This is an abridged version of the original article published in the May 11th issue of “The Militant”)
BARRIO Adentro, which translates roughly as “Into the heart of the neighbourhood,” is the name of a government-sponsored programme that has brought thousands of volunteer Cuban doctors operating free neighbourhood clinics in working-class districts and rural areas across the country where workers and farmers have had little or no access to health care. This is one of the social programmes launched last year, along with nationwide literacy campaigns now involving 4 million that have spread around the country with aid and volunteers from Cuba.
The state government in Carabobo and the Valencia city administration have been in the hands of the pro-imperialist opposition since Hugo Chávez was elected president of Venezuela in 1998. The coalition of opposition forces, Coordinadora Democrática, and the Venezuelan Medical Federation have waged a virulent campaign against Barrio Adentro, charging that Cuban doctors are here as “agents of Fidel Castro” who came not to save lives but “to indoctrinate the poor with communism.”
Until the end of 2003, authorization by local governments was required to bring in Cuban doctors. Now 1,200 Cuban doctors in Carabobo, about half of them in Valencia’s working-class neighbourhoods. A total of 10,000 Cuban doctors are now working in the country.
To cut through the obstacles to Barrio Adentro in the eight states where the government is controlled by forces allied with Coordinadora Democrática, the national government declared all neighbourhood clinics operated by Cuban doctors to be primary care centres under the jurisdiction of the national ministry of health. As a result, approval by local authorities is no longer needed to bring volunteer doctors from Cuba. So Barrio Adentro has now reached virtually every corner of the country.
HOW THE PROGRAMME SPREAD
About 250 Cuban doctors, nurses, and technicians had served in Venezuela for about five years, arriving soon after Chávez’s election. The ministry of health first appealed to Venezuelan doctors who were willing to live in the working-class areas and offer their services to residents for free, with a salary of about $600 a month paid by the government. Very few came forward.
Through an agreement with Havana, large numbers of volunteer Cuban doctors, most of whom have carried out internationalist volunteer missions in other countries, began arriving in March 2003. The Cuban doctors receive a stipend of $250 a month to cover living expenses. They live in workers’ homes in the areas where they serve, operating clinics out of community centres and other facilities. They provide much of the medicine, which is donated by Cuba, free of charge. After receiving morning patients at the walk-in clinics, in the afternoons they visit residents in the neighbourhoods assigned to them and practice preventive medicine. Local residents were virtually unanimous in saying that the Cuban doctors, unlike many Venezuelan doctors, treat them as human beings, answering their calls after hours, even in the middle of the night.
As the programme’s popularity began to spread last year, Barrio Adentro came under fire from vested interests. The Venezuelan Medical Federation spread false rumours accusing Cuban doctors of malpractice, and it asked the courts to bar Cuban volunteers from practicing in the country. A lower court ruled in favour of the Medical Federation but the government appealed against the decision. While the legal challenge to the programme has not yet been completely resolved, the exemplary conduct of the Cuban doctors has begun to defeat the anti-communist propaganda campaign against the programme.
At the same time, physical threats against the doctors have mounted and in some cases have been carried out. One Cuban doctor was killed last year in Araguá state, and a Venezuelan assistant to a Cuban doctor was killed in the Petare neighbourhood of Caracas. Many working people said that a slogan promoted by some supporters of Coordinadora Democrática during opposition rallies has been, “Be a patriot, kill a Cuban doctor.”
SHARP CLASS DIVIDE
Many class contradictions are evident, however, among those backing the Barrio Adentro programme. Padrino, a Venezuelan co-ordinator of the programme said that many Venezuelan doctors had come forward in Valencia since December. “But they don’t have the kind of training Cuban doctors have,” he said, “especially for servicing working-class neighbourhoods and living there.” A retraining programme has been established for these doctors. He added, “They can sign up to finish some additional medical and social relations courses in order to enroll in Barrio Adentro.” Now radical Venezuelan doctors have developed working relations with the Cuban doctors, and have helped out in a number of the neighbourhood clinics that Cuban doctors operate.
SCOPE OF BARRIO ADENTRO EXPANDS
Despite these contradictions, Barrio Adentro is now expanding not just in numbers of volunteer doctors and geographic area but in scope. Popular clinics, scheduled to be built starting this year, will expand primary care offered through the modules operated by the Cuban doctors. They will include modern equipment and a larger number of doctors specializing in various medical skills so they can offer minor surgery, dental care, and other such services. The popular clinics will offer free medical care to all, regardless of income.
