We are pleased to offer this first-hand account of the health care system in Venezuela. The bottom line seems to be that under the leadership of Hugo Chavez, millions of citizens are receiving adequate health care for the first time in their lives. As Barry Karlin suggests, perhaps we in the United States have something to learn from the the example of Venezuela.

by Barry Karlin

March 12, 2008

daily camera

Exactly what is Venezuela? Does it represent a 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 demonizing 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 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.

The Chavez government is determined to provide free services regardless of cost, using massive oil revenues to pay for Cuban doctors and nurses and for the overall program. In 2007 alone, some 78 million medical consultations were provided. Services are basic but are increasingly supported by excellent diagnostic and treatment facilities. Poor people tend to love these new services. The middle class is unsure. Traditional health workers and the well-to-do usually express deep concern about such profound health changes.

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 health services for the first time will not allow these services to disappear. Some 60,000 ordinary citizens 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 now receive to allow that to happen.

One can attempt to put Venezuela’s health changes into a political or economic context. But I think that the best way to understand these changes is to read what Charles Hardy, an American from Wyoming who served as a slum priest in Caracas for many years, wrote in his recent book: Cowboy in Caracas. He says that in the slum where he lived, in the morning, one did look into the face of neighbors passing by. Chances are that they are carrying paper bags made of newspaper containing the family’s feces, their homes lacking toilets, running water or often electricity. Such humiliating conditions have quickly disappeared under Hugo Chavez. Hardy feels that outsiders and even wealthy Venezuelans cannot understand the popularity of Chavez without appreciating such conditions.

Venezuela, with only one-sixth of America’s per capita income, has taken a daring step to address its health crisis. America’s health context is quite different from that of Venezuela. Still, I wonder whether we in Colorado and the USA have the courage to honestly address our own health crisis rather than band-aid solutions We might even come to recognize that a bold change such as a single-payer system is worthy of consideration.

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Barry Karlin has a Doctorate in Public Health and is currently an Adjunct Professor at CU in Boulder. He has worked in the field of international public health since 1959.