On 9 April, The Canary published an on-the-ground article looking at the state of Venezuela’s health service. It challenged the corporate media’s general representation of a health service in a state of collapse, while offering critical context about why it is, in many ways, struggling.
Two doctors with significant knowledge on the subject – Rebecca Martínez and Amy Cooper – responded by commenting on the complex reality of healthcare in Venezuela. They spoke exclusively to The Canary about political autonomy, neoliberalisation, and crisis in the country’s health system.
Dr Rebecca Martínez
The neoliberal years
Martínez is the author of Marked Women: The Cultural Politics of Cervical Cancer in Venezuela. The book investigates “women’s experiences with cervical cancer, the doctors and nurses who treat them, and the public health officials and administrators who set up intervention programs to combat the disease”. Her work focuses on Venezuela’s neoliberal years during the 1990s, as well as a return to the country in 2008.
The Canary asked Martínez to explain the impact of neoliberalism in Venezuela with regards to its health system:
Neoliberal policies that started taking root in the 1980s were shaping health care across Latin America. These structural adjustment policies backed by the World Bank and the International Monetary Fund [IMF] failed to deliver the health care benefits promised… From 1980 to 1992, it is estimated that average Venezuelans lost over half of their purchasing power.
The number of poor increased from 7.8 million in 1987 to 9 million in 1989. Public health hospitals experienced a shortage of supplies and resources, which in turn meant that the health of Venezuelans suffered.
She continued by explaining how issues of gender, class, and ethnic inequality were reflected in the country’s health system:
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I found that the perceptions of and treatment of women with cervical cancer in Venezuela were very much wrapped in a discourse of modernity, particularly in the context of hygiene, health practices, reproduction, and sexuality. Working-class and poor women were conceptualized as intrinsically “different” (read inferior) from middle- and upper-class Venezuelans.
For example, what doctors communicated (and did not communicate) to their patients about their medical conditions was in part mediated by the perception that working-class and poor patients are unable to properly absorb and react to information.
Ultimately, cervical cancer stigmatized women as socially marginal, burdens on society, and threats to the “health” of the modern nation.
The coup attempt to bring neoliberalism back to Venezuela
Many healthcare officials in Venezuela are concerned about the return of international financial agencies like the IMF and World Bank to the country. The Canary asked Martínez if this was justified. She said:
All we have to do is look at the history of the IMF and World Bank’s austerity programs, not only in Latin America but globally, to answer this question. Inevitably, these programs tend to include the privatization of public enterprises like health clinics and a reduction of expenditures on social welfare projects. This would mean the likely destruction of the now structurally embedded and most popular health care program begun by [former president] Hugo Chávez: Misión Barrio Adentro. This is healthcare that has actually gone into the poor barrios [neighbourhoods] of Venezuela and has provided community-based primary healthcare.
She concluded by talking about the media’s biased approach in Venezuela, saying:
What I see mostly in the media tries to pass for ‘research’ but is a knee-jerk reaction to socialism and the misuse of the word ‘dictatorship.’ Progressive and conservative political circles alike are discussing a ‘humanitarian crisis’ without a critical understanding of the role of US sanctions in causing needless suffering of the Venezuelan people. The media doesn’t mention the Venezuelans living in the barrios who have benefited from healthcare in their communities and what has happened to affect the demise of that healthcare with US sanctions and Venezuelan oil production.
Dr Amy Cooper
Cooper recently published a book entitled State of Health: Pleasure and Politics in Venezuelan Health Care under Chávez. It investigates “how people’s lives changed for the better as the state began reorganizing [Venezuelan] society” between 1998 and 2013.
The Canary asked Cooper about the “hundreds of hours” of research she conducted in Venezuela. She said:
I have studied Venezuelan health care as a medical anthropologist for fifteen years. Between 2006 and 2009, I spent fifteen months in Caracas conducting ethnographic research on Barrio Adentro.
I also conducted interviews with patients, medical professionals, administrators, and community activists. The majority of people who participated in this research were poor and working-class Venezuelans living in the central and western zones of Caracas (Libertador Municipality).
Some journalists argue that it is hard to conduct research in Venezuela. But Cooper continued:
Local and municipal authorities approved the research project but I worked without government oversight and experienced no attempts to chaperone or restrict my access to medical facilities.
Barrio Adentro: a popular programme which empowered poor communities
She then spoke about how Chávez’s Barrio Adentro programme – which instituted thousands of free clinics in poor communities – changed the structure of healthcare in Venezuela:
People told me Barrio Adentro was important because, beyond improving access to medicine, it was the first time they could visit a clinic in their neighborhood or have a doctor look them in the eyes. Barrio Adentro also empowered people by structuring opportunities for historically marginalized Venezuelans to engage in self-care, community health activism, and professional medical training. Health programs operated alongside other Chávez-era social programs that, in spite of their imperfections, undoubtedly improved people’s material conditions and promoted a sense of empowerment and belonging.
The international media, she continued, “largely failed to report on the positive impact of social programs in Bolivarian Venezuela”. Out of 304 BBC reports published about Venezuela between 1998 and 2008, for instance, “only 3 of those articles mentioned any of the positive policies introduced by the Chávez administration”.
Criticisms focused on the use of Cuban doctors (sometimes accused of being spies and communist indoctrinators), a lack of integration with pre-existing government medical services, insufficient investment in specialized medical services and hospital care, and the alleged mismanagement of Barrio Adentro itself.
These criticisms, however:
fail to explain the level of animosity that members of the right-wing opposition express toward Chávez-era health policies, evidenced by violent attacks perpetrated against government medical facilities and Cuban doctors. To understand the outsized role of health care in Venezuelan politics requires seeing Barrio Adentro’s popularity and its success in empowering the poor as threats to opposition efforts to delegitimize chavismo [Chávez’s political project].
The dangers of a neoliberal coup
Cooper similarly spoke about the prospect of the return of neoliberalism to Venezuela’s health system:
Politically speaking, re-neoliberalizing health care is not a viable solution, because it would be extremely unpopular. Venezuelans who participated in my research spoke passionately about how neoliberal policies of the past exacerbated social inequalities, increased poverty, and restricted access to health care.
In fact, one study found that barrio residents viewed state-guaranteed access to health care as one of the most important features of the country’s democracy. Neoliberalizing health care is also not a viable solution from a policy standpoint. We know that neoliberal health policies result in worse access to health care and worse health outcomes.
The Canary asked if US-backed opposition leader Juan Guaidó would likely pursue the re-neoliberalisation of Venezuela’s economy:
It is unclear whether neoliberal health policies would resurface under an opposition-led government. However, Juan Guaidó’s proposed plan for the country involves just that: privatizing and marketizing the provision of social services like health care that people could pay for with an individual account comprising a share of state oil profits. This gives us some sense of what kinds of policies would be on the table if Guaidó’s backers got their way.
Much needed balance
Venezuela’s health system lies at the centre of a wildly politicised debate about the presence of a ‘humanitarian crisis‘ in the country. This debate, in turn, functions to justify possible ‘humanitarian intervention’ in the country.
The discussion, consequently, often loses balance about a health system that, like many others, is cast with complexities and contradictions. By talking to experts like Martínez and Cooper, however, we can form a clearer picture of what’s really going on in Venezuela’s health service.
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