미션 바리오 아덴트로

본문

Speech given by Dr. Fidel Castro Ruz, President of the Republic of Cuba, at the first graduation of students from the Latin American School of Medicine. Karl Marx Theatre, August 20, 2005

Excellencies and dear friends who, in representation of the countries that are home to the doctors who graduate here today, honor us with your presence; Tenacious and dedicated young people who graduate today as a new class doctor, and their families; Professors and workers of the Latin American School of Medicine; Dear compatriots from Cuba, the Caribbean and Latin America;

Distinguished guests:

Almost seven years ago this graduation ceremony was merely a dream.
Today, it is a confirmation of the power of human beings to reach the
loftiest of goals, and it is truly a prize for those of us who believe
that a better world lies within our grasp.

The idea was born when the news services began to report that Hurricane
Mitch had taken the lives of more than 40 000 people in Central America.
We proposed to send a medical corps that would save, on a yearly basis,
as many lives as those which had been taken by the hurricane.  We did
not hesitate to do this, even though we were still enduring the worst of
the Special Period.  It was made possible because, even in the midst of
those terrible tribulations that followed the collapse of the socialist
block and the USSR, which deprived us from all outside cooperation, and
at a time when the world had given up our cause for lost, the Revolution
never ceased, for one moment, creating human capital.

Together with the idea of helping Central America by sending over
thousands of doctors, the Latin American School of Medicine sprang into
being, with the aim of progressively replacing the Cuban medical
personnel with local doctors, as the former completed their missions.
Today this school, with its ever-expanding development, helps to train
doctors not only in Central America, but also in other parts of the
world.

Looking back in retrospect, we remember that before January 1, 1959, a
bloody and repressive regime closed down hundreds of our institutions of
higher education, including the only Medical School at the University of
Havana.

Most of the graduates came from economically secure families. Half of
the doctors, lured by the United States, abandoned their threatened and
assaulted Homeland. Only three thousand doctors and a reduced number of
Professors of Medicine stayed. Alongside them we began to build what we
have today.

Because of this, only a handful of students graduated as doctors during
the first years following the triumph of the Revolution.  The first
graduation of young doctors who had begun their studies after January 1,
1959 took place on November 14, 1965.

Our armed struggle in the eastern range of the Sierra Maestra had ended
hardly six years earlier. With memories of that conflict fresh in my
mind, I invited that group of 400 young people who were completing their
medical studies to hold the graduation ceremony on the highest peak in
that range and in Cuba, at an altitude of two thousand meters, that is,
at the Turquino Peak.

Today, as I stand before you in this theatre, the words that I spoke to
those graduating doctors on the summit of that steep mountain seem
unreal.

After underlining some paragraphs from that speech, I cannot resist the
temptation to repeat some of the things that I said then tonight, when a
group of 1,610 doctors are graduating from the Latin American School of
Medicine, including graduates from the Caribbean who studied in other
Cuban universities.

At that time, we were also victims of constant pirate attacks and acts
of terrorism directed against our country, which were organized by the
government of the United States.

This is what I said to those young people at the time: ´In this journey,
many of you had the opportunity to understand many things, things
unspoken, without indoctrination, without speeches, transmitted in this
soundless but highly eloquent language that speaks of social and human
realities. I am sure that rather than abstract ideas, inclinations,
vocation, and the natural condition of each and every one of you -which
are unquestionably good - the factor that will make you live up to your
duties and always act the best way possible, will be the attitude of the
peasants of these mountains, the type of men and women that you have
seen here; the goodness, friendliness, generosity, solidarity,
appreciation, and gratitude of men, women, children and elderly people
who have worked, grown and lived under such difficult conditions in
these mountains; their truly spontaneous gestures, the flowers with
which they welcomed you, the fruits of their harvests, the coffee, the
water, their willingness to help you, their cooperation in all types of
organization, their high regard for doctors. ¨

 The oath taken by these graduating students, its internationalist and
revolutionary spirit...all of this must be very painful to the enemy.
Perhaps they tried to minimize this in some way, so last night,
according to the news we received this morning at approximately 12:45
a.m., a pirate boat opened fire on the coast, in the area of Lagunas
Street in Havana.  Three or four minutes later, another pirate boat,
apparently searching for the President's residence, opened fire and
caused great damage with machine gun fire on the National Aquarium
building.  This happened just today.¨

I will try to make a brief summary of the results of our efforts with
regard to the training of personnel and the development of medical
sciences all along these years for the distinguished guests who honor us
with their presence as well as for all those who are also present here
at this graduation ceremony.

