Jul 02, 2011, 06:42 PM
By Frances Robles
frobles@MiamiHerald.com
CARACAS -- Venezuelan President Hugo Chávez is on his fourth week in the hospital in Havana, raising this question back home: Why doesn’t he get cancer treatment in Caracas?
“Because he knows he could die here!” said Alfonzo Linares, a security guard in Caracas’ Bello Monte neighborhood. “What goes around comes around. He governed badly, giving away our riches to other countries. You can die in a hospital here. The health system is useless, so he had to run to Cuba.”
To many experts, Chávez’s decision to stay behind in Havana to be treated for an unspecified cancer is a tacit admission that his efforts to rebuild the Venezuelan public health care system failed. Staying in Cuba and praising its medical care is at the same time a reaffirmation of his choice to create a parallel health system staffed with Cuban doctors, and a recognition that when it came to his own illness, Chávez had nowhere else to turn, experts say.
For Venezuelan doctors, it underscores what the Caracas medical establishment has said for years: the country’s public health system is in shambles, and the Cuban clinics Chávez built have not fared much better.
Chávez disappeared from public view nearly a month ago, when he fell ill during a visit with Fidel Castro in Cuba. After weeks of publicly admitting only to a pelvic abscess that required draining, Chávez made a surprise announcement Thursday night: He has cancer.
The government interrupted TV programming late Thursday to air a solemn prepared speech taped in Cuba. In it, the firebrand former paratrooper forlornly acknowledged that he hadn’t visited the doctor much and ignored weeks of discomfort.
It was Castro, Chávez said, who made him get a checkup. And it was the former Cuban dictator who ultimately delivered the diagnosis days later.
“I think initially Chávez intended to present it as a vote of confidence for the Cuban health care system — an effort to ratify his vision of health care and socialism,” said former Health Minister Rafael Orihuela. “If he came home, he knows he’d have to go to a private clinic, where the doctors are well-trained and have access to technology. But that’s the worst message he could send: that what he built here doesn’t work.”
Plus, at a private hospital, Chávez would have a harder time keeping his condition secret, Orihuela said.
Chávez’s administration attacks private hospitals as capitalist institutions that long refused to treat the uninsured. In 2003, Chávez went to war with the private medical establishment by hiring thousands of Cuban doctors to staff neighborhood clinics known as Barrio Adentro.
While the ministry of health touts its successes — 1.6 million lives saved at 506 diagnostic centers — even Chávez has admitted they have deteriorated.
“We have to review it thoroughly,” he told the National Assembly. “We cannot allow new projects to catch the same ills as the old ones … otherwise the failure will be the end of this revolution.”
Meanwhile, malaria and dengue rates soared, and at least one public hospital closed for two days when all 140 doctors resigned en masse.
“Observers describe public hospitals as increasingly dangerous places where underpaid, undersupplied, and understaffed doctors struggle to provide medical services to Venezuela’s poor,” a 2009 U.S. embassy cable released by Wikileaks said.
"Due to shortages of basic medical supplies, doctors ask patients to purchase their own needles, disinfectants and gauze. ... Doctors sometimes dress wounds with the same dirty bandages. Other patients are told to bring their own X-rays from private clinics. As in many areas of Caracas, public hospitals suffer from water shortages, forcing doctors to postpone important operations."
Orihuela said a “handful” of public hospitals in Venezuela are equipped to treat Chávez’s illness. The main problems, he said, are very high operating room infection rates and a shortage of anesthesiologists.
“Instead of investing in the public health care system, he created a parallel system, and let the public hospital system collapse,” said Douglas León Natera, president of the Venezuelan Medical Federation. “The Cuban system here is receiving 80 percent of the health care budget. We have denounced the condition of the public hospitals many times.”
On the same day Chávez revealed his diagnosis, doctors here went on strike to protest low salaries and poor conditions.
The World Health Organization ranks Venezuela’s health system 54th in the world. The United States is 37th, and Cuba 39th.
"He doesn’t trust the medical system here or Venezuelan doctors," León said. "He trusts the doctors there.”
Efforts to reach the Health Minister were unsuccessful Friday and Saturday.
Luis Capote Negrín, coordinator of the Ministry of Health’s National Cancer Registry, said the nation’s social security program guarantees access to chemotherapy and free medication to all cancer patients.
“There are various chemotherapy centers in the principal and largest cities in the country where you can guarantee the material needed as well as trained personnel,’’ Capote said.
However, he said they are short-staffed, so sometimes patients must wait a month for an appointment at a center further from their home.
