Free Neighborhood Clinics Spread Across Venezuela

Barrio Adentro is a government-sponsored program that has brought thousands of volunteer Cuban doctors operating free neighborhood clinics in working-class districts and rural areas across the country where workers and farmers have had little or no access to health care.
In the remote poor neighborhood of El Winche in Caracas, free access to doctors is just a few blocks away 24 hours a day.
Credit: Martin Sanchez, Venezuelanalysis.com

Valencia, Venezuela—“This state and this city, in particular, were a test case for Barrio Adentro,” said Joel Pantoja, a doctor who graduated last year from the medical school at the University of Carabobo. Pantoja spoke on March 17 to Militant reporters in this major industrial center and capital of Carabobo state.

Barrio Adentro, which translates roughly as “Into the heart of the neighborhood,” is the name of a government-sponsored program that has brought thousands of volunteer Cuban doctors operating free neighborhood clinics in working-class districts and rural areas across the country where workers and farmers have had little or no access to health care. This is one of the social programs launched last year, along with nationwide literacy campaigns now involving 4 million, that have spread around the country with aid and volunteers from Cuba.

The state government in Carabobo and the Valencia city administration have been in the hands of the pro-imperialist opposition since Hugo Chávez was elected president of Venezuela in 1998. The coalition of opposition forces, Coordinadora Democrática, and the Venezuelan Medical Federation have waged a virulent campaign against Barrio Adentro, charging that Cuban doctors are here as “agents of Fidel Castro” who came not to save lives but “to indoctrinate the poor with communism.”

On a previous visit last October, Pantoja and a handful of other Venezuelan doctors told Militant reporters they were trying to start Barrio Adentro themselves in Valencia, since it seemed that Cuban doctors would not set foot in Carabobo until the local and state governments changed hands. Until the end of 2003, authorization by local governments was required to bring in Cuban doctors.

Pantoja said there are now 1,200 Cuban doctors in Carabobo, about half of them in Valencia’s working-class neighborhoods. A total of 10,000 Cuban doctors are now working in the country. Their numbers have increased five-fold since October, according to figures in the Cuban press and reports by the Libertador municipality of Caracas, where the program was launched.

Hilario Padrino, a traumatologist who serves as the Venezuelan coordinator for Barrio Adentro in Carabobo state, confirmed these figures in a March 17 interview in his Valencia office.

To cut through the obstacles to Barrio Adentro in the eight states where the government is controlled by forces allied with Coordinadora Democrática, the national government declared all neighborhood clinics operated by Cuban doctors to be primary care centers under the jurisdiction of the national Ministry of Health, Pantoja said. As a result, approval by local authorities is no longer needed to bring volunteer doctors from Cuba. So Barrio Adentro has now reached virtually every corner of the country. “The victory in Carabobo was a watershed for the spread of the program,” Pantoja said.  
How the program spread

About 250 Cuban doctors, nurses, and technicians had served in Venezuela for about five years, arriving soon after Chávez’s election. But their presence has increased exponentially since last spring, when the government launched Barrio Adentro in the Libertador municipality of Caracas, whose mayor, Freddy Bernal, is one of the figures in the party led by Chávez, the Fifth Republic Movement. The Ministry of Health first appealed to Venezuelan doctors who were willing to live in the working-class areas and offer their services to residents for free, with a salary of about $600 a month paid by the government. Very few came forward.

Through an agreement with Havana, large numbers of volunteer Cuban doctors, most of whom have carried out internationalist volunteer missions in other countries, began arriving in March 2003. The Cuban doctors receive a stipend of $250 a month to cover living expenses. They live in workers’ homes in the areas where they serve, operating clinics out of community centers and other facilities. They provide much of the medicine, which is donated by Cuba, free of charge. After receiving morning patients at the walk-in clinics, in the afternoons they visit residents in the neighborhoods assigned to them and practice preventive medicine. Venezuelans interviewed by the Militant were virtually unanimous in saying that the Cuban doctors—unlike many Venezuelan doctors—treat them as human beings, answering their calls after hours, even in the middle of the night. (For more details see “Cuban doctors in Venezuela operate free neighborhood clinics” in Nov. 3, 2003, Militant.)

As the program’s popularity began to spread last year, Barrio Adentro came under fire by many capitalists and upper- middle-class layers. The Venezuelan Medical Federation spread false rumors accusing Cuban doctors of malpractice, and on June 1 it asked the courts to bar Cuban volunteers from practicing in the country. A lower court ruled in favor of the Medical Federation but the government appealed the decision. While the legal challenge to the program has not yet been completely resolved, the exemplary conduct of the Cuban doctors has begun to defeat the anticommunist propaganda campaign against the program.

At the same time, physical threats against the doctors have mounted and in some cases have been carried out. One Cuban doctor was killed last year in Araguá state, and a Venezuelan assistant to a Cuban doctor was killed in the Petare neighborhood of Caracas, said Ricardo López, a Cuban doctor who works in the January 23 neighborhood of Caracas, in a March 19 interview. A Venezuelan facilitator of literacy classes was also killed in his car in another Caracas neighborhood in late February, workers in the area said.

