[Marxism] [com-news] Cuban-led neighborhood clinics, literacy campaigns spread; 4 million in adult education

Fred Feldman ffeldman at bellatlantic.net
Sat May 1 09:31:53 MDT 2004

Useful article.  The emergence of a layer of pro-revolution doctors in
Venezuela is a positive development.
Fred Feldman

   Vol. 68/No. 18           May 11, 2004  
Competent neighborhood clinics operated by
Cuban doctors spread across Venezuela 
Nationwide literacy campaigns involve
4 million in adult education classes
VALENCIA, Venezuela—“This state and this city, in particular, were a
test case for Barrio Adentro,” said Joel Pantoja, a doctor who graduated
last year from the medical school at the University of Carabobo. Pantoja
spoke on March 17 to Militant reporters in this major industrial center
and capital of Carabobo state. 
Barrio Adentro, which translates roughly as “Into the heart of the
neighborhood,” is the name of a government-sponsored program that has
brought thousands of volunteer Cuban doctors operating free neighborhood
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 programs 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.” 

On a previous visit last October, Pantoja and a handful of other
Venezuelan doctors told Militant reporters they were trying to start
Barrio Adentro themselves in Valencia, since it seemed that Cuban
doctors would not set foot in Carabobo until the local and state
governments changed hands. Until the end of 2003, authorization by local
governments was required to bring in Cuban doctors. 

Pantoja said there are now 1,200 Cuban doctors in Carabobo, about half
of them in Valencia’s working-class neighborhoods. A total of 10,000
Cuban doctors are now working in the country. Their numbers have
increased five-fold since October, according to figures in the Cuban
press and reports by the Libertador municipality of Caracas, where the
program was launched. 

Hilario Padrino, a traumatologist who serves as the Venezuelan
coordinator for Barrio Adentro in Carabobo state, confirmed these
figures in a March 17 interview in his Valencia office. 

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 neighborhood clinics
operated by Cuban doctors to be primary care centers under the
jurisdiction of the national Ministry of Health, Pantoja said. 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. “The victory in Carabobo was a watershed
for the spread of the program,” Pantoja said.  
How the program spread 
About 250 Cuban doctors, nurses, and technicians had served in Venezuela
for about five years, arriving soon after Chávez’s election. But their
presence has increased exponentially since last spring, when the
government launched Barrio Adentro in the Libertador municipality of
Caracas, whose mayor, Freddy Bernal, is one of the figures in the party
led by Chávez, the Fifth Republic Movement. 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

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 centers 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 neighborhoods assigned to them and practice preventive
medicine. Venezuelans interviewed by the Militant 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. (For more details see “Cuban doctors in
Venezuela operate free neighborhood clinics” in Nov. 3, 2003, Militant.)

As the program’s popularity began to spread last year, Barrio Adentro
came under fire by many capitalists and upper- middle-class layers. The
Venezuelan Medical Federation spread false rumors accusing Cuban doctors
of malpractice, and on June 1 it asked the courts to bar Cuban
volunteers from practicing in the country. A lower court ruled in favor
of the Medical Federation but the government appealed the decision.
While the legal challenge to the program has not yet been completely
resolved, the exemplary conduct of the Cuban doctors has begun to defeat
the anticommunist propaganda campaign against the program. 

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 neighborhood of Caracas, said Ricardo López, a
Cuban doctor who works in the January 23 neighborhood of Caracas, in a
March 19 interview. A Venezuelan facilitator of literacy classes was
also killed in his car in another Caracas neighborhood in late February,
workers in the area said. 

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.” 

Security for the Cuban doctors has substantially improved since last
year, said Luis Casadiego, who coordinates a community center hosting a
clinic with Cuban doctors in the Montepiedad section of the January 23
neighborhood. “That’s why assassinations have remained few and physical
attacks have begun to concentrate more on Venezuelan assistants,” he
Sharp class divide 
Many class contradictions are evident, however, among those backing the
Barrio Adentro program. 

Joel Pantoja said he and another 10 young doctors he knows in Valencia
immediately volunteered to assist the Cuban doctors who began arriving
in Valencia in December. “We were flatly turned down by Padrino,”
Pantoja said, “who claimed we were troublemakers.” Pantoja said he and
these other young Venezuelan doctors have led many public protests in
the city demanding more radical measures against the economic power of
the pro-imperialist opposition trying to overthrow the elected

The national government launched Barrio Adentro about a year ago, first
by calling for Venezuelan doctors to step forward. About 50 volunteered
nationwide at that time. 

In the March 19 interview, Padrino acknowledged that 65 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 neighborhoods and living there.” A retraining
program has been established for these doctors, Padrino added. “They can
sign up to finish some additional medical and social relations courses
in order to enroll in Barrio Adentro.” 

Pantoja said that in many areas of the country, Barrio Adentro is in the
hands of Venezuelan coordinators like Padrino. He and his group, Pantoja
added, have developed working relations with the Cuban doctors anyway,
and have helped out in a number of the neighborhood clinics that Cuban
doctors operate. “We’ve also signed up for the retraining course Padrino
set up,” he said, “in order to eliminate that obstacle too.” 

