bromselick
8/25/2006 6:12:00 PM
Thursday, Aug 24, 2006 Print format --
By: Michael Fox - Venezuelanalysis.com --
Felix Jose Espinoza Ledesma is a cab driver in Caracas, Venezuela's
capital, and one of the largest and most violent cities in South
America. If not for his large print and the way his eyes squint
slightly when he reads an address or a phone number, you would never
guess that just over a year and a half ago, he was on his deathbed, his
vision nearly completely gone, and barely struggling to stay alive.
He never thought it would happen to him. He had seen people succumb
while treating patients first hand as a licensed nurse and emergency
medical technician during his 35 years on the Caracas Fire Department.
So when he began to notice the first symptoms: increased thirst, the
loss of sensation in his feet, the loss of strength in his legs, he
ignored them.
But that was before his world came crashing down around him, and the
doctors confirmed what he already knew. Felix Espinoza had diabetes.
A few short years later, during one of a number of sick leaves, he
arrived to the offices to sign some forms and among them was his
retirement. They congratulated him, shook his hand, and sent him home.
Felix did not want to retire. His symptoms increased until he was
unable to leave his bed. His will to live was slowly walking away.
His partner decided that something had to be done. She called his
former fire department co-workers for help. A phone call that started
in motion a process that Felix can only describe as a "miracle."
One week later, Felix was being wheeled on to the Cubana airliner, too
sick to sit up in a wheelchair. Three and a half hours passed and on a
Wednesday afternoon in mid January 2005, the plane landed in Jose Marti
International Airport, in the outskirts of Havana- green fields
expanding out from the tarmac, a thick sun sinking low in the Caribbean
sky- and Felix was rolled off the plane followed by one hundred and
fifty fellow Venezuelans heading to Cuba to be cured. Felix and the
rest of the patients were taken from the airport and dispersed to
various hotels, centers, and hospitals across the island.
Venezuelans on the Convenio's 182nd flight- heading to Cuba to be
treated.
Credit: Silvia Leindecker
A little less than one year later, in December of last year, Felix
again boarded the Wednesday flight, this time walking on his own two
feet, this time with near perfect vision, and this time heading home.
Felix never really thought he would actually go to Cuba. It had been a
dream of his for many years. The music had always called him, says the
lifelong singer, "there is not another place like it." But this was
different, he says, "I didn't think I was going to come back
alive."
In Cuba, Felix was moved from Cienfuegos clinic, to Pinar del Rio, to
Tarara, to the Pradera International Health Center and elsewhere
according to the intensity and type of care needed. He received no
less than ten eye operations for his diabetic retinopathy, plus daily
rehabilitation, treatment and medicine that, according to Felix, is
unavailable in Venezuela. With each step he was slowly rehabilitated
back to health.
Once able to walk and well enough to get around, Felix began to give
back to the island. He began to sing, and in his words, "did in one
year what he hadn't done in 60 in Venezuela." He recorded four
tracks towards what he plans to be his first album; During his last
months on the island, Felix was practically on tour, invited by Cuban
artists to perform with them around the country; and days before his
return to Venezuela, Fidel Castro himself offered him support to record
a full-length album when they met briefly during a chance encounter at
a Cuban television station.
Felix now drives his partner's taxi as she has just undergone surgery
herself-in Venezuela-and will be in bed for the next few months. As
for Felix, he has learned to live with his disease and takes insulin
twice a day. Only his eyes are beginning to be a problem.
"I'm seeing a little cloudy, not a lot... but I'm not seeing as
well as when I came back," he says.
Which is why most patients who go to Cuba through the Convenio Integral
de Cooperacion de Salud, Cuba-Venezuela (Cuba- Venezuela Comprehensive
Cooperation Agreement on Health)[1] will go back within six months to a
year. Some return for precautionary check-ups, others for further
rehabilitation and treatment. Some go back every year for as long as
six months, depending on the illness. Felix plans to return to the
island before December and "as soon as [his] papers are in order."
Of the nearly 13,000 Venezuelan patients that have traveled with the
Convenio over the past five years and eight months since it was signed,
the illnesses and patients are as varied as the Venezuelan regions from
which they hail:
Over two thousand patients with nervous system illnesses; nearly two
thousand patients with sight problems; patients with circulatory,
respiratory, and digestive system illnesses; around eight-hundred tumor
patients; patients with cancer, malformations, infections, skin
diseases, blood diseases, mental problems, addiction problems, muscular
and orthopedic problems.
Of course, not all of the cases are a success, but all are impactful.
The director of the Convenio is Jhonny Ramos. Having just overseen his
100th flight in his three years coordinating the program, he is a true
veteran in a Chavez administration, which has an unusually high
turnover rate. Ramos tells the story of a Venezuelan patient who
passed away in Cuba during surgical complications, far away from his
home in the Andean Mountains of Merida state.