“But we always treat urgent cases very fast,” he said.
Lorena Lion, an oncologist at the Luis Razetti Hospital, said the government made a huge advancement in cancer treatment three years ago, when it began offering medications at low cost, or even free.
She acknowledged that a shortage of equipment forces patients to go from place to place for each phase of their care.
“Hopefully, what the president is going through will make him think a bit about oncology patients, from the level of attention they get to an increase in salaries for the medical professionals who dedicate themselves to tend to these patients,” she said. “If there are 125 oncologists in Venezuela, that’s a lot. Young people don’t want to specialize in this, because the salaries are so low.”
Lion said she can’t understand why Chávez hasn’t come back, because cancer patients can get excellent treatment in both public and private hospitals here.
”It’s a big mystery,” she said. "We have highly trained doctors, the latest medicines, and a lot of dedicated professionals. The cancer patient can be treated successfully, but they have to move around a lot.”
In an interview Friday night with Cuban TV journalist Randy Alonso, Chávez said Castro was the one who convinced him to stay behind in Cuba.
“I kept telling him, ’I have to go to Caracas,’” citing an upcoming presidential summit and other pressing affairs. “He made me reflect. Who knows what labyrinth I’d be in if it wasn’t for his eagle eye and experience.”
Some experts wonder if after two surgeries in three weeks, Chávez is simply too sick to fly.
“I got the sense that he was to ill to move,” said Luis Vicente Leon, a well-known political analyst here.
Mark Weisbrot, co-director of the Center for Economic and Policy Research, suspects Castro forced Chávez’s hand.
“Maybe Castro convinced him he could recover better in Cuba,” he said. “Because he is a workaholic, if he goes back to Venezuela, it’s hard to imagine him just resting. Castro probably said: ‘Look, you have to rest. Stay here,’ and he listened.
“Castro is the only person who can tell him what to do.”
Orihuela, the former health minister, said he sent Chávez a tweet last week. “I told him: ‘Stop listening to Castro,’ ’’ Orihuela said. ‘Go get a second opinion at the MD Anderson Texas Cancer Center.’ ”
Miami Herald special correspondent Sandra Sierra Nunez contributed to this report from Caracas.
Read more: http://www.miamiherald.com/2011/07/02/22...z1QziC2MdI
frobles@MiamiHerald.com
CARACAS -- Venezuelan President Hugo Chávez is on his fourth week in the hospital in Havana, raising this question back home: Why doesn’t he get cancer treatment in Caracas?
“Because he knows he could die here!” said Alfonzo Linares, a security guard in Caracas’ Bello Monte neighborhood. “What goes around comes around. He governed badly, giving away our riches to other countries. You can die in a hospital here. The health system is useless, so he had to run to Cuba.”
To many experts, Chávez’s decision to stay behind in Havana to be treated for an unspecified cancer is a tacit admission that his efforts to rebuild the Venezuelan public health care system failed. Staying in Cuba and praising its medical care is at the same time a reaffirmation of his choice to create a parallel health system staffed with Cuban doctors, and a recognition that when it came to his own illness, Chávez had nowhere else to turn, experts say.
For Venezuelan doctors, it underscores what the Caracas medical establishment has said for years: the country’s public health system is in shambles, and the Cuban clinics Chávez built have not fared much better.
Chávez disappeared from public view nearly a month ago, when he fell ill during a visit with Fidel Castro in Cuba. After weeks of publicly admitting only to a pelvic abscess that required draining, Chávez made a surprise announcement Thursday night: He has cancer.
The government interrupted TV programming late Thursday to air a solemn prepared speech taped in Cuba. In it, the firebrand former paratrooper forlornly acknowledged that he hadn’t visited the doctor much and ignored weeks of discomfort.
It was Castro, Chávez said, who made him get a checkup. And it was the former Cuban dictator who ultimately delivered the diagnosis days later.
“I think initially Chávez intended to present it as a vote of confidence for the Cuban health care system — an effort to ratify his vision of health care and socialism,” said former Health Minister Rafael Orihuela. “If he came home, he knows he’d have to go to a private clinic, where the doctors are well-trained and have access to technology. But that’s the worst message he could send: that what he built here doesn’t work.”
Plus, at a private hospital, Chávez would have a harder time keeping his condition secret, Orihuela said.
Chávez’s administration attacks private hospitals as capitalist institutions that long refused to treat the uninsured. In 2003, Chávez went to war with the private medical establishment by hiring thousands of Cuban doctors to staff neighborhood clinics known as Barrio Adentro.
