Beginnings of a public health revolution in Venezuela

One of the best-known and most successful aspects of Venezuela's Bolivarian revolution has been the "social missions" — social programs funded by Venezuela's oil wealth aiming to solve the most pressing problems of the nation's poor majority. One of the best known and most successful social missions was one of the first to be established, the health program Mision Bario Adentro ("Into the Neighbourghood"). Established in April 2003, the mission has brought free quality health care via the establishment of popular health clinics in poor neighbourhoods across Venezuela. Before Barrio Adentro, health care was out of reach for many of the poor, as private health care was too expensive and the public health system was in a state of disrepair.

When Venezuelan doctors refused to work in the poor areas, Venezuela turned to socialist Cuba, which provides more than 20,000 volunteer medical personnel — who work for a basic stipend and live with the community they serve — in return for discounted oil. Through the new Bolivarian University, the government is training thousands of poor Venezuelans to become doctors themselves, with the aim not just of replacing the Cuban doctors in Venezuela, but emulating Cuba and sending volunteers around the world.

There are now 2500 popular clinics across Venezuela, with the aim of constructing 5000. The second phase of Barrio Adentro was the creation of 226 diagnostic centres and 318 rehabilitation centres. Now, the mission has entered its third phase, rebuilding the run-down and inefficient public hospitals.

Preceding Barrio Adentro, the government of President Hugo Chavez carried out important but very difficult work attempting to improve the public heath system and reform the health ministry. This helped lay the groundwork for Barrio Adentro, which was established separately to the ministry and is guided by many of the principles the government tried to introduce through the ministry. The work of the first health minister, Dr Gilberto Rodriguea Ochoa, who died in 2002, was important to the subsequent work of Barrio Adentro. On August 20 last year, the Dr Gilberto Rodrigues Ochoa Children's Latin American Heart Hospital was inaugurated. It is the largest of its kind in Latin America and will treat poor patients from across the continent.

Green Left Weekly correspondents Coral Wynter and Jim McIlroy spoke with Rodrigues Ochoa's son, Andres Eloy Rodrigues Ochoa, who is a research student at the Institute for Experimental Medicine at the Central University of Venezuela, about his father's work.

Andres Eloy began: "First, I am very proud because this hospital, [named after my father], is the most important in Latin America, and one of the largest in the world. My father worked all his life, teaching medicine and supporting the fight for social development.

From a young age, Gilberto Rodrigues Ochoa was inclined toward social service, and therefore was always involved in social medicine. "He was always opposed to privatised medicine, and wrote a book about this. To have his name given to this hospital is a recognition of his achievements, and his work in establishing a national system of public health. This was one of the things my father always fought for, because the public hospitals had been [in a state of] collapse for a long time. This was because the hospitals [were obliged to] attend to cases that should have been dealt with outside the hospital system.

"Part of my father's work was to decentralise this process. Barrio Adentro was born from an idea of my father's. He called it 'integral medicine'. But, it was part of the plan to decentralise and remove the congestion from the hospitals. This was the only way you could properly use the hospitals' resources — the equipment, the human labour and all the material — in cases that really needed hospitalisation. [Thus], the majority of patients could be treated in community consulting rooms.

"My father worked hard as minister for health ... At the start he had to confront the disaster that was the health ministry, and the disaster that was the health system throughout the country. It required a double reform: changing the functioning of the ministry as an institution, and in addition, reforming the national health system.

"It was a massive task. Thousands of people were being paid, but didn't do any work; or employees had died, but the family was still being paid the wages in the form of social security. At that time, the ministry of health was separate from the ministry of social development. Later the ministry of health and the ministry of social development and the family were amalgamated.

"Now, the ministry of health has everything to do with the functioning of the family, so that the emphasis is more on the social side — not just health, but social development. Now, the health ministry has to deal with a national system [relating to] children, youth, adolescents — a much wider field."

"The ministry of health did many revolutionary things" in regard to adolescents, Andres Eloy said. For example, it changed the rules relating to cigarette packets so that the previously very small warning signs had to be enlarged. "They banned the sale of cigarettes to those under age. They controlled the advertising of cigarettes and drinks on TV, at dances and public events. This all happened during the period my father was minister.

"He did many positive things: projects relating to diagnostic centres, and establishing consulting clinics and centres for hospital equipment. There were many profound changes."

"And on top of all this, he coordinated the [public health] response to the disaster of Vargas, on the other side of the Avila Mountain [from Caracas], in 1999" when floods caused the collapse of the hillside, leading to an estimated 20,000 deaths. "Many people were trapped, buried under mud, and died. Many times during this crisis, my father slept in his office, as Chavez did as well. My father cried over the Vargas disaster.

"My father was a dermatologist, but he also studied public health. He was one of the team who developed the vaccine against leprosy. After that, he became director of dermatological services in Maracay, and later moved to the Amazon region where he worked in the Centre for Tropical Diseases. He was twice director of the hospital in Puerto Ayacucho [capital of Amazonas state], as well as Amazonas state director of health. In addition, he practiced dermatology for the army and the Ayacucho hospital.

"During my father's term [as national health minister], other important achievements included improvements in the treatment of HIV and AIDS. As this is very costly, he introduced free treatment for all AIDS victims. The treatment of cancer, infant mortality, maternity hospitalisation — all the most important aspects of health — were considerably improved.

"With the congestion of the hospitals, there are now centres for integrated diagnosis, where all the treatment is free and of the highest quality. This is all part of the public health system, so that people don't have to pay for something my father considered a fundamental right for everyone, and a responsibility of the state. This right is now recognised in the Bolivarian constitution.

"The quantity of achievements in the public health field was enormous. The intention of the [Bolivarian public health system] is to provide an absolutely free service of the highest quality, so that medicine is not a commercial business. Moreover, medicine has been changed to focus on a model of prevention, rather than cure, which satisfies the transnational pharmaceutical companies.

"It is more effective, less costly and the only real alternative for poor countries.

"Our public health system is based on prevention, with community diagnostic centres, and most importantly, education of the people in health care. To achieve this, the outcome of a medical career must be to integrate with the community. We shouldn't see the doctor as an isolated person with special knowledge, whose sole job is curing disease. Rather a doctor should be seen as a member of society, who has considerable skills, but whose role is based primarily on the prevention of illness."