Their trip to bring the body home to the family climbed mile after
mile, and hour after hour into the Andes. High, up and way from the
University town of Merida. It was only then, after meeting the humble,
grateful family-in their tiny home, on their small plot of land-did
Ramos realize the lengths, the significance, and the distance which
this project reaches, even though, in this case, the patient did not
survive.
"It was great satisfaction for me... to feel the incredibleness of
what [this Convenio] is achieving," said Ramos. "How this person
was able to get to Miraflores [Presidential Palace] and go to Cuba is
amazing. That is satisfaction."
Friendship
The entire program is free. Not just for the patients, but for
Venezuela. Venezuela pays for the weekly flight to and from the
island, for the approximate 75 patients and their companions (almost
every patient is accompanied by someone)[2] each way, plus the cost of
the four Cuban doctors working with the Convenio in Miraflores and some
equipment on the island. The rest is all covered by Cuba: The
treatment, hotels, hospitals, food, doctors, nurses, and in-country
transportation. Everything is covered by Cuba. What does Cuba get in
return?
"Our friendship" says Ramos with a smile, who travels to Cuba every
couple of months and speaks with his people there daily. According to
Ramos, when President Hugo Chavez brought the first eight Venezuelan
children to receive treatment on the Caribbean island, Fidel Castro
stated, "We can not charge for this," and so the portion of the
Convenio which sends patients to be treated in Cuba was set aside from
the rest of the agreement.
Nevertheless, Cuba does receive something in return, just not directly
from the health agreement. Under the Convenio agreements were signed in
which Cuba would provide support or expertise in ten areas, ranging
from agriculture to tourism, to education, and to health. In exchange,
at the time, Venezuela would send upwards of 50,000 barrels of oil a
day. The sending of Venezuelan patients to Cuba under the health
portion of the Convenio was just one of the many points in the
agreement, but it has nevertheless become the most well known.
Integration between Cuba and Venezuela has steadily increased since the
Convenio was signed in late 2000, and the agreement is now just a small
piece of cooperation between the two countries, and encompassed under
the framework of the Bolivarian Alternative for the Americas (ALBA),[3]
which was conceived in 2001 and attempts to lay the groundwork for an
alternative form of integration and development based on solidarity and
cooperation.
As a result, last year, trade between the two countries reached $1.2
billion. Venezuela currently sends 90,000 barrels of oil a day at
preferential financing rates to the island, and is investing in the
Cuban oil industry. In return, Venezuela has received support in its
social and educational programs from the large "human capital"
(Cuban doctors, and health and education professionals) that the island
nation has built over the last half a century, and amidst a US-imposed
economic blockade, which has forced the island nation to search for
another road to development based on the resources at its disposal.
"Thank God, thank Chavez, and thank Castro!"
"You need to talk about your experience when you return to Venezuela.
Tell about the good and the bad, but talk about it," said Ramos on
Wed, Aug. 2 to a group heading to the island. "Because they say we
are terrorists because we fill planes of sick people to send to Cuba.
For them, this is a terrorist act, and they are the good guys, filling
planes with bombs to kill people."
For the majority, this was their first flight, and most of the patients
agree. Nearly all are in total support of President Chavez and Fidel
Castro, who have opened the doors to their recovery.
"First, thank God, second thank Comandante Chavez, and third Fidel
Castro for this beautiful Convenio!" says Felix, verbalizing an order
that most of the patients would agree with, but not all. Aritis
Bejarano Marin returned on August 2nd from six months in a drug
rehabilitation center in eastern Cuba. Although he is "very
grateful" for the treatment and is supposed to return in January, he
doesn't want to go back.
"I don't like the Cuban regime," he says, "I think that with
the death of Fidel... hopefully it can pass in to hands of democracy,
so that there's more justice."
A crowd of his fellow returning compatriot patients, who were also in
line for their luggage, loudly and harshly rebuked his comments:
"Don't go, if you don't like it!"
"Aren't you grateful?"
"You've got a problem, Aritis," said a nearby patient, "If you
believe that with the death of Fidel, as you say, it is going to change
the people. Democracy exists there now. But if you weren't in
agreement with what's going on, you shouldn't have gone."
The incident highlights the ideological freedom that exists within the
program, if only one must compete with one's peers. Nevertheless,
there is little doubt that regardless of political orientation, upon
embarking on the journey, most return committed to Presidents Chavez
and Castro. And why not? Their lives have been changed, and in many
cases saved.
The Airport
Sitting in the National Terminal of Simon Bolivar International
Airport, just down the hill from Caracas, when the returning Wednesday
flight arrives from Cuba, is powerful. One is overwhelmed by the sight
of patients stepping back on to their native soil after one, five, or
ten months on the island.
