Yensi Rivero | IPS

When one of Gladys’ three children falls ill in Los Jardines del Valle, a poor neighbourhood on the southwest side of Caracas, she no longer has to hike down the steep hill from the narrow street where she lives, to find medical assistance.

Now she just steps over to the home of her neighbour, a Cuban doctor who is taking part in the Mision Barrio Adentro (which translates roughly as the “into the heart of the neighbourhood” programme).

“I’m more at ease now. If you go out at night with a sick child, you have to brave the ‘malandraje’ (criminal elements), and it’s a huge relief to have a doctor in the neighbourhood,” she tells IPS, standing in the doorway of her little shack.

Gladys and her children are attended by one of the 13,000 Cuban doctors who have come to live in poor neighbourhoods of Venezuela over the past two years to provide primary health care as part of the Barrio Adentro programme.

The programme is just one part of a broad web of social projects implemented by left-leaning President Hugo Ch�vez, whose support base is made up largely of the poor, and who won the backing of 59 percent of the voters in an August presidential recall referendum with which the opposition alliance hoped to remove him.

The projects include shops selling foodstuffs at subsidised prices, community soup kitchens, an adult literacy drive, scholarships for low-income high school and university students, small loans for microenterprises, dental care, and property title deeds in rural and urban areas.

Angel Buro, 35, is one of the doctors involved in the Barrio Adentro programme. He works in La Cumbre, a shanty-town on a hill that has a spectacular view of Caracas but no paved streets, piped water or sanitation services.

“I came here from Havana, where my six-year-old son and my wife live, a year ago,” Buro explains to IPS as children scamper about, playing baseball (Venezuela’s national sport) with small stones instead of a ball.

“When I feel melancholic, I stand in the doorway and enjoy the view of the city,” he added.

Buro lives and works in one of the 4,600 50-square-metre two-story “modulos” or brick buildings that have been built around the country for the Barrio Adentro project.

The small buildings not only serve as housing for the Cuban physicians, but as community health clinics as well.

Until his modulo was completed, Buro lived with a family in La Cumbre, and attended patients in their living room.

He earns a monthly stipend of 200 dollars, has 250 families under his care, and sees up to 60 patients a day, including people “who live in extreme poverty, in shacks that have no bathroom, and only latrines.”

Buro tries to provide comprehensive care, “to the point that at times I help the kids with their homework.”

It costs the Venezuelan government 50,000 dollars to build and furnish each modulo, “and our goal is to have 12,500 within a few years,” Venezuelan Dr. Juan Carlos Marcano, who heads the Barrio Adentro programme, commented to IPS.

So far there are just 85 modulos in Caracas. The rest of the programme’s doctors live with local families or in buildings that belong to the municipal governments.

“This was the parking lot of a church whose only aim was to rake in money. The members of the community took over the space, to start building this modulo,” Jose De Matos, a community leader in Los Jardines del Valle told IPS while pointing to the small health clinic with pride.

Only 1,000 Venezuelan doctors have become involved in the Barrio Adentro project.

Venezuela’s Medical Federation (the doctors’ association) represents 55,000 physicians, 25,000 of whom work in the public health sector, 20,000 in private clinics and hospitals, and 10,000 of whom are unemployed.

“We took out ads inviting Venezuela’s doctors to join the programme, but we did not receive the hoped-for response, even though in Venezuela it is a requisite for recent medical school graduates to do a one-year ‘rural internship’, which can be in a small town, an indigenous community or an urban slum neighbourhood,” said Marcano.

The doctors’ association responded to the ads by saying that better conditions, comparable to those offered in some other Latin American nations, would be required in order for the physicians to take part in the programme.

“How can it be that in our country, a doctor who is just starting out earns a mere 200 dollars a month and a specialist with 30 years of experience earns 400 dollars, when in countries like Costa Rica, a specialist can make 3,000 dollars a month,” Dr. Rafael Mendez, a Medical Federation spokesman, commented to IPS.

Public health system doctors earn an initial salary of 200 dollars a month for three to six hours a day of work, three to five days a week, according to the Medical Federation.

By contrast, a physician working in the private sector in Caracas can earn between 15 and 40 dollars per consultation.

“In Venezuela, a labourer earns approximately 375 dollars a month, 175 more than a doctor. Physicians should earn at least 1,000 dollars a month,” argued Mendez.

According to the Medical Federation, a specialist makes 1,400 dollars a month on average in Argentina and 2,000 dollars in Chile, while a general practitioner earns 1,700 dollars a month in Colombia.

In Mendez’s view, “Barrio Adentro is trying to politicise health, and does not address the underlying problem: the critical situation facing doctors, who are affected by inadequate conditions for exercising their profession.”

“The predominant government attitude has been to ignore the doctors’ association and the health sector in general,” said Mendez. “Networks of health posts existed prior to the government of Ch�vez (who first took office in 1999). In 1992 there were 80 clinics in poor areas of Caracas, but they began to close down after 1997.”

The few remaining public health posts are now being dismantled or incorporated into the Barrio Adentro project. The Health Ministry plan is for all of the neighbourhood clinics to gradually become part of the programme.

So far, most of the cases treated by the Barrio Adentro doctors have involved intestinal parasites, malnutrition, diabetes and hypertension.

In this oil-producing nation of 25 million, an estimated 17 million people live in poverty, and “dengue fever, tuberculosis, malaria and violence are serious public health problems, especially among the low-income strata of society,” Jose Reyes, president of the Venezuelan Public Health Association, told IPS.

“Barrio Adentro is a good programme,” he said. “But nothing will be solved unless real networks are created between all of the country’s health clinics and hospitals, instead of each health centre working on its own.”

“The lack of a centralised information system makes it impossible to have reliable statistics, in order to address our health problems,” he added.

Barrio Adentro is one victim of that situation: there are no precise statistics on its activities. Health Minister Roger Capella has not answered requests for interviews by the foreign press.

Each Barrio Adentro clinic has the basic equipment: a stretcher, a desk, chairs, a notice board with health recommendations and advice, a blood pressure apparatus and a nebulizer.

The doctors write up basic medical histories on each patient, which are kept in old-fashioned files, because there are no computers for storing the data or transmitting statistical or epidemiological information.

The clinics provide primary health care, and supply some basic medications, most of which are produced in Cuba. For more complex diagnoses or treatment, the patients are referred to a public hospital.

So far, the project has been financed by windfall profits from the record high international oil prices. (Venezuela is the world’s fifth-largest oil exporter). But next year, the plan is to include Barrio Adentro in the national health budget, and assign it 1.3 billion dollars, said Marcano.

In 2004, the federal budget amounted to 26 billion dollars, of which 6.3 percent—1.67 billion dollars—were earmarked for the Health Ministry.

State and city governments also allot part of their funds to health spending.

Waldo: excellent point!