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Revista de Neuro-Psiquiatría

Print version ISSN 0034-8597

Rev Neuropsiquiatr vol.85 no.2 Lima Apr./Jun. 2022  Epub June 21, 2022

http://dx.doi.org/10.20453/rnp.v85i2.4228 

Artículos de revisión

Venezuelan Migration in Latin America: History and sociodemographic aspects.

Migración Venezolana en América Latina: Historia y Aspectos Socio-Demográficos.

Renato D. Alarcón1  2  , Psychiatrist, Master in Public Health
http://orcid.org/0000-0002-7316-1185

Antonio Lozano-Vargas1  3  , Psychiatrist
http://orcid.org/0000-0002-5615-2076

Elvia Velásquez  , Psychiatrist
http://orcid.org/0000-0003-1376-4782

Silvia Gaviria4  , Psychiatrist, Magister in Higher Education
http://orcid.org/0000-0002-0735-4894

José Ordoñez-Mancheno5  6  , Psychiatrist, Magister in Health Research
http://orcid.org/0000-0002-1718-8367

Miriam Lucio5  , Psychologist, Magister in Health Research
http://orcid.org/0000-0002-6497-6518

Alina Uribe7  8  , Psychiatrist
http://orcid.org/0000-0002-6617-4121

¹ Universidad Peruana Cayetano Heredia. Lima, Perú

² Mayo Clinic School of Medicine. Rochester, MN, USA

³ Clínica Anglo Americana. Lima, Perú

Universidad de Antioquia. Medellín, Colombia

5 Universidad de Cuenca. Cuenca, Ecuador

Latino Clínica. Cuenca, Ecuador

7 Pontificia Universidad Javeriana. Bogotá, Colombia

8 Clínica de la Mujer. Bogotá, Colombia

SUMMARY

The migration of millions of Venezuelans to South American countries in the last two or three decades is one of the most significant social phenomena in the continent’s history. This article presents a brief historical account of the process and describes a variety of dramatic aspects of the migrants’ experiences throughout the long road towards Colombia, Ecuador, Perú and other countries. The main socio-demographic characteristics of the migrant population (numbers, population types, geographic location in the host country, age, gender and civil status, work and employment) in the above three countries, are described as a relevant basis of further inquiries on the repercussions of migration on the mental health of its protagonists. The information covers important aspects of the journey and the arrival as the initiation of a painful and uncertain process of acculturation and adaptation.

KEYWORDS:  Migration; demography; host societies; acculturation

RESUMEN

La migración de millones de venezolanos a países sudamericanos en las últimas dos o tres décadas constituye uno de los fenómenos sociales más significativos en la historia del continente. El presente artículo formula un breve recuento histórico del proceso y describe odiseas de diversa naturaleza, experimentadas por los migrantes en el extenso recorrido hacia Colombia, Ecuador, Perú y otros países. Como base relevante de futuras investigaciones en torno a repercusiones de la migración en la salud mental de sus protagonistas, se examinan las principales características socio-demográficas (cifras, tipos de población, ubicación geográfica en el país receptor, edad, género y estado civil, trabajos y empleos) de los migrantes en Colombia, Ecuador y Perú. La información cubre aspectos importantes de la travesía y el arribo que generan un doloroso e incierto proceso de aculturación y adaptación.

PALABRAS CLAVE:  Migración; demografía; sociedades anfitrionas; aculturación

INTRODUCTION

The 21st Century has undoubtedly accentuated the strength and the multiple impact of Globalization, a process that, essentially, entails a pragmatic erasure (or substantial modification) of frontiers and the opening of ambiguous routes toward concepts like “universal citizenship”, “diversity” or “identity” 1,2. Technology and migrations are, in turn, prominent epistemological pillars of Globalization 3: the former, with primarily instrumental bases, supports areas of communication, transportation, geographic exploration, and scientific development 4; the latter, characterized by mobilization and interactions, either voluntary or obligated but always massive and intense, of human groups until then distant from each other, create new demographic, civic, political, economic and socio-cultural realities 5.

Migrations have taken place from the beginning of human history. The intense change of vital everyday scenarios for migrants provokes intrapersonal and interpersonal disturbances, confrontation with conflictive realities, and not always favorable outcomes (6, 7). These experiences, lived for by migrants proper, internal and external displaced people and refugees, do have a critically relevant impact at individual, familial and socio-political levels 3,4,5.

