Barrio Adentro As Seen from the Perspective of a U.S. Health Professional

The process of change that is being brought about in Venezuela and
its positive results in the social area, supported by international
organizations is becoming a constant motive for study in academic
circles in the United States. An interview with a U.S.-Indian Doctor who visited Venezuela's Barrio Adentro mission.

By Dr. B. Padma
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The process of change that is being brought about in Venezuela and its positive results in the social area, supported by international organizations is becoming a constant motive for study in academic circles in the United States. The health mission Barrio Adentro (Inside the Barrio) is one of the areas of greatest interest.

This interest brought Dr. B. Padma, a doctor from Boston, specialized in endocrinology, diabetes, and metabolism, University Professor, and member of the American Association of Endocrinology to travel to Caracas last month to gain firsthand knowledge of Mission Barrio Adentro.

What follows is an interview that Dr. Padma gave to the press office of the Venezuelan Consulate in Boston upon her return.

What was the motivation to go to Venezuela?

I visited Venezuela for the first time in December of 2005. At the time, I had read a great deal about Hugo Chavez’s victory in a fair election in 1998, the general strike, the failed coup against the popular government headed by Chavez and the inroads that were being made in health, education and workers’ rights. After a very inspiring visit in December 2005, I decided to go back again in May 2008 as I was eager to experience the gains that were being made by the national accessible free health care program called Mission Barrio Adentro (Inside the Neighborhood). The program has drawn praise from the Latin American branch of the World Health Organization and the UNICEF. I am a physician with 12 years of experience in the U.S. and I believe that healthcare should not be a commodity and should be a fundamental human right. I had read extensively that the Barrio Adentro program was providing free and quality health care to hundreds of thousands of Venezuelan citizens who had never seen a doctor previously in their lives. I was excited to get the opportunity to take a tour and interview some health care professionals in Barrio Adentro II and III programs.

What is your opinion, as physician, of the Barrio Adentro Mission?

With the help of the Ministry of the Popular Power of Health and National Direction of Indigenous Health, I was able to get a tour of the Barrio Adentro II and Barrio Adentro III programs in May of 2008. Although it was a short visit, it was sufficient to give a very good idea of the tremendous work that is being done to prevent disease and promote the health of the Venezuelan people. I had a first hand experience of going to a clinica popular (popular clinic) in Catia which is a populous working class neighborhood in Caracas. I interviewed a nurse and the doctor who was on duty at the clinic. The doctor and the nurse were both from Venezuela, they were happy to be able to deliver care to patients completely free of charge. I was informed that the clinic treated about 200 patients a day for various ailments that ranged from emergency visits secondary to trauma to patients with diabetes, hypertension and related complications like heart attacks and cerebrovascular events. In addition, the clinic treated patients with gynecological problems and also had a pediatric unit to treat children. The clinic was spotlessly clean and provided x-rays, electrocardiography and other radiology services. It provided 24 hour services, which were accessible to everyone and was in keeping with articles 83-85 of the Bolivarian constitution that enshrine free and quality health care to all citizens. I also visited an Integrated Diagnostic Center (CDI) and Integrated Rehabilitation Services (SRI) about which I will mention later. I had the distinct pleasure of meeting with the director of Barrio Adentro 3, a dynamic nephrologist, and her staff. The Barrio Adentro III program is upgrading and providing state of the art equipment and infrastructure to the existing hospitals in the country many of whom were deliberately neglected by previous administrations. In 2006, 42 hospitals were chosen for upgrades, which now has been extended to more than 90 hospitals. The final goal will be to improve all the 300 hospitals in the country. The Director of the University Hospital in Caracas told me that the premier teaching hospital in the country is a direct beneficiary of Barrio Adentro 3 program. It is known for its excellence in cardiac surgery and neurosurgery and offers free tertiary care to the population.

The Barrio Adentro program with its dedicated group of health care professionals is aiming to place free and quality primary health care as the cornerstone of the national health care system. Since its inception in 2003, it has delivered health care, both preventive and therapeutic, to vast sections of the population that previously never had set eyes on a doctor. The statistics are impressive-more than 2,700 community health centers (Consultorios Populares) have been constructed and more than 3,000 are under construction. The newly established Comprehensive Diagnostic Centers under Barrio Adentro II have handled more than 800,000 emergency room visits and since 2003 the doctors in the program have conducted over 40 million consultations. In my opinion, the Barrio Adentro program which coordinates with the subsidized pharmacies program called SUMED (Distribution of Medicine) and Mission Mercal (a network that distributes food and commodities at low cost) is emphasizing a holistic approach to health care.

