How the World Is Supposed to Work

Misión Barrio Adentro: Experiencing Health Care as a Human Right in Venezuela
Written by Rebecca Trotzky Sirr
Thursday, 24 May 2007

For once in my career as a medical student, I have absolute faith that my patients will be taken care of regardless of how much money they have in their pocket. Entering the Misión Barrio Adentro clinic in San Rafael de Tabay, a town in Merida, Venezuela amazes even the most jaded visitor. The local community hospital, Centro de Diagnostico Integral (CDI) brings alive Venezuela’s social revolution in health care.

The premise of Misión Barrio Adentro is simple: doctors live and work in communities providing health services free of charge to anyone.(1) In the span of four years, Barrio Adentro added 1612 modules (with 4618 under construction) to the 4,800 existing public ambulatory clinics.(2) The national goal is to have one primary care doctor for every 1250 to 2500 habitants. While Cuban doctors currently cover a large portion of this health need, new medical schools are training over 17,000 Venezuelan youth to become doctors. A corollary training program has around 3,000 Venezuelan doctors in a postgraduate residency community medicine. It’s one thing to look at the numbers, but does this massive expansion of primary health through Misión Barrio Adentro actually work? To gain perspective, I have been studying as a medical student under Venezuelan and Cuban physicians in both the traditional and revolutionary Barrio Adentro public health clinics. Beyond the reports and statistics, I carry back with me the experience of participating in egalitarian medicine, a goal I can keep in my mind’s eye.

Many who view the new health care programs as a radical departure, may not know that even before the Chavez government, all people had a right to health care, education, social protection provided free from the state. However, access was limited. A report of the Panamerican Health Organization and World Health Organization, “Barrio Adentro: the right to health and social inclusion in Venezuela” documents the history of health care in Venezuela. Before Chavez, there was an underinvestment in social programs, increased orientation to the private sector. When Chavez was first elected president in 1998, over 35 percent of the poorest 20 percent of the population indicated that they didn’t go to see a medical for their health problem because they didn’t have the money to pay for a consult, medicine, or exam.(3)

Since the 1970s until Chavez’s Administration, investment in public health did not match the expanding population’s needs. During the 80s and 90s, only 50 new public clinics were built. Meanwhile, 400 new private clinics were constructed. From the 70s to Chavez’s election, there was only one public hospital built. A 1985 study revealed that Venezuelans had trouble getting care in Caracas, even in spite of the fact that the capital had disproportionately more physicians than the rest of the country. This is for many reasons. Clinics were too far away and badly organized for the communities needs. They also lacked appropriate referral systems, and were focused on curing instead of preventing disease. In poor and rural communities, care was provided by recently graduated inexperienced physicians.(4) These results match the stories I am told by my patients.

Misión Barrio Adentro was founded in 2003 as a part of 17 Misións, or comprehensive national social service programs, that together have similar explicit objectives to overturn decades of growing social inequalities. By recognizing the social rights of health, education, nutrition, housing, and employment, the Misións create sustainable new power relations based on democratic and participative ideals.

How does a country with a per-capita gross domestic product 1/6th that of the United States fund this massive expansion of primary clinics? In an example of South-South economic cooperation, bypassing neoliberal economic trade models, Venezuela sends up to 50 thousand barrels of oil per day in exchange for the services of Cuban health workers and related medical supplies. A ‘petrol for physicians’ trade agreement brings over 23,500 Cuban health professionals including nearly 15,500 doctors to serve the community. Importantly, new medical schools led by these doctors are training Venezuelan medical students, youth who would never otherwise have had access to advanced formal education.(5)

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