It is estimated that a little more than 4% of the world population, approximately 280 million, is made out of migrants, with a marked increase in the last two decades 8. More than half of migrants are men, almost 10% are refugees and, towards 2018, almost 50 million people were exclusively counted as internally displaced, while the total of those considered displaced (internal and external) reached a world level higher than 80 million 9,10. Europe is the continent with the highest number of migrants, followed by Asia and North America; as far as countries is concerned, United States occupies the first place, followed by Canada, Australia, Sweden, Norway, France, Spain and England. The low and middle income countries (LMICs) and the African continent do have the highest proportions of refugees (86% of the total). Furthermore, the persistent conflicts between countries of the Middle and Far East generate equally high figures of displaced and refugees 11.

MIGRATIONS IN LATIN AMERICA

In Latin America, the migratory phenomenon shares in several of the characteristics noticed in other continents. Throughout a long period, the migration from Central American countries and Mexico towards the United States has been the most dramatic and intense; currently, it experiences a critical phase of overcrowding in both sides of the border, family separations, abandonment of children, the elderly and women, with a background of interminable political debates about its present and future management (12, 13).

During the first half of the 20th. century, other important migratory flows were recorded in Latin America. Brazil received migrants from Japan and Peru from China, whereas a majority of Italian and Spanish migrants settled in Argentina. During the 60s, the mutual migration between countries of the subcontinent did increase 14. As examples, a 12% of Belize’s population comes from Central America and, on the other hand, Chile provided residency visas to 275,000 Haitians in the last ten years 15, in addition to its continuous reception of immigrants from Peru, Ecuador and Colombia.

THE VENEZUELAN MIGRATION

From the beginning of this Century, another massive migratory wave has triggered in Latin America, with unique characteristics and a variety of implications, both for the protagonists and for the inhabitants of the host countries. Millions of Venezuelans have left their country due to the socio- political uncertainties generated by an authoritarian government, a notable economic debacle (in a country considered by decades, particularly in the second half of the past century, as one of the planet’s richest owed to its abundant petroleum resources) and the subsequent scarcity of jobs, massive poverty and collective malnutrition. The Venezuelan Migration (MV) was initially mainly oriented, as expected, to the neighboring countries in the Northern part of the subcontinent (Colombia and Ecuador), and has continued down towards the central, Southern and Eastern areas, currently reaching currently Perú, Chile, Bolivia, Argentina and Brazil. This article is the first of a series of four that will include specific inquiries into the MV’s impact on mental health, effects of the COVID-19 pandemic and migrant women’s response to the experience. Its main purpose is to examine the history and the evolvement of the VM, fundamentally in three of the host countries: Colombia, Ecuador and Perú. From this perspective, it will incorporate as far as possible, reliable figures, socio-demographic and economic characteristics of both, migrant and host populations.

A BRIEF HISTORY

A study, conducted in Colombia, identifies four 4 migratory waves coming from Venezuela in the last 20 years: the first three, slow and of small numbers and the latest, on the other hand, going beyond the most serious predictions (16, 17). In February 1999, Hugo Chavez Frias was elected President of Venezuela, and gradually started a process of radical political changes that, in turn, generated significant economic variations in all the population segments. Venezuela is, today, one of the ten countries around the world with extreme nutritional precariousness, scarcity of public services, low general quality of life and very low levels of health 18,19.

This process resulted in a sort of “selective migration” with a first wave, between 1999 and 2005, mainly composed of members of high entrepreneurial sectors, leaders and militants of opposing political parties; the second, between 2005 and 2009, by entrepreneurs, professionals and midline employees of the petroleum industry as a result of the massive firing from the state enterprise; the third, between 2010 and 2014 (Chavez died in 2013 and was succeeded by Nicolas Maduro), constituted by professionals and students of different disciplines and more middle class people; and finally, the fourth wave, from 2015 up to now, an authentic diaspora, made out, in its great majority by members of deprived and poor communities, vulnerable people in desperate search of surviving possibilities 17.

The first phase of this migratory process had the United States and Europe as its principal points of destiny; the second, Colombia, Panamá. Dominican Republic and other Caribbean countries, whereas the two most recent phases, named “the migrations of desperation” went towards Colombia, Ecuador, Peru and Chile, in addition to those that attempted to reach countries outside South America, mainly Central America and the Caribbean region (Trinidad Tobago, Aruba, and Curaçao) 20. The VM is, therefore, a humanitarian crisis, a regional emergency that has generated numerous international pronouncements, response and management actions of diverse order. Eleven countries of the region have dictated more rigid measures to allow the admission of potential Venezuelan migrants 21 which has produced, as expected, a significant increment of illegal migrants.