What do you think of the Venezuela-Cuba collaboration?

The Venezuela–Cuba collaboration is based on human needs and not on profits. It is a beautiful example of international solidarity. This was a very heartening experience to witness first hand. It is well known that the Venezuelan government did not get a satisfactory response in 2003 when it appealed to the Venezuelan medical community to work in medically underserved areas in the country. The Cuban medical professionals on the other hand volunteered to be part of the humanitarian mission to deliver care to remote parts of Venezuela where doctors previously had seldom set foot. It is also well known that the Venezuelan government has been helping Cuba with its oil needs. There are more than 25,000 Cuban health professionals and about 10,500 Venezuelan health care professionals in the Barrio Adentro program. Recent statistics indicate 12,272 Cuban doctors and 1,935 Venezuelan doctors in the program.

I had the opportunity to tour a Comprehensive Diagnostic Center (CDI) and the Comprehensive Rehabilitation Center (SRI) which was attached to the CDI, both part of the Barrio Adentro II program in a middle class neighborhood called Los Dos Caminos in Caracas. The CDI and SRI have Cuban professionals from doctors and nurses to podiatrists, occupational therapists and speech therapists. The CDI had a well-stocked emergency room, an ICU with 4 beds, a general ward with several beds to treat illnesses from pneumonia to diabetic emergencies. I interviewed a patient a truck driver with diabetes and cellulitis (skin infection) who was touched by the loving and dedicated care he had received. He said it was fortunate to have Barrio Adentro to help poor patients like him who cannot afford treatment in private clinics. Patients were booked for endoscopic procedures on a routine basis. There are state of the art interventions available to treat patients with conditions like heart attacks, sepsis, asthma and heart failure.

I spent hours talking to the physician in charge whose responsibilities include seeing patients, teaching and some administration. She was happy with the successes of the Barrio Adentro program in saving lives and in promoting health care to communities that had very little access previously to health care. However, she was equally honest about the need to fight infectious diseases like dengue, malaria and diarrheal illnesses in Venezuela. Cuba of note has eradicated malaria since 1968, there have been no cases of diphtheria since 1971 and there are very few cases of gastroenteritis. Recent statistics in Venezuela are very heartening. There is a drop in the infant mortality rate from 21.4 per 1000 live births in 1998 to 13.9 at the present time. This is likely from expanded vaccinations program and reduction in infectious diseases. Every Cuban professional that I met exuded compassion and a passion to help their fellow human beings regardless of their color, nationality or political affiliation. They felt that serving the health care needs of people was of utmost importance and they would stay as long as they were needed. However, there was general optimism that Venezuela under the Bolivarian process is training enough medical professionals whose presence in the Barrio Adentro program will be increasingly seen in the future.

Is there something like Barrio Adentro in the US or India?

There is no program like the Barrio Adentro in the United States or India that I am aware of. The U.S. has some of the best doctors and hospitals in the world. However, it is no secret that more than 45 million Americans are without health insurance. Uninsured people don’t often seek medical care except in an emergency situation. They are afraid of being saddled with debt. Among others, the Physicians for a National Health Program (PNHP), which has more than 10,000 chapters in the U.S, is advocating a comprehensive universal health care program to all Americans. The Indian health care system is one of the most privatized in the world. 40% of hospitalized Indians are forced to sell assets or borrow money. While a small section of the Indian population has prospered under neoliberal policies, the vast majority is being pauperized and is at the mercy of private hospitals and doctors in private practice.

Any thing else you would like to add?

I did not directly experience the work being done by the Barrio Adentro program with the indigenous population in Venezuela who make up more than half a million. However, my conversations at the Ministry of the Popular Power of Health and National Direction of Indigenous Health were very positive. A doctor and dentist in the Ministry said that the public health system being built in Venezuela is sensitive to different people and cultures. The system is against having a paternalistic attitude and is encouraging the indigenous communities to be partners in their health care.

Finally, I would like to share two of my favorite quotes with you. One is by Reverend Martin Luther King who said "Of all the forms of inequality, injustice in health care is the most shocking and inhumane." The other quote is by Rudolf Virchow the public health activist and pathologist who said “Health is Politics and Politics is Health.” Cuba has showed us that a band aid approach will not eliminate disease and health care has to be in concert with a radical political and social transformation of the society. Now, Venezuela, through the Bolivarian process is addressing the injustice and inequality in health care through Mission Barrio Adentro and other social programs and this simply would not be possible if there was no political will.