Coming to Venezuela to witness the revolution and the social missions at its heart, I have ended up having a closer view of one of the most important missions – Barrio Adentro (Into the Neighbourhood) – than I might have hoped. Or cared for, for that matter.
Barrio Adentro was established around two years ago as a way to bring free, quality health care to the poor majority, in whose neighbourhoods doctors in the past have mostly shunned and who can often not afford the fees charged. In order to get Barrio Adentro off the ground, the government invited Cuban medical volunteers to help staff the clinics established in the poor areas, whilst Cuban doctors (sociailst Cuba has a world renowned health care system and an internationalist approach, with more doctors volunteering abroad than the WHO) teach courses in the free Bolivarian University in order to create a new generation on Venezuelan doctors to replace them. There are currently more than 20 000 Cuban medical personal in the country.
The Venezuelan government invited the Cubans in after first attempting to recruit Venezuelan doctors to the cause. However only around 50 Venezuelan doctors raised their hands, most – a product of the old system based on using their careers to make themselves more comfortable – declining the governments offer of a US$600 monthly stipend to bring health-care to the poor. The Cubans, who accepted $200 per month, have taken to their roles and proven a big hit with the community. Not being in it for the money, but out of genuine humanitarian concerns, they treat their patients with genuine consideration and respect and have only their best interests at heart.
The Venezuelan revolution is creating new ideals in people, however, and thousands are studying in the Bolivarian university to take the Cubans place. It is a requirement of this free course, which requires only a year 12 certificate to enter, that those who graduate work in the poor areas, rather than take their skills to set up private practices to get rich.
I got to see the Cuban doctors in action, and get a comparision with their private counter-parts, while in the state of Bolivar as part of the first Australian-Venezuelan solidarity brigade. I was lucky enough to become one of the 1% of victims of travellers diahrear to be hospitalised. While out travelling on a bus with a 10 other participants and a handful of Venezuelan comrades, I was struck down with a particularly bad bug. I started getting sick on Saturday, but the usual anti-biotic treatments wasn´t working and I was just getting worse. It became impossible to even take medication because I was throwing what ever I ate back up.
By Monday arvo, I was sick enough that the comrades decided to take me to a health clinic to get treatment. There was no Barrio Adentro clinic near where we were in Porto Ordaz, so they took me to the nearest private clinic. The first thing they asked when we walked in was could we pay. The short answer is, without travel insurance, no way. I didn´t have the money available myself, but another comrades was able to cover the costs on the basis of being re-imbursed through travel insurance later.
The doctor came and did a few basic tests, such as hit my stomach and take my blood pressure, and asked me some questions. The doctor then diagnosed me as having e-coli, which turned out to be wrong, and wrote some prescriptions. I was so dehydrated by this stage I was hooked up to a drip to rehydrate. This took two hours max, for which I was charged 250 000 bolivars, or a bit under $200 Australian dollars. On top of this, the anti-biotics I was prescribed, which turned out to be wrong anyway, cost 64 000 bolivars, or over $40.
We had gotten back to Cuidad Bolivar where we were based, but I was getting sicker still, and wasn´t able to hold down the anti-biotics prescribed. The comrades, seeing how sick I was, took me to the nearest available hospital, a private hospital that took me in, hooked my up to the drip and gave me anti-biotics that way. At this hospital, I had a large, private room with a tv and a bed for my partner to stay in. The room was undoutedly very nice, but the treatment was simply not working. They pumped me full of a number of anti-biotics while I failed to get better. The costs involved were enormous, the day and half I was there cost over $1000, way beyond my payment means, but again another comrade was genorous enought to cover the costs until travel insurance could cover it.
After a day and a half of not getting any better, the Venezuelan comrades were determined to take me to Barrio Adentro to be treated by the Cubans. The Cubans, looking over the treatement records, were extremely cynical about the private hospital, beleiving they were merely pumping full of drugs and charging me money, regardless of whether or not I was getting better. They were shocked by the records of what I had been given, claiming it was not the right treatment for what I had. Their explantion seemed too cynical to me, it struck me as probably more a question of culture of treatment, with the private hostpial stuck in a ´pump them full of drugs´mentatlity, which isn´t always the most effective, rather than being consciously negligent.
