Clad in blue t-shirts that read “Health is the heritage of the people,” and grey t-shirts with “Health Committee,” participants in the national health program waited patiently with street vendors selling red t-shirts with ironed-on images of President Hugo Chavez with text that read “With Chavez the people continue to rule.”

Maritza Rojas was one of those waiting in line. Rojas explained that her committee is one of hundreds across the country that help keep the Barrio Adentro program running smoothly with the direct participation of the people in her Caracas neighborhood, the Calvario. “Our job is to take care of the doctors in our neighborhood, to make sure they are doing well, and that they have the supplies they need,” Rojas said, “everything is going smoothly in my neighborhood.”

Barrio Adentro is a national health care program based on local neighborhood clinics for primary medical care. Treatment includes vaccinations to control epidemics as well as the provision of free medicine for the most common illnesses, illnesses such as intestinal parasites and diarrhea that once killed the most vulnerable such as children and the elderly.

Barrio Adentro is present in primarily poor neighborhoods where approximately 80 per cent of the Venezuelan population live. Many of these neighborhoods, where homes are typically made of red bricks, were built by children of squatters who invaded lands around Venezuelan cities decades ago.

Because of the poverty of these areas, most Venezuelan doctors refused to participate in the Barrio Adentro program, so President Chavez brought in Cuban doctors through an agreement with the Cuban government. That was more than a year ago. Today there are over 10,000 Cuban doctors practicing in the poorest Venezuelan neighborhoods and they don’t seem to mind.

“This has been an extraordinary experience,” said a Cuban doctor waiting in line, dressed in a white smock and who works in the Baruta area of Caracas, “the reception of the people has been marvelous,” he said explaining that the first steps were cautious on both sides, “at first the people were a little scared because of political reasons, but now they’ve opened up,” said the tall, dark-haired young doctor who is in Venezuela on his first international mission. He preferred not to be named.

According to government statistics, this past year in the country more than 18 million people have been treated and more than 6,000 lives have been saved. This means that approximately 70 per cent of the population has been reached by Barrio Adentro.

Inside the elegant Teresa Carreño theatre that once was reserved for the Venezuelan elite, thousands of volunteers from impoverished neighborhoods across the country filled the plush brown seats. Maria Sojo, a volunteer health committee coordinator from Coche, a Caracas suburb, had been waiting 5 hours for the beginning of the Barrio Adentro event. Sojo said the event isn’t as important as the Barrio Adentro program, which she and her community fully support. “Nothing like this (Barrio Adentro) ever existed before. We were never taken into consideration. Now we are and we are grateful to our president for what he has done for us,” Sojo said.

The noise was deafening at the commencement of the event with thunderous applause and chanting “Barrio no se va!” or “Barrio [Adentro] will not go!” Venezuelan Minister of Health and Social Development, Roger Capella, spoke at length of the Barrio Adentro program and said that the most serious problem that faced Venezuelans was lack of access to Medicare. “Venezuelans faced exclusion that was not just social, but political, economic and racial,” Capella said, adding that Barrio Adentro is “the revolution in healthcare for Venezuelans.”

Capella told the history of the country’s lack of social infrastructure before the current government’s Bolivarian social platform and how Barrio Adentro is the response to historical failings. Capella praised the current healthcare accord between Cuba and Venezuela. “Barrio Adentro is a shining example of South-South cooperation,” Capella said. To deal with the lack of participation of Venezuelan doctors, the health minister announced that more than 1,000 Venezuelans are being trained as doctors to continue the Barrio Adentro program.

The Latin American branch of the World Health Organization also praised Barrio Adentro. Renato Gusmao of the Pan-American Health Organization said he was impressed to see 1,300 Venezuelans training as doctors to participate in the healthcare program, adding that Barrio Adentro is helping to knock down social and economic barriers, providing access to healthcare for the majority of Venezuelans. “Barrio Adentro permits the planning of a health care system based on the demands of the population, not just on how much they have and how much they can afford,” Gusmao said.

Gusmao lauded the cooperation between Cuba and Venezuela, “Is it always necessary for us from the underdeveloped world to give more respect to a white person from another country who makes speeches?” “Through the cooperation between Cuba and Venezuela we are starting to respect each other,” he added.

Gusmao read some words from the director of his organization: “I thank President Chavez for being one of few leaders who combats social exclusion - this is what we want in health - this shows new leadership in health. Congratulations Venezuela.”

The creation of the dental component of the Barrio Adentro program had an interesting inception according to Freddy Bernal, mayor of the city of Caracas. Bernal said he came up with the idea after attending two pro and anti Chavez demonstrations on the same day. “I saw that on the anti-Chavez side, the people seemed to be happier because they were smiling and had beautiful teeth, while on our side, the people didn’t seem to be smiling and when they did, they would hide their smile behind their hand. I realized later that it was because so many on our side have bad teeth,” Bernal said.

According to government figures, 3,013 dentist chairs have been set up in 24 states across the country with 2,493 specialists in dentistry and oral health for free service that used to cost Venezuelans 20,000 Bolivares (about $10) for a consultation, while dentures could cost between 85,000 and 150,000 Bolivares ($40-75). The minimum wage in Venezuela is 321,000 Bolivares per month (about $160 a month).
Also, an ophthalmology program has been included. It came about because of the needs of the population who were enrolled in Mission Robinson, a national literacy program that has in one year managed to teach more than 1 million Venezuelans how to read and write. According to the government, many people enrolled in the program required glasses and had other vision problems, so the ophthalmology component of the Barrio Adentro was added.

The Barrio Adentro program is reaching deep into the vast neighborhoods surrounding Venezuelan cities with an approach that integrates education, sports, culture and social security. Caracas mayor Freddy Bernal calls the Barrio Adentro program, “the fundamental engine of the Bolivarian Revolution.”

Due to the extensiveness of the program and the demands of the population, the program is not without its problems. President Chavez himself later the same night said the government has had problems building enough doctor offices across the country. “This year our goal is build 5,000 doctor offices. We have only reached 10 per cent of that figure,” Chavez admitted.

But at the end of the night of the 8 hour-long Barrio Adentro event, the audience was apparently not deterred by the challenges presented by president Chavez, as the packed theatre thundered with applause and chants of “Barrio will not go!,” and the ever popular “Chavez no se va!”

(This is the first in a series of articles covering the development of the Barrio Adentro healthcare program.)

Robin Nieto