Barrio Adentro II: Victim of its Own Success

Venezuelan health care is moving forward. After spreading primary health care through the Mision Barrio Adentro all over Venezuela in just two years, by constructing thousands of doctor’s offices staffed mainly with Cuban doctors and sports trainers, Venezuela inaugurated the Mision Barrio Adentro II in June this year. An interview with its director, Claudio Letelier.
Barrio Adentro II Clinic, Clinica Popular Caricuao
Credito: Ronald de Hommel

Venezuelan health care is moving forward. After spreading primary health care through the Mision Barrio Adentro all over Venezuela in just two years, by constructing thousands of consultorios (doctor’s offices) staffed mainly with Cuban doctors and sports trainers, Venezuela inaugurated the Mision Barrio Adentro II in June this year. This second phase of the public health care program goes further than the first one, through the construction of hospitals, Integrated Diagnostics Centers (CDIs) and Integrated Rehabilitation Rooms (SRIs). The first 30 CDIs were inaugurated in June this year, just as the first 30 SRIs. In total, 600 CDIs and SRIs are planned for the coming years. These CDIs and SRIs will complement several newpublic clinics, which are also part of Barrio Adentro II.

One of such public clinic can be found in Caricuao, a suburb in south-western Caracas. This outer end of the city, with huge barrios surrounding it, is one of those places that many middle- or upper class Venezuelans would try to avoid at all costs. The area is known as one of Caracas’ most unsafe regions. A good reason to go there is however the clinica popular Caricuao. The Caricuao clinic started functioning one and a half years ago, as the first one in Venezuela under the Mision Barrio Adentro II program. Although most hospitals and clinics in Caracas are in a deplorable state, this one isn’t. The clinic is quite crowded, yes, but that is due to its own success. And the rooms and the halls are clean and tidy.

Director of the Barrio Adentro II Clinic, Clinica Popular Caricuao
Credito: Ronald de Hommel

The clinic, which occupies four floors, has its surgery rooms downstairs. While behind us a man receives surgery on his intestines, I am talking to Claudio Letelier, the 52-year old Director of the clinic. When I ask him why he supports the Bolivarian Process, he lowers his voice a bit, since there are many doctors, nurses and patients surrounding us. “Listen,” he almost whispers. “I live in the eastern part of the city. My family has an ultra-right background. We are a family of landowners. My parents did however also teach me about social responsibility. The health programs of this government are very beneficial for the people of Venezuela. I want to support them. That is why I am supporting this process.”

According to Letelier, who has been the Director of this clinic for only two months, the good shape his clinic is in can be explained by the fact that the people working in the clinic are supporting the health care system that they are working for. “Before, in some hospitals the situation was appalling. Patients were dying in the hallways, because of a lack of doctors or medicine. Nowadays, most of the hospital directors are supporting the Bolivarian process. That is why we can adapt to situations in a flexible way. If I urgently need a device that is not available in our hospital, I just call a colleague and we can arrange something.”

About an hour before, I started talking to Letelier in his office a few floors further up. Here’s my first question.

Mr. Letelier, the public hospital in Caricuao has existed for one and a half years now. How was the health service situation here before?

Before, people had to go to a military hospital, which was more than half an hour away, if you were lucky with transport. This place only was an ambulatorio (out-patient clinic), a place for consultations on minor health issues. 

The Caricuao hospital is part of the Mision Barrio Adentro II. What does this program in Caricuao look like?

Indeed, the hospital was the first one in the whole country to start under Barrio Adentro II. We offer a complete package of health services, all for free. In our hospital, we have departments for surgery, traumatology, dermatology, psychiatry, language therapy, dentistry and cardiology. Furthermore, we have a pharmacy, a laboratory and we do different forms of social work. Our work is flanked by 52 modules all over Caricuao, where mainly Cuban doctors, nurses and sports trainers are working. The doctors often direct patients of them towards us. We are also in constant contact with the health committees in the area. In Caricuao, there are 72 health committees, in which usually about ten community volunteers coordinate the health service on the most basic level. I meet with all of the coordinators each Saturday. Although we can deal with almost all forms of surgery here, we sometimes send patients to Cuba, as part of the Misión Milagro, for eye surgery. Another part of Barrio Adentro II are the CDIs and the SRIs. Although they are not ready yet in our region, the first ones will open here in the next months.

Do you consider the hospital to be a success?

Absolutely. In June we served 43,764 patients. The number of patients has been increasing steadily by about 25 percent each month. Our fame is traveling across the city borders already. We are not only popular in south-western Caracas, people come from places as far as San Fernando de Apure (about 300 miles to the south, ed.), because family members told them about our services.

Does the popularity of the hospital cause problems?

We are on the edge of our capacity limits, sometimes we trespass them. A few times we didn’t have enough food. The coordination of our logistics is now improving. Still, right now, at the end of July, we are already using our supplies for mid-August. I hope that after January, with new statistics and delivery plans, the situation will become better. Another factor is that in the coming months, three or four more Barrio Adentro II hospitals will open in Caracas, which will take off some pressure off of us.

Where do the employees in the hospital come from?

They all come from Venezuela. We cooperate a lot with the Cuban doctors in the barrios. Let me say something about them. Many people have a stereotypical image of them. According to them, Cuba is a dictatorship, all the doctors are communists and the quality of their work cannot be not as good as ours. The Cubans however come here to help. They are too professional to be occupied with politics; they come here on a purely humanitarian mission. 

A few weeks ago, the FMV (Medical Federation of Venezuela) demonstrated in the streets of Caracas, amongst others against presence of the Cuban doctors in Venezuela. According to them, they take away the employment of Venezuelan doctors. What is your comment on that?

Unfortunately, some of the medical organizations in Venezuela are very politicized. While there might be some unemployment among Venezuelan doctors in Caracas, there are many places in the countryside where there is a need for doctors, but where the Venezuelans don’t want to go. Anyway, Barrio Adentro has always been open for Venezuelans as well. There are some Venezuelan doctors participating in the program. And apart from that, within a few years the Cuban doctors will be substituted. As part of Barrio Adentro, a course of study was set up, the Plan Postgrados de Medicinas Generales Integral (Postgraduate Holistic General Practice). This education plan prepares young people in three years to become active in Barrio Adentro. We can expect the first 3,000 students to graduate in about two and a half years from now. They can all substitute the Cuban doctors.

The FMV also demonstrated for higher salaries. Can you understand that?

It is true that salaries for people working in the public health in Venezuela have been very low. While I, as a Director, am responsible for the well-being of my patients in this hospital, I am also responsible for a decent income of my employees. The demand for higher salaries is something completely independent from the perception of some of us of the Cubans.