Medical doctors who graduated in our country following the triumph of
the Revolution:

*       During the decade 1960-1969: 4,907.
*       During the second decade, 1970-1979: 9,410
*       During the third decade, 1980-1989:  22,490.
*       During the fourth decade, 1990-1999:  37,841.
*       During the fifth decade, 2000-2004:  9,334

The total reaches 83,982.  Three thousand six hundred and twelve out of
this big total have come from other countries. We must also add the 1
905 Cuban doctors graduating this year, which means that the total
actually reaches 85,887.

Nowadays the methods used to train doctors are radically different.
Before the Revolution, the size of school classes was huge, practical
lessons were minimal, and the fundamentals of basic sciences were
virtually non-existent. Students were able to graduate without having
ever directly examined a patient or assisted childbirth. The curriculum
was mainly aimed at curing patients and the private practice of the
profession.  These features were far removed from the health problems,
thus affecting the country. The word 'prevention' was hardly ever used.
On average, 300 doctors and 30 stomatologists graduated each year.

Today the number of youth from Cuba and from other countries around the
world, who are ever more united in the struggle for a more just and
humane future, is rising considerably in the different areas required by
a logical and efficient public health system.

During the academic year 2004-2005, the students' breakdown was as
follows:

*         Medicine:   28.071
*         Stomatology:  2.758
*         Nursing:  19.530
*         Health Technology: 28.400

Current students' sum total: 78.759.

Currently, 11 154 medical students from 83 different countries are
studying for their degree in our country:

*         5.500 come from South American countries
*         3.244 come from Central American countries
*         489 come from Mexico and North America, including 65 young

people coming from the United States and two from Puerto Rico.

*         1,039 come from the Caribbean
*         777 come from Sub-Saharan Africa
*         42 come from 6 countries in Northern Africa and the Middle East
*         61 come from Asia
*         2 come from Europe

The Latin American countries with the largest numbers of students in
Cuba are:

1. Venezuela               889
2. Honduras                            711
3. Guatemala               701
4. Paraguay                             641
5. Brasil                                  629
6. Bolivia                                 567
7. Nicaragua                           560
8. Ecuador                              551
9. Colombia                             545
10. Perú                                  532

From the Caribbean:

11. Haiti                                                          676
12. The Dominican Republic                 403
13. Jamaica                                                    134
14. Guyana                                                     117
15. Belice                                                         79
16. Saint Lucia                                      69

Today we have the enormous satisfaction of seeing you, 1 610 new
doctors, graduate:


*         495 from South America
*         771 from Central America
*         343 from the Caribbean
*         1 from the U.S.A.

Over the past seven years our battle for solidarity and for the training
of doctors from Cuba and from other sister nations has been intense and
ever-increasing.

The means and the methodology have been incredibly revolutionized, and
theoretical and practical training has considerably surpassed that which
had traditionally prevailed throughout history.  It would be more
accurate to say that the traditional form of training has been improved
several times over.

While in the past there was only one university hospital, now all
hospitals fall into the honorable category of university hospitals.

What is more: today, any of the 444 polyclinics which offer primary
medical care can also serve as medical training centers. With the
support of audio visual aids and interactive computer software, plus the
assistance of dozens of specialists, Master degree and even PhD's
holders, our results can compare and are even superior to those achieved
by past methods used to train those who must ensure the health and
well-being of the people.

Seven months ago I had the great satisfaction of meeting with 300 young
people from Haiti, Guatemala and Honduras, who were in the midst of
their last semester of studies and were about to return to their
respective countries to work alongside brigades of Cubans specialized in
General Comprehensive Medicine, who were working in the most far-flung
corners of this region. They were accompanied by 50 young Cubans from
the same level of studies.  The results have been impressive.  I
promised them that I would attend their graduation ceremony, and here
they are, as part of this very crowd, standing shoulder to shoulder like
Spartan soldiers of Medicine, brandishing their victorious shields.

