Cuban Doctors in Venezuela Operate Free Neighborhood Clinics

The Barrio Adentro (Inside the Barrio) program is one of the government's most popular programs because it provides free healthcare to Venezuela's poorest. An extensive report on the program and its controversies.

CARACAS, Venezuela—“You can find the Cuban doctors at the clinic until noon, but then they continue visiting people in the neighborhood, house-to-house. It doesn’t matter what time it is, they are always there when you need them,” said María Elena León. “What the Cuban doctors have done, Venezuelan doctors have never come close to. I had a terrible lower back pain from December 16 to June 19. I lost 18 kilos [40 pounds]. No one could tell me what was wrong. I finally went to a Cuban doctor who diagnosed the problem and now, after the treatment I got for free, I have recovered.”

León, a resident of the January 23 neighborhood, a working-class district on the hills overlooking downtown Caracas, spoke to Militant reporters there October 8. Her view was typical of opinions expressed by the overwhelming majority of working people interviewed by the Militant in some of the poorest neighborhoods of Venezuela’s capital, as well as in four other cities and several rural areas of the country.

About 250 Cuban doctors, nurses, and technicians had served in Venezuela in recent years, arriving soon after Hugo Chávez was elected president in 1998. But their presence has increased exponentially this year under the Barrio Adentro (Inside the Neighborhood) program. Cuban doctors now provide basic health care to millions of Venezuelans in areas where the toilers had little or no access to medical services. Barrio Adentro was launched in the Libertador municipality of Caracas this spring. By early June, more than 1,000 Cuban doctors were serving in working-class neighborhoods, primarily in and around Caracas. Four months later, their number has more than doubled and their services have reached as far as the industrial city of Puerto Cabello in the state of Carabobo, and peasant communities in the mountainous areas of the state of Lara in northwestern Venezuela.

The more its popularity has spread in workers districts and peasant communities, the more Barrio Adentro has come under fire from the Venezuelan bourgeoisie and layers of the middle classes. El Universal, in particular, and other big-business dailies and TV stations have waged a virulent campaign against the program. Opposition politicians—who have been leading a two-year-old effort to topple Chávez with Washington’s support—charge that the Venezuelan government is “Cubanizing” the country. They also claim that the Cuban physicians are not here to save lives but are “Castro agents”—in reference to Cuban president Fidel Castro—brought to “indoctrinate the poor.”

The Venezuelan Medical Federation has denounced the program. On June 1 it asked the courts to bar the Cuban doctors from practicing. On August 21 the First Administrative Court obliged, ruling in favor of the Medical Federation’s request, a decision that the Venezuelan government is planning to appeal. Over the last month, anonymous threats of physical attacks against Cuban doctors have increased.  
Visit to January 23 neighborhood
More than 1.5 million people live in the January 23 neighborhood, a good number in makeshift dwellings. These were built by residents largely on land they took over, and for which they don’t have titles. Narrow streets wind up the hills to the neighborhood. Many people live in housing projects built in the 1960s and ’70s as prospective residences for the middle classes. According to local residents, however, these buildings were occupied at that time by working people, who ended the developers’ “gentrification” dreams. Since then, most projects have fallen into disrepair.

We started our journey there by visiting the Sergio Rodríguez ambulatorio, a neighborhood walk-in clinic taken over by residents a decade ago. It’s been run since the year 2000 by 20 local volunteers. Eleven doctors serve there, all Venezuelan, who are paid by the Libertador municipality of Caracas, the mayor of which, Freddy Bernal, is pro-Chávez. Visits and medicine are free, and the in-house pharmacy seemed well stocked.

“We are now trying to get more funding to extend operations to 24 hours per day, including weekends,” said Juvenal González Bolívar of the January 23 Community Network, who is in charge of organizing the volunteer non-medical staff. The clinic is now open Monday-Friday 8:00 a.m.-5:00 p.m. “The constant presence of the Cuban doctors inside the projects is part of the inspiration.”

