May 13, 2002
LAS SALINAS, Venezuela -- When businessmen and army officers launched a
coup against leftist President Hugo Chavez last month, Damaris Fernandez
figured she and fellow medical workers at this rundown, seaside clinic would
be going home to Cuba .
Mr. Chavez's opponents, from the middle, upper and professional classes,
despise the two-year-old accord that brings about 250 physicians, nurses and
technicians, like Dr. Fernandez, to Venezuela from Cuba . They serve in poor,
rural areas where Venezuelan doctors are reluctant to practice.
Critics maintain that the medical exchange program is the leading edge of a
plot by Mr. Chavez and his friend, Fidel Castro, to "Cubanize" this
oil-rich nation of 24 million people. That's why the coupsters and their
supporters in the short-lived interim government moved quickly to root out the
Cuban presence in Venezuela. They cut electricity and water service to the
Cuban Embassy and threatened to halt shipments of bargain-priced oil to the
island. But Mr. Chavez's loyalists launched a lightning counter-coup that
brought the populist leader back to power and returned the Cubans to their
status as Venezuela's key ally.
Now that Mr. Chavez has returned, the Cuban doctors are digging in and are
more controversial than ever. "We come here to give humanitarian aid.
We're trained with the idea of giving service to the most needy," says
Dr. Fernandez, who came to Las Salinas in January.
Venezuela is one of about a dozen countries in Latin America and Africa that
play host to some 2,000 Cuban doctors, as well as athletic coaches and
technicians. The Cubans provide free medical care for impoverished patients
who previously had few opportunities to see doctors.
But the Venezuelan experience not only reveals something about Mr. Castro's
subtle effort to export revolution. It also highlights the severe class
divisions in Venezuela that have turned the rift between Mr. Chavez and his
opponents violent.
The Venezuelan Medical Federation, a national professional group, viscerally
opposes the Cuban presence. The Cubans, they argue, are
"proselytizing" poor Venezuelans with communist propaganda. What's
more, they note that Venezuela already has far more physicians than
international health organizations recommend for adequate public-health
coverage. Indeed, the federation says about one in five of Venezuela's
approximately 45,000 doctors currently is unemployed or underemployed. Instead
of importing Cubans, the Chavez government should be improving Venezuela's
dilapidated public-health system and boosting doctors' pay, which starts at
about $600 a month, the federation says.
But Miguel Requena, dean of the medical school at Caracas's Central University
of Venezuela, argues that, for now, there's a genuine need for the Cuban
doctors in Venezuela. He concedes that Venezuela has a large number of
doctors. However, few of them care to work where they are most needed, as
general practitioners in rural or urban primary-care clinics. Almost all the
new doctors want to live in Caracas and other big cities and engage in
lucrative specialties, such as plastic surgery, he says.
The Cuban doctors, for their part, make it a point to keep a low profile and
avoid controversy. They generally live in groups of three or four in rented
houses in the communities where they serve. Only three of the hundreds who
served here have so far defected to join family in the U.S. All three cases
occurred in early 2000, when the first large group of Cubans arrived to
provide emergency aid to victims of a devastating flood and mudslide.
The deputy director of the Cuban medical program here, Adalberto Sotolongo,
stresses that he and his colleagues came to Venezuela to help poor and sick
people, not politicians like Mr. Chavez. As for Venezuela's health-care
system, Dr. Sotolongo carefully notes that "there are great inequities
that at times seem inexplicable."
The Chavez government says it has a plan to reorient Venezuela's health system
to provide complete coverage through local clinics that emphasize preventive
medicine. But, in the meantime, says Venezuelan Health Minister Marķa
Urbaneja, the Cubans "don't do any harm to anyone" and are
"helping a population that's excluded and very needy."