These clinics are supposed to be staffed by a combination of Cuban volunteers and Venezuelan doctors. About 500 Venezuelan youth are now studying in the Latin American School of Medicine in Havana, The first contingent of them to graduate will be among the first to staff the popular clinics.
Initial skepticism about how this will all work, has now been replaced by hope. The impact of the Barrio Adentro programme can now be felt across the country in most urban centres. For the first time in decades, congestion and long lines have begun to ease at emergency rooms in a number of major hospitals.
As a result of the expanding and widespread activity of Cuban volunteers throughout the country for two years, and the growing numbers of Venezuelan students going to Cuba for three-month stints at Cuban schools, there is evidence that anti-communism and prejudices against the Cuban Revolution are substantially less now.
‘HALF THE POPULATION IS STUDYING’
Cuban volunteers numbering about 15,000 throughout the country – include agricultural specialists, physical education teachers, and trainers showing Venezuelans some of the most effective methods to eliminate illiteracy.
Mission Ribas is the second major literacy programme that has mushroomed across the country. Its goal is to teach mathematics, geography, grammar, and English as a second language to adults who have not graduated from high school. After a preliminary course of six months, students who pass a basic test go on to the programme’s last phase, which lasts two years. Classes are from 6:00 to 9:00 on weekday evenings. The aim is for everyone to get a high school diploma in half the time it takes at public schools. According to government statistics, nearly 1.4 million people are currently enrolled in the programme.
The aim of Mission Robinson, which preceded Mission Ribas, is to teach reading, writing, and arithmetic to 1.5 million people who are illiterate— about 12 per cent of adults in this country of 24 million people. Literacy classes are taught by some 100,000 volunteers, most of them university students. The Cuban government donated more than a million TV sets, VCRs, reading glasses, and literacy manuals used in these classes. In some cases — such as the indigenous village of Mapiricure in Anzoátegui state, inhabited mostly by Cariña Indians, Cuban volunteers are organizing the translation of literacy manuals into the indigenous languages. The first phase of Mission Robinson lasts three months, during which students learn the alphabet and basic arithmetic. Mission Robinson II lasts six months. Since the programme started last July with substantial aid and volunteer trainers from Cuba, some 1 million people have graduated. A good number of them are now moving on to Mission Ribas classes.
Mission Sucre, which lasts for about a year, aims to prepare those with a high school diploma for entry into universities and vocational schools. “I decided I could do this now because the classes are right around the corner from where I live,” said Naudy García, 51, an auto mechanic. “No other government in the past has made it possible for us to do such a thing.” Most workers interviewed said organizing the literacy classes within walking distance of their block has made all the difference. Some have set their sights high, reflecting increased self-confidence. “I will finish these courses and I will go on to Mission Sucre, and I will get into medical school, and become a doctor,” said Elida Liendo, the former garment worker. “I don’t care if I am 40; I don’t care what anybody says.”
Students who volunteered to teach Mission Robinson classes last year were promised a stipend of about $80 per month from the get-go. As most did not get paid regularly, however, thousands dropped out and did not volunteer for the second phase of the programme that started last fall. The majority, however, more than 70,000, according to government statistics, did continue teaching classes on a voluntary basis.
The government has recently announced it will give a small stipend to the facilitators of Mission Ribas classes. “I won’t turn it down, but that’s not the reason I am doing this,” Peña – a volunteer teacher — said. “It’s an honour for me to help my neighbours improve their skills.”
Until about 9:00 on weeknights, many of the households in workers districts are empty or half empty. “There is a joke now that it’s almost impossible to organize any neighbourhood meetings during the week because of the literacy classes,” said Ibis Pino, a university student whose mother was attending another Mission Ribas class that night. “Almost half of the country’s population is studying now.”
Some 4 million people are now involved in the country’s three main literacy programmes. Combined with those attending public and other regular schools, the number exceeds 10 million, we were told.
“The literacy classes and the Cuban doctors are not solving the basic economic problems we face,” said José Landines, a truck driver who lives in the Sierra Maestra section of the January 23 neighbourhood. “But we are in a better mood and we have more confidence we can change the situation.”