“This clinic is an exception in Caracas, and most of the country,” said Omar González, who works for the Red Cross in the evenings and volunteers at the clinic’s pharmacy during the day. Virtually all ambulatorios are run by the Caracas city government, which has remained in the hands of the pro-imperialist opposition since Chávez’s election, and medical services are inadequate at best.

We arrived at the Sergio Rodríguez clinic at the beginning of the afternoon shift October 8. There is a lunch break from noon to 1:00 p.m. in all medical facilities, clinic personnel reported. The clinic was full, with about 50 people waiting in line. Sign-in records showed that doctors see about 230 patients on average per day. A number of patients come here with referrals from the Cuban doctors or for dental work and other procedures that Cuban physicians don’t have the facilities to provide inside the projects.

Support for Barrio Adentro was overwhelming among those we interviewed. “In their great majority, Venezuelan doctors work for lucrative benefits and pay,” said José Gregorio Frías. “That’s not true of the Cuban doctors. They treat us like human beings.”

A number pointed to problems they face from Venezuelan physicians and hospital administrators when they are sent by Cuban doctors.

“When someone goes to a hospital with a referral from a Cuban doctor, they are turned away or have to wait all day,” said Carmen Reyes. “One time, I went to the Elías Toro pediatric hospital, referred by a Cuban doctor, and they told me to go see Chávez if I had a problem. It’s a lie that the Cuban doctors are here to ‘indoctrinate’ people. Barrio Adentro is here to solve many problems and we are very appreciative of them, since the Venezuelan doctors don’t want to go up the hill.”

Aurora Bastida, the pediatrician at the Sergio Rodríguez clinic, said the problem is more serious. “The Venezuelan Medical Federation [FMV],” she stated, “has accused the Cubans of medical malpractice. A couple of months ago a child died. The FMV accused a Cuban doctor of prescribing the wrong medicine. The kid’s mother finally appeared on TV to refute the charges, denying that the child had received medicine from the Cuban doctor. She explained, instead, that she was turned away from one hospital after another until her child died. She named a number of hospitals and doctors who refused to accept the kid because she showed up with a referral from a Cuban.”

Other clinics in the area have hardly any work, even though they are bigger, have more modern equipment, and are in better condition, Bastida said. “Here we struggle to attend the patients. The city government gives us nothing. They claim they haven’t received funds from the national government. But then, how is it possible that we get some funding from the Libertador municipality, which has a lot less resources?”  
Other clinics are empty
A visit to two other clinics in nearby areas confirmed Bastida’s observation. The Caño Amarillo ambulatorio was in a much better condition than the Sergio Rodríguez clinic. But it was empty at 3:00 p.m. All the doctors had left. The nurse in charge, who did not give her name, showed us the facilities and said, “Medicine is free, but there is none.” She also said some of the equipment is malfunctioning.

At a second walk-in clinic shortly thereafter, we interviewed Rosa Martinson, the internist in charge. This clinic is much larger than the Sergio Rodríguez, with about the same number of doctors. In the afternoon, though, only two to three doctors are on site. They serve about 70 patients a day, on average, compared to 230 at Sergio Rodríguez. When asked why, Martinson said the problem is the attitude of most doctors, including a number who work there. “For them, it’s offensive to work in the barrio,” she said. “They’d rather work in the Caracas central hospital. They say this neighborhood is ugly. They look at the people here as dirty, smelly, and dangerous.” Martinson said she works there because she feels people need medical care.

When asked about Barrio Adentro, Martinson said the Cuban doctors are doing something virtually no Venezuelan doctor would do, and “I admire them for that.” But, she stated, “they don’t have the same level of training that Venezuelan doctors do.” She enumerated all her years of schooling, describing how she had gone to the United States for some of her training, and emphasized that Venezuelan doctors are using the latest technology, including the Internet. “In Cuba they don’t have the resources for this kind of training,” she said. When Cuban doctors serving in nearby housing projects don’t have medicine to give out, they send patients to Martinson’s clinic to get her signature on the prescription so they can get a 50 percent discount at the drugstore next door. Even though she has not found any fault so far with the prescriptions Cuban doctors write, Martinson said she still doubted their training.