Women on crutches who, six months ago, boarded the outgoing flight in
wheel chairs; Others walking, who where told they would never again
move their limbs; Patients with cancer, tumors or degenerative
illnesses returning cured, or with renewed hope.
Reydalis Jimenez walks on to the Aug. 2nd flight with her mother,
Claudelys
Credit: Silvia Leindecker
Patients like the 11 year-old Reydalis Camacho Jimenez, who is from
Maturin, has refractory epilepsy and went to Cuba last year to remove a
brain tumor. According to her mother, Claudelys, she was one of only
six children who underwent the operation to survive. Shortly before,
not only did she not walk, but she was barely conscious. "A complete
vegetable", says her mother. Now she is a young girl who smiles,
hugs, talks, laughs and cries just like any child and who, it appears,
has been given a second chance. According to Claudelys, the Venezuelan
doctors told her that she should have another child, because her
daughter wouldn't live past age nine. "It's a miracle," says
her mother. "Thank god my child is alive and will stay alive."
Smiling, Reydalis gives you a hug as she gets in line to board her
return flight to Cuba where she will receive a check-up, and she and
her mother will consult the doctor at the Cira Garcia Clinic to decide
if they want to risk a further surgical operation to remove the blood
clots left over from the tumor.
Cerebral paralysis patient, Jose Gregorio, and his father at the
Miraflores ceremony the morning before their most recent flight with
the Convenio.
Credit: Silvia Leindecker
Perhaps most impressive are the hundreds of patients who spend half of
each year on the island. Patients with debilitating lifelong illnesses
and injuries, such as 10 year-old Jose Gregorio Borges Gil, from
Caracas, who was one of the first eight children to travel to Cuba with
the Convenio in 2000, and who has returned with the program six
additional times. Jose has cerebral paralysis and atrophy, and is
confined to a wheel chair. It is difficult to tell if he understands
you and his limbs seem to move around uncontrollably, but his father
has seen massive improvements.
"It's not as if you are going to make miracles but one feels that
the quality of life of the patient is improving," says his father,
Ivan. "[During] the first trip, my child didn't move and didn't
say anything, and now, at least he says, 'agua', he moves and
understands, if you put on cartoons, he understands, he recognizes. He
recognizes me, he recognizes his teacher... and the people that are
always with him."
Ivan is grateful for his son, "Everything I have, I owe to him," he
says "and thank god, little by little he is improving." Ivan and
his son, who have become permanent fixtures with the Convenio, will
continue traveling to the island.
Anywhere else, for the majority of these patients, the time and cost of
the slow and minute improvements would have been cost-prohibitive long
ago, but at the Convenio there appears to be a true un-official motto
of "no child (or Venezuelan) left behind."
Tears well up in the eyes of Merido Saavedra, 52, when he talks about
his improvements during his nearly six months with the Convenio in
Cuba. Now a paraplegic, Merido is a former mountain tourist guide, who
was injured four years ago in a fatal accident when during torrential
rains his van flew off the windy mountain road and fell 175 meters
before crashing in to the vegetation below. Merido was lucky. Three of
the nine passengers were killed. Now, just returning from nearly six
months on the island, he is perhaps bound to a wheel chair for life,
but he can move his right foot and is "really happy." Merido will
be returning to Cuba in February for another five to six months of
treatment and rehabilitation, but for now he is going home. He
hasn't told his wife and four daughters that he is on his way. He is
going to surprise them.
Why Cuba?
Why not cure these patients in Venezuela? Ramos assures that this is
the eventual goal, with the possibility that Cubans and other Latin
Americans may one day come to Venezuela to cure themselves. "We have
to convert the Convenio into a model," says Ramos, "so that the
institutions here have the capacity to set up the structures here."
But first the doctors must be trained, the specialized faculties built,
and the institutions set up to handle the capacity. Venezuela is on its
way. Over 3,000 Venezuelan students are currently studying medicine in
Cuba. Three classes have already graduated since the Latin American
School of Medicine's (ELAM) founding in 1998, and those graduates are
working in Venezuela. Other Venezuelans are also studying popular
medicine in Venezuela and there are plans to build an ELAM-Venezuela.
Since June 2005, Venezuela has opened a total of over 360 Integral
Diagnostic Centers, Rehabilitation Centers, and High Technology Centers
throughout the country, with hundreds more on the way. In October, the
Venezuelan Ministry of Health plans to distribute new electrical
equipment for patients with neuro-motor diseases, to the nearly 200
rehabilitation centers; and just this past weekend, Venezuela
inaugurated the Latin American Cardiological Children's Hospital in
Caracas, which is said to be the largest of its kind in the world,
where they hope to save a thousand lives per year, and carry out 4,500
operations annually. But other than these first steps under
Venezuela's in-country technical medical mission Barrio Adentro II,
according to Ramos, the specialized facilities necessary for these
technical cases are just now being set up.