ODYSSEYS

Almost five of the almost seven million people that constituted the “fourth wave” (with an acme between 2017 and 2019), opted to seek residency in the three Andean countries mentioned above: Colombia, Ecuador and Perú. The journey of the great majority of these migrants has been the nuclear factor of numerous odysseys. It is not only the dramatic decision to abandon their native country, break social groups and family ties or face the unpredictable risks of cultural uprooting, but also the frontal confrontation with an uncertain fate as they were lacking in the most minimal resources. The different migrant groups, small or big and coming from different points, could coincide in purposes and even in designing the route to follow, but as they did not previously know each other, could also constitute potential sources of heterogeneity, discrimination, tensions, conflicts and distress.

In Latin America, the great majority of Venezuelan migrants displaced themselves by foot throughout a good part of the route, carried their children and very few belongings and, many times, their only source of food and sustainability was the charity of inhabitants of cities and towns along the way. Under these conditions, the nutritional level of the migrant population decreases significantly, their sleep pattern is disarticulated, discouragement gets bigger, and the tensions are accentuated. At the climax, the physical and mental health of these migrants suffer enormous consequences (22, 23).

As an example, the route from Venezuela to Perú covers about 4,500 kilometers. According to a study from the Migration Policy Institute of the United States, the journey lasts between one and 22 months, with an average of 2 1/2 months 24. It is estimated that only a 10% of those that cross the Rumichaca bridge, in the province of Nariño at the Colombo-Ecuadorian border, remain in Ecuador; the remaining continue towards Tumbes in the Ecuador-Perú frontier before entering the latter and, eventually, go on towards countries in the Southern Cone of South America. Those who decide to go to Brazil cross Colombia in successive North- South and West-East segments crossing forests and rivers through the aggressive Amazonia 25.

That is why several of the initial components of the experience in the host country constitute intense challenges including, for instance, procedures of formal registration, personal documentation, place and condition (temporary or definitive) of permanence, working possibilities, individual and collective security, familiarization with public places, socialization elements, linkage options, etc. (26, 27). In the following pages, the main socio-demographic characteristics of the VM process in Colombia, Ecuador and Peru are examined on the basis of carefully obtained and systematically evaluated information from scientific publications and documents of public and private agencies and offices. These characteristics shape up the socio-cultural and emotional impact of the process, which is the main objective of ongoing inquiries and future publications of our research team.

SOCIO-DEMOGRAPHIC ASPECTS

General characteristics

In 2020, Colombia kept on being the host country with the highest number of Venezuelan migrants and refugees, having accepted about 1,8 million, almost one third of the total 28. The numbers may not be exact due to the fact that not all the migrants are registered and many, in fact, enter illegally into the countries. In fact, it is estimated that in 2015 there were approximately 200,000 Venezuelans in Colombia, but, towards the third trimester of 2019, shortly before the onset of the COVID-19 pandemic, the number of migrants had reached almost two million 29.

The Colombian government guarantees to the migrants, independently of their status, the same rights of access to health services (mental health included) that applies to the country’s citizens. Currently, however, only 10% of the migrants do have an active health insurance in Colombia due to difficulties in the implementation of rules that would allow a formal access to the system 18.

On its side, Ecuador shares with Venezuela a series of historical and socio- cultural characteristics within the so-called “Bolivarian Spirit”. Except for two diplomatic conflicts (in 1928 and 1955), the relationship between these two countries has been very cordial. Since 2010, the flux of migrants became more pronounced and was even more intense at the beginning of the 2015-2016 biennium. In the first six months of 2018, approximately 4,000 people were daily entering the country, and the total number of migrants was 954,217, 69% of whom entered Ecuador with passport, and 30% with another personal identity document. From the population in transit, the majority between 18 and 35 years of age, 56% were men, 43% women, and less than 1% LGBTQ people 30.

The economic situation of Ecuador, with the fall of the petroleum price, adjustments and a 3% growth of public expenditures have made it difficult an adequate response of acceptance and protection to the Venezuelan migrants, thus aggravating their problems of mobility and their fight against discrimination and xenophobia 31.