But one example brought home vividly what is wrong with how they operate. It had become clear than one anti-biotic in particular was making me throw up. When it was put on in the middle of the night, with nothing in my stomach, it had caused my to throw up bile. The next day (just before I was moved to Barrio Adentro), my friends visiting explained repeatedly and with increasing urgency to the nurse who was about to put this drug on the drip that I had a violent reaction to it. But the nurse had her orders from the doctor and that was what she was going to do. Eventually however, she was persuaded to go and talk to the doctor. She came back shortly and said the doctor had told her to put the drug on the drip regardless. She put it on. I instantly threw up. I threw up the food, and most importantly, the pills I had just swallowed. It was clear I wasn´t going to get better very quickly with this sort of treatment, for which I was being charged an arm and a leg.
I left this hospital no better than I entered it and was driven to the Barrio Adentro clinic staffed by the Cubans. It is a new clinic, only built three months ago, part of the extension of the mission through Barrio Adentro II. It is a modern, clean building staffed by 30 doctors with 8 – 10 nurses. There are three hospital beds, one of which I got, plus two beds for intensive care. The main function is for the doctors, as well as looking after those patients staying there, to see people who visit the clinic in the mornings and to go out on trips around the communities in the afternoons.
The doctors set me up with a much simpler drug regime, avoiding the drug that I had the reaction to – which they said was wrong anyway. I didn´t have a private room and tv, instead I shared the room with two other patients. It was definitely not as luxurious as the private hospital, but it was definately functional and I hadn´t come for a holiday, but to get better.
The treatment I recieved from the Cuban doctors was very effective, and I started to feel better by the next morning. I continued to get much better quickly and, although still weak from the illness, I was able to leave in under two days, sooner than they had expected, to continue anti-biotic treatment myself.
While I was there, despite language barriers, I was able to observe how the Cuban doctors operated and related to the patients. The doctors are extremely friendly, warm and genuinely compassionate. They clearly have real feeling for their patients and have personal investment in them getting better. Without financial incentive, there is no other explantion for why they do what they do, and why they clearly put so much into it. The doctors treat their patients, not just with respect, but informally as equals. The formality that surrounds most doctor-patient relations didn´t exist from what I could see with how they related with the Venezuelan patients. Genuine affection and friendship was shown between them.
The other thing that struck me was the way the Cuban doctors operated collectively. You could see them regurlay have collective discussions amongst themselves about the patients and treatment. When there is a change of shift, one of the doctors who has been on takes all of those coming on shift to each patient one by one explaining what the situation is. The treatment of a patient is not the responsibility of an individual doctor, but is taken collectively. When I was told I could go, the doctor informed me that they had had a discussion about me, and decided I was well enough to go.
One other noticeable thing, compared to pretty much everywhere else I have been in Venezuela, is the absence of political material inside the clinic. This is a country where revolutionary graffiti, beautiful murals or political posters are everywhere and dominate in the revolutionary instutions. But it is missing inside Barrio Adentro. The reason is quite simple – health care is for people, regardless of politics. Anyone who needs treatment is made to feel welcome. The opposition claim the Cubans are here to indoctrinate the Venezuelan people, but I didn´t see any evidence whatsoever. They didn´t strap me to the bed and read Lenin´s State and Revolution, or start on those four-hour long Fidel Castro speeches. Their only propaganda is the propaganda of the deed.
And, of course, all of the treatment was completely free. I was not charged a cent. Not for the bed I slept it, not for the food they fed me, not for the drugs in the drip. When I left, they didn´t give me a script for anti-biotics to go fill out at my own cost at a pharmacy. They handed me the anti-biotics I needed for free.
My experience with Barrio Adentro was extremely limited. I didn´t see a large part of their work that involves both preventative and diagnostic work with the community. But my experience was extremely impressive. It isn´t hard to see why the program is so popular with the people, especially when the costs involved in private treatment are considered. What would the poor do without Barrio Adentro?
I am deeply grateful for the treatment I was provided. The Cuban doctors are the product of a socialist revolution, and Barrio Adentro is a key program in the struggle in Venezuela to build a "new socialism of the 21st century." I can testify first hand that sociailsm does make you feel better!
You can read this article from Venezuela Analysis
http://www.venezuelanalysis.com/articles.php?artno=1510 about a Barrio Adentro II clinic in Caracas similar to the Cuidad
Bolivar one I was in.