When asked if the goal in Venezuela is to emulate the Cuban health-care
system, which offers medical care as a universal right that is free of
charge, eliminating medical practice as a business, Padrino replied,
“Not exactly.” 

“Our goal is to provide health care to the poor,” Padrino said. “But
those who have the resources and want to go to a private clinic should
still be able to do so.” 

Padrino himself is the owner of a large private clinic in Valencia. 

“This is what I and the other doctors I collaborate with are battling
against within the pro-Chávez camp,” Pantoja said. El Cimarrón, a
political community group Pantoja helps lead, has now reached the
conclusion, he said, that what is needed in Venezuela is a health-care
system like that in Cuba, “which means a social revolution is needed to
bring it into being.” 

Many of the social programs being carried out in Venezuela today may
seem similar on the surface to those in Cuba, Pantoja noted. But they
have a different class content and dynamic in a state where the
working-class has taken political power than when run by a capitalist
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. While
in the January 23 neighborhood of Caracas, Militant reporters visited
several of the new “modules” built every several blocks in that
district. “Thirty-eight of them are under construction,” said Casadiego,
in a neighborhood with a population of 1.5 million. “Two were just
inaugurated last week.” 

These are two-story structures. The bottom floor will be the walk-in
clinic while the top is a small apartment that can comfortably
accommodate two doctors. The modules are being built with government
funds and will provide better facilities for the Cuban volunteers. Until
now, all Cuban doctors volunteering in these neighborhoods have been
living in the homes of people who offered to host them. 

Popular clinics, scheduled to be built starting this year, will expand
primary care offered through the modules operated by the Cuban doctors,
said Casadiego. 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. “These clinics will
replace the state-owned ambulatorios,” Casadiego said, referring to
walk-in clinics built under previous regimes that have largely stopped
functioning in most working-class neighborhoods. “The popular clinics
will offer free medical care to all, regardless of income,” he said. 

These clinics are supposed to be staffed by a combination of Cuban
volunteers and Venezuelan doctors, we were told. About 500 Venezuelan
youth are now studying in the Latin American School of Medicine in
Havana, Casadiego and Pantoja reported. “The first contingent of them to
graduate will be among the first to staff the popular clinics,”
Casadiego said. 

Pantoja said he was skeptical of how this will all work, given the
initial challenges to Barrio Adentro faced by revolutionary-minded
Venezuelan doctors in Valencia. 

“But one thing is for sure,” Pantoja added. “The impact of the Barrio
Adentro program can now be felt across the country in most urban
centers. For the first time in decades, congestion and long lines have
begun to ease at emergency rooms in a number of major hospitals.” This
is a measurable, statistical impact, we were told by a number of
Venezuelan doctors and others in Caracas, Valencia, and elsewhere. 

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 anticommunism and prejudices against the
Cuban Revolution, which were more noticeable during an earlier Militant
reporting trip to Venezuela in 2002, 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

On the evening of March 19, some 15 students were taking part in a
Mission Ribas class in the Sierra Maestra section of the January 23
neighborhood, on the hills overlooking downtown Caracas. All were
workers. The oldest, Deusdedit Palacios, 54, is an auto mechanic. The
youngest, Galaxo Orrellana, 23, is a cook. Most of the students were
women. They included Marbani Castillo, 25, who has three children and is
unemployed, and Elida Liendo, 40, a former garment worker who now does
laundry at home for people in the neighborhood after losing her sewing

Mission Ribas is the second major literacy program 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 program’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, publicized
in displays at a March 20 pro-government rally in Caracas, nearly 1.4
million people are currently enrolled in the program. 

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 percent 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,
which Militant reporters visited March 24—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 program 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

Mission Sucre, which lasts for about a year, aims to prepare those with
a high school diploma for entry into universities and vocational

None of the workers who were at the Mission Ribas class in the Sierra
Maestra on March 19 had gone through Mission Robinson classes. All said
they had finished elementary school and then dropped out, or had only
completed first or second grade in secondary education. 

“I got pregnant when I was 14, that’s why I dropped out of high school,”
said Marbani Castillo. “I have three kids now, but I decided I don’t
want to just stay at home.” A number of other women workers gave similar
reasons for quitting school at a young age. 

“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

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.” 

All of the students praised their teacher, Raísa Peña. “She talks to us,
she helps us understands things that seem difficult, she is here every
day even though she has a day job, she is motivated to do this,” said
Yeny Palacios. 

Peña said she has a regular job at a high school and volunteered to do
the classes in the evenings, especially since she lives around the
corner too. There are many elementary and high school teachers doing
this, she said, as well as university students and others, all on a
volunteer basis. 

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 program that started last fall,
Militant reporters were told in a number of interviews last October. 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 said. “It’s an honor for me
to help my neighbors improve their skills.” 

Until about 9:00 on weeknights, many of the households in workers
districts like the January 23 neighborhood are empty or half empty.
“There is a joke now that it’s almost impossible to organize any
neighborhood 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 programs. 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 neighborhood. “But we
are in a better mood and we have more confidence we can change the

Olivia Nelson and Natalie Doucet contributed to this article.  


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