Caracas, Venezuela – Going for a medical check-up at an unassuming red brick clinic in a working class Caracas neighbourhood, pensioner Maria Vivas could be considered a foot solider of Venezuela’s Bolivarian Revolution, never mind her bad knee.
“I like coming to this clinic, it’s close to home and the doctors really take care of you,” Vivas told Al Jazeera, as she sat in the waiting room festooned with posters on how to avoid foot fungus and pictures of communist revolutionary Che Guevara.
Staffed by Cuban doctors and funded as part of a public health campaign by populist president Hugo Chavez, this clinic and hundreds like it have become controversial among some Venezuelans.
“The public health system is bad, where I live it’s all Cuban doctors,” Jusair Mendez, a student and government critic, told Al Jazeera. “No matter what is wrong with you, they just say you have a cold and send you home with no medicine.”
Venezuela sends Cuba about 90,000 barrels of oil per day, in exchange for the services of as many as 30,000 doctors. Supporters of the programme believe both countries benefit from what economists call “comparative advantage”. Cuba is known among developing countries for its healthcare system and Venezuela exports plenty of oil.
Critics say Cuban doctors are undermining Venezuelan talent because of their low wages and Chavez is giving away oil to his political allies.
|Maria Vivas believes Cuban doctors are providing professional medical service to poor Venezuelans [Chris Arsenault/Al Jazeera]|
None of the Cuban doctors working in the San Agustin del Sur neighbourhood were authorised to talk to journalists, due to the political sensitivity of the issue during election season.
Supporters of the programme, including residents of San Agustin del Sur who were going for their check-ups, said Cuban doctors had become part of a community marginalised by Venezuela’s power-brokers prior to Chavez’s initial election in 1998.
“Cuban doctors live here. If you have a pain at midnight, you can come down to the clinic or send someone down and the doctor will come to your house,” Alba Castro, a health promotion volunteer with the local council, told Al Jazeera. “This is preventative medicine.”
‘Fix your life’
Known as “missions” and part of a broader plan called “Barrio Adentro” or “Inside the Neighbourhood”, the government’s programme to provide basic healthcare to poor neighbourhoods with Cuban help began in 2003.
“In the past, if you were poor and had a broken leg, it would be a problem all your life, because you wouldn’t be able to afford private rehabilitation,” Clara Platt, a local resident visiting the clinic, told Al Jazeera. “Now you can go to a rehab centre (located in the community) and fix your life.”
Community councils, where neighbourhood residents are elected by secret ballot, coordinate with Cuban doctors as part of a broader social mobilisation to build sports facilities, repair houses and teach literacy in the country’s slums. The medical programme is financed by PDVSA, the state oil company, which sends crude oil to Cuba’s communist government.
Many Venezuelans think this is a bad idea. “Why is PDVSA bringing doctors from Cuba?” Milos Alcalay, Venezuela’s former ambassador to Brazil, wondered rhetorically. “Shouldn’t the ministry of health be recruiting doctors?”
Critics fear PDVSA has become a state within a state, focusing on partisan political issues and neglecting its core mandate of oil production and safety.
Local people say they don’t mind if their clinic is financed by petro-dollars. They say the “missions” are an efficient use of state resources, as they allow people to be treated for minor illnesses closer to home, rather than going to a public hospital, where visits are more expensive for the state.
Platt, a retiree, says she has seen both sides of Venezuela’s contentious health debate first hand. “I have two nieces who graduated from CVU [the Central University of Venezuela which is seen as prestigious],” she told Al Jazeera. “One is working in the Canary islands, the other is in Spain.”
One of her other nieces studied at a new “Bolivarian” university, designed to train doctors to work in poor areas. “She just graduated, worked in the countryside, and is now working at a big hospital here in Venezuela.”
Losing talent to other countries is a symptom of capitalism, where profit is valued over local health, according to residents of the barrio.
Eventually, many hope Cuban doctors won’t be needed, as newly trained Venezuelans will be able to serve in poor areas.
Some of Chavez’s harshest critics agree that missions such as the one in San Agustin del Sur have been key to his consistent electoral success.
Chavez “drew on enduring support among poorer Venezuelans who had benefited from his social programs” in the 2006 vote, according to Freedom House, a conservative US think-tank. In October, 2012, he won the presidency for the fourth time, garnering about 54 percent of the vote.
“Not everyone loves Chavez here,” Castro said, pointing up the mountain where small homes cling to the hillside. “But they like being treated at the clinic.”