The People Before Profit Community Healthcare Project Visit to Venezuela: An Interview with Netfa Freeman
by Gregory Elich - Monthly Review
In June, the People Before Profit Community Healthcare Project visited Venezuela in order to assess the state of its healthcare system. The People Before Profit Community Healthcare Project models itself on the Cuban community-based approach to healthcare, and has established a project along those lines in a small neighborhood in Washington, DC. The visit was therefore directly relevant to its own project's goals. Netfa Freeman is an organizer with the organization, and he discusses here what the delegation saw in Venezuela.
Greg Elich: What led the People Before Profit Community Healthcare Project to decide to send a delegation to Venezuela?
Netfa Freeman: Well Greg, there are a couple reasons for this. I guess I should start by mentioning that our project is inspired by and modeled after the Cuban healthcare system, particularly their door-to-door approach in providing for people's healthcare needs and how communities are involved in coming up with solutions. A couple of us have been to Cuba before, on unrelated occasions and we do intend to eventually take a project delegation there. But as you know the U.S. government imposes travel restrictions that make it much more challenging for U.S. citizens to go to Cuba. That's one reason. The other reason and probably the main reason is that Venezuela's situation more closely resembles the situation our project is up against, in the sense that Venezuela is still relatively new at their implementation of the Cuban healthcare model. Cuba already has 50 years under their belt and has already solved most if not all of the healthcare problems plaguing the U.S. Also Venezuela has a more industrialized economy than Cuba, with urban and community conditions that more closely resemble those we have in the District of Columbia.
So the direct answer to your question is that we decided to go to Venezuela to see how they were doing in implementing the Cuban healthcare model and to see what lessons there were for us in what we are trying to do with our project.
Elich: I'd like to come back to how the trip ties in with the project a bit later. But, for now, let's jump into the trip itself. What towns and areas did you visit? I assume you stopped in Caracas first. What did you see there?
Freeman: Yes, we actually stayed in Caracas at the Hotel Alba. The Alba is a state-run establishment that was once a Hilton Hotel but at some point the company abandoned it in opposition to Venezuela's Bolivarian Revolution and the state had to take it over.
Caracas reminds me a little of downtown Manhattan. During the weekdays it's a very congested city. There we visited the Ministry of Health and met with people from the union of healthcare workers. I'm sorry I can't remember the official name of their union but they gave us a very detailed and compelling history of the movement for socialized medicine in Venezuela, which actually began in 1935. They made a lot of advances in this movement over the years until the so-called free trade agreements under the Clinton administration saw the privatization of things in the healthcare industry. This was followed by a rapid closing of public hospitals and the deterioration of both healthcare conditions and the rights of healthcare workers. Of course people began to organize, and once the new government led by Hugo Chavez came to power, their demands began to get a revolutionary response.
This response being the enshrining of healthcare as a human right in the new Bolivarian Constitution, improvements in conditions for healthcare workers, and an invitation for Cuba to come help them with their new socialized system.
The meeting was very enlightening and the spirit and respect of the people we met was inspiring. They were very curious about and supportive of our project and allowed us to talk about the conditions of healthcare in the U.S. and in DC in particular. They treated us like very important people, which we saw as a mutual respect for fellow social justice activists.
We also visited the Dr. Gilberto Rodriguez Ochoa Children's Cardiac Hospital of Latin America, which if not in Caracas is right outside. This was a very remarkable hospital with state-of-the-art facilities. It was opened in 2006 and named after an icon in the movement for socialized medicine, a pioneer in the more recent movement that arose in response to the NAFTA-instigated decline in healthcare. Unfortunately Dr. Ochoa was killed in a car accident in 2002. Now the driving culture in Venezuela is another story, which we hope our sisters and brothers will eventually address. But this hospital was exceptionally clean. There is so much to say about it. In the patients' rooms there were mini sofas that unfolded into visitor beds so that parents could stay with their children in the hospital.
Venezuela has an estimated 4,500 children per year born with heart defects, with about 70 percent of them needing surgery. Even with eight other regional children's cardiovascular centers, only 600 children out of that 70 percent received surgery prior to the opening of the Ochoa Children's Cardiac Hospital. Now the number of those getting the surgery they need has increased by nearly 800 percent.
This includes 45 patients from Saudi Arabia, Bolivia, Colombia, Ecuador, El Salvador, Gambia, Nicaragua, Mexico, Peru, and the Dominican Republic. And in the same spirit of the Cuban healthcare missions, these patients are also treated free of charge, as if they were citizens of Venezuela.
The Ochoa hospital is a very big hospital and there were a lot of young people as technicians and physicians. A young doctor telling us about the blood bank was so enthusiastic and passionate about what he was describing to us. He couldn't have been over thirty years old. It was a humbling experience.
Elich: Did anyone at the Ministry of Health talk about the extent of domestic opposition they faced in undoing the damage done under the neoliberal approach? I imagine there must have been powerful interests that wanted to maintain the healthcare system as a profit-making enterprise rather than one that served the people.
