When he spoke to the Militant here October 6, Salazar was part of a crew putting the finishing touches in the Bergoña Integrated Diagnostic Center, a clinic in the Maguanagua section of Valencia, the country’s third most populous city and one of its top industrial centers. La Bergoña, financed by the government like all the neighborhood clinics largely staffed by Cuban doctors, is scheduled to be completed before the end of the year, said Uvaldo Rivera, the construction crew foreman.

“We are well into the second phase of Barrio Adentro,” said Nelly Gaerste, a Venezuelan doctor who is part of the program. A small but slowly growing number of Venezuelan doctors, about 2,000 nationwide, according to Gaerste, work alongside Cubans in these neighborhood clinics.

The program was launched in the Libertador municipality of Caracas in 2003. The Ministry of Health first appealed to Venezuelan doctors who would be willing to live in urban working-class neighborhoods or rural areas and offer their services for free, with a salary of about $600 a month paid by the government. Very few came forward to begin with.

Through an agreement with Havana, large numbers of volunteer Cuban doctors, most of whom had carried out internationalist missions in other countries, began arriving in March 2003. The Cuban doctors receive a monthly stipend of $250 to cover living expenses. Many live in workers’ homes in the areas where they serve, operating primary care clinics out of community centers and peoples’ houses. Since 2004 the government has also built nearly 2,000 modulos, small neighborhood clinics with a doctor’s office on the first floor and a couple of rooms above where medical personnel can rest. These doctors staff the clinics in the morning and in the afternoons they visit people at home, from building to building, getting to know their families, medical records, and living conditions, and practicing preventive medicine.

Unlike many Venezuelan doctors, “they treat us like human beings,” said Jesús Arena, a security guard at the Borgoña construction site. This remark about the Cuban doctors has become commonplace as they have reached every corner of the country and their reputation has spread, cutting across anti-communist prejudices that were prevalent four years ago. (See also “Cuban doctors in Venezuela operate free neighborhood clinics” in Nov. 3, 2003, Militant, and “Clinics operated by Cuban doctors expand in Venezuela” in July 18, 2005, issue.)

The number of these primary care clinics reached a high of 15,000 in Venezuela last year, said Joel Pantoja Jr., 27, a Venezuelan doctor here who pioneered the entry of Venezuelan doctors into Barrio Adentro. “The number of the primary care clinics has now declined to about 9,000,” Pantoja added. The reason, he said, is that more Cuban doctors are being shifted to larger clinics, called Integrated Diagnostic Centers (CDI), and there are not enough Venezuelan doctors who have been qualified yet to fill the gap.

Under Barrio Adentro 2, which started in early 2005, larger popular clinics are being built that are open around the clock. The CDIs offer quality emergency care, including minor surgery, free of charge. Modern equipment in well-built and air-conditioned facilities allows advanced diagnosis and care. Ambulances are included. The government is also building Integrated Rehabilitation Centers and advanced technology labs.

The third phase of Barrio Adentro, which was launched this year, includes repairing and re-equipping the country’s 299 public hospitals and building new ones that would offer care like the clinics operated by Cuban doctors.

Speaking October 5 at the inauguration of a hospital in Barcelona, Anzoátegui state, Venezuelan president Hugo Chávez said the government has built 216 larger clinics and 6 high-tech labs across the country in the last year and a half.

The pace is much slower than what had been anticipated. The government had projected building 1,200 CDIs and rehabilitation centers by the end of 2005.

“There is opposition to Barrio Adentro in the health-care establishment because most Venezuelan doctors practice medicine to make a profit,” said Gaerste.

In June 2003 the Venezuelan Medical Federation (FMV) filed suit asking the courts to bar Cuban doctors from practicing. A lower court decision to grant the request was overturned by higher courts. In July 2005 hundreds of FMV members protested in downtown Caracas claiming Cuban volunteers are taking the jobs of Venezuelan doctors. A handful of incidents of physical attacks on Cuban doctors took place when the program started. But these have subsided. As Jesús Arena put it, expressing a popular sentiment, “If they touch the Cuban doctors we’ll go after them because the Cubans save our lives. We take care of their security.”

Mabel Martínez is a Cuban doctor working at the Florida CDI in Valencia. She told the Militant October 6 that two months ago, after treating a man who had been hit above his left eye with a rock, she referred him to a nearby hospital with an X-ray showing he had a fracture that required surgery. “The Venezuelan doctor on duty threw the X-ray in the garbage and sent the man home when he saw the referral was from a Cuban doctor,” she said. “The man almost lost his eye.”

Martínez said such incidents have become less frequent. Last month, she said, some Venezuelan doctors from a nearby public hospital asked for a meeting with Cuban doctors at the Florida clinic to discuss how to collaborate better.

All the nurses, janitors, and other personnel at these clinics, besides the doctors, are Venezuelan. Gaerste, one of a few Venezuelan doctors who works at the Canaima CDI, introduced Militant reporters to three of the janitors there, María Hisea, Paula Piñedo, and Carmen Salazar, who said the attitudes of the Cuban doctors of selfless human solidarity and putting the interests of the patients first are prevalent among the Venezuelan personnel too. “We don’t just clean the floors,” Salazar said. “When there is an emergency and someone comes in bloody late at night we help the people from the ambulance bring them in. We like it here. Barrio Adentro is how the whole society should be.”
 
 
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