Occupying the second place after Colombia as the final destiny chosen by the migrants, Perú has not been away from the type of social commotion that the VM has produced in the continent. It is estimated in almost 2 million, 92.6% of whom declared at the time of entry that they were planning to reside in the country, whereas 5.3% said that they would continue their way down to Chile, 1.2% to Argentina, and 0.6% to Bolivia. It is interesting that these figures, taken at the time of entry through the border zone of Tumbes, change when compared with the analyses from, for example, the International Organization for Migrations OIM, sigla in Spanish) which in 2018 reported a 23% of migrants going through Peru in route to other countries, particularly Chile (19%) and Argentina (3%) 32. During 2019, an average of 1,235 migrants were daily crossing the Ecuadorian- Peruvian border. In February 2020, 60% were traveling with members of their families and 35.6% did so, alone; 70.6% were men and 29.4%, women, whereas 3.8% were part of non-family groups composed by neighbors and/or friends 33. On the other hand, the May 2021 report indicated that at the place of destiny, 83% of the migrants were counting on family support, 15% had the support of friends, and 3% had a job offer 34.

After the establishment of the humanitarian visa in June 2019, the migratory flux descended considerably. In 2020, there were 1,043,000 Venezuelan migrants established in Peru, 500,000 of whom had requested asylum. Although the displacements through regular ways went down, the irregular mobilizations increased since March 15, 2020, with the border closing, mobility restrictions and the declaration of emergency status due to the COVID-19 pandemic 28.

Types of migrant populations

The Venezuelan migrant population in Colombia is formed by those that remain in the country, those “in transit”, the “returned Colombians”, the children of Venezuelan mothers born in Colombia and, last but not least, the so-called “pendular population” of Venezuelans that have a special permit, getting in and out on a daily basis by crossing points of the 2,219 kilometers long Colombo-Venezuelan frontier to buy, work or study and returning then to their housing quarters in Venezuela. In 2019, it was estimated that the total number of this population was 4’880,529 persons.

The “returned Colombians” that had migrated to Venezuela during the period of violence in their country, coinciding with the petroleum-based prosperity of the latter, had double nationality and summed about 500,000 between 2015 and 2020. In the first waves of the VN, many returned quickly, constituting then up to 75% of the migrants, whereas in 2019 they were only 10% 35. On their side, up to February 2020, the number of Colombian-born children of Venezuelan mothers was calculated in 43,540. According to a study of the Banco de la República, these children were given the Colombian nationality in order not to be left out as stateless (“apátrida”) and to have due access to health services 35.

Even though it was initially thought that the majority of migrants arriving in Ecuador would decide to stay in the country, less than 25% have done so in the last two years, and Ecuador has, then, been considered more as a “passing by territory” towards Peru, Chile, Argentina and other countries. Three fourths of the migrants use the Colombo-Ecuadorian border point of Rumichaca, and a close 72% the Huaquillas passing towards Perú.

The monitorization of the Venezuelan migrant flux towards Peru, through the city of Tumbes, conducted by the OIM in May 2021, identified 38% of men and 17% of women travelling alone, 18% of lactation-providing women, 13% of families with children younger than 12, 5% of children separated from their parents, 4% of pregnant women, and 3% of physically disabled people 34.

Geographic location of Venezuelan migrants

The entry of Venezuelan migrants in Colombia takes place in seven legally established points. According to the World Bank, the migrants converge in border zones (North of Santander, Araca and La Guajira) 35. Later on, most migrants locate themselves in cities and urban zones, somehow similar to those of their native country. A 65% of migrants reside in the 32 departmental capitals, and the remaining in different municipalities across the country. About 1/3 reside in the capital city of Bogotá, followed by Cúcuta, Barranquilla and Medellin 36. According to the 2018 census, Bogotá and 22 close municipalities harbor 425,120 Venezuelan migrants, a 4.8% of the near 9 million inhabitants of the capital.

The Bogotá municipality and Migration Colombia report that 79% of Venezuelans in the capital city live in low socio-economic areas (Levels 2 and 3, with 6 as the highest), peripheric zones, “neighborhood of invasion” and temporary hosting places with scarce public services infrastructure. The dynamics is similar to that of the internally displaced local population: migrants can mobilize more or less constantly within the city but also express a clear willingness and determination to stay (29, 36, 37).

