Since 2003, Cuba has been sending battalions of doctors to Venezuela in exchange for cash and crude.
The program, known as Barrio Adentro, offers free medical care to some of the nation’s poorest. It’s been credited with saving more than a million lives and is one of the pillars of the socialist revolution.
But according to health workers who have defected from the program, Barrio Adentro has been hollowed out by fraud. And they say they were under such intense pressure to hit quotas that they’ve been faking statistics for years.
As a dentist in the program, Thaymi Rodríguez said she was required to see 18 patients a day, but often only a handful would make their way to her clinic. Medical workers who didn’t hit their daily quota were threatened with having their pay docked, being transferred or, in extreme cases, being sent back to Cuba.
To make up for the patient shortfall, Rodríguez said she and her colleagues would routinely fake paperwork and reinforce the fiction by throwing out anesthesia, dental molds and other supplies.
“I worked for three and a half years as a dentist in Venezuela and it was horrible dealing with the statistics,” said Rodríguez, who defected from the program late last year and is in Colombia awaiting a U.S. visa. “I might see five patients a day but I had to say I’d seen 18, and then throw all that medicine away, because we simply had to.”
Trashing medicine in a country where it’s desperately needed was painful, doctors said. But if they were caught giving it away — or even worse, selling it — they would be kicked out of the mission and sent back to Cuba. And regular audits of their supplies meant they needed them to match their patient count.
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The claims are difficult to verify, and calls to Venezuela’s Ministry of Health seeking comment went unanswered. But the Miami Herald spoke to three different groups of health workers who had abandoned the program, and all told similar stories.
The quota pressure stems from Cuba’s economics. Desperate for hard currency, the government sends its legions of health workers abroad under contracts that let the administration keep the lions share of the revenue.
According to an article published by the Wharton School at the University of Pennsylvania, there were 37,000 Cuban health professionals working in 77 countries during 2015. Citing unnamed Cuban officials, the document claims the health workers generated about $8 billion in foreign exchange revenue for the island that year.
Venezuela’s state-run PDVSA oil company, which pays for the program, says it pumped $28.8 billion into Barrio Adentro from 2003 through 2015.
There’s no doubt the clinics (there were 7,287 of them in 2015) have saved lives. The World Health Organization, among others, has praised the program for helping reduce infant mortality, and President Nicolás Maduro says the Cuban doctors have saved more than 1.4 million lives since the program started.
But it’s also clear the program is less effective than the administration would like the world to believe.
A Cuban IT expert who oversaw medical missions in four Venezuelan states said it was his job to transmit patient logs and other statistics back to Havana. The 34-year-old technician asked to remain anonymous because he’s been told he’s facing arrest warrants in Venezuela and Cuba for stealing data from the medical mission.
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Venezuela pays Cuba based on the number of patients that are seen, or educational workshops that are given, he said. And the island’s authorities simply doesn’t want anemic patient turnout to get in the way of the revenue.
“You have to understand that Venezuela pays Cuba based on statistics, not based on what’s really happening in the clinics,” he explained.
In the four states under his purview — Aragua, Yaracuy, Guárico and Carabobo — he said there were some 6,800 Cubans on different “missions,” including 5,900 medical workers.
As he compiled his monthly reports, it was clear they were fabricated, he said. Dentists were regularly logging 18 patients a day and doing five educational workshops per week. In addition, they had to fill out extensive paperwork on each patient. There simply weren’t enough hours in the day, he said.
“I’m an IT worker and a mathematician and like all my data to make sense,” he said. “And none of this made sense.”
Dentists are particularly under the gun because Venezuela pays for their services in cash, as opposed to crude, workers said. But nobody was immune from the quotas.
Ibrahím Mustelier, an ophthalmologist, said he was required to deliver six patients every Thursday for cataract surgery under a program known as “Operation Miracle.”
But the real miracle was finding that many people.
“What I would see in my practice were infections, conjunctivitis…things that didn’t need surgery,” he explained.
When he didn’t have enough cases, his bosses would send him out knocking on doors to fill the beds.
“My supervisors would say ‘Doctor, you know you’re going to be punished because we have to meet these quotas — and these orders are coming from the highest levels,’” he recalls.
The pressure on doctors may be one of the reasons they’ve been defecting in droves. Thousands of them received expedited visas to the United States under the Cuban Medical Professional Parole program, which was canceled on Jan. 12.
The IT expert said that from January to October he had records of 90 doctors defecting from Aragua state alone.
But Barrio Adentro has also been a victim of Venezuela’s economic crisis, which features shortages of food and medicine. Doctors said that even as they dumped some medicine others, particularly antibiotics, were impossible to find.
In October, shortly before he abandoned his post, the technician said Cuba recalled hundreds of doctors from the program because, he believed, Venezuela was falling behind on payments. His IT department, for example, was reduced from 22 to 12 workers.
But even as the program is struggling, both countries have a vested interest in the program’s success as it helps maintain the idea that free healthcare is viable and thriving under Venezuela’s socialism, he said.
“In the end,” he said, “Venezuela and Cuba are just lying to each other.”