The internist said she supports Chávez “because he is trying to make a change for the poor by democratic means.” Many Venezuelan families have divided over the Chávez administration, she said. Only her husband and two children have stayed in the country, Martinson stated. All her other relatives have left for the United States and now live in Georgia. “But don’t misunderstand me,” she added. “I like Chávez but I don’t support Fidel Castro at all.” In Cuba, she said, there are many scarcities and they have tried to have too much equality, “with disastrous results.” Martinson said she has a nice two-story house in Alta Mira, one of the well-off, middle-class neighborhoods, and she wouldn’t give that up.  
On to Bloque Adentro
A few blocks away, inside the housing projects of the Montepiedad section of the neighborhood, the Cuban physicians have a small doctor’s office in the Integrated Community Center. Four doctors serve there, two in the morning and two in the afternoon. When we arrived, both of the Cuban doctors had left—but not for a villa in a wealthy neighborhood.

Luis Casadiego, president of the Ali Primera committee and one of the organizers of the community center, said the Cuban doctors were out on house-to-house visits that afternoon as part of Bloque Adentro (Inside the Block). This is a new phase of Barrio Adentro. The Cuban doctors are now assigned a few specific areas. They visit every house and get to know everyone’s living conditions and health problems. And they spend more time doing house calls, sometimes after midnight.

“Their services and medicine are free,” Casadiego said. “Pretty much everyone knows where they live, since they stay at people’s homes and give their addresses to patients. They are called on for emergencies quite often in the evenings and on weekends. But the most important thing they are doing now with the Bloque Adentro is preventive medicine. We never even dreamed of that before.”

This was confirmed in many interviews on the street and in house visits by these reporters.

What was most striking in these interviews was the amazement by most people at the completely different social relations between the Cuban doctors and patients—compared to Venezuelan doctors.

“When you go to a social security doctor in Venezuela, you are just a number in their eyes,” said Joel Mierez, a resident of Montepiedad. “Sometimes they won’t even look up from their desk. They’ll check off your name, prescribe some pill, and send you off in minutes. But the Cuban doctors care for other human beings. They come visit us at home. They don’t mind the neighborhood. They talk to us and get to know us. They have improved the mood here.”

The January 23 neighborhood was infamous for its high level of crime. Even in July 2002, the last time Militant reporters visited here, we were told to be extremely careful. Some taxi drivers refused to take us there. But there’s been a noticeable change. There is a different atmosphere now, with more people on the street in the evening, more spruced up small parks with new playgrounds, better lighting, and above all many more people with smiles on their faces. Government funding for housing repairs and other projects—along with the presence of dozens of Cuban doctors—has a lot to do with the change.

Public works and other social programs by the Chávez government that have begun making a change for the better in the living conditions of working people across Venezuela include extensive construction of inexpensive housing, new subway systems in seven cities, a railway line linking Caracas with northwestern cities, and the building of a modern medical center for treatment of congenital heart diseases—one of the leading causes of high infant mortality—aimed at quadrupling capacity for complex operations.  
Class divisions over Cuban doctors
Because of the attacks by the opposition on Barrio Adentro, and their pleasant surprise at the human solidarity that permeates the conduct of Cuban doctors toward patients, many workers have become curious about the Cuban Revolution, about which there has been widespread ignorance within the working class. At the same time, the class hatred of the wealthy towards the Cuban Revolution has become more pronounced, and prejudices about the Cuban doctors, cultivated by the capitalist class, are evident among layers of working people.

Carmen Rosa González, a warehouse worker at Industrial de Perfumes, lives in Barrio Nuevo in the Chapellín neighborhood of Caracas. (See “Workers in Venezuela occupy plants” in the October 20 Militant for details on the occupation of the cosmetics plant that González is part of.) She accompanied Militant reporters in an October 3 visit to El Recreo community center near her house. Four Cuban doctors have an office there. El Recreo is on a street right on the border between Barrio Nuevo and an adjacent middle-class neighborhood that’s fenced in.

