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Mike Ceaser
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While backers of Venezuelan le

Olivia Canelón emerged from a downtown Caracas store happy despite the strain of several bulging shopping bags. "They have a variety of products of good quality and much cheaper (than in normal stores)," Canelón said of the staples like rice, sugar and flour that she buys at the government’s subsidized Mercal stores.

The Mercal stores are one of several initiatives, including adult education programs and doctors in the poorest barrios, launched by the government as President Hugo Chávez’s opposition pushes for a recall vote on his rule.

Chávez’s critics accuse his government of violating civil rights, weakening democratic checks and balances and dividing the nation with the president’s belligerent rhetoric.

The Mercal stores have gained devoted customers who line up before stores open so as not to miss the best bargains. But the stores have also received criticism from Chávez opponents, who claim the president is trying to weaken the business community, which overwhelmingly opposes his presidency. They also accuse him of populism as the Venezuelan leader tries, at least in part, to replace a market-driven economic system with Cuban-style government-run distribution programs.

Numerous critics

Critics of the Mercal where Canelón shops are not hard to find. A half block up the street, employees of a family-owned grocery store said that since the Mercal opened last year, sales of products such as powdered milk and flour have dropped as much as 50 percent.

"It certainly affects us …We don’t have subsidies," said employee José Aguiar.

And if the Mercal stores have cut expenses on some foods, Venezuelans continue suffering from skyrocketing retail prices for most of what they buy. Inflation of about 30 percent annually and a 75 percent devaluation of the bolivar currency against the dollar over the past 2 1/2 years have slashed Venezuelans’ buying power. Despite the Mercal and other programs, Venezuelans’ food consumption declined last year as the economy shrank 9.2 percent and unemployment soared to 15 percent of the workforce.

Chávez says the Mercal is part of a broader program to make Venezuela, the only nation in South America which imports most of its food, more self-sustaining.

"Venezuela has to become once again an agriculturally-productive nation, which produces a good part of what we consume," Chávez said last December after inaugurating a new Mercal store. "Food for life, for sovereignty, for mental, physical and above all collective strength."

The government has also launched a program called ‘Mercal Maximum Protection’ intended to serve the poorest of the poor, in which government-supplied food is prepared in homes, where neighbors come to eat.

Cuban doctors

None of Chávez’s programs have escaped criticism from opponents, who say that his adult education programs are unrealistic and intended to indoctrinate the poor with communist ideology. They have made the same criticism of the government’s Barrio Adentro program, placing Cuban doctors in the nation’s poorest neighborhoods. For Chávez critics, the doctors, in addition to spreading communist ideology, are practicing medicine illegally and taking jobs from Venezuelan MDs.

"We know that these people are Cubans, but we don’t know whether they are doctors," says federation president Dr. Douglas León Natera.

León Natera says the Cubans have committed malpractice by bungling deliveries and prescribing aspirin for fever, even though that could be dangerous if the patient has dengue.

León Natera wants the Cubans replaced with Venezuelan MDs — but says the Venezuelans will go work in the barrios only when security and living conditions are appropriate. The government says that when it made its recruitment call for doctors to serve in Barrio Adentro, only a few Venezuelans showed up, and they lost interest after learning they would have to live in the barrios.

In a lawsuit brought by León Natera last year, a court ordered the Cuban doctors replaced by Venezuelans. But Chávez ignored the ruling and later dissolved the court.

In Winche, a neighborhood of brick and concrete homes on the hills on the outskirts of Caracas, where several dozen Cuban MDs live and work, residents credit the Cubans with saving some 30 lives since they arrived in June 2003. The drive to the nearest hospital takes at least an hour — and much longer during frequent traffic jams.

"When (the Cubans) first arrived here the community was very pleased," said Marta Mujica, a member of the neighborhood’s recently-organized Health Committee. "(Before), when there were traffic jams, many patients arrived at the hospital already dead."

The Cubans doctors say they have been practicing preventative medicine by teaching residents the dangers of high cholesterol diets, smoking and lack of exercise. Water quality is also an issue, since the neighborhood receives potable water for only a few hours each month, when residents fill barrels for storage.

Cuba also sends doctors to several Caribbean nations as well many African ones. One of the Cubans in Winche, Dr. Osmany Ramos, 38, did similar work in Gambia. Dr. Ramos said that while Venezuela has more wealth, Cuba’s public health system is more highly developed.

"(In Venezuela) there is a lot of technological development, but it isn’t within the reach of the whole population," he said. "In Cuba there is less technology, but there is access."

There are now more than 10,000 MDs, most of them Cubans, in the Barrio Adentro program, and the government’s goal is one doctor for every 250 poor families. The government says the Barrio Adentro program will be the foundation of a new health care structure in which most conditions will be treated in the neighborhood, and only those with more serious illnesses will go to clinics or hospitals. The government is also redesigning the nation’s medical training to put more emphasis on routine care for poor people instead of expensive treatments for the wealthy.

"Our universities don’t train doctors for social work, but for clinical work," says National Coordinator of Primary Attention Juana Contreras.


Cuban doctor Osmany Ramón
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