Delivering Health Services to the Poor
a) Interview with two medical leaders
We met Dr. Felipe Guzman, former minister of health, and Dr. Graciela Angarita at a rally of Bolivarian journalists. The two doctors had been among a contingent of progressive health professionals who organized a demonstration of support at this rally. What follows integrates comments made by both of them.
Health is conducted on a much broader basis now, with 250 families for each primary-care doctor. Before, 70% were excluded from care. The first priority was to include these, and this has been done through the missions, like Barrio Adentro. These are a sort of parallel government, alongside the bureaucracy.
Barrio Adentro I, the primary-care service, is being carried out more and more today by Venezuelan doctors. Barrio Adentro II, which provides integral diagnostic, rehabilitation, and high-technology services, is still staffed to a greater extent by Cubans. Two-thirds of the Cuban contingent is still here in Venezuela. Doctors provide service in the morning in their clinics and do house calls in the afternoons.
Not everyone is sympathetic to the Cubans. There is some xenophobia built up by the media. Barrio Adentro was launched because qualified Venezuelan doctors did not want to provide service for the poor. At that time, most of the public hospitals were nearly abandoned. The doctors assigned to them would go there an hour or two a day, and be paid for eight hours. The rest of the time they were in private clinics. The medicines would be channeled off from the hospitals to these clinics.We now have 19,000 students in medical school in Venezuela, 50% women. Before, only privileged people went to university, but now people in the barrios can become doctors and are doing so—and winning scholarships to study in India, China, England, and France.
There are signs of change: mortality in pregnancy is down; parasitic infections are down; preventive medicine is much more effective; the AIDS problem is under control, with 15,000 under treatment with retroviral drugs supplied free. We have big problems with the drug monopolies, of course: we have relationships with Indian drug manufacturers; all medicines go free to poor people..
There are homes for old people, but in Venezuela the family looks after their elderly members, with the help of neighbours.
Contraception is free, and young people can obtain it without involvement of their parents.
b) Visit to Barrio Adentro I clinic in Libertador, State of Carabobo: The centre is simple A-frame construction with the consultancy below and a dwelling for the doctor above. It was built with municipal funds. The Cuban doctor, Idis Merina, has been here four years. She sees 50-60 patients daily. All services are free, as are medicines. Mision Milagro operations are done here—more than 200 so far—this is also free. The greatest health problems are parasites, which are now seen less often, and dengue fever, a new problem brought on by the wet season.
Before Barrio Adentro, the municipality had nine primary care health centres; it now has 74, all built with community support.
c) Barrio Adentro II. We visited a Unified Diagnostic Centre (Centro Diagnostico Integral) in Libertador. It is located in Juncalito, though it serves a bigger area. It is a single-storey building with several rooms, four doctors, and about 20 beds in total. Different rooms provide for intensive care, observation, and assessment; a pharmacy, a cafeteria. The centre analyzes blood, urine, and results of other tests on the spot—50 such tests a day. The most frequent problems are dengue, parasites, blood poisoning, and iron deficiency. Modern equipment such as a defibrillator and ultrasound is available in the centre..The doctors are Cuban, but Venezuelans come to be trained. The equipment comes from Cuba, most often made there but in some cases bought internationally (the new Toshiba X-ray equipment). One of the doctors served in Pakistan, in the mountains, after the great earthquake. “We donated 30 hospitals. It was so cold up there!”
Patients who arrive with urgent problems are seen immediately. For consultation, the wait would be 15 minutes at the most. As we arrive (late afternoon), the hospital is functioning but not busy; we see about half a dozen patients of which two are in beds. The centre provides medicines and all other services free. They practice alternative medicine when possible. There is one ambulance for the municipality, which is quite adequate and provides near-immediate service; if needed, ambulances in neighbouring municipalities can be called in.
A doctor explains: “We are not here to change anyone’s political views but out of humanitarian commitment. We look after everyone, including some people committed to the opposition, and some who are Cuban gusanos (exiles).”
There are four such centres in the municipality, of which one is equipped as a top-tier hospital; the other three second-tier diagnostic centres. This one serves 25,000people. Patients can come directly, but the usual route is by referral from the primary-care centre, one of which is on the same property.
Beside the hospital is the Centro Integral de Rehabilitación, with a gym, massage room, heat treatments, ultrasound, laser, hydro-therapy (water massage), foot treatments, speech therapy. The entire centre (rehab, diagnostic, primary care) was established in the last few years..
d) A centre for seniors: About 60 frail seniors come here in the morning for supervised exercise, with blood pressure taken before and after. There is a sleeping area. About 30 of the most needy stay for a substantial meal. This is a community project, which cost 30 million bolivars ($15 thousand). The structure is bare and elementary. Cuban workers come here from the Barrio Adentro Desporte service, a program providing sports training inside the communities.