Revolutionary Doctors This page intentionally left blank Revolutionary Doctors How Venezuela and Cuba Are Changing the World’s Conception of Health Care by STEVE BROUWER MONTHLY REVIEW PRESS New York Copyright © 2011 by Steve Brouwer All rights reserved Library of Congress Cataloging-in-Publication Data Brouwer, Steve, 1947– Revolutionary doctors : how Venezuela and Cuba are changing the world's conception of health care / by Steve Brouwer. p. ; cm. Includes bibliographical references and index. ISBN 978-1-58367-239-6 (pbk. : alk. paper) — ISBN 978-1-58367-240-2 (cloth : alk. paper) 1. Community health services—Venezuela. 2. Community health services—Cuba. 3. Medical education—Venezuela. 4. Medical education—Cuba. I. Title. [DNLM: 1. Community Health Services—Cuba. 2. Community Health Services—Venezuela. 3. Education, Medical—methods—Cuba. 4. Education, Medical—methods—Venezuela. 5. Health Services Accessibility—Cuba. 6. Health Services Accessibility—Venezuela. 7. International Cooperation—Cuba. 8. International Cooperation—Venezuela. 9. Physicians—Cuba. 10. Physicians—Venezuela. 11. Poverty—Cuba. 12. Poverty—Venezuela. WA 546 DV4] RA481.B76 2011 362.109-7291—dc23 2011016108 Monthly Review Press 146 West 29th Street, Suite 6W New York, NY 10001 5 4 3 2 1 Contents Acknowledgments.............................................7 1. Where Do Revolutionary Doctors Come From?............11 2. Solidarity and Internationalism ...........................21 3. Creating Two, Three . One Hundred Thousand Che Guevaras...........................................41 4. Medicine in Revolutionary Cuba..........................55 5. Barrio Adentro..........................................73 6. Witnessing Barrio Adentro in Action......................95 7. New Doctors for Venezuela .............................111 8. Building Community Medicine on a Daily Basis ..........129 9. Revolutionary Medicine in Conflict with the Past .........153 10. The Battle of Ideas and the Battle for Our America........175 11. The War on Ideas: The U.S. Counterinsurgency Campaign ...........................201 12. Practicing Medicine, Practicing Revolution ...............215 Notes ......................................................231 Index ......................................................247 This page intentionally left blank Acknowledgments I did not go to Venezuela in September of 2007 to write a book about the revolutionary practice of medicine. I went to live in a mountain vil- lage and write about how rural people, especially the campesinos in and around Monte Carmelo, were transforming their lives through their active participation in the Bolivarian Revolution. Although I nar- rowed my focus to tell about one important part of this revolutionary process and its connection to the Cuban Revolution, I learned an immense amount about rural life from my campesino neighbors in Monte Carmelo, who provided support, kindness, and friendship to me and my sons during our nine-month stay. This small village is gaining renown throughout Venezuela for its cooperative spirit, soli- darity, experimental agriculture, and grassroots organizing ability, and so it really merits a book of its own. (I hope to write more about Monte Carmelo. In the meantime, readers can still find blog articles I wrote in 2007–08 at www.venezuelanotes.blogspot.com.) Though I cannot possibly list the names of everyone who ought to be thanked, I want to give special thanks to the family of Gaudy and Omar Garcia and the family of Abigail and Gabriel Garcia, and other members of their extended families: Sandino, Luz Marina, Polilla, Carmen Alicia, Hector, Alexis, Arturo, Cesar, Javier, and Maira. They 8 REVOLUTIONARY DOCTORS not only provided us with hospitality, close friendship, and a place to live but were invaluable in sharing an intimate knowledge of village life, farming, and the beautiful natural world that surrounds them. I am especially indebted to the medical students and doctors in the Monte Carmelo and Sanare area who allowed me to spend time in their clinics and classrooms, as well as learn about their lives and aspi- rations. I refer to them only by their first names since I do not have everyone’s last name accurately recorded. The Venezuelan medical students: Mariela, Milena, Édison, Jonás, Arelys, Iris, Yeiny, Inez, Odalys, Luisa, Antonio, Magaly, Vanesa, Dilbex, José, Hilario, Rosana, Mileidy, Vanesa, Karina, Juan, and José Antonio; the students from Suriname: Georgo, Isabel, and Meredith. Doctors working at the Barrio Adentro walk-in clinics and the Diagnostic Center: Dr. Tomasa, Dr. Barbara, Dr. Edita, Dr. Raúl, the two Dr. Franks, Dr. Alina, and Dr. Humberto. Many thanks to two North American friends, Lisa Sullivan and Charlie Hardy, who have lived for decades in