“There are a number of private clinics in the area, but there is no hospital or maternity ward anywhere near here,” said Flor Gómez, who volunteers at El Recreo. A single visit with a doctor at a private clinic costs up to 50,000 bolivars ($31), which is beyond the means of virtually everyone in Barrio Nuevo, Gómez said. Most of those who have jobs there earn close to the minimum wage of 200,000 bolivars ($125) per month, Gómez and others added. “But even for many in the middle class across the street, going to the private clinics has become too much,” she pointed out. “Given that El Recreo is right on the border, and not inside Barrio Nuevo, a number of residents from this middle-class area have begun to see the Cuban doctors too,” she said.

In response, Carmen Rosa González added, two Venezuelan doctors who are with the opposition opened their own walk-in clinic in the middle-class neighborhood offering free visits and free medicine, like the Cubans, twice a week for a couple of hours. González, Gómez, and others said most people in the area don’t know where this office is. “Let them do that!” González said. “Why didn’t they ever do that before?” Still these Venezuelan doctors won’t set foot inside Barrio Nuevo, she stated. Many Venezuelan doctors used to pay off the appropriate authorities so they would not have to serve in any rural areas, which they are supposed to do the first year after graduating from medical school, we were told.

Since the Cuban doctors had finished their shift in El Recreo when we got there in the late afternoon, González insisted on taking us to visit a nurse in Barrio Nuevo who organizes housing for the Cuban physicians. The nurse, who asked that her name not be used, said that a lot of political work still needs to be done inside Barrio Nuevo to get rid of prejudices promoted by the big-business media against the Cuban Revolution and the Cuban doctors. She was disturbed by the number of people in the Barrio, she said, who won’t accept a Cuban volunteer to visit them at home. They say things like, “Would they give me an injection and then take me to Cuba?” These are views born out of ignorance and are not rare in working-class neighborhoods. Most in the middle class don’t tend to believe such things. Knowing better, however, doesn’t lessen their hatred for the Cubans and their communist example.

Support for Barrio Adentro and admiration for the Cuban doctors among a number of workers we spoke with does not translate into identification with the Cuban Revolution and its political course, but a discussion has opened.

Carlos Enrique Rangel, a truck driver for Industrial de Perfumes who accompanied us during the visit to the January 23 neighborhood, said he thought a change in leadership to younger generations is needed in Cuba. Venezuela shows social change can be carried out in a “democratic way,” he said.

Later, during a coffee break at the home of José Landines, a co-worker from Industrial de Perfumes, Rangel listened carefully and at the end nodded approvingly at the comments of a neighbor, Celina Azuaje, who is a garment worker. She explained how she was fired from her job at the Confecciones Paramount plant along with 23 fellow sewers in February because she was “an outspoken Chávista” during the bosses’ “strike” that attempted, unsuccessfully, to bring down Chávez last December-January. When the discussion turned to Cuba, Azuaje said she didn’t know much about the Cuban Revolution. “I never learned how to read before, but I am taking literacy classes now,” she stated. “I have the gut feeling, though, that what we need in Venezuela is the kind of revolution they had in Cuba. That’s what I see from the Cuban doctors and the help Cuba has given with the literacy program.”  
Virulent opposition campaign
It’s the open expression of views like these that have struck fear in the hearts of the Venezuelan bourgeoisie, which has gone out of its way to wage war on Barrio Adentro.

“They gave them jobs without even seeing if they were doctors,” said Douglas León Natera, president of the Venezuelan Medical Federation, referring to the Cuban physicians in Venezuela, according to the August 22 Miami Herald. “This is causing big public health problems.”

León’s group has 45,000 members; all Venezuelan doctors are obligated by law to join the federation in order to practice. The federation filed an injunction in June seeking to bar the Cubans from practicing. The group’s leadership argued that Venezuelan law spells out what foreign doctors—and Venezuelans who have studied abroad—must do to practice medicine legally in the country. The Cuban doctors failed to undergo the yearlong process to have their foreign degrees validated by one of the nation’s nine medical schools, León claimed.