Glory be to these young people! Glory be to these new saviors of lives
who are taking this noble medical profession to new heights of
dedication and ethics, never before seen in this world!  They embody the
kind of doctors claimed for with desperate urgency by billions of
people.

However, everything that I have said so far pales in comparison to the
colossal movement that is being promoted by Venezuela and Cuba to train
doctors ready to march in the vanguard of the Bolivarian dawn. Thanks to
this, and as part of the ¨Barrio Adentro¨ Mission developed by President
Hugo Chavez, 22,043 Venezuelan under-graduates have now embarked on
their pre-med studies in the 7,898 Barrio Adentro surgeries, in close
cooperation with the Venezuelan Ministries of Higher Education and
Public Health.

On October 3, they will begin their first-year studies in Medicine.  In
only ten years time, 40 thousand will be graduating.

Likewise, in Cuba we are developing a program to educate, in an equal
length of time, 20 thousand Venezuelan doctors from the Ribas Mission
and from high-schools, as well as 30 thousand doctors from Latin
American and Caribbean countries. These programs are available to young
people from Latin American and the Caribbean who have not been able to
study in the best high schools or been able to secure entry into medical
schools due to their humble backgrounds.

Training a medical doctor in the United States will cost the family no
less than 300 000 dollars.  Cuba, however, is presently training more
than 12 000 doctors for the Third World, thus contributing to the
well-being of these countries, to a value of more than three billion
dollars.  If we train or help to train 100 000 doctors from other
countries in a period of ten years, we will be contributing the
equivalent of 30 billion U.S. dollars, despite the fact that Cuba is a
small, Third World nation suffering from an economic blockade imposed by
the United States.

What is the secret? It lies in the solid fact that the human capital is
worth far more than the financial capital. Human capital involves not
only knowledge, but also - and this is essential - conscience, ethics,
solidarity, truly humane feelings, spirit of sacrifice, heroism, and the
ability to make a little go a long way.

These vast figures of which I speak are real and have their price in the
capitalist market, but they do not require extensive material resources
and can be, in fact, within the grasp of any country.

Venezuela and Cuba are cooperating together in one of the most exciting
programs ever implemented:  to return or preserve the sight of more than
six million people in Latin America and the Caribbean.

Conditions have been created in Cuba, and are being developed in
Venezuela, to diagnose, operate on or cure 25 000 people from the
Caribbean, 100 000 from Cuba, 100 000 from Venezuela and 120 000 from
South and Central America each year.

As a matter of fact, this program is already underway in 14 of the 24
ophthalmologic institutions that will become operational in our country
by the end of this year.  They have been equipped with the most advanced
world-class technology available.  Our country is now performing 1,500
eye surgeries per day.

This year we have reached the figure of 50 000 Venezuelans from the
Barrio Adentro Mission who have undergone eye surgery as from the middle
of January up until today, August 20.  In less than a month 1 093 people
from the Caribbean have received the same treatment, by virtue of the
Agreements signed at the Venezuelan state of Anzoátegui, on June 30
last.

It is important to note that every year, more than four and a half
million people from Latin America and the Caribbean require this
service, but do not receive it due to conditions of poverty, and more
than half a million each year loose their sight, often without ever
having been examined by a doctor.

Just as I did 40 years ago, please allow me to dream.  The only
difference being that now, after half a century of struggle, I am
absolutely sure that no-one can say of our dreams what Calderon de la
Barca once said: ¨life is but a dream, and dreams, they are but dreams
as well. ¨

Let us march forward!  Forward, all of you invincible standard-bearers
of such a noble profession, in demonstration of the fact that all the
gold in the world cannot subdue the conscience of a true guardian of
health and life, who is ready to go to any country where its services
are required, convinced that a better world is possible!


EVER ONWARDS TO VICTORY!

본문

차베스의 베네수엘라는 포퓰리즘인가 소셜리즘인가?

카를로스 문타네*

카라카스 (베네수엘라) - 2005년 5월 6일

"우리에게 신경써주는 것은 이 정부가 처음이다."

