By Rachel Morenz
According to statistics compiled by the government of the Bolivarian Republic of Venezuela, 42.5 percent of the Venezuelan population was living in extreme poverty in 1996, while inflation averaged 30 percent. Moreover, the public healthcare system was very weak. Care was becoming increasingly curative as opposed to preventive, and it was generally only available to those who could pay, meaning that a large portion of the population was receiving inadequate healthcare. In 1999, during Chavez's first year in power, Venezuela ratified a new constitution that guarantees the provision of healthcare as a basic social right.
To carry out this new healthcare guarantee, the government partnered with the Cuban Medical Mission and started a comprehensive primary healthcare delivery network called Mission Barrio Adentro (mission into the neighborhoods). The network consists of three levels. Level one is the popular medical dispensary, a house that has been turned into a basic family medical clinic. The dispensary is staffed by at least one doctor (who lives there), a nurse, and a local health promoter. They are responsible for the immediate and long-term care of 250-350 families. There are currently over 1,000 dispensaries in Venezuela. Level two is the Integrated Diagnostic Center, which is basically like a small hospital with an emergency department, ICU, OR, rehabilitation services, and dental consultation. The final tier is the High Technology Center, stocked with state of the art equipment, where patients are sent for MRIs, CAT scans, mammograms, EKGs, and lab work-ups. At all centers, patients pay nothing.
Just because Barrio Adentro provides free care does not mean it is substandard. A recent report from the Pan American Health Organization shows that Barrio Adentro has significantly improved Venezuelan healthcare, upholding the government's earlier promise. Seventy percent of the population previously barred from care is now covered. Prenatal care coverage has increased from 25 percent to 57 percent. Perhaps most importantly, primary care consultations, 40 percent of which are home visits, have increased fourfold. This has lead to increased capture, monitoring, and follow-up for five of the most common chronic diseases in Venezuela: hypertension, diabetes, heart disease, cerebrovascular disease, and bronchial asthma.
Of course, Barrio Adentro is not without its problems. For example, many Venezuelans question why 20,000 Cubans, instead of Venezuelans, currently staff Barrio Adentro. I wondered the same thing, until I came to know some of these Cubans through my volunteer work with Barrio Adentro. Lis, Maria Caridad, Alexis, Jenni, and other Cuban doctors have come from a country that according to the World Health Organization has the lowest doctor to patient ratio in the world, one of the lowest AIDS rates in the Caribbean at 0.1 percent of the population, an infant mortality rate below that of the US, and a life expectancy equivalent to that in the US. These doctors left their lives and families in Cuba and came to Venezuela of their own free wills, receiving very modest incomes, in order to share their medical knowledge and care to the best of their abilities for the Venezuelan community.
I vividly remember one of my first days at La Cruz Integrated Diagnostic Center. I was observing a rehab consult for an elderly man with bursitis. The patient told my supervising physician, Maria Caridad, "I'm not Chavista." (In other words, he doesn't agree with the Chavez government.) Maria Caridad replied, "Okay, but I don't need to know about your political or religious views. I just want to know about your shoulder and see what we can do to help it feel better." The Cuban doctors have come not to turn their patients into communists but to provide healthcare to fellow human beings, and they do not intend to stay forever. Barrio Adentro currently works with a Venezuelan medical school to train and recruit a new generation of Venezuelans to take over the mission, in line with the current community care approach.
However, much of Barrio Adentro's funding comes from Venezuela's oil surplus, and as the price of oil continues to decline, will Barrio Adentro survive? I hope so. I hope the next generation of Barrio Adentro doctors will carry on the current Cuban physicians' strong ethical principles that can be encapsulated in the words of one of Cuba's leading intellectuals, Juan Antonio Blanco: "We are part of a movement that believes that human happiness does not reside in our unlimited capacity to consume but in our unlimited capacity to give solidarity to our fellow human beings." I definitely know I will not forget these Cuban doctors steadfast dedication to a humanitarian effort when I return to the United States in the upcoming fall to begin my medical education.
