By Humberto Márquez
CARACAS, Jan 27 2005 (IPS)

The Cuban doctor had barely stepped out of the car in the working-class Caracas neighbourhood of La Vega when the local health care committee emerged out of nowhere and set to work: one member offered his house for use as a clinic, another brought chairs, a third put together makeshift stretchers, a nurse appeared, a security system was organised, and the doctor began making house calls.

The Cuban physician who arrived in this densely populated, traditionally poor and marginalized community in southwest Caracas is one of the 12,000 doctors from the Caribbean island participating in a programme known as “Barrio Adentro” (which roughly translates as “into the heart of the neighbourhood”).

While the main goal of this programme is to bring primary health care to the country’s poorest inhabitants, it has also served as a catalyst for community participation.

Community leader Luis Morín told IPS that prior to the arrival of Barrio Adentro in 2003, the residents of La Vega had a certain amount of experience in grassroots organisation thanks to the neighbourhood assemblies created back in 1991.

Morín explained that these open, non-hierarchical community meetings were inspired by an experience shared by leftist Mexican political leader Cuauhtémoc Cárdenas during a neighbourhood rehabilitation conference held that year.

Local residents gathered at these assemblies to discuss issues like health care, food and education, and organised neighbourhood work committees and cultural events.

These initiatives, along with the local health care, food and education committees formed to help implement them, are all part of the social programmes or “missions” launched by Venezuelan President Hugo Chávez in 2003.

By devoting part of the country’s oil export revenues – which are higher than ever, thanks to the rise in world market prices – to programmes for Venezuela’s historically excluded sectors, Chávez has gained a solid base of popularity and support, and was able to emerge triumphant from the presidential recall referendum held under opposition pressure last August with a healthy majority.

“Programmes like Barrio Adentro have contributed significantly to grassroots organisation,” said Morín. “The people who live here are happy to have medical care from doctors who are friendly, down-to-earth and not at all elitist. They also feel a sense of motivation, because they see it is possible to achieve things and obtain services, and have developed a sense for taking care of what they have managed to obtain.”

A hill separates La Vega from El Valle, another working-class Caracas neighbourhood that has also experienced an impressive upsurge in community participation, leading to significant advances in social development.

“Around here, everything started with a committee formed to take care of this park,” said El Valle resident José Matos, pointing to the half-hectare of grass and swings that serves as a sort of “town square” for this community.

The “friends of the park society” drummed up neighbourhood support to help reclaim this green space, whose lack of lighting and proliferation of untended bushes had turned it into a haven for drug traffickers and other petty criminals at night.

Once this mission had been accomplished, the community collective then turned its efforts towards organising the construction of a Mercal subsidised food market next to the park.

After the launching of the Barrio Adentro programme and the arrival of the first Cuban doctors, the group originally formed as “friends of the park” became a health care committee with 16 neighbourhood delegates, who have gone on to form committees devoted to sports, culture, lighting, water, adult education and activities for seniors.

“Before, a lot of families used grandparents to stand in lines to buy things or pay bills. But now there is a whole programme of activities especially for them. They have exercise classes and group discussions about nutrition and health care, they go on excursions, and they have also become storytellers for the neighbourhood children. Now the park is like a community centre for our senior citizens,” said William, another committee member.

Draisa de León, a neighbourhood activist who “always raises (her) hand” at community meetings, told IPS, “I got involved because of all of the needs in this area, and was inspired by what I saw in the meetings. Now we even have Cuban sports trainers to teach basketball, volleyball and chess, but only for recreation, not for competition.”

Matos noted that a series of other projects are also in the works. “We are going to look for support to build a dental clinic next to the ‘modulo’ (the two-storey house which serves as both home and clinic for the Cuban doctor) and start up a programme to renovate houses, beginning with 60 that most need fixing up,” he said.

The whole network of neighbourhood committees is involved in the “social supervision” of the small local hospital that serves the El Valle district, and is run by Greater Caracas City Hall.

“In the past, there were problems with supplies getting stolen. The doctors didn’t work the hours they were supposed to, and were distant and unpleasant with the patients. Now we keep track of everything that gets used and everything that goes missing, and we make sure that everyone is doing a better job,” he said.

Dr. William Freites, the new director of the small hospital, said that until now, there was no coordination between this facility and Barrio Adentro. Today, however, there are even plans to incorporate Venezuelan doctors into the programme during their internships.

In accordance with Venezuelan law, newly graduated doctors must go through a period of “social service”, working in rural, indigenous, or poor urban communities.

The difference between “then” and “now” is largely a result of the fact that Greater Caracas City Hall – which runs dozens of health care facilities – passed from opposition to ruling party leadership in last October’s elections, in a country still marked by deep political divisions along pro- and anti-Chávez lines.

The Cuban doctors participating in Barrio Adentro consulted by IPS noted that their cooperation extends beyond providing health care services to such areas as helping schoolchildren with their studies or organising sports activities for them.

According to Morín, “now the people have experienced what it’s like to receive more human, less distant medical care, as well as much simpler procedures for access to that care, and they are more receptive to all of the ideas related to preventive medicine, better hygiene, better nutrition, cleaner surroundings, and the importance of vaccinations,” he said.

“The struggle for health care has to be ongoing, and our next challenge is to bring about the wide-scale involvement of Venezuelan doctors. The Cuban doctors are only a temporary solution, they won’t be here forever,” he added.

For Morín, one of the obstacles that still needs to be overcome is that many people have only a limited commitment to participating in the various programmes that form part of the peaceful “revolution” of social and political changes spearheaded by Chávez.

“This is something that we have to work at every day, so that we don’t lose the benefits given to us by the 1999 constitution, which talks about popular participation and the leading role played by the people, but also about shared responsibility,” he added.

Matos also said that he supports the “revolutionary process” led by Chávez. “A lot of people think that revolution means going around with a gun. But it doesn’t. Revolution means educating and informing and organising the people to defend their rights.”

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