Oncologist Gabriel Romero performs hundreds of lifesaving surgeries a year, but he no longer takes pleasure in his work.

That's because he believes that many of the mastectomies he does on some of Venezuela's poorest women wouldn't be needed in a normally functioning country. Doctors say they are being forced to return to outdated treatments because the country's economic problems make it impossible to ensure the proper running of radiation machines in public hospitals, where patients receive free treatment under Venezuela's universal health care.

"You don't feel comfortable with it, because you're making a decision that goes against your professional judgment," Romero said recently after seeing patients in the grubby basement clinic of the Dr Luis Razetti Oncology Center adjacent to a Caracas slum. The hospital's only linear accelerator machine, the more modern of the two kinds of radiotherapy devices used in Venezuela, has been broken since November.