Wednesday, November 12, 2008

The World Medical Doctors down the street (WMDs part three)

(originally written in January of 2008)

An innocent, beautiful little village nestled into the mountains at the northern end of the Andes. Hardly the place anyone would look for one of the greatest concentrations of WMDs in the world. Should we leave town before Bush tries to retaliate?

The new generation of WMDs in Venezuela (for those of you who have not encountered them in two previous posts on Venezuela Notes) are World Medical Doctors in training, and they’re living on all sides of us. Monte Carmelo, a village of about 700 people, has 8 residents who are studying Medicina Integral Comunitaria, or Integral Community Medicine, in the Mission Sucre program of higher education that serves this municipality. A ninth resident is studying medicine in Cuba.

On the left, Mariela, Arelys, and Milena live in Monte Carmelo. Next, Inez is from the nearby village of Bojó, and Karen comes from Peru.

    Milena and Mariela began studying three and a half years ago as part of the first class that now includes twenty-eight students. They responded to public announcements inviting interested people to take an exam that would qualify them to enter the medical training program. Mariela, who had just finished liceo (or high school), had always dreamed of being a doctor but doubted that she would have the opportunity to study at one of the big city universities. “So, when I heard that we could take the test to enter the program in Medicina Integral Comunitaria, I raced down into Sanare to sign up.”

Milena on the other hand, was already out of school, married and the mother of a two year-old daughter when she took the exam. When she and Mariela passed and were accepted into the medical program, they faced a rigorous 6 month preparatory course that was designed to get all students, those fresh from high school and those who had not attended classes for a long time, performing at more or less the same level.

Then they were ready for the course of study itself, a serious commitment that involves completing six years of work, the same amount required by medical schools at many other universities in Europe and around the world.

Their school, however, is unique in two ways. For one, the university training comes to them in their hometowns and prepares them for spending their careers serving the areas they live in or other parts of the country (or world) that have a shortage of doctors and good health care.

Secondly, they begin spending time with patients in their very first year, working three or four hours in the morning, Mondays through Fridays, in the ambulatorios (walk-in offices) and the larger diagnostic clinic created by the Barrio Adentro program. Besides taking note of various kinds of treatment, the students begin developing their communication skills and abilities to interact sensitively and humanely with patients.

In the afternoons, all the students working in various locations converge on a building in Sanare, the large town in the area, for their formal classes. These consist of watching DVDs of lectures from Cuban medical schools, discussing the material and things they have observed with the Cuban doctors who are their local instructors, reviewing other medical information on computers, and also taking weekly exams.

When Mariela and Milena completed their second year, they and all the other students entering the third year were rewarded with gifts: their own computers to use at home. This allows them to take DVD copies of the Cuban lectures and various readings and films with them for night-time review. They were delighted, of course, because few people in Monte Carmelo are lucky enough to have their personal computer and because they feel the complexity and intensity of their work has increased this year. The two of them mentioned their current physiology course in particular since it demands a lot of rapid memorization -- all those bones, organs, muscles, tendons, ligaments and their various functions.

Every fifteen days, two of the third year students have to be on call all night at the Yacambu Diagnostic Center. From 8 pm to 8 am, they help admit emergency patients and assist the lone Cuban doctor who is on call. Sundays, though they are supposed to be a days of rest, are sometimes devoted to a quick medical tour to one of many isolated villages and hamlets in the area. Students will hop into a jeep with a doctor and plow through the muddy mountain lanes to reach people who seldom ever get to Sanare, let alone to a doctor’s office.

All in all, this is a grueling regimen, so I asked how many had dropped out. “Four of five out of the 39 of us,” the students said, “are no longer with us. There was only one who thought it was too simply much work. Another having a baby. The others felt the financial or family pressures were too great. And then, of course, there are six of our original group who aren’t with us here, but are still studying. They’re at the Latin American University of Medicine in Cuba.”

There are other health care students in Monte Carmelo, such as Elsy Perez, a middle-aged nursing student who helps out at the ambulatorio. She was an original member of the village health committee that worked with the first Cuban doctor who arrived in 2003. Now she and 52 other students from the Sanare area, four of them from Monte Carmelo, are enrolled in the Mission Sucre nursing program. Elsy Perez said that previously only one Monte Carmelo resident had completed her nursing degree by commuting an hour and half to the big city of Barquisimeto.

Elsy also works three days, in 7am to 7 pm shifts, at the small municipal hospital in Sanare that is staffed by two Venezuelan doctors. She says that they, possibly because they were trained years ago in the established medical schools in the big cities, are often unsympathetic and harsh with their patients. The nurses notice that some patients are treated much better than others, and this seems to be due to class prejudices held by the doctors, who sometimes will hardly speak to the poorest campesinos. This is in stark contrast to the Cuban doctors Elsy has worked with who give everyone equal attention and treatment, and often put people at ease with their friendly style.

