The Miami Herald August 19, 2003, Tuesday

Rise of Cuban doctors raises questions for Venezuela's Chavez By Frances Robles

CARACAS, Venezuela _ When poor Venezuelans like Jenny Preciado fall ill, they must leave their distant slums and arrive at public clinics by 6 a.m., lest they miss being one of 20 patients assigned a number for a chance to see a doctor that day.

"Sometimes it is so packed, you just don't get a number," Preciado said, standing outside her barrio's new makeshift clinic, manned by a Cuban doctor. "This town is never letting this new doctor go."

While the poorest of Venezuela's poor beam over the arrival of up to 1,000 Cuban doctors who have been assigned to poor neighborhoods and even make house calls, their influx has enraged others who see them as another example of leftist President Hugo Chavez's quest to "Cubanize" this nation.

Doctors, literacy trainers, sports coaches and agronomists have openly poured into Venezuela in past months. Allegations of Cuban advisors in the armed forces, police and Chavez's presidential offices bubble up occasionally but have never been proven. Internet gossips talk of Cuban ships and planes bringing arms to pro-Chavez militias but offer no evidence.

Venezuela's increasing reliance on Cuban experts illustrates the ever-warming relations between President Fidel Castro and Chavez, a self-proclaimed "revolutionary" who has said that Cubans "swim in a sea of happiness." It has even become a source of concern in Washington.

A recent editorial in the El Nacional newspaper declared that "Venezuela is being colonized by Cuba. For everything, the government looks to Cuba, consults with Cuba and tries to read the signs coming from Cuba. We cannot do anything without approval from Havana."

But the Cubans' presence here also underscores the deep-seeded divisions between Venezuela's rich and poor. While Chavez's mostly middle- and upper-class opponents decry the Cubans' services as political brainwashing, few Venezuelans seem willing to take their places.

"The doctors here in Venezuela are involved in politics, not taking care of patients," Preciado said. "We want our children taken care of, and that's it."

Preciado lives in Cipres, one of the many slums that dot the hills surrounding Caracas. Plagued by poverty and crime, the barrios are considered a no man's land where no Venezuelan doctor dares journey.

"Pregnant women in these neighborhoods have never been to the doctor for prenatal care, and give birth at home on the floor," said Rafael Vargas, a former Chavez chief of staff who now runs the Cuban doctor program. "There are 10-, 14-year-old kids who have never been to the dentist."

In Cipres, Dr. Felix Ramon Viltres Gutierrez works in a clinic set up in the back of a grocery store, where a 101 Dalmatians cartoon bed sheet separates the waiting room from the potato chips. His one-room office has a shelf with neat piles of medicines and a desk. In 2 [months, he has seen 1,000 patients, who suffered mostly from asthma, diarrhea, parasites and hypertension.

"We think what we're doing is right: helping people," said Viltres, who has also worked in Nicaragua and Haiti. As for the clamor: "That's a political problem."

Cuba has sent thousands of its doctors and teachers to work in poor countries all over the world in the past decade as a sign of its "internationalist solidarity" with underdeveloped nations _ and sometimes as a way of earning extra income for the Havana government.

Viltres came under fire last week when the fiercely anti-Chavez media reported that a child he had seen later died of meningitis. It turned out that while Viltres was the first to see the 7-year-old, several Venezuelan doctors had seen him as well.

The Venezuelan doctors association has filed a complaint in court seeking to bar the Cubans from practicing. Arguing that they are under-qualified and unlicensed, they have been quick to cite alleged cases of malpractice.

"We're not xenophobes," said Douglas Leon, president of the Venezuelan Medical Federation. "We have information that these people, almost 100 percent of them, are not doctors. These are people masquerading as doctors, wearing white robes with stethoscopes around their necks."

The Venezuelan Medical Federation asserts there are 9,000 unemployed or under-employed physicians in this country, so there was no need to hire the Cubans. The government says it placed four ads seeking doctors, and there were few takers. The Cubans, Chavez claims, have saved 300 lives.

The absence of Venezuelan doctors in crime-plagued barrios underscores the very factors that helped put Chavez in power. Although Venezuela is the world's fifth-largest oil exporter, at least 70 percent of its populace lives in poverty, and half endures extreme poverty.

Chavez, a former paratrooper, swept into office five years ago promising to change all that. He calls the rich "the squalid ones," and says they do nothing to help the poor. While his critics note that the number of poor rose under his government, surveys show he enjoys 30 percent support.

When Chavez was briefly ousted in a military coup last year, it was the desperately poor who came down from the hills to demand his return. And as unemployment rises along with inflation, Chavez now needs their continued support as his critics push for a recall referendum, expected later this year.

"They are as much about indoctrinating as they are about providing services," said Miguel Diaz, a South America analyst at the Center for Strategic International Studies in Washington, of the program. "I compare it to missionaries. They teach and provide healthcare, but at the expense of suffering through their preaching."

"I think Chavez is using the Cuban doctors for political purposes," Diaz said. "On the other hand, the fact that Venezuelans themselves have never provided support to the marginal communities that the Cubans are now serving speaks a lot to what divides Venezuela."

While Washington has said little, it's clear the State Department has kept an eye on the issue since the literacy trainers began arriving earlier this summer.

"We support people who want to learn to read and write," a State Department official said. "But we're concerned over the increasingly close ties between the two countries. We expect the Cuban trainers will be limited to their literacy camp."

Vargas scoffs at the outcry. The oligarchs, he said, are simply against Chavez's revolution on behalf of the poor.

"If it's necessary to go to Mars or the moon to help the poor, then we'll get the doctors from Mars," he said.