While the ministry of health touts its successes — 1.6 million lives saved at 506 diagnostic centers — even Chávez has admitted they have deteriorated.
“We have to review it thoroughly,” he told the National Assembly. “We cannot allow new projects to catch the same ills as the old ones … otherwise the failure will be the end of this revolution.”
Meanwhile, malaria and dengue rates soared, and at least one public hospital closed for two days when all 140 doctors resigned en masse.
“Observers describe public hospitals as increasingly dangerous places where underpaid, undersupplied, and understaffed doctors struggle to provide medical services to Venezuela’s poor,” a 2009 U.S. embassy cable released by Wikileaks said.
"Due to shortages of basic medical supplies, doctors ask patients to purchase their own needles, disinfectants and gauze. ... Doctors sometimes dress wounds with the same dirty bandages. Other patients are told to bring their own X-rays from private clinics. As in many areas of Caracas, public hospitals suffer from water shortages, forcing doctors to postpone important operations."
Orihuela said a “handful” of public hospitals in Venezuela are equipped to treat Chávez’s illness. The main problems, he said, are very high operating room infection rates and a shortage of anesthesiologists.
“Instead of investing in the public health care system, he created a parallel system, and let the public hospital system collapse,” said Douglas León Natera, president of the Venezuelan Medical Federation. “The Cuban system here is receiving 80 percent of the health care budget. We have denounced the condition of the public hospitals many times.”
On the same day Chávez revealed his diagnosis, doctors here went on strike to protest low salaries and poor conditions.
The World Health Organization ranks Venezuela’s health system 54th in the world. The United States is 37th, and Cuba 39th.
"He doesn’t trust the medical system here or Venezuelan doctors," León said. "He trusts the doctors there.”
Efforts to reach the Health Minister were unsuccessful Friday and Saturday.
Luis Capote Negrín, coordinator of the Ministry of Health’s National Cancer Registry, said the nation’s social security program guarantees access to chemotherapy and free medication to all cancer patients.
“There are various chemotherapy centers in the principal and largest cities in the country where you can guarantee the material needed as well as trained personnel,’’ Capote said.
However, he said they are short-staffed, so sometimes patients must wait a month for an appointment at a center further from their home.
“But we always treat urgent cases very fast,” he said.
Lorena Lion, an oncologist at the Luis Razetti Hospital, said the government made a huge advancement in cancer treatment three years ago, when it began offering medications at low cost, or even free.
She acknowledged that a shortage of equipment forces patients to go from place to place for each phase of their care.
“Hopefully, what the president is going through will make him think a bit about oncology patients, from the level of attention they get to an increase in salaries for the medical professionals who dedicate themselves to tend to these patients,” she said. “If there are 125 oncologists in Venezuela, that’s a lot. Young people don’t want to specialize in this, because the salaries are so low.”
Lion said she can’t understand why Chávez hasn’t come back, because cancer patients can get excellent treatment in both public and private hospitals here.
”It’s a big mystery,” she said. "We have highly trained doctors, the latest medicines, and a lot of dedicated professionals. The cancer patient can be treated successfully, but they have to move around a lot.”
In an interview Friday night with Cuban TV journalist Randy Alonso, Chávez said Castro was the one who convinced him to stay behind in Cuba.
“I kept telling him, ’I have to go to Caracas,’” citing an upcoming presidential summit and other pressing affairs. “He made me reflect. Who knows what labyrinth I’d be in if it wasn’t for his eagle eye and experience.”
Some experts wonder if after two surgeries in three weeks, Chávez is simply too sick to fly.
“I got the sense that he was to ill to move,” said Luis Vicente Leon, a well-known political analyst here.
Mark Weisbrot, co-director of the Center for Economic and Policy Research, suspects Castro forced Chávez’s hand.
“Maybe Castro convinced him he could recover better in Cuba,” he said. “Because he is a workaholic, if he goes back to Venezuela, it’s hard to imagine him just resting. Castro probably said: ‘Look, you have to rest. Stay here,’ and he listened.
“Castro is the only person who can tell him what to do.”
Orihuela, the former health minister, said he sent Chávez a tweet last week. “I told him: ‘Stop listening to Castro,’ ’’ Orihuela said. ‘Go get a second opinion at the MD Anderson Texas Cancer Center.’ ”
Miami Herald special correspondent Sandra Sierra Nunez contributed to this report from Caracas.
Read more: http://www.miamiherald.com/2011/07/02/22...z1QziC2MdI