Thursday, August 25, 2005

This is why the Cuban doctors are needed. 

One of the constant complaints of the opposition (I know, I know, they have lots of complaints) is that Chavez has brought in lots of Cuban doctors. First, they complained that they weren't real doctors and weren't qualified to practice medicine in Venezuela. In fact they once even tried to pin the unfortunate death of one youngster on the Cubans even though it later turned out it had nothing to do with them. Of course, it has since been amply shown that Barrio Adentro (and the add on program Barrio Adentro II) provide excellent care so the opposition now claims it no longer opposes it. In fact they claim they would maintain and expand it if they were to come to power (and if you believe that...)

Then their complaint became focused on the fact that Barrio Adentro was using Cuban doctors to the exclusion of Venezuelan physicians, which was largely true. There are two reasons for this. First, Venezuelan doctors would insist on being paying much more than the Cubans. Likely 3 or 4 times as much. This would certainly be a budget buster for the program as a key aspect of Barrio Adentro is having doctors in all neighborhoods. To pay the going rate to Venezuelan doctors would force dramatic cutbacks in the number of areas to which they could offer their services. Secondly, Venezuelan doctors have historically and almost universally refused to work in the poorer neighborhoods. They complain that it is too dangerous to work there but the largely unspoken reason is their open contempt for the people who live in the barrios. So to this day although the Venezuelan government has made efforts to incorporate Venezuelan doctors into Barrio Adentro it is still overwhelmingly staffed by Cubans.

Yesterday we were given a dramatic example of why we should be grateful to have the Cubans. In a hospital in the western section of Caracas that serves largely lower income people four patients died overnight Tuesday after their oxygen supply ran out. The supply of bottled oxygen at this hospital had been running low for a couple weeks. The main oxygen tank was completely exhausted and the hospital had been using oxygen supplied in metal cylinders by an outside company. Tuesday night these cylinders of oxygen also ran out, the ventilators that the four patients were on could no longer function, and the patients died.

As can be imagined, the finger pointing over who is responsible has been intense. The opposition media has been going ape blaming it on Chavez ("its all his fault for taking too many trips"). The hospital administration at first blamed it on the company that supplied the oxygen saying they didn't deliver more oxygen on time. The company then said it wasn't its fault because its delivery truck broke down. They later changed their story and said that they hadn't been paid in a long time - but that even so they delivered all requested supplies on time. Then the hospital administration said they didn't understand why the oxygen ran out when it did - it was to have lasted several more hours.

During this whole sorry spectacle there is one group that is trying to keep a very low profile, the doctors who were presumably caring for the patients. So far all their statements have been one version or another of "don't look at us, we don't have anything to do with the oxygen - its not our fault there aren't any supplies".

But of course, as much as they may wish to duck their responsibility here I don't think its going to be that easy. First, yes, public hospitals in Venezuela are notorious for lacking supplies. Generally when you go to a these hospitals you have to bring all your own supplies - bandages, painkiller, antibiotics, etc. I'm not kidding - you really have to do that. Now if you ask any of the doctors in these hospitals why that is they will tell you it’s the administrations fault or the governments fault that there is no money for these supplies. However, that doesn't quite square with reality. The biggest single reason there are no supplies in the hospitals is that the doctors (who often have outside private practices) and the staff steal them. For example, if you go to a hospital thinking you might have broken a bone and need an x-ray you may well be told by the doctor "sorry, there isn't any x-ray film". But it won't end there. The doctor will then proceed to tell you "but I know where you can get some". And sure enough, for the right price, you will get your x-ray film by coughing up some money and without ever leaving the hospital. Rather fishy, don't you think? This exact thing happened to a friend when I accompanied her to the hospital.

So there is indeed a problem with a lack of supplies in the hospitals, which in no small measure involves a lot of very unethical Venezuelan doctors. But in this instance its gets worse. The doctors had two and a half ours advance notice that the oxygen was running out and they apparently did nothing. Now some of them are trying to cover it up.

From the above article we have this. One of the Drs on duty that night, Livia Gonzalez, said: "around 10:30 at night the oxygen pressure fell. We had five patients with mechanical ventilation, of which two were in critical condition. We immediately attended to Raul Perez who died fifteen minutes later..... It was out of our hands to do anything because we simply didn't have oxygen."

However, this version of events is contradicted by one of her own colleagues. According to the same article: "Abelardo Oballes, a trauma resident, was also on duty and said that at 8:30 he was told that there was only two hours of oxygen left and that the patients were to be transferred…."

So here we have a strange situation. The doctors were given at least a couple hours warning that the oxygen was running out and they did...nothing. They apparently made no effort to either get alternate supplies or simply transfer the patients to other hospitals. This is bitterly ironic given that in the case were they tried to blame a death on the Barrio Adentro doctors the young patients was actually transferred from hospital to hospital trying to find doctors that would treat him. In that case when the doctors didn’t want to act it very easily occurred to them to put the patient in an ambulance and send him elsewhere. But in this case they were just stood there and did nothing, like deer in the headlights.

This is beyond simple malpractice. This is really criminal negligence on the part of these doctors. To have done nothing during hours to try to save these patients lives is simply unconscionable. Didn’t these people take the Hippocratic oath? Of course, they know what they did was inexcusable. That is why they have already huddled together with their union and made it clear they won’t take any blame. Considering these people are really just slime walking around with white lab coats I’m not surprised. So it looks like it is time for Barrio Adentro IV. Lets put the Cuban doctors in the public hospitals too. I’m sure faced with a similar situation they would at least have enough common sense and humanity to pick up the phone and call for help.

Addendum: After writing this I read Tal Cual and none other than Teodoro Petkoff is jumping on the band wagon about how it’s the governments fault. This man just has no shame. When he was in the Caldera government in charge of the economy there was a doctors strike (back then he was on the other side and it was all the doctors fault) that led to the deaths of dozens of patients who couldn’t get any medical care. But Petkoff throughout that event kept telling everyone “yes, yes, I know things are hard for those who can’t get medical care but the primary enemy is inflation and that is what we have to worry about”. And now he complains about this. Sinverguenza.

UPDATE A friend sent me these not so old photos of a demonstration by Venezuelan doctors that I thought would be interesting to share:

This one says: " Venezuelan Medical Federation, The supposed Cuban doctors make more money than Venezuelans do - invaders out" That of course is complete lie. But hey, since when does the Venezuelan opposition ever tell the truth?

This one is a little simpler just saying "out pirates of the carribean" obviously referring to the Cuban doctors. And of course it has to obligatory hammer and sickle to scare people.

This one says "no more malpractice by the Cubans" (iatrogenia is just a sophisticated term for illnesses you get from treatments doctors give you - ie in this context malpractice). I'm sure the four people who died Tuesday just would have wished the Venezuelan doctors would have done their own jobs instead of worrying so much about what the Cubans are doing.

This one says "The hypocratic oath doesn't permit us to be hypocrites with our patients" But apparently it does permit you to stand around and do nothing while they die because you just don't give a shit.

Now if only we could find Venezuelan doctors who cared about their patients as much as they cared about fighting "communism". Not to worry, Venezuelan students are starting to graduate from Cuban medical schools in large numbers. Somehow I have faith they'll be different then these clowns and imposters.


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