Many working people said that a slogan promoted by some supporters of Coordinadora Democrática during opposition rallies has been, “Be a patriot, kill a Cuban doctor.”

Security for the Cuban doctors has substantially improved since last year, said Luis Casadiego, who coordinates a community center hosting a clinic with Cuban doctors in the Montepiedad section of the January 23 neighborhood. “That’s why assassinations have remained few and physical attacks have begun to concentrate more on Venezuelan assistants,” he said.  

A local house in Las Brisas, Caracas, was equipped with an industrial kitchen and turned into a "House of Nutrition" (Casa de la Alimentación) where malnourished kids receive meals everyday. The government's Nutrition Institute provides the ingredients for the meals and local personnel receive a salary for their daily work.
Credit: Martin Sanchez, Venezuelanalysis.com

Sharp class divide

Many class contradictions are evident, however, among those backing the Barrio Adentro program.

Joel Pantoja said he and another 10 young doctors he knows in Valencia immediately volunteered to assist the Cuban doctors who began arriving in Valencia in December. “We were flatly turned down by Padrino,” Pantoja said, “who claimed we were troublemakers.” Pantoja said he and these other young Venezuelan doctors have led many public protests in the city demanding more radical measures against the economic power of the pro-imperialist opposition trying to overthrow the elected government.

The national government launched Barrio Adentro about a year ago, first by calling for Venezuelan doctors to step forward. About 50 volunteered nationwide at that time.

In the March 19 interview, Padrino acknowledged that 65 Venezuelan doctors had come forward in Valencia since December. “But they don’t have the kind of training Cuban doctors have,” he said, “especially for servicing working-class neighborhoods and living there.” A retraining program has been established for these doctors, Padrino added. “They can sign up to finish some additional medical and social relations courses in order to enroll in Barrio Adentro.”

Pantoja said that in many areas of the country, Barrio Adentro is in the hands of Venezuelan coordinators like Padrino. He and his group, Pantoja added, have developed working relations with the Cuban doctors anyway, and have helped out in a number of the neighborhood clinics that Cuban doctors operate. “We’ve also signed up for the retraining course Padrino set up,” he said, “in order to eliminate that obstacle too.”

When asked if the goal in Venezuela is to emulate the Cuban health-care system, which offers medical care as a universal right that is free of charge, eliminating medical practice as a business, Padrino replied, “Not exactly.”

“Our goal is to provide health care to the poor,” Padrino said. “But those who have the resources and want to go to a private clinic should still be able to do so.”

Padrino himself is the owner of a large private clinic in Valencia.

“This is what I and the other doctors I collaborate with are battling against within the pro-Chávez camp,” Pantoja said. El Cimarrón, a political community group Pantoja helps lead, has now reached the conclusion, he said, that what is needed in Venezuela is a health-care system like that in Cuba, “which means a social revolution is needed to bring it into being.”

Many of the social programs being carried out in Venezuela today may seem similar on the surface to those in Cuba, Pantoja noted. But they have a different class content and dynamic in a state where the working-class has taken political power than when run by a capitalist government.  
Scope of Barrio Adentro expands

Despite these contradictions, Barrio Adentro is now expanding not just in numbers of volunteer doctors and geographic area but in scope. While in the January 23 neighborhood of Caracas, Militant reporters visited several of the new “modules” built every several blocks in that district. “Thirty-eight of them are under construction,” said Casadiego, in a neighborhood with a population of 1.5 million. “Two were just inaugurated last week.”

These are two-story structures. The bottom floor will be the walk-in clinic while the top is a small apartment that can comfortably accommodate two doctors. The modules are being built with government funds and will provide better facilities for the Cuban volunteers. Until now, all Cuban doctors volunteering in these neighborhoods have been living in the homes of people who offered to host them.

Popular clinics, scheduled to be built starting this year, will expand primary care offered through the modules operated by the Cuban doctors, said Casadiego. They will include modern equipment and a larger number of doctors specializing in various medical skills so they can offer minor surgery, dental care, and other such services. “These clinics will replace the state-owned ambulatorios,” Casadiego said, referring to walk-in clinics built under previous regimes that have largely stopped functioning in most working-class neighborhoods. “The popular clinics will offer free medical care to all, regardless of income,” he said.

These clinics are supposed to be staffed by a combination of Cuban volunteers and Venezuelan doctors, we were told. About 500 Venezuelan youth are now studying in the Latin American School of Medicine in Havana, Casadiego and Pantoja reported. “The first contingent of them to graduate will be among the first to staff the popular clinics,” Casadiego said.

Pantoja said he was skeptical of how this will all work, given the initial challenges to Barrio Adentro faced by revolutionary-minded Venezuelan doctors in Valencia.

“But one thing is for sure,” Pantoja added. “The impact of the Barrio Adentro program can now be felt across the country in most urban centers. For the first time in decades, congestion and long lines have begun to ease at emergency rooms in a number of major hospitals.” This is a measurable, statistical impact, we were told by a number of Venezuelan doctors and others in Caracas, Valencia, and elsewhere.

