Thursday, November 13, 2008

WMDs -- World Medical Doctors – now being produced in Venezuela (WMDs Part 2)

(originally written in October of 2007)

Jonas, left, with his brother and his father
Jonas lives on a tiny dairy farm on the hill above Monte Carmelo. His father is intensely proud that his son is studying to be a medical doctor. “He’s only in his second year,” he said, “and already he sees patients.”

“Remember, Papá,” cautioned Jonas, “we do see the patients and talk to them, but we don’t treat them yet. We’re just there to observe and assist our teachers and ask questions.”

“I know that,” his father responded. “What I mean is that it’s important that all of you are learning to talk to the patients, treating them like friends and fellow human beings.”

Jonas is not the first person in his extended family to attend medical school, according to his father. He tells the story of his niece, who many years ago dreamed of being a doctor. Her mother, who was very poor, worked constantly to save every penny and told her daughter to study hard. The extended family pitched in to help the mother.

“She really did go to medical school,” explained Jonas’ father, “at one of the big city universities. Then she her got her training in a specialty, and now sees lives and sees her patients in a rich neighborhood of Caracas. Of course, now, as far as she’s concerned, I don’t exist. In fact, my niece doesn’t want to associate with anyone in the family and doesn’t talk to any of us.”

This is why the government has introduced a totally new system of teaching doctors. The old system, centered around elite universities where only a tiny minority of poor and working class students are enrolled, has continued to turn out professionals who want to work in the urban centers and enjoy a fairly rich, upper-middle class lifestyle. These kinds of universities, home to many of the students who are currently protesting against the constitutional reforms, are not unique to Venezuela, for their counterparts exist all over the world.

The Venezuelan government has avoided the temptation to abruptly seize control of these older universities and force them to operate in a manner that serves the poor majority. Instead, it has simply bypassed them and constructed a new kind of university.

Where is this university? All over Venezuela, because it exists in the realm of ideas, not in a particular set of buildings. The Mission Sucre school of Integral Community Medicine trains students where they live, utilizing the local medical facilities and doctors in their towns and neighborhoods as the campus and professors. The students enter with the expectation that they are choosing a vocation that involves serving the people and their home communities after they finish their training.

This unique form of education could not exist without Cuban doctors. They arrived by the thousands to staff the Barrio Adentro neighborhood medical offices that sprouted up all over the country in 2003 and 2004 and brought free health care to poor barrios and rural areas that had neglected for many decades. The Cubans are helped by a four or five thousand Venezuelan doctors who were trained in the old system, but for reasons of social commitment and political conviction have chosen to work with the poor.

Party time for medical studentsAfter dancing, Doctor Barbara, takes a break at the feet of her students, Magale, Antonio, and Luisa.About a month ago Jonas invited me to walk up the mountain to his house where I joined him and his fellow students for a little rest and relaxation. It was Sunday, time for a little music and dancing, plus sitting and chatting and enjoying the view over the valley below. Barbara, the dynamic Cuban physician who holds the students to a rigorous schedule the other six days of the week, took charge of the family kitchen and prepared a big pot of tasty stew.

All of the students are residents of some part of the municipality surrounding Sanare (comparable to a county in the U.S.) and are enrolled in the second or third year of the Mission Sucre medical program (also see earlier article, Fidel’s WMDs) Their Cuban and Venezuelan teachers work in local “ambulatorios” (free public walk-in facilities in various neighborhoods and villages) or in the Barrio Adentro 2 Diagnostic Clinic in the middle of Sanare.

The medical career is demanding. After completing six months of classroom preparation to make sure everyone is starting out on an equal footing, the students commit themselves to a six-year program. Beginning in the very first year, the students are spending part of each day with patients in medical settings. They spend their mornings accompanying doctors as they see patients and offer treatments, looking after medical records and medications, weighing and measuring babies and children while the doctors attend to the rest of the family. Their afternoons are spent in the classrooms. Nights are for study, reviewing CDs that cover the material of each class lecture, and some sleep.

The first year serves to sort out the serious students, the ones who truly have a vocation for medicine, and the less committed drop out. Jonas thinks that the students who come from the rural villages and farms are most likely to stick with the program, perhaps because they are used to hard work. His fellow student Luisa comes from La Bucarita, an isolated coffee-growing village more than two hours out of Sanare by Jeep. She’s living with an elderly relative in Sanare and really misses the company of her large family, but she’s determined to get her medical degree.

Jonas had been out of high school for a number of years before the new integral community medical program began. During the early years of the Bolivarian Revolution, he and other recent high-school graduates were teaching as temporary rural “maestros,” even though they didn’t have college degrees. They served as literacy volunteers who went to the more isolated areas of the county to work for Mission Robinson, the basic education program that taught illiterate adults to read and now helps them and others to complete their elementary schooling. At the same time, he also continued helping his father with farm work and building a new house for the family.

Doctora Edita is a Venezuelan physician who was serving the poor before the Cubans arrived.

Some Venezuelans, like Doctor Edita Goyo, who trained as a pediatrician in the big city of Barquisimeto, were committed to providing health care to everyone before the Chavez government came to power. The Barrio Adentro program was the answer to Edita’s dreams. It has allowed her to practice medicine for the last three years with dedicated Cuban professionals in the walk-in medical office in Palo Verde, a village just outside of Sanare. Currently she’s works in the same room with the Doctor Barbara, who arrived five months ago and replaced the previous Cuban doctor. (The Cubans generally sign up for a two-year tour of duty, and many re-enlist for another round of service.) They and their six medical students make a formidable team.

Antonio and Luisa bring records and medications as Dr. Barbara consults with a family.Dr. Barbara served in four other countries, including Angola, before coming to Venezuela.Each doctor has a desk, one on each side of the room, where they receive a steady stream of patients while the students perform various tasks. One mother arrived with four little children, two on her knee and two standing and clinging to her. The medical students moved in and entertained the children one by one, then managed to measure them and examine their eyes, ears, and throats. Meanwhile Doctor Barbara took extensive notes on the medical history of the woman, for she was the one who was ill.

The files on individuals and families are extensive and allow the doctors and students to review the various trends within the community. They use this information to create wall charts describing the predominant health care problems in Palo Verde. This provides them with a comprehensive view of the most pressing local needs that “integral community medicine” must address. One important component of the medical team’s work is educating the public about preventative measures. Many of the common maladies enumerated on the wall charts – such as diabetes, asthma, and hypertension – are combated by introducing exercise programs and changing diets.

I saw the wall charts below three years ago in a Barrio Adentro office in Caracas. Volunteers from the local Health Committee had helped the Cuban doctors gather information on every family in the neighborhood. The charts showed exactly how many local residents (and the numbers were high) suffered from preventable afflictions such as malnutrition, hypertension, and asthma. The medical students were having good luck entertaining most of the kids, but this baby simply did not want to get weighed by Jonas. Fellow student Vanesa is amused by the proceedings.


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