Hands clasped and gesturing toward the camera, Hugo Chávez Frías, President of the Bolivarian Republic of Venezuela, is shouting. Men and women in white coats stand at his side as he proclaims “un nuevo sistema, a revolution in the National Public Health system, moving forward each day. These are the signs of the Revolution!” In this episode of his weekly television broadcast, Aló Presidente, President Chávez stands in front of a clinic in the middle of the national health initiative, Barrio Adentro. It is one of several new social projects that has placed over 15,000 doctors in the poor barrios of Venezuelan cities since 2003. Chávez depicts Barrio Adentro as a symbol for a transformed Venezuela, a successful attempt to provide basic care and medicine within the community. A separate institution from the traditional public health system, the program has affected every lower class neighborhood in the country. In each case, physicians move into the community, furnishing preventive medicine, consultations, vaccinations, and education in the service of larger public health objectives.

Before the election of Chávez to the presidency in 1998, a state system of public hospitals provided the great majority of the population with healthcare. However, these public hospitals were crowded and the resources were limited. Another critical problem, one of the central targets of Barrio Adentro, was that the hospitals were distant from the neighborhoods where the demand was highest. Chávez and the Ministry of Health conceived of the Misión Barrio Adentro as a parallel institution to the traditional system. A physician from the MSDS, Luis Montiel Araujo, explains: “Much of our health problem has to do not so much with economic factors as with the organization of communities. Barrio Adentro was conceived as a way to bring medical services to the excluded…to put a physician in every community.” The objective is to create a basic medical presence in the heart of the poor neighborhoods of Venezuela. Rather than prioritizing facilities, the program focuses on the doctors themselves and the basic primary care that they can bring to the community.

These physicians, so integral to the health mission of Barrio Adentro, are predominantly Cuban. In exchange for medical services, Venezuela offered Cuba its most valuable asset: oil. Although oil wealth supports all of Chávez’s spending on health missions, Venezuela continues to send 53,000 barrels of oil per day to Cuba. Political opponents have accused Chávez of wasting oil that could have been sold on the international market, but Chávez maintains that Cuba purchased the oil fair and square, stating, “All these plans…[are] not just being paid for with oil; we are also selling oil to Cuba and Cuba is paying us at the international rate.” Chávez essentially created agreements independent of international finance institutions, receiving humanitarian aid from a fellow developing country.

Since its inception, the Venezuelan political opposition has condemned the new national health program not because of the oil agreement that sustains it, but also because its participating doctors are Cuban. Within Venezuela, the controversy over Barrio Adentro symbolizes the fervent class polarization that has gripped the country.