Reader Comments

The real Venezuela Doctors

by Otto Alexander Sanchez (2008-12-04)

Dear invited editors and Dr. Oscar Feo,

Both my wife and I graduated from the Universidad de Oriente (UDO) Medical School in Ciudad Bolivar in the State of Bolivar in the south east of Venezuela. From my readings of the articles I think there is a lack of acknowledgment and misinformation about the health care system in Venezuela and the profile of our medical schools.
With regard to this article "Neoliberal Policies and their Impact on Public Health Education: Observations on the Venezuelan Experience"
The information there is completely unfunded, at least in comparison to my own experience. Our medical school was founded on the principal of prevention instead of treatment as the main approach to treating patients. The Medical School in the UDO went for 14 semesters and for 10 of them we had courses on preventive medicine, from epidemiology, vaccination programs, studies of social problems and the assessment of environmental conditions of our populations and its relation to diseases. We performed field studies and went to both urban and rural community clinics to performed preventive and curative duties. Upon graduation we did not enter immediately a residency program, it would take at least 2 years before we can do that. Why? Because in order to apply to a residency program we have to register our title in the ministry of health, but were not allowed until we performed what is called the rural year (law still in effect), that is, we have to work for a year in a town with a population no larger than 5 or 10 thousands population, if we don't do that, we can work in a bigger city, but it would take us two years instead of one. During that time, we perform functions as a general practitioner and were the representative of the ministry of health in that area, we had to inspect slaughter houses, restaurants, water supply, drainage, in addition to vaccination programs and health educational programs in the community. I and my wife both worked in rural and urban community clinics with great devotion towards our patients, earning only the meager salary that was paid by the public health system at that time, less than $500 a month. We were not two isolated cases of devoted physicians, the great majority of our colleagues went beyond their obligations to bring health to the population with no further payment, but the gratitude of the patients and the peace of mind that we have done good. The idea that we only responded to the forces of the market is an enormous lie and a slap in our face, especially for those of us and the many that still work in Venezuela who continuously give the best possible effort to bring health to our population.
More evidence of the lack of reality in the statement that medicine was driven by private good and individual consumption, was the fact that many specialist, including professors in our medical school and many of my former classmates, work ad honorem in our main hospital as a way to give back to our community and our medical school. I am not sure of this, but I think we still do not have a private medical school in our country and all the medical schools belong to state funded universities, but autonomous from the state and revise their curriculum to keep up with the advances in medical technologies and the main health problems in our society.
In regards to the Barrio Adentro mission, that is nothing new, what Chavez has created is parallel health system. Before he came into power, the health system was modeled following designs by the Pan-American Health Organization and we followed many of the health programs carried out by the Cuban government, so following the Cuban model was being implemented in Venezuela before Chavez came to power. As I mentioned before, health care clinics or hospitals were divided into rural and urban clinics and each of them was further classified into type 1, 2, or 3 depending on the population and the services it would give. The ministry of health had urban type 1 clinics in places as far away as in Santa Maria de Arebato, two days into the Amazon Jungle and in every neighborhood, especially the under privilege ones. Before I moved to the US, the Institute of Health of our state was developing a strategy to have family practice physicians direct all or most of the community clinics and again with the main focus on preventive medicine, and all this before Chavez.
It is true that most of the physicians ended up in specialties that are well rewarded, but who can live in with government salaries ~$500 a month? Try to feed your children with that salary, buy them clothes, medications and give them proper education. However, most of my colleagues do not forget where they came from and to whom they owe what they have and they give back by performing ad honorem duties in hospitals. In case you have not heard, Caracas, where I was born, is the most or the second most dangerous city on Latin America, with about 50 death every weekend from violent causes, would you work in a war zone? Not many people would.
I am very hurt by the comments on those articles and would like a version adjusted to the truth to be known.

Best regards.

Otto A. Sanchez MD PhD
Research Instructor
Vanderbilt University Institute of Imaging Science
1161 21st Avenue South
Medical Center North, AA-1105
Nashville, TN 37232-2310

Office phone: 615 343 5856
Fax: 615 322 0734


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