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Revolutionary DoctorsHealthcare as it should be

What is being done, in Cuba and Venezuela puts to shame the dysfunctional healthcare system of the US and exposes the Coalition government in Britain as it steers the NHS towards the profit-driven American model. Peter Arkell reports.

Of the many statistics in Steve Brouwer’s book, Revolutionary Doctors: How Venezuela and Cuba are changing the World’s Conception of Health Care, one in particular stands out. There are more students, about 73,000, in medical school in Cuba and Venezuela, with a combined population of 39 million people, than there are in the whole of the US with a population of 300 million.

And they are all educated and trained for free. Many of them will go to Bolivia, Haiti and other countries in order to “to serve the poor, heal the afflicted and make a better world”.

This is the complete opposite of what happens in the United States where the average debt of graduates who take out loans to attend medical college approaches $200,000. The new doctors there, not surprisingly, are attracted to careers in high-paid disciplines like plastic surgery in order to pay off the loans, rather than the less well-paid jobs in family medicine and community practice. The health issues of the community, of primary care treatment, of preventative medicine, of an integrated health system in the interest of the mass of the people, take on a secondary role, as the doctors and other health workers plan out their careers in a market economy.

The book recounts the inspiring story of the birth and growth of a new kind of health provision in Cuba after 1960 when half of the country’s 6,000 doctors left for the US rather than co-operate with the revolution. Che Guevara, who was himself a doctor, took an active role in the early development of the ideas behind the new provision of universal health care. He is revered in Cuba, of course, but also in Venezuela and Bolivia.

Unbelievably, the Bolivian army sergeant, Mario Teran, who was ordered by his superiors (working to the CIA agenda) to murder Che after his capture in 1967, was one of 300,000 Bolivians who had their eyesight restored for free between 2006 and 2008 by Cuban doctors. A programme called Miracle Mission was financed by Venezuela to provide free eye surgery to more than 1.5m people in the whole of Latin America.

In 1962 a second medical university was opened in Santiago de Cuba at the opposite end of the island to Havana. By 2008 there were 25 medical schools in the country. The new doctors and other medical workers were deployed in an entirely different manner. The emphasis was on providing primary care for the whole population. The remote and under-served areas were assigned  doctors. Medical teams were sent out to every part of Cuba, while local residents were encouraged to help in promoting preventive care and participate in public health campaigns. The doctors and nurses were generally expected to live in the area they practised in. “By gathering vital statistics on everyone, and then emphasising preventive care and health education, the doctors and nurses made Cuban citizens more conscious of maintaining good health, which led to a marked reduction in hospitalisation rates,” Brouwer writes.

In 1998 the Latin American School of Medicine (ELAM) was set up near Havana to promote internationalism and solidarity on the part of health professionals. By 2000, there was one doctor for every 167 people, allowing Cuba to accelerate its international programme and ELAM to step up the project for training doctors from all over the world (including even a few from the US).

Between 1961 and 2008, Cuba sent 185,000 medical specialists to work in 103 nations. Most of the placements were for years. By 2005 this new model healthcare army had developed to the point where the medical experts felt able to make a big leap. Fidel Castro announced that Cuba and Venezuela would join forces to educate 100,000 more doctors over the following ten years: 30,000 from Venezuela, 60,000 from other countries in Latin America and the Caribbean, and another 10,000 from nations in Africa and Asia. The Cuban doctors serving overseas took on a double role: as practising doctors and as educators for medical students from the host country.

The Chavez government wanted to deliver universal free health care to those not living in the prosperous parts of towns in Venezuela. It had the money (from oil), but lacked the expertise and manpower. From 2003, thousands of Cuban doctors, dentists, nurses and other health workers went to work in Venezuela. Within a couple of years, 13,000 physicians, most of them from Cuba, were working all over the country in the Barrio Adentro (Inside the Neighbourhood) programme, as it is called.