Freeman: They touched on this a bit but the conversations we had with the Venezuelan and Cuban doctors of Mission Barrio Adentro had the most to say. They said that when they were trying to start this new initiative in health, a call was made for Venezuelan doctors to step up and help in impoverished areas of the country. Because most were orientated in the field of medicine from a capitalist framework, they weren't inclined to give their services without substantial personal gain. They described how many Venezuelan doctors become so because it is seen as a profession that makes a lot of money, and not because it is a profession that provides better quality of life for others.
Many people might tell themselves differently but if this were not true there wouldn't have been so few doctors answering the call. They made sure we understood that many Venezuelan doctors did respond but it was not enough to address the health disparities they were up against. So Venezuela turned to Cuba for help. Of course Cuba is very renowned for their healthcare missions in many other countries around the world.
They told us that many of the more capitalist-minded doctors and medical associations were overtly against the mission and actually organized to oppose it. They even went so far as to try slandering the Cuban doctors and spread talk of them being there to implant "the communism of Fidel Castro." Many people don't know that Cuban doctors actually have a prime directive that forbids them from interfering in the politics of the countries in which they're serving.
Well, the organizing spirit of a people who just fought for their Bolivarian revolution didn't take the opposition to the healthcare mission lying down and in turn began organizing to combat that anti-people movement. Now Venezuela, with the help of Cuba, is training many of their own young people to become doctors and healthcare workers so they can help in their own communities. We visited one class and spoke with the students. They're very enthusiastic. It was very obvious from what they had to say and ask that the education they're getting is not just to teach them medicine but also to imbue them with selflessness as agents of social change. They are very conscious of their mission, not only to change the conditions of the less economically privileged in Venezuela, but also the world. Several of them expressed this. It was incredibly moving to speak with those youth.
Elich: I can well imagine how moving that must have been. Tell us about Mission Barrio Adentro.
Freeman: Mission Barrio Adentro, meaning "mission inside the neighborhood," is the name of Venezuela's social mission around healthcare. There are several "social missions," which are state-funded social programs covering diverse areas of human development like education, medicine, nutrition, and culture. In 2003 the government began the missions to revolutionize the country's old social service institutions and reach out to communities all over the country in an aggressive program to address people's fundamental needs. The social missions are funded with revenues from the state-owned oil company PDVSA.
So Barrio Adentro is not one location but refers to the network of healthcare missions scattered across the country that include community clinics in rural and urban areas, Integral Diagnostic Centers they call CIDs, which are like mini-hospitals, and the public hospitals, most of them new. We visited one CID that was fully equipped with state-of-the-art x-ray machines and sonograms, facilities for dental and ophthalmology treatment, pharmacies, and a trauma center. They also have a few beds for short-term stays and hold classes for medical students at the CIDs and students do some of their residency at CIDs. More numerous and accessible are the community clinics that are staffed by at least one doctor and a nurse. We visited one in a rural town that I believe is called Juarena. The clinics are for regular checkups and treating people who are ill. The doctors also go out regularly into the community to check on the people and are expected to go to those who are sick but may not, for some reason, be able to make it to the clinic. When we went to this clinic not only the clinic staff met with us but the community leaders as well.
They explained to us that the spirit of Mission Barrio Adentro is to work in collaboration with the community, under the assumption that some of the best solutions to the problems can come from those directly impacted by them. So the doctors don't go in with the condescending attitude of telling the community what to do but instead hold meetings and listen to people first. Then together they come up with solutions that often end up not being medical. For example in Juarena they told us that before the mission came there was a 60% malnutrition rate among the children. The solution was to build a cafeteria in the school, which was part of Venezuela's education mission. Now the children are able to get a hearty breakfast and lunch at school. I threw in the word "hearty" because they fed us in the cafeteria and we couldn't stop talking about how good the food was. The result was a reduction in the previous 60% malnutrition down to 6%.
They also told us that the cafeteria was built by a local manufacturing plant that employed many of the community's residents. The company wasn't particularly fond of Hugo Chavez's Bolivarian Revolution. They made a point, however, to explain to us that, while many of the elite are opposed to the revolution, they're not all bad people and are mostly affected by the negative propaganda saturating the media there. So the community was ambitious enough to approach the plant owners, explain the situation to them, and propose that they donate the cafeteria, which they did. It was an interesting story.
The community is also extremely grateful to the Cuban medical workers. They spoke of the fact that when the doctor first came he had no place of his own to stay, so the community ended up coming together to build him a house. We got the feeling that the community and the doctor have all become very close. We learned a lot.
Elich: It sounds like a remarkable achievement for a rural town. Do you have anything else to add about what you saw in rural areas? I suppose that meeting people's health needs in the countryside presents special challenges, and it is probably there where the contrast with pre-revolutionary healthcare is greatest.
Freeman: Yes, the contrast is greater in rural areas. It's usually more logistically challenging and expensive to service rural areas because of transporting supplies for one thing. Private healthcare not only has prohibitive cost for the rural poor but generally healthcare professionals aren't even geographically accessible in rural areas. There is no profit incentive for doctors to live in or set up practice in the rural areas and often the living conditions are not considered desirable for those used to or intent on more affluent living.