As a result of the expanding and widespread activity of Cuban volunteers throughout the country for two years, and the growing numbers of Venezuelan students going to Cuba for three-month stints at Cuban schools, there is evidence that anticommunism and prejudices against the Cuban Revolution, which were more noticeable during an earlier Militant reporting trip to Venezuela in 2002, are substantially less now.  
‘Half the population is studying’

Cuban volunteers—numbering about 15,000 throughout the country—include agricultural specialists, physical education teachers, and trainers showing Venezuelans some of the most effective methods to eliminate illiteracy.

On the evening of March 19, some 15 students were taking part in a Mission Ribas class in the Sierra Maestra section of the January 23 neighborhood, on the hills overlooking downtown Caracas. All were workers. The oldest, Deusdedit Palacios, 54, is an auto mechanic. The youngest, Galaxo Orrellana, 23, is a cook. Most of the students were women. They included Marbani Castillo, 25, who has three children and is unemployed, and Elida Liendo, 40, a former garment worker who now does laundry at home for people in the neighborhood after losing her sewing job.

Mission Ribas is the second major literacy program that has mushroomed across the country. Its goal is to teach mathematics, geography, grammar, and English as a second language to adults who have not graduated from high school. After a preliminary course of six months, students who pass a basic test go on to the program’s last phase, which lasts two years. Classes are from 6:00 to 9:00 on weekday evenings. The aim is for everyone to get a high school diploma in half the time it takes at public schools. According to government statistics, publicized in displays at a March 20 pro-government rally in Caracas, nearly 1.4 million people are currently enrolled in the program.

The aim of Mission Robinson, which preceded Mission Ribas, is to teach reading, writing, and arithmetic to 1.5 million people who are illiterate—about 12 percent of adults in this country of 24 million people. Literacy classes are taught by some 100,000 volunteers, most of them university students. The Cuban government donated more than a million TV sets, VCRs, reading glasses, and literacy manuals used in these classes. In some cases—such as the indigenous village of Mapiricure in Anzoátegui state, inhabited mostly by Cariña Indians, which Militant reporters visited March 24—Cuban volunteers are organizing the translation of literacy manuals into the indigenous languages. The first phase of Mission Robinson lasts three months, during which students learn the alphabet and basic arithmetic. Mission Robinson II lasts six months. Since the program started last July with substantial aid and volunteer trainers from Cuba, some 1 million people have graduated. A good number of them are now moving on to Mission Ribas classes.

Mission Sucre, which lasts for about a year, aims to prepare those with a high school diploma for entry into universities and vocational schools.

None of the workers who were at the Mission Ribas class in the Sierra Maestra on March 19 had gone through Mission Robinson classes. All said they had finished elementary school and then dropped out, or had only completed first or second grade in secondary education.

“I got pregnant when I was 14, that’s why I dropped out of high school,” said Marbani Castillo. “I have three kids now, but I decided I don’t want to just stay at home.” A number of other women workers gave similar reasons for quitting school at a young age.

“I decided I could do this now because the classes are right around the corner from where I live,” said Naudy García, 51, an auto mechanic. “No other government in the past has made it possible for us to do such a thing.”

Most workers interviewed said organizing the literacy classes within walking distance of their block has made all the difference.

Some have set their sights high, reflecting increased self-confidence. “I will finish these courses and I will go on to Mission Sucre, and I will get into medical school, and become a doctor,” said Elida Liendo, the former garment worker. “I don’t care if I am 40; I don’t care what anybody says.”

All of the students praised their teacher, Raísa Peña. “She talks to us, she helps us understands things that seem difficult, she is here every day even though she has a day job, she is motivated to do this,” said Yeny Palacios.

Peña said she has a regular job at a high school and volunteered to do the classes in the evenings, especially since she lives around the corner too. There are many elementary and high school teachers doing this, she said, as well as university students and others, all on a volunteer basis.

Students who volunteered to teach Mission Robinson classes last year were promised a stipend of about $80 per month from the get-go. As most did not get paid regularly, however, thousands dropped out and did not volunteer for the second phase of the program that started last fall, Militant reporters were told in a number of interviews last October. The majority, however, more than 70,000, according to government statistics, did continue teaching classes on a voluntary basis.

The government has recently announced it will give a small stipend to the facilitators of Mission Ribas classes. “I won’t turn it down, but that’s not the reason I am doing this,” Peña said. “It’s an honor for me to help my neighbors improve their skills.”

Until about 9:00 on weeknights, many of the households in workers districts like the January 23 neighborhood are empty or half empty. “There is a joke now that it’s almost impossible to organize any neighborhood meetings during the week because of the literacy classes,” said Ibis Pino, a university student whose mother was attending another Mission Ribas class that night. “Almost half of the country’s population is studying now.”

Some 4 million people are now involved in the country’s three main literacy programs. Combined with those attending public and other regular schools, the number exceeds 10 million, we were told.

“The literacy classes and the Cuban doctors are not solving the basic economic problems we face,” said José Landines, a truck driver who lives in the Sierra Maestra section of the January 23 neighborhood. “But we are in a better mood and we have more confidence we can change the situation.”

Olivia Nelson and Natalie Doucet contributed to this article.