From an approximate total of 360,000 Venezuelan migrants in Ecuador, approximately 120,000 do have a regular residency. Quito, the capital city, Guayaquil, Manta and Cuenca are the main localities where they have chosen to reside, even though many of those who have arrived recently look for smaller cities in search of labor and housing opportunities 31.

Lima, the capital of Perú, was chosen as place of permanent residency by 66% of the Venezuelan migrants, according to a survey of 1,235 persons in 2019. This is basically explained by a greater availability of jobs, transportation and public resources. It is understandable, on the other hand, that more than 25% decided to stay in five departments North from Lima and, therefore, closer to the border with Ecuador: La Libertad, (9.2%), Lambayeque (4.6%), Tumbes (4.2%), Ancash. (4.2%) and Piura (4%.). Less than the remaining 5% went to three cities in the South: Ica (2.3%), Arequipa. (1.3%) and Cusco (1% ) 32. According to data from the OIM, towards 2020, an 80.6% of Venezuelan migrants were residing in relatively deprived zones of several capital districts, and a minority in similar areas of the neighboring port city of Callao 38.

Age, gender and civil status.

Distribution by age groups is similar in Colombia and Venezuela. As it happens in many migratory processes, the Venezuelan migrant population is mostly formed by healthy, strong, capable and determined young people; it would also seem that in the face of risks and the uncertain fate awaiting for them, a good number of migrants are self-selected, so that those with more possibilities of success are, almost always, the first ones to leave their country.

That is why the structure of the Venezuelan migrant population in Colombia was showing the following characteristics around 2019:

Twenty-six per cent were young adults between 20 and 29 years of age, a proportion greater than in the Colombian population that had only 16.7% occupying this rank.

Children younger than 9 years of age constituted 23.8% of the migrant population vs. 16.7% in Colombia; on the other hand, those older than 65 were only 1.5% among the migrants vs. 8.9% among Colombians.

The proportion of men compared with women was major in the first migrant waves but, towards 2019, they were practically similar.

Two years later, the Quality of Life and Integration Survey of Venezuelan migrants in Colombia, performed by the Migra Venezuela project and published in March of 2021 39, showed that these tendencies remained. The percentage of elderly people is low and most of the migrants are active. About gender, however, the percentage of women became slightly higher: 51 versus 48.4% of men.

In general terms, the distribution by age groups and gender of the Venezuelan migrants in Ecuador does not significantly differ from that of their compatriots in Colombia.

In Perú, 42% of the residing Venezuelan migrants are young adults between 18 and 29 years of age, followed by adults (30 to 44 years) that represent 29.8% of the total. Eight percent are full adults from 45 to 59 years and 1.6%, elderly adults. Children and adolescents represent 18.7%; from them, 7.9% belong to the first infancy, 6.3% are between 6 and 11 years of age, and 4.5% are adolescents from 12 to 17 years (40, 41). About gender, 55.2% are women and 44.8%, men 32. In turn, 51.8% are married or living together, 45.2% single, and 2.8%, widowed or divorced.

Jobs and employment

In 2018, approximately 84.2% of Venezuelan migrants that arrived in Colombia during the preceding five years, were of working age; in 2019, 79.6% of them were already laboring, even though the largest part (53.5%) were doing it in the informal commercial sector, restaurants, hotels and services; the remainder were in the manufacturing industry, construction, agriculture, transportation, and real estate agencies. Their income levels were much lower than the minimum salary of Colombian workers, a reason for which it was estimated that 90% of the migrants did not qualify for healthcare coverage 35.

Labor and employment offer in Ecuador were, in general, similar to those in Colombia. In spite of several measures dictated by Government offices, the migrants do not seem to be sufficiently informed about them or were not determined to take the necessary steps.

In Perú, during the year 2020, 76.5% of Venezuelan migrants (the majority, young people between 20 and 39 years of age) had a job, but almost 40% of them were in precarious positions 38; they were not adequately inserted in the work market due, in many cases, to irregularities in their entry process and/or subsequent lack of formal work permits. Moreover, the fear of Peruvian workers to be substituted by the migrants exposed the latter to being victims of eventual rejecting behaviors 33. This resulted in a high number of migrants involved in modest and unstable street commercial activities (i.e., food selling) while hoping to obtain a temporal permit of permanence 33,40. Other lines of labor included transportation (i.e., truck helpers), restaurant services, casinos, bakeries, fast food chains, car washing, etc. (32, 41). Those making a regular salary were receiving a monthly average equivalent to U.S. $ 270 U.S.; professionals, $ 500; business, $150, and street vendors, approximately 8 to 10 U.S. dollars daily.