Liberatador 지역 주민

미국 "좌파" 중 일부가 베네수엘라에서 볼리바리안 혁명 이후 일어나고 있는 교육, 의료, 그리고 토지 개혁에 있어서의 긍정적 변화들을 돋보이게 하려는 노력에 대해서는 축하받아야 마땅하다. [그러나] 불행하게도, 그럴 권리가 있고, 또 자기가 올바르다고 생각하는 문화적 전통에 따라, 많은 미국의 필자들은 거의 이해하지도 못하는 이 볼리바리안 혁명에 대해서 이러니 저러니 평가해야만 한다는 느낌을 받고 있는 것 같다.

더 네이션 The Nation, 과학과 사회 Science and Society, 에서부터 지넷 ZNET (정보가 많은 베네수엘라 왓치 Venezuela Watch를 제외하고)에 이르기까지, 많은 분석가들은 볼리바리안 혁명과정에 대한 자신들의 지지를 변명하기 위해 소문으로 떠돌아다니는 우고 차베스의 "권위주의적 경향"을 먼저 문제삼아 준다.

만약 차베스가 미국의 해설가들이 이야기하는 권위주의적 선동가였다면 그는 자신과 대통령직에 대한 공격들(암살 위협, 쿠데타, 미디어에 의한 계속적 비난, 전국적 파업 등등)에 대해 버얼써 보복했을 것이다. 그러나 복수하거나 반대파들을 감옥에 넣는 대신, 차베스는 조용히 6년간 8개의 선거에서 승리했다. 이 중에는 60% 이상의 지지를 받은 지난 8월의 국민투표도 있다.

[차베스 정권에 보내는 자신의 지지에 대해] 미안해하는 다른 흔한 행위는 볼리바리안 혁명의 사회주의적 성격에 대해서 "포퓰리스트"라는 라벨로 격하하는 것이다. (예로, 과학과 사회 Science and Society의 Eteve Ellner의 글을 보라.) 냉전시기의 버릇에 따라, 미국 좌파들의 가장 큰 걱정은 정부에 의해 "공산주의자"라는 딱지가 붙는 것을 어찌하면 피할까이다. 이것은 자기 파괴적 전략인데, 스칸디나비아적 기준 정도의 강한 복지국가를 만들자는 중도적인 움직임 조차도 "공산주의자"로 낙인찍힐 것이기 때문이다. (ex. 50년대 과테말라의 Arbenz)

예를 들어 더 네이션 The Nation지에 실린 Christian Parenti의 기사를 보자 (2005년 4월 11일자). Parenti는 현재 베네수엘라인들의 정치적 의지를 "석유-포퓰리즘"이라 잘못 낙인찍는데, 이는 그들은 그저 석유때문에 부유한 것일 뿐이라는 뜻이다; 따라서 미션 바리오 아덴트로와 같은 사회-민주주의적 개혁을 위한 그들의 독특한 헌신의 실체를 잘못 규정하는 것이다. 또한 Parenti의 관점과는 반대로, 볼리바리안 헌법은 사회주의적이기보다 자본주의적인 것이 아니다: 그 헌법에서는 경제제도를 베네수엘라인들의 삶을 향상시킬 수 있는 도구로 보고 있다. (볼리바리안 헌법에 대한 자세한 분석으로서는 Luis Salamanca와 Roberto Viciano Pastor의 최근 책을 보라.)

이에 더하여, Parenti가 미션들(새로이 정부에 의해 지원되는 사회 프로그램들)에 대해 참여 민주주의를 시민들에게 "강요하는 것"이라 규정하는 점은 몰인정하며 부당하다: 이 과정은 베네수엘라인들이 어떻게 그들의 헌법을 집필하며 어떻게 그들의 국가를 조직할 것인지 결정했는가를 반영한다. 그런 점에서라면 어떤 정부라도 한 방향, 혹은 다른 방향으로 그들의 시민들을 "강제"할 것이다. 국민 대다수의 정치적 태도를 묘사하기 위해 저자가 조사(survey)보다는 예시를 사용하겠다고 한다면, 대표성이 있는 사람들을 고르는 것이 중요하다. 그러한 점에서, Parenti는 더 균형을 맞춘 예를 들 필요가 있었다: 그의 글에서 차베스를 지지하는 단 한 사람은 "감상적인 주부"로 그린 반면, 그에 반대하는 저널리스트는 마치 정치적으로 객관적이고 성숙한 민주주의자인 것처럼 묘사했다. 사실 그녀[저널리스트]가 대표하는 이러한 '충직한' 반대파들이 정부 관료들에 암살 위협을 가하는 등의 행위를 통해 정부를 지속적으로 침식하고 있다. 마지막으로, Parenti는 한 정부부서에서 자신이 받았던 냉대에 대해 불평한다. 하지만, 미국 출신임에도 불구하고, 장관 중 한명을 인터뷰하고 비판까지 할 수 있도록 허가받은 사람이, 이런 불평을 하는 것이 과연 정당한 것인가?