Venezuela, spending most of that time living and working among the poor in the barrios of Caracas and Barquisimeto. They were indispensable for introductions to many Venezuelans who became friends and contacts, and invalu- able in their help on various trips I made to Venezuela. Five friends from the nearby town of Sanare, all of them teachers—Honorio, Irlanda, Rubén, Goya, and Luis—were particularly helpful in acquainting me with local progressive and revolutionary traditions in education, politics, religion, and society that predate the Chávez gov- ernment institutions. The two Morochos, the unofficial village anthro- pologists and poets of Monte Carmelo, were very generous in filling me in on local history and folklore. My first guides to Caracas, Marcela and Antonio, gave me an exceptional introduction to the barrios and the rest of the city. Other valued friends who helped in Venezuela include Mario, Rosa Elena, Pablo, Ledys, David, Pachi, Maia, Joséito, and Father Mario Grippo. In Cuba, my good friends the poet Victor Casaus and journalist Hedelberto Lopez Blanch were extremely helpful in Havana. Gail Reed and Conner Gorry, journalists based in Havana working for ACKNOWLEDGMENTS 9 MEDICC Review, provided me with invaluable advice and informa- tion. MEDICC Review, featuring articles by Cuban and U.S. medical experts, is the only peer-reviewed journal in English dedicated to Cuban medicine. This magazine and website, a joint venture by Cuban and U.S. medical experts, is a great resource and extremely reliable. I want to thank philosopher and journalist Enrique Ubieta Gómez for sharing his time with me and thoughts related to his excel- lent book, Venezuela rebelde: dinero vs. solidaridad. At ELAM, the Latin American School of Medicine in Havana, Dr. Midalys Castilla Martínez, the vice rector, was generous with her time as she intro- duced me to the school and some of the students. At Monthly Review Press, I would like to thank Fred Magdoff, who visited us briefly in Venezuela and suggested the press could be interested in a book on revolutionary medicine. Michael Yates has been an excellent editor, displaying great patience and sound judg- ment, and Erin Clermont served as a great copyeditor with a sharp eye for clarity. My two sons, Jan and Ari, who were eighteen and sixteen at the time, lived with me in Monte Carmelo and provided wonderful com- panionship and good humor. They also ended up working full-time with our campesino neighbors at the Las Lajitas cooperative organic farm—they began their half-hour climb up the mountain at 5:30 every morning and spent their days digging, planting, harvesting, and com- posting with worms; they even learned how to plow with a horse on the steep mountainsides. In the afternoons they came home with an extraordinary variety of vegetables and the world’s tastiest yogurt. And many thanks, as always, to my wife, Susan, who could only visit us for a few weeks because she had to stay at home in Pennsylvania teaching her classes while providing lots of encouragement, love, and our material support. Finally I want to dedicate this book to the memory of my father, Dr. Stephen W. Brouwer, a physician renowned for his good humor and willingness to listen to patients. One of the few things that could anger him was the death of someone who sought treatment too late because of worries about the cost. He blamed such deaths on a health 10 REVOLUTIONARY DOCTORS system that would not countenance free and universal care. My father was the only doctor I knew in my youth who was a socialist—in fact, he was the only socialist I knew—so he would surely be glad to know that today revolutionary doctors are transforming health care in the poorest and most remote parts of the Americas. 1. Where Do Revolutionary Doctors Come From? The campesinos would have run, immediately and with unreserved enthusiasm, to help their brothers. —CHE GUEVARA, “On Revolutionary Medicine,” 1960 Even though he came to Cuba with a rifle slung over his shoulder and entered Havana in 1959 as one of the victorious commanders of the Cuban Revolution, he still continued to think of himself as a doctor. Five years earlier, the twenty-five-year-old Argentine had arrived in Guatemala and offered to put his newly earned medical degree at the service of a peaceful social transformation. Dr. Ernesto Guevara was hoping to find work in the public health services and contribute to the wide-ranging reforms being initiated by President Arbenz, but he never had much opportunity to work as a physician in Guatemala. Within months of his arrival, Arbenz’s government was brought down by the military coup d’état devised by the United Fruit Company, some Guatemalan colonels, the U.S. State Department, and the CIA. Che never lost sight of the