The FMV leadership also argued that the Cubans are “proselytizing” Venezuelan workers and peasants with communist propaganda. What’s more, León and other wealthy Venezuelan doctors contend, the country has far more physicians than international health organizations recommend for adequate public health coverage, about one for every 500 inhabitants. They also claimed that the Cubans are taking the jobs of about 8,000 Venezuelan doctors who are jobless or underemployed. The Chávez government should be improving Venezuela’s dilapidated public-health system and boosting doctors’ pay, which starts at about $600 a month, León said, according to the Wall Street Journal.

The views of León and others from the FMV leadership were widely disseminated and sensationalized with front-page headlines in a vicious campaign against Barrio Adentro led by the daily El Universal, which peaked in July.

On August 21 the First Administrative Court ruled in favor of the FMV’s request to bar the Cubans from practicing, saying they should be replaced by local doctors.

Venezuela’s health minister, María Urbaneja, called the decision “grotesque,” saying the government would appeal. She told an August 22 news conference that the Cuban doctors would stay in Venezuela and their numbers would increase. “There is not a court decision that can be above our commitment to provide health and well-being for the people,” she said, according to Reuters.

Urbaneja said the Cuban doctors were brought in because the government could not find enough Venezuelan doctors willing to work in working-class neighborhoods.

Miguel Requena, dean of the medical school at Caracas’s Central University of Venezuela, made a similar point, arguing that there is a genuine need for the Cuban doctors in his country. Few Venezuelan doctors care to work where they are needed most, he told the Wall Street Journal, as general practitioners in rural or urban primary-care clinics. Almost all the new doctors want to live in Caracas and other big cities and engage in lucrative specialties, such as plastic surgery, he said.

Earlier this year the Venezuelan government published a call for Venezuelan doctors to fill the positions now held by Cuban physicians, Aurora Bastida, the pediatrician at the Sergio Rodríguez clinic, told the Militant. “No more than 50 Venezuelan doctors volunteered in Caracas,” she said. “That was before Barrio Adentro was launched with the Cuban doctors. In Petare, one of the largest working-class neighborhoods of Caracas, only one came forward. It’s a lie that the Cubans are taking the jobs of Venezuelan doctors.”

Bastida also blamed the Venezuelan Medical Federation and the opposition for the sorry state of public hospitals and clinics. “In many states, opposition governors and mayors have shut down public hospitals or privatized them,” she said. “There are well-known cases of doctors telling patients they can’t perform an operation at a public hospital, and then giving them a business card for their private clinic where they do the same procedure for a hefty price.”

The Chávez government has said it intends to reorganize Venezuela’s health-care system by providing virtually free medical care to all through local clinics that emphasize preventive medicine. Down the road, Venezuelan doctors will replace the Cubans, Urbaneja and other government officials have said. But in the meantime the Cubans are “helping a population that’s excluded and very needy,” Urbaneja stated.

Under these conditions, the Cuban doctors in Venezuela have been very cautious, avoiding interviews and focusing on their work. “We are here to elevate the level of health care—that’s it,” said Cuban physician Laura González in August, according to the Miami Herald.

For its part, the Cuban government has publicly repudiated the barrage against Barrio Adentro. One such effort was a round-table TV program aired in Cuba in July, titled “The crude lies of the Caracas daily El Universal.” A transcript and a videotape of that program is widely circulating in working-class areas of Venezuela.  
A few native doctors emulate Cubans
The revolutionary example of the Cuban doctors has began to spread among a small, but significant, number of Venezuelan doctors.

Aurora Bastida in Caracas told us she belongs to the Bolivarian Federation of Doctors, a group of physicians who support Barrio Adentro and the efforts of the Chávez government to reorganize the country’s health-care system.

