VENEZUELA:Under President Chávez the health service - a shambles for decades - is slowly beginning to improve, reports Hugh O'Shaughnessy, in Caracas
Dr Coromoto Landaeta is an opposition spokesman for the doctors and the health industry in Venezuela's National Assembly and he does not like what is going on here. "Under President Hugo Chávez, we are seeing the end of the democratic medicine as we know it in Venezuela," he declares with the utmost forcefulness.
Sadly for the good doctor and his many supporters, Venezuelans know that their country's health care has never been "democratic" - indeed it has been a total shambles for decades. Many Venezuelan doctors traditionally look on medicine less as a caring profession and more as a well-paying career.
After graduation, most do their compulsory eight-month stint in public health in rural areas but then head back to the big towns where the money is.
The UN World Health Organisation suggests that there should be 40 hospital beds for every 10,000 members of the world's population. Despite President Chávez's efforts here, there are fewer than 18 beds per 10,000 people on average.
In the remote state of Delta Amacuro where the Orinoco falls into the Atlantic Ocean, there are no more than seven beds per 10,000. And the system is short of 18,700 nurses. There are reports of women in labour having to go to up to eight hospitals before getting attention.
Public hospitals were regularly starved of money by previous governments, maladministered and crippled by corruption. In the Pérez Carreño Hospital here, only eight of the 24 operating theatres functioned last year.
In Venezuela, where an oil economy has over the decades produced a sparkling elite of super-rich, a quarter of under-15s go hungry, for instance, and 60 per cent of people over 59 have no income at all. Less than a fifth of the population enjoys social security.
Only now under President Chávez, the former parachute colonel elected to office in 1998, has medicine started to become something of a reality for the poverty-stricken majority in the rich but deeply divided - virtually non-functioning - society.
Since he won power in democratic elections and began to transform the health and welfare sector which catered so badly to the mass of the population progress has been slow. But it has been perceptible - not least because Venezuela has joined with Cuba in a joint health strategy which has brought perhaps 20,000 Cuban doctors and other health professionals here and spread them around the country from Caracas to remote spots where Venezuelan doctors refuse to serve.
The like of the scheme has seldom, if ever, been seen anywhere before.
Cuba's experience of decades of training doctors has met up with a Venezuelan government with the cash from oil to satisfy Cuba's needs and launch continental schemes together. It clearly has the cash to spend on health and last month drew some $6 billion from its €32 billion reserve to spend on social projects. The government is spending a fortune on public hospitals.
For their part many of the Cuban health teams, drawing modest wages, live in rough accommodation and eating the food provided by the poor communities they serve. Some of them - called "pseudo-doctors" by Dr Landaeta's friends who have opposed their right to practice here - live in little octagonal módulos or modules of red brick which have a small office and consulting room downstairs and a tiny bedroom above.
The other day I saw a Cuban woman doctor hard at work in her módulo in the rough and violent Christ the King area of Caracas. The little building was dwarfed by 20-storey blocks of flats and overlooked from the hills by the slums which have spread across the beautiful mountain valley in which the capital sits. Her office was full of patients awaiting attention.
The Venezuelan staff in a city-run health centre nearby, with 30 half-time staff who see 200 patients a day, said they had little contact with the Cubans but were full of praise for them.
Edgar, a Venezuelan health professional, union leader and Chávez supporter, expressed disgust with the mercenary attitude of his country's doctors. "Our doctors are always after money, they turn away poor people who can't afford to pay and they won't go to the countryside. Sometime they even sabotage the public health service," he said.
"The Cubans are much better.They treat everyone and are good at preventive medicine, which our doctors often ignore because it doesn't bring in much cash. And they live simply."
The country's health is struggling ahead, helped by a scheme to get cheap staple food out to state-run shops in poor areas. As a result, in the years from 1998 to 2002 infant mortality has fallen slightly to 17.2 per 1,000 and life expectancy has increased a little 73.7 years.
Meanwhile Castro and Chávez are launching a scheme aimed at saving the sight of six million people on the continent of America, from Alaska to Cape Horn, at no cost to the patients, at the rate of 600,000 a year. A quarter of places on this scheme, which will require treatment in Cuba and later Venezuela, are reserved for US citizens.
Chávez is bent on a policy of promoting public medicine over private practice. "Health isn't a thing that should be bought and sold," he says.
Dr Landaeta will have a difficult job persuading many Venezuelans otherwise.