Peter Maybarduk, Caracas
It is nearly impossible to travel in Venezuela without hearing reference to the government's highly popular and controversial health-care initiative that invites Cuban doctors to treat, train and live with working-class Venezuelans in communities across the country.
In the 18 months since Barrio Adentro's inception, the number of Cuban physicians in Venezuela has grown to more than 13,000, their medical services available to approximately 17 million Venezuelans, or two-thirds of the country's population, according to Venezuela's health ministry.
Poor Venezuelans say the program means that they have access to medical services for the first time. But not, they stress, without their participation. Neighbourhoods organise themselves into local health committees (comites de salud) to oversee the operations of clinics that the government funds. Barrio Adentro enlists the patient as a partner in the care of his or her health.
Since the 1998 election of radical left-wing candidate Hugo Chavez as president, the government has set out to remake the culture of health care in Venezuela, bringing it, in health ministry physician Luis Montiel's words, "from medical assistance to social and participatory medicine". The new constitution, approved by popular referendum and enacted in 2000, guarantees all citizens the right to health care and forbids the privatisation of health services.
Treatment at public hospitals has always been free, but their services have been limited. Pro-government Venezuelans speak often of the prohibitive costs that once attended special medical needs, from some surgery to eyeglasses. "Seventy, 80, 100,000 bolivares [US$35-70] for a consultation. Five million [$2500] for an operation", estimates Elizabeth Bustos Uribe, a Chavista nurse. Such prices are well beyond the means of working Venezuelans. Barrio Adentro now provides some of these services at no charge.
Bustos works as the Barrio Adentro clinic nurse in Casco Central, Parroquia La Pastora, Caracas. She helps the two Cuban medics in her module administer treatments for parasites, skin allergies, diarrhoea and other common ailments. "Barrio Adentro is the essence of the revolution", she says.
Bustos pulls from her purse the prescription glasses fashioned for her by a Cuban optometrist. "They were free."
In the 1980s and 1990s, successive administrations inaugurated market reforms, restructuring the system of "retroactive" severance pay, eliminating subsidies on consumer goods and cutting tariffs and social spending. The state petroleum corporation, PDVSA, ran on self-defined priorities, revenue for the state not among them. Poverty rose from an oil-boom low of 10% in 1978 to 86% in 1996.
Mindful of popular discontent with market models of governance, and of the popular success of Barrio Adentro, some opposition strategists now state that a new, opposition-backed government would retain the program.
In the southern Caracas barrio of Las Malvinas, Judy Moros, mother of three, talks about the clinic that opened in her neighbourhood one year ago. "It's marvellous. They open the door at any hour, and treat everyone."
Moros is married to Franklin Gamboa, a member of the Las Malvinas Health Committee. Arranging for the care of approximately 3000 residents, the committee is divided into two bodies of about 10 citizens each — one group to support each doctor.
The Venezuelan government pays the doctors a monthly stipend of $250, and "the city sends them baskets of food". The medicine they use — some 103 drugs treating 95% of Venezuela's most prevalent illnesses — comes from Cuba.
The health ministry claims that at least 11,000 lives have been saved through Barrio Adentro thus far. The presence of clinics in communities brings primary care far closer to people who were, in many cases, accustomed to living without treatment until their illness became an obvious emergency.
A national immunisation plan has elevated vaccination rates. Renato Gusmao, the Pan-American Health Organisation's Venezuela representative, praises the project. "Barrio Adentro permits the planning of a health-care system based on the demands of the population, not just on how much they have and how much they can afford."
First and foremost among Barrio Adentro's opponents is the Venezuelan Medical Federation (FMV), a powerful doctors' group with 55,000 members. In June 2003, the FMV filed suit to stop Barrio Adentro's Cuban physicians from practicing in Venezuela, alleging that the doctors were not licensed to practice. On August 21, the First Administrative Court ruled that the Cuban doctors should be replaced by licensed practitioners. The government appealed, and the case is not yet resolved.
Venezuela boasts one doctor for every 500 people, much better than the 1200-to-1 minimum ratio recommended by the World Health Organisation. Yet many barrio dwellers have never had an attendant physician. Working-class Venezuelans view doctors' avoidance of their neighbourhoods as class prejudice.
Until the recent addition of Venezuelan post-graduate medical students, only 29 Venezuelan doctors worked in the popular consultarios of Barrio Adentro. The majority of Venezuelan doctors grew up in the country's wealthier neighbourhoods, and many are not comfortable in the dirty and crowded neighbourhoods of poor Venezuela.
In line with Barrio Adentro's ethic of community care, the Venezuelan government is helping barrio residents attend medical school and return to practice in their own communities.
The first class of 250 Venezuelan students has just graduated from medical school in Cuba. Another 1000 are in training. The government has already integrated 1200 Venezuelan post-graduates into Barrio Adentro for two-year residencies, after which the new doctors will have the option to stay on if they so choose.
There are also plans to start a medical school tied to Barrio Adentro within the recently chartered Universidad Bolivariana de Venezuela (UBV) in Caracas, part of an effort to open higher education to the poor.
After just a year-and-a-half of operation, Barrio Adentro has attained near sacred status among working-class Venezuelans. Even those who can afford private clinics are finding that they can save money and receive the same quality of care for basic needs at the program's modules.
Barrio Adentro was built and is continuously shaped by the same people who benefit from it. From their perspective, Barrio Adentro is not a government program, it is their program — one that belongs to the Venezuelan people — and health is their right.
[Peter Maybarduk is a freelance writer and law student at the University of California, Berkeley. This article has been abridged from Venezuelanalysis.com.]
From Green Left Weekly, December 15, 2004.
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