We found the most enthusiastic support for the Cuban doctors among a group of young Venezuelan physicians and medical students organized in El Cimarrón, a community-political group in Valencia, capital of Carabobo state, one of the most industrialized areas of the country. Two days before we visited there on October 7, Chávez had announced on TV that Barrio Adentro would soon be launched in Puerto Cabello, a coastal city near Valencia in the northern part of Carabobo. The city’s pro-Chávez governor had made arrangements to bring Cuban doctors there.

“We got agreement from the Ministry of Health to start Barrio Adentro in Valencia with a group of five of us,” said Joel Pantoja, 26, who graduated from medical school at the University of Carabobo this year. Since both the Carabobo governor and the mayor of Valencia are with the opposition, Pantoja said they will run this directly through the Ministry of Health, without bringing Cuban doctors there. Pantoja showed us an abandoned building in one of the working-class neighborhoods in south Valencia where the group of five young doctors plan to set up a small clinic and offer their services and medicine for free. The Ministry of Health has promised them funding for setting up the clinic.  
How the program began, spread
In a July 7 interview conducted by Cuban journalists Félix López and Ricardo López Hevia for the Cuban daily Juventud Rebelde, Víctor Felipe Tamayo, chief of the Cuban medical mission in the Libertador municipality of Caracas, explained how Barrio Adentro began.

“We started by meeting with people in the neighborhoods to select where the Cuban doctors would stay and where they would establish their offices,” Tamayo said. “In a spontaneous manner, the people began offering their houses and community centers. That allowed us to provide care to 724,000 inhabitants in 20 of the 22 districts in the municipality.

“On April 21, the first 54 doctors from Cuba arrived in Libertador. Now—with 627 doctors—we have served 564,898 patients, 25 percent of them in their own houses, and we have saved the lives of 699 Venezuelans.”

Tamayo pointed out that virtually all the Cuban doctors volunteering in Venezuela have served on at least one other internationalist mission before—in the Caribbean, Latin America, or Africa.

In another interview with the Cuban daily Granma, also published in July, Odalys Leyva González, chief of the Cuban medical mission in the Sucre municipality, a working-class neighborhood in a hilly area of northeast Caracas, said Cuban doctors first arrived there June 19.

“Sucre has a population of approximately one million, of whom 600,000 live in abject poverty,” González pointed out. Less than 20 percent of inhabitants there have full-time jobs, while 38 percent of children younger than 15 have never gone to school. More than half of pregnancies occur among women 18 or younger and about 6 percent of children up to six years old had never seen any doctor, the Cuban physician noted.

By late July, 500 Cuban doctors were serving in Sucre. “In October, another 642 specialists will arrive,” she stated, “allowing 100 percent coverage for the population, with one doctor for every 250 families.”

As respect for the Cuban doctors has spread among the toilers, some governors and other institutions have taken initiatives to bring Barrio Adentro to other parts of the country. This is the case in the largely mountainous state of Lara in northwestern Venezuela, whose governor, Luis Reyes, is pro-Chávez.

Nilda Collazo, from Las Tunas, Cuba, is one among 14 Cuban doctors, including two dentists, who have served in the peasant communities in the mountains there since July. “Up here,” Collazo told Granma reporters, “you find diseases long eradicated in our country. It’s rare to find a child who doesn’t suffer from parasites or a pregnant woman who has even once seen a doctor.… It’s a picture that brings out your human sensibilities.” Collazo became widely known and respected in the region when a child almost died from a snake bite at Los Portones, a rural community 23 miles from Barquisimiento, Lara’s capital. It was raining that day, and the only vehicle on site was not working. Collazo covered the kid in a blanket and walked with her for three hours to the nearest hospital. The child survived and Los Portones celebrated.

In recent weeks, as the opposition campaign against Barrio Adentro has faltered, anonymous death threats against the Cuban doctors have risen. Some Cuban doctors say they think the possibility will increase that they or their colleagues may be hurt or killed—as occurred in Nicaragua in the 1980s when Cuban doctors and teachers volunteered there when a workers and farmers government was in power. But, they add, that is the price they are willing to pay.

Source: The Militant