“This is what we want to do, too,” added Arelys, another mother who is now in her first year of study to become a doctor. “We are thinking of medicine as a vocation, our calling in life, our way of serving the people and building socialist values. We don’t want a profession in the old sense, like some of the older Venezuelan doctors, who are motivated by a desire for money and prestige, and want to feel that they are superior to the patients, the nurses, and everyone else.”

This year, a new development in WMDs

Just arrived in Monte Carmelo last week: Karen from Peru and Georgo from Surinam

This week another 335 World Medical Doctors-in-training were thrown into the potent Venezuelan mix of WMD production. If you will recall from the previous posts on this site, about 23,000 Venezuelans are now studying Integral Community Medicine at home and another 4,000 are in medical school in Cuba as part of the 20,000 foreign students training to be physicians under the auspices of Raul and Fidel.

Nine months ago the foreign students started arriving in Venezuela as well, so they could be prepared to study within the Integral Community Medicine program. Now that they have finished the pre-medical course, they are being dispersed around the country. Seven of them have just arrived in Sanare, including Karen and Georgo, pictured above. The two of them were at work in Monte Carmelo on Thursday when I visited the ambulatorio.

No wonder Bush and Cheney are quivering in their cowboy boots. They thought they had knocked off Doctor “Che” Guevara 40 years ago, and now he’s back, multiplied a thousand-fold. As you may recall, after the young Ernesto Guevara finished his motorcycle journey around South America, he quickly completed his medical school exams, and took off again. This time he was determined to put his training as a doctor to work in the service of humanity, so he headed to the one place in Latin America that was having a peaceful social revolution. Guatemala.

Soon after his arrival in 1954, U.S. intervention put an end to Guatemala’s successful experiments with land and labor reform and unleashed a half century of pro-capitalist brutality in Central America. Ernesto had to flee the country to Mexico where he met a new group of friends who were amused by his Argentine habit of saying “che” all the time. Thus, “El Che” was born, the internationalist physician who picked up a gun, joined the Cuban guerrilla fighters, and became a leading “comandante” in their Revolution. He would later die fighting with a small band of revolutionaries in Bolivia.

So it is interesting that, out of the 335 students who left Caracas this week to begin their six years of training in various parts of Venezuela, about half are Bolivians. Perhaps the CIA, which had a direct role in murdering Che after he was captured by the Bolivian Army in 1967, is alarmed by this new threat. Last week, in an intelligence report to the U.S. Senate, the CIA claimed that Cuba and Venezuela were having a negative effect on the governments of Bolivia, Ecuador, and Nicaragua. The chancellor of Bolivia quickly responded, “I don’t know where they are coming from and where they get their information. The people of Bolivia know what relations are like with Cuba and Venezuela.”

Joining the Bolivians who are studying medicine in Venezuela are students from many Latin American countries, including some who are not native Spanish speakers: a large contingent from Brazil, eight from Surinam, and even some Guaraní speakers from Paraguay. They were enrolled in intensive Spanish courses while completing their six-month preliminary training in Caracas.

Georgo, from Surinam, is now speaking pretty good Spanish after completing his intensive course, and he identified me right away. “I think I detect Spanish with an American accent,” he said in very good English, also with an American accent. He explained that in Surinam, once a Dutch colony, English has become the main educational language.

Georgo heard about the medical training in Venezuela and went directly to the Venezuela Embassy to apply for admission to the program. Karen said that she and most of the other forty Peruvians who arrived with her had applied through various revolutionary youth groups to which they belonged. Many of them had previously applied for admission to the Latin American School of Medicine in Havana, but were put on waiting lists because their was such a backlog of interested and qualified young people. Karen herself had been waiting for two years, so was happy to land a spot in the group that came to Venezuela instead.

The enthusiasm for this revolutionary vocation is clearly contagious and spreading rapidly through all the Americas, not to mention Africa, which is home to many other students studying in Cuba and the site of other medical schools that are staffed by Cuban physicians. A number of U.S. students are now attending medical school in Cuba, and one of them finished his studies and passed his state medical board exam to practice medicine last year.

According to Karen and Georgo, another contingent of 650 foreign students will be enrolling in the Integral Community Medicine program in the next two months. And who knows, perhaps there will be some U.S. students joining the others in Venezuela within the next year. If so, we can expect to hear from Washington that Hugo Chavez and Fidel are promoting one more “negative influence,” this one aimed at young U.S. citizens.

Still it’s doubtful that the U.S. health care system will be inundated with socialist doctors anytime soon. But here in Venezuela, it is a different story. Our little village of Monte Carmelo could be the WMD champion of the world, with one out of a hundred people becoming a World Medical Doctor.

(don´t forget to look for the great film on Cuban health projects around the world, Salud.)


john said...

great post. thank you so much for taking the time to write. i email these to all my students
( )as examples of creative/scientific survival intelligence. also, my english professor partner agrees that your writing is great.
be well,

Anonymous said...

Do you have data (statistics) that support that this system is working?

Anonymous said...

It seems like Diseases like Chagas are coming back!
I dont know how a person that is not a doctor can talk about the health system..