Exactly what is Venezuela? Does it represent a health model with important messages for people everywhere who have been disenfranchised and ignored; a threat to democracy; an “Axis of Hope” as one writer, Tariq Ali, suggests, or a bit of each of these? And do these lessons have any meaning in terms of N. American’s struggles for decent and affordable health care?
In early January, 13 University of Colorado Denver and Boulder graduate students and I went to Venezuela to study their rapidly changing health care system. We met with clinic and hospital officials in 3 Venezuelan cities, with schools of public health staff, the vice minister of Public Health, the director of PAHO/WHO, with many Venezuelan and Cuban physicians and nurses, and many more.
We even interviewed more than 40 people from many walks of life in streets, shops, and on the Caracas subway about their feelings and concerns about changes they have experienced with their health care systems.
It was a remarkable experience. One arrives in Venezuela influenced by many media reports condemning President Hugo Chavez for his lack of diplomacy, his “in-your-face” style, his friendship with Cuba and others seemingly hostile to U.S. interests, and for his somewhat mysterious Bolivarian Socialist Revolution.
Rather than simplifying what is really happening, we have learned that the situation in Venezuela is far more complicated than Fox News reports.
Venezuela has for centuries been a highly polarized nation since the first Spaniards arrived 500 years ago with their swords, horses and attack dogs.
And, to this day, Venezuela remains, like much of the Americas south of our border, a have/have not society. Some two-thirds of the population, 14 million people, live in poverty, many of whom have never seen a doctor in their lives. Many die from preventable communicable diseases, as well as young mothers and babies during childbirth.
Hugo Chavez was elected president in 1999 with the promise to bring major changes. Following serious landslides and floods in Caracas, he began by bringing in 54 Cuban family physicians who were quickly followed by 30,000 more, a number not much smaller than the total number of practicing doctors in the country.
They were stationed in poor neighborhoods, working on the ground floor of modest houses and living upstairs. Six mornings a week, they see anyone who needs care with no charges whatsoever, and regardless of age, sex, political affiliation, or sexual orientation.
During the afternoons, they conduct home visits, often accompanied by a Venezuelan medical student or nurse. Millions of people have received these services or have been referred to new, free modern diagnostic and treatment centers being built throughout the nation.
The Chavez government is determined to provide these services regardless of cost, using massive oil revenues to pay for Cuban doctors and nurses and for the overall program. The problem is that disregarding costs have resulted in an ignoring of the impact of this effort.
Vital statistics are weaker than ever. No cost-effectiveness studies have been undertaken and it is impossible to say with accuracy what impacts have resulted. Poor people tend to love these new services.
The middle class is unsure. Traditional health workers and the well-to-do usually express horror, with the Government not being clear about the future of private (for-profit) hospitals, traditional decaying public hospitals, and the new Cuban-style system.
So, is Venezuela an Axis of Hope? Time will tell. It’s encouraging that the Government has asked The World Health Organization to help in evaluating some of its health efforts, and that UNICEF has been welcomed.
One thing is certain, the masses of people who have received decent and improving health services for the first time will not allow these services to disappear. They have been too deeply a part of their community health committees, and too appreciative of the free and respectful care which they and their families receive to allow that to happen.
Venezuela, with only one-sixth of America’s per capita income, has taken a daring step to address its health crisis. I wonder if we in Colorado and the USA have the courage to do so, and in a way which minimizes pain and confusion associated with such significant change.
Barry Karlin has a Doctorate in Public Health and is currently a visiting professor at CU. He has worked in the field of international public health since 1959.