The quality of affordable Venezuelan medical care has traditionally
left much to be desired for. Venezuelan doctors wanted to amputate
Felix's right foot. Others wanted to amputate Merido's leg. Others
swore they had to take off Maracaibo resident, Ricardo Petin's leg.
Each of these limbs was saved in Cuba, where Felix says the treatment
is quality, holistic, and constant. "You are there to receive medical
attention, to get well. You can't miss a rehab appointment," he
says. While in Venezuela, where the attention is not constant or
focused, it is easy to "put it off till tomorrow."
The majority of the Convenio's patients have low incomes, and do not
have the funds to cover all of their everyday living expenses,
never-mind the cost of a transplant operation, brain surgery, or daily
physical rehabilitation. There are Venezuelan doctors that can do the
job, but they are expensive and not trained in the nuances of
"popular" holistic medicine, not trained to provide both quality
and free medical attention.
This is part of the criteria by which patients of the Convenio
Cuba-Venezuela are chosen. Ramos says he chooses patients by severity
of illness, distance they must travel, and according to economic need.
Those in the most critical condition, from the farthest away, and with
the least resources fly first.
But he is not the only one who decides who stays and who goes. In
total, a team of twenty-five coordinate the health department of the
Convenio, all under Ramos' command, including four Cuban doctors.
Miraflores tour
Miraflores, the President Palace, has opened its doors to the Convenio.
The Palace is now bustling with activity in a way that never would
have been dreamed of before Chavez. Individuals arrive constantly with
their requests, and Miraflores welcomes patients from all across the
country for breakfast, lunch, and entertainment every Wednesday morning
before their departing flight.
Ramos gives us a tour of Miraflores and walks us through the process of
being accepted as a patient to be sent to Cuba. "First, the petitions
arrive in person or by card," he says, as he shows us a letter
addressed, Dear President Chavez.
The letters are answered personally by the staff of the Convenio and
the submissions are entered into a computer where the team of Cuban
doctors analyzes the severity of the illness and each patient's case,
and perhaps contacts the individual for more information.
Once medical records are verified and the cases analyzed, the doctors
themselves make the final decisions and book the flight. It departs
once a week from Havana with the latest group of returning patients and
their companions. Once in Bolivar International Airport, the new and
returning patients board the plane and head off to join their nearly
1,500 fellow Venezuelans currently undergoing treatment on the island.
As of the Aug. 2nd flight (the 182nd since the program began), over
23,000 Venezuelans have traveled to Cuba under the program (12,898
patients and 10,672 companions), and most of these patients have
returned at least one or two additional times for checkups,
rehabilitations, and further medical attention.
As for the waiting list, there are currently 35,000 individuals on it,
some going all the way back to 2001, but Ramos admits that as free
medical attention improves within Venezuela they are increasingly able
to treat some cases in-country.
For example, Venezuela's Medical Mission, Barrio Adentro I, began in
2003 and has brought just under 30,000 Cuban doctors to directly attend
to the health problems of the Venezuelans. Focusing on preventative
care, and setting up in some of Venezuela's poorest communities,
Barrio Adentro I attempts to resolve residents' illnesses from the
root of the problem, and it has been a success. According to the
Venezuelan Ministry of Health, as of July 2006, there have been just
under 193 million Barrio Adentro I consultations across the country.
Ramos believes that with Barrio Adentro, they have been, or will be
able to resolve the problems of about half of those on the waiting
list. The Convenio is a last resort, for already advanced illnesses.
This highlights the important focus Venezuela has given to health care
under the Chavez administration. In this country of 27 million,
although many do not want to admit it, the formerly marginalized and
poor population is receiving free and professional medical attention
for the first time in their lives, and it is in large part due to the
increased collaboration and cooperation with its not-so-popular
Caribbean neighbor.
But the size of this cooperation has not been lost on the over 13,000
patients who know very well the extent to which Cuba's solidarity has
changed their lives. Patients like Felix, who believes that this
Convenio has given him life, something which he describes as nothing
less than a "miracle."
This is the second in a four part series on ALBA, integration and
cooperation between Cuba, Venezuela and Latin America.
See also, ALBA part 1: Defining the Bolivarian Alternative for the
Americas - ALBA
--------------------------------------------------------------------------------
[1] Referred to informally as the "Convenio."
[2] The companion also receives a full medical check-up, plus attention
and treatment if necessary. Interestingly, the companion often times
turns out to be more ill than the patient.
[3] The first official agreement under the framework of ALBA was signed
between the two nations in December 2004, and Cuba, Venezuela, and
Bolivia signed the first People's Trade Agreement in April of this
year, increasing trade between the three countries.