They lived in the area where they practised and were supported by local committees of volunteers. For the first time comprehensive health care became available to everyone in the country. The project went from strength to strength as new levels of care were added, as the Cuban doctors started to train new students from the barrios and as more local grassroots supporters came forward through community councils and neighbourhood health committees. New doctors are now trained locally. Outposts of ELAM have been set up in the regions and it has become possible to develop a unique medical curriculum.

The medical establishment in Venezuela was not happy. Hardly any of their doctors volunteered to be part of Barrio Adentro. The two systems ran side by side, but the old set-up which served the rich middle classes, found itself sidelined by the new health service. It found common cause with various right-wing Cuban exile groups in Miami and with the US government as it attempted to discredit the initiative. The George W Bush administration organised a cynical attempt to lure the Cuban doctors to America with the promise of huge salaries, but this was largely unsuccessful. As for the colossal health initiative that was transforming the lives of millions of people, this was largely ignored by the American press. So was the Cuban programme to build a long-term sustainable healthcare system in Haiti, rather than just giving aid, after the devastating earthquake that killed over 300,000 people in 2010.

The book provides a detailed analysis of the ideology behind this inspirational story as well as the detail of how it was set up and developed. There is an abundance of statistics, driving home the central point, that the Cuba/Venezuela health co-operative tie-up is an example of what can be achieved.

“The revolutionary doctors and medical students from Cuba and Venezuela and the rest of the Americas and the nurses, physical therapists, sports-trainers and other skilled technicians who work with them are offering a serious challenge to the rest of the world”, Brouwer writes. “They are demonstrating that humanity is capable of delivering medical care to everyone – not in the remote future, but right now – and they are accomplishing this while openly defying the logic of capitalist development that dominates most of the globe”.

They have shown, says the author, that “a model of comprehensive community medicine, based on over half a century of successful experimentation in Cuba and abroad, can be adapted to the needs of other nations... At the same time as they are constructing a universal public system of primary care, advanced care and preventive medicine they are also training the medical personnel who will sustain that system over the long haul.

“The intensive grassroots, democratic participation of the Venezuelan people in the ongoing development of Barrio Adentro has been crucial to the success of the Cuban collaborators; it has also been indispensable to the success of the Bolivarian revolutionary process. For this reason, the Venezuelan experiment is an inspiration to other societies that are trying to invent their own versions of 21st century socialism”.
There remains a fundamental question that is hardly touched on by Brouwer in his book. Is this extraordinary health programme vulnerable from the fact that Venezuela, Bolivia, Brazil, Haiti are still capitalist countries with a bourgeoisie and a capitalist state machine in place? The money to pay for the projects comes out of the revenues from Venezuelan oil sold in the global capitalist market place. Is the re-distribution of these profits to pay for what is undoubtedly a revolutionary social programme something that is irreversible? Are the healthcare reforms secure? Is it possible to construct a new social order gradually from within? 

Brouwer sees the new “army in white jackets” as “a moral and ethical weapon that strikes at the hollow core of capitalist values”. He views the medical co-operation between Cuba and Venezuela as more than just about healthcare, but about “preparing people to re-make the world”. He believes that Washington strategists are “totally unprepared and unequipped mentally to mount a defence” against this new army. And he visualises the spread of these concepts and practices to other nations: “The panic at the centre of the capitalist world is due to the fact that 21st century socialism is an attractive proposition to many nations.”

Few can doubt that the development of these social programmes does threaten not only the resident capitalist classes, but also the United States which might be able to ignore them (at the same time as scheming against them) for a while, but not for ever. The reforms, for that is what they are, do empower the masses, and that is dangerous for the warriors of counter-revolution to the North, as the defeat of the coup attempt against Chavez in 2006 proved. But the CIA, with a long history of supporting and organising counter-revolutionary coups in South America, is always looking for new ways of de-stabilising these anti-American regimes. The WikiLeaks revelations prove it, if any proof were needed.

In the final analysis, these countries operate within capitalism and therein lies the great danger to the extraordinary, revolutionary experiment in health care so well documented in this book.   

8 February 2012

Revolutionary Doctors: How Venezuela and Cuba are changing the World’s Conception of Health Care by Steve Brouwer. Monthly Review Press. £13.50, Kindle edition £7.84

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