Ochoa, 52, came in on the second day suffering shakes and fainting spells. He was diabetic and in need of insulin.

When Figueredo told him the clinic didn’t have any, Borges’ face crumpled. He began to unload all of the things standing in his way. Insulin for a month cost about $45, but the minimum wage in Colombia is about $240 a month, and he didn’t make nearly that much selling candy on the street.

Ronald Figueredo, known as “Dr. Fig,” consults with a man who had come looking for insulin to treat his diabetes. [MARTHA ASENCIO-RHINE | Times]

Figueredo listened, then interrupted. “What are you going to do to get insulin? What are you going to do today to get it?” he asked urgently, leaning forward and looking in the man’s eye.

“I don’t know,” he said, his eyes reddening.

“You need to find a way,” Figueredo said. “Today.”

Sometimes, the doctors avoided suggesting procedures or medicine they knew the patients had little chance of obtaining. But with such a dire condition, he felt he had to be forceful.

After Borges left, the doctor slumped in his chair. He could imagine what would happen. Borges’ condition would deteriorate until he was admitted to the emergency room. Then he would be released, over and over, until his body gave out.

It was the kind of case that made him feel overwhelmed and frustrated with the little he could offer on a four-day trip.

After purchasing an entire basket of snacks from a street vendor who came to consult at the clinic, Dr. Ronald Figueredo shares the treats with the teenage staff, who served as intake coordinators. [MARTHA ASENCIO-RHINE | Times]

In the room next door, Dr. Hazrat was trying to coax words from a woman with two boys at her side. Her blood pressure was high, and she looked distressed.

“Do you want to talk about it?” she asked through the translator.

The woman nodded. Her husband was getting surgery in the emergency room at that very moment, and she didn’t know what would happen. “It’s good that the doctors are with him. They are going to do the best they can,” Hazrat said, trying to reassure her. She held the woman’s hand and offered to pray.

“Do you know how to do the prayer?” she asked the interpreter. Hazrat is Muslim and wasn’t sure what was expected in a Christian prayer, but she could sense the patient needed a way to calm down. The interpreter nodded, and they formed a little circle. “Please, God, protect him, so that all goes well today so he returns to his family,” he said.

Dr. Yalda Hazrat, a Canadian doctor, allows a young patient to listen to her heartbeat. [MARTHA ASENCIO-RHINE | Times]

For Hazrat, now living in Canada, the work was deeply personal. As a child, her family fled Afghanistan and ended up in a refugee camp in Pakistan.

The doctor’s tent there remains imprinted in her memory. She used to play marbles outside and watched as families entered the tent with desperation written on their faces. Minutes later, they would emerge calmer, their heads held high, even smiling.

“I used to think about that,” she said. “What’s happening inside that tent with this magical thing — that can actually change someone’s life?”

One day, she peeked in the tent and saw a physician. His white coat seemed to glow, shinier than anything she had ever seen, and he spoke in a soft, kind tone. “He was like the whole definition of a hero,” she said. “I have been on the other side. Now I am very fortunate and blessed to be on this side.”

Dr. Yalda Hazrat waits among patients to enter the makeshift pharmacy. Many of the prescriptions were for children’s vitamins, fever and pain reducers and anti-parasitics. The vitamins ran out quickly. [MARTHA ASENCIO-RHINE | Times]

Downstairs, Maria Fernanda Palomo picked up prenatal vitamins and anti-rash cream for her 3-year-old daughter before preparing to return to her one-room apartment. She thought about her former life, just a few years ago.

In Venezuela, she was a nurse who took pride in making her patients feel at ease. Her husband was a paramedic. Now, the only medical care she could access was this free clinic. At first, she wasn’t sure if she even wanted to come — It was a reminder of how far her living standard had fallen.

Maria Fernanda Palomo holds her daughter, Aranza, 3, at the front door of their one-room living space at a public parking garage. Palomo’s husband got the room in exchange for his work as a parking attendant. The couple are expecting another baby in a few months. [MARTHA ASENCIO-RHINE | Times]

In Bogotá, she couldn’t work legally because she left Venezuela without her passport and couldn’t get a work permit. She spent most of her days inside the apartment, afraid to go out alone. When she thought of the future her children would have, she often cried.

But she had dragged herself to the clinic, her only chance to get a prenatal checkup, and it felt good to be around doctors again. Talking with Dr. Figueredo lifted her spirits, at least for the day.

Epilogue

Since this story was reported, conditions have changed drastically in both countries in response to the coronavirus.

Colombian President Iván Duque closed all land and sea borders on March 16 and says they will remain closed until May 30.

Relief services for refugees in Colombia have been restricted. Jobs, even street-selling and begging, are on hold, compounding economic challenges.

Hospitals, already mostly inaccessible to Venezuelans, are preparing for more strain than ever.

Some predict Venezuelans will keep trying to come. The situation at home is even worse.

This story was written by Kavitha Surana. Photography by Martha Asencio-Rhine. Video by Jennifer Glenfield. Fixer Juan Manuel Bueno Barrero contributed to this reporting.

Contact Kavitha Surana at ksurana@tampabay.com. Follow @Ksurana6.