This is actually the argument the people used when they had to refute the mobilization of bourgeois medical professionals against the Cuban doctors. That is, when these professionals claimed the Cuban doctors were intruding upon their roles in society or displacing them, the people would correctly point out that the Cuban doctors were working in areas of the country that these doctors refused to go. This was in fact the reason Cuban doctors were invited to Venezuela in the first place.
Elich: What else did you see in Venezuela?
Freeman: Well, I would be remiss if I didn't mention our visit to Curiepe, which was the first town of freed Afro-Venezuelans, founded in 1723. It was liberated by a militarized group of Afro Venezuelans, led by Juan del Rosario Blanco. After fortifying the area they petitioned the Spanish crown to recognize its sovereignty. Curiepe is located in Barlovento, a traditionally African region in the Venezuelan state of Miranda, and Curiepe is known for having maintained many African traditions. We saw this celebrated while we were there during the San Juan Festival that takes place from June 23 to 24.
We toured a very nice library in Curiepe named after Juan del Rosario Blanco. It looked very new. If I'm not mistaken, Professor Alejandro Correa, who was our guide in Barlovento and who is actually the Assistant Director of the Instituto Universitario de Barlovento, attributed the town's funding and support for the library to the Bolivarian Revolution.
I should add that support for Hugo Chavez is extremely high among Afro-Venezuelans. The library is designed to give the people and particularly the children a sense of pride and understanding of their rich African heritage within Venezuela. It's equipped with computers and internet access.
We did also visit the Instituto Universitario de Barlovento, which was founded in 1991 and is one of the only historically Black institutions of higher education in Latin America. IUB is doing some very remarkable things with young people, including the establishment of exchange programs, where Venezuelan students will visit the U.S. and U.S. students will visit Venezuela. In fact we've already helped them a little in that regard.
The people in Barlovento are a beautiful people and distinctly African. It was very refreshing to be among them celebrating and dancing to the drum. Much like how African descendents in Cuba adapted their beliefs and traditions through the practices of Santaria, to preserve them against the cultural impositions of Spain and the Catholic Church, Afro-Venezuelans had to do similar things. So, during the San Juan Festival you see an interesting blend of the Spanish culture with things that are very much African in nature.
Elich: A very full and rich schedule. It's probably too soon to answer such a question, as I am sure your team has much information to analyze and process. But what are some of the concepts that you witnessed in Venezuela that you think could be applied by the People Before Profit Community Healthcare Project on its home turf? Your trip came at an interesting time, given the healthcare debate here in the U.S. The Cuban healthcare model your organization seeks to implement presents a real alternative to healthcare reform as it is shaping up, where the one essential ingredient is that corporate health insurance profits must be maintained or increased. All other aspects of healthcare are potentially dispensable.
Freeeman: A big difference that makes it hard to translate the lessons from Venezuela into things that can be applied in the U.S. in general and Washington, DC in particular is that Cuba's and Venezuela's healthcare systems have the support of the state. This of course allows them so much flexibility with what they're able to do and affords them resources. And as you pointed out, here it's the opposite. It is in fact the U.S. government, serving primarily as agents of corporate health insurance and pharmaceuticals, that is actually working against the people's interests.
But a concept that can certainly be applied without state support and is in fact indispensable for what we're trying is ideological buy-in from the community. When the community as a whole internalizes the ideas that, first, healthcare is their human right and, second, only they themselves are capable of solving this issue, then we can see some change. We also have to begin realizing that the issue of healthcare is inextricably related to all other aspects of injustice that the people face and act accordingly. That is to say that the root causes for lack of healthcare, affordable housing, quality, empowering education, job security, and even issues like the prevalence of police brutality and the industrial prison complex's "school-to-prison pipeline," etc. fundamentally all have the same root causes, so our actions must begin to reflect this understanding.
In Venezuela we noticed that part of what is being done on the community level, at least in some areas, is to find the civic leaders in each community and work with them. And just like in Venezuela or any other place we have such leaders within our neighborhoods in the District of Columbia. They might not always be easy to find or identify but such leaders are always there and we have identified some within the neighborhood where we're working. And once their commitment is secured it is easier to get the community as a whole to work together.
Another thing we can certainly take away from the trip and apply is an unshakable faith in the people to understand their conditions and their ability to come up with the means to solve their own problems. This is something liberal advocates generally lack. They instead tend to see change as only coming through appealing to the powers that be and not from a profound and prerequisite transformation on the ground. I suppose that's the main difference between reformists and revolutionaries.
Netfa Freeman is director of the Social Action and Leadership School for Activists at the Institute for Policy Studies  and is also an organizer with the People Before Profit Community Healthcare Project . Gregory Elich is on the Board of Directors of the Jasenovac Research Institute and on the Advisory Board of the Korea Truth Commission. He is the author of the book Strange Liberators: Militarism, Mayhem, and the Pursuit of Profit.