DISCUSSION

The massive, continuous and disorganized displacement of large groups of men, women, elderly and children, and the changes of every type that such situation induces among the migrants themselves and in the host communities, are of a considerable magnitude. Intracontinental migrations such as the VM in Latin America, are even more disturbing, because they shake the socio-cultural and politico-economic structure of the neighboring and, for the same reason, similar countries, making such negative impact much more immediately direct and devastating (2, 41, 42). The misfortunes of a Venezuelan migrant in Perú affect Peruvians much more than those of a Somali migrant do to their occasional hosts in the United States. It can be said that the migration opens up curtains of denial or ignorance on the side of the receiving communities vis-a-vis themselves; it creates a “new reality” that can be, however, as old as their own history; it generates changes and sequelae whose evidence was only intuited before.

In the matter of Human Rights, the United Nations Organization has adopted seven conventions that include the elimination of every form of racial or gender discrimination, international agreements on civil, political, economic and socio-cultural rights, conventions against torture and other cruel, inhuman or degrading practices, protection and rights for children, migrant workers and their families. These declarations imply, first, a complete registry of reliable socio- demographic information including data about life and work conditions, prevention of degrading and inhuman management, freedom of thought, expression and religious affiliation, maintenance of their own cultural values, prevention of disproportionate punishments, among them, expulsion, and facilities of access to education, health and social and financial services (43, 44).

The history and evolvement of the VM in Latin America have original traits even though they touch on many of the above mentioned areas 45. The number of migrants is probably the highest in the history of the subcontinent, and the political origin of the process has been much more intense than the one of previous displacements. Likewise, the processes of acculturation, educational and labor adaptation and social integration have been more painful than those expected among populations, communities or countries with a common historical origin; lastly, their current status and their outcome are even more uncertain, when not conflictive or costly, in economic and, essentially, in the human terms of the so-called “social capital” (46, 47).

For a profound study of these themes and their eventual impact on the individual and collective mental health, it is indispensable to examine in detail the process and the journey, as well as basic socio-demographic, occupational and economic information. Every migration implies a series of processes that put to a test the convictions, decision-making capabilities, temperamental traits, and moral principles of all participants. These perspectives will also focus on two additional points to be matter if further publications by this group: the impact of COVID-19 on the Venezuelan migrants and the particular experience of women migrants having their strengths and vulnerabilities confronted by the displacement process.

CONCLUSIONS

The Venezuelan Migration to Latin American countries is probably one of the social phenomena of the greatest impact in the continent since, at least, the second half of the last century. The complex variety of circumstances, amalgamated in a socio-political and economic reality unsustainable for millions of Venezuelans, resulted in their decision and the onset of a massive migration towards mainly three Andean countries (Colombia, Ecuador and Perú). The impact of this process in the migrant population as well as in the host communities has been intense and multiform. It has put to a test personal, family and group strategies of adaptation and resilience, as well as levels of tolerance, possibilities of empathy and acceptance, potential and/or declared forms of rejection or discrimination, and national systems of medical attention, physical and mental health, and social coexistence. A clear description of the socio-demographic characteristics of the migrant population offers not only substantial basis for an analysis of this process and its impact on the mental health of the affected communities, but also a constructive approach to the future, based on the reinforcement of the socio- cultural integration of the continent, and on cogent policies of reception, acceptance, solidarity and preservation of inalienable principles and rights.

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Financial sources: There have not been financial sources for the study.

Recibido: 07 de Febrero de 2022; Aprobado: 25 de Abril de 2022

Correspondence: Renato D. Alarcón. Av. Camino Real No. 961, Dpto. 2402, San Isidro, Lima 18, Perú. E-mail: Alarcon.Renato@mayo.edu

Authors’ contributions: RDA and EV conceived the original idea of the study and designed the plan of systematic search of pertinent information. All the authors participated in the search of articles and documents carrying research data of their original countries. RDA and AL wrote the preliminary manuscript version whose final text was revised and approved by all the authors. Likewise, all assume responsibility for the article’s content.

Conflicts of interest: The authors declare not to have conflicts of interest.

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