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Docs-for-oil trade shows Cuba's flair

The Castro-Chavez deal saves the eyesight of many Venezuelans.

By DAVID ADAMS
Published February 12, 2007

HAVANA — A few months ago Venezuelan farmer Ramon Morillo, 52, was going blind and there wasn’t much he could do about it.

His condition, a fibrous tissue growth over the cornea known as pterygium, was treatable. His local health service in western Venezuela was ill-equipped, and he couldn’t afford private care.

That was before he heard about a Cuban medical program known as Operation Miracle from a local social worker. Next thing he knew he was on a government-chartered plane to Cuba.

It was too late for one of his eyes, but after several months of treatment and surgery, Cuban doctors may have saved the other.

“Everyone has been wonderful,” said Morillo, who said he is the father of 20 children.

Morillo’s condition is typical of many rural poor in Latin America who have no access to proper health services. Since Operation Miracle was created in 2004, organizers say doctors have performed 500,000 operations, mostly on low-income Venezuelan patients.

The medical services are financed by a broad barter agreement between the two countries. Cuba provides fully equipped medical teams in Venezuela, with as many as 25,000 doctors, dentists and nurses. In return, Venezuela sends 93,000 barrels a day of refined petroleum products, valued at almost $2-billion a year.

Venezuela is one of the largest oil exporters in the world, but corruption and misgovernment have squandered much of those riches, leaving half the population in poverty and with rotten health services. Cuba, on the other hand, has modest natural resources. But its health system is highly regarded worldwide, with an excess of well-trained medical personnel.

“For some patients, it’s their first trip on an airplane,” said Dr. Marcelino Rios, 62, the head of ophthalmology at the Pando Ferrer hospital, Havana’s top eye clinic, where most of Operation Miracle’s patients are treated.

“It’s the poor people who we are interested in seeing,” he added.

The Miracle project is the brainchild of Fidel Castro and his Venezuelan alter-ego Hugo Chavez. One day in July 2004 Castro showed up at the Pando Ferrer for a meeting with Rios. He wanted to discuss what Cuba could do to help Venezuela tackle a serious problem.

Chavez had launched an adult literacy program — one of a series of innovative social welfare schemes to raise living standards — only to discover that many students not only couldn’t read or write, but they couldn’t see properly either.

Chavez turned to Cuba. Castro had already sent thousands of doctors to Venezuela’s poorest slums under another social program, Inside the Barrio.

That day, Rios recalled, Castro arrived at the hospital at 8.30 a.m. He didn’t leave until 2 a.m. the next morning, mapping out every detail of the program.

“Fidel is a special case. Not every country has had a Fidel. He is very sensitized to health questions,” Rios added.

Some Venezuelans have criticized the deal, saying it amounts to a political subsidy of Cuba’s communist government.

“It’s a barter trade, so if you try to understand it mathematically, you won’t understand it,” said Mario Munoz, spokesman at the Venezuelan embassy in Havana.

“How do you put a value on a medical service? You can’t analyze it coldly. It’s priceless to give someone their eyesight back.”

Operation Miracle has expanded to Bolivia, Ecuador, Haiti and Guatemala and involves 11 Cuban hospitals in Havana and the provinces. Chavez and Castro have pledged to treat 6--million patients over the next 10 years throughout Latin America.

At the Pando Ferrer a new eight-story hospital wing is being built with a dozen new operating theaters, equipped for laser and microsurgery. The pace of the operations has astonished foreign medical experts. Doctors at the Pando Ferrer perform 20 to 40 operations a day, sometimes as many as 60. The record is 300, he said. On that occasion doctors operated past midnight.

Last year the hospital performed 314 cornea transplants and 12,000 cataract operations.

“I don’t think there’s many institutions that can compete with that,” Rios said.

More than 2.3-million Americans undergo cataract surgery each year, making it the most frequently performed operation in the United States. But, at most U.S. clinics, surgeons operate only once a week.

The Cuban program has yet to be evaluated by outside experts, but it is making waves in international ophthalmological circles. Some critics question the economic sense of flying patients to Cuba when cataract surgery is a relatively simple, and cheap, procedure. Wouldn’t it make more sense upgrading local facilities instead, especially as cataract surgery requires followup, they ask.

In the cases of some patients, after being evaluated in Cuba, operations can’t be done and they have to be sent back. To improve efficiency, Cuban officials say the program is being transferred this year to the patients’ home countries. Clinics staffed by Cuban medical personnel are being set up in Venezuela, Bolivia and Ecuador. Only the more difficult cases will be treated in Cuba.

“It’s hard to judge whether it’s high-quality or not,” said San Francisco eye doctor Bruce Spivey, general secretary if the International Council of Ophthalmology. “Some people are saying outcomes are not very good. But they may just be naysayers.”

Spivey questioned the political aspect of the program. “The proselytizing that goes along with it is not what I would consider medical care; it’s political care,” he said.

But Cuba has undoubtedly woken countries up to the ocular needs of the poor.

“There’s no doubt that this is going to have an impact that goes far beyond Cuba,” he said. “It’s likely that the countries Cuba is helping will eventually thank them because it will stimulate them to do a better job locally,” he added.

Many of the patients suffer from cataracts and glaucoma, two eye diseases which if untreated can cause blindness.

They are common in the developing world, where many people work outdoors and are exposed to sunlight for long periods without eye protection.

Some Cubans complain that programs such as Operation Miracle have strained domestic resources to breaking. But others are proud that their country has talent to export, even if it means some sacrifice at home. They point out that the new facilities and surgical equipment benefit Cuban patients as well.

“We have come here several times and we have been impressed by the equipment here,” said Niurka Mederos, 45, who accompanied her son, Alejandro Dustet, 17, for an eye check up at the Pando Ferrer. The waiting room was full of Cubans. “It’s for Cubans and foreigners. There are benefits for us too with all this new equipment.”

Alejandro said his school had put up some of the foreign patients in makeshift dormitories. Cuban students looked after the patients, including cleaning their living quarters, as part of a social work requirement.

The program has put a heavy load on Cuban medical staff who work long hours for little pay. Cuban doctors earn an average of about 500 pesos, or $20, a month.

But there are compensations, staff say. “We get a lot of satisfaction from seeing the patient recover their sight,” said Yamil Rodriguez, a 21-year-old nurse.

“People outside Cuba don’t understand. It’s about human solidarity. In Cuba, we may lack things, but we want to share the things that we do have.”

David Adams can be reached at dadams@sptimes.com.

[Last modified February 12, 2007, 21:37:03]