베네수엘라가 이룬 성과들: 국제 사회주의의 협력과 보건의료에 있어서 참여 민주주의

이러한 저널리즘이 확산되는 동안, 더욱 객관적인 분석들은 "좌파" 매체들에 실리지 못한다. 미션 바리오 아덴트로의 예를 보자.

국제 금융 기관들의 권고에 반대하여 바리오 아덴트로는 의료에 대한 접근성이 없는 약 1천7백5십만 명(전체 인구의 약 70%)의 베네수엘라인들에게 무상 보건 서비스를 공급하기 위해 고안되었다. 이 프로그램에는 (1999년 헌법의 제84조에 따르는) 공동체 구성원에 의한 참여 관리와, 통원치료기관의 증가(이미 300개 이상이 지어졌으며 5000개 건설을 목표로 한다), 그리고 공동체 내에 거주하는 의사들 (12,500명 당 의사 1인)을 포함한다.

이 프로그램은 쿠바와 베네수엘라 정부 간의 협력 협정 덕분에 가능해졌다. 베네수엘라의 의사들은 가난한 동네에서 진료하고 싶어하지 않는다. 이것은 [또한] 카라카스의 시장과 차베스가 대담한 보건의료의 대안을 그릴 수 있었기 때문에 가능했다. 2003년 3월과 12월 사이에 일차진료를 수행하기 위해 10,000명 이상의 쿠바 의사들이 베네수엘라의 마을로 이주했다.

이 의사들은 졸업 후 최소 10년 이상 경력을 가진 사람들이며, (건강을 주거, 교육, 체육, 환경, 그리고 식량 안정성의 일부로 보는) 통합 의료(integral medicine)에서 2년의 경력을 갖고 있다. 이들은 다양한 예방적 활동에 더하여, 매일 아침 20-40회의 진료를 보고, 오후에는 왕진을 한다. 이에 따라, 별개의 보건 서비스 시스템으로서 바리오 아덴트로의 의사들은 23개 주 전체에 걸쳐 8천만회에 가까운 진료를 행했으며, [같은 시기] 기존의 시스템에서는 23개 주를 모두 포괄하지도 못했고, 진료도 2천만회 밖에 하지 못했다.

이에 더하여, 볼리바리안 헌법의 제84조에 따라, 바리오 아덴트로는 참여 민주주의의 원칙 하에서 운영된다. 거주민에 의해 직접적으로 선출되는 지방 위원회 (Comites de Salud)는 그들의 공동체를 위한 새로운 혹은 향상된 서비스를 요구하기 위해 지방 혹은 연방 정부와 직접적으로 접촉할 권리를 갖는다. 예를 들어, 진료 과정에서 쿠바인 의사들과 지역민들은 글읽기 수업이나 치과진료, 환경적 위험요인의 제거 등이 필요하다는 것을 깨닫게 될 수 있고, 따라서 정부의 적합한 부서와 접촉하여 이러한 서비스를 얻어낼 수 있다.

미국 분석가들을 위한 제안

따라서, 기본은 매우 단순하다. 최근 우리 나라[미국]가 베네수엘라의 정치에 간섭해왔던 상황을 볼 때 (소름끼치는 예로, 내셔널 리뷰 National Review 4월호에 실린 Otto Reich의 기사를 보라.), 좌측에 속하는 필자들은 객관적 보도나 지지를 보내는 겸손한 분석으로 볼리바리안 혁명 과정을 도와줄 수 있다. 그게 아니면, 베네수엘라를 그냥 두어도 된다. 그들은 [자기들끼리도] 잘 해나갈 것이다.

* 카를로스 문타네 Carles Muntaner, MD, PhD는 미국 메릴랜드 대학의 사회 역학자이다. 그는 현재 베네수엘라 볼리바리안 공화국 보건사회개발부의 보건정책 고문이다.

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