Porlamar, Venezuela: Few places capture the disarray of this country's public health system like the Hospital Luis Ortega. Unconscious patients lie on cots strewn near the reception desk. Paint peels from walls neglected for years. Soldiers stand guard to prevent worried relatives gathered on the curb from bursting inside.
But in a recovery room tucked away at the end of a dim corridor, a group of Nicaraguan patients with patches over their eyes offers an insight into one of President Hugo Chávez's boldest and most successful health initiatives. Called "Mission Miracle" and now in its fourth year, it provides free eye surgery to Latin America's poor.
The evolution of the program into a symbol of Chávez's political movement across the region illustrates how Venezuela's leader is intensifying efforts to lift his government's profile abroad even he faces growing criticism at home over social problems like decaying hospitals and shortages of basic foods.
"Those who call Chávez a vulgar populist are wrong," said Julio Araoz, one of 96 Nicaraguans flown here to correct ailments that had left them partly or completely blind. Before doctors restored his vision in one eye on Monday, Araoz said he could barely stand to hear Chávez's name or that of his ally, President Daniel Ortega of Nicaragua.
"Now I salute Chávez and Ortega with profound gratitude and admiration," said Araoz, 40, a carpenter from the northern Nicaraguan city of Matagalpa who was suffering from pterygium, a vision-restricting condition commonly found in tropical climates. The procedure, which would have cost more than $1,000 in Nicaragua, cost him nothing here.
Few of Chávez's foreign aid programs have produced such enviable results. Started in 2004 with financing from Venezuela for doctors in Cuba to perform eye surgery in Cuban hospitals, the project has helped more than 400,000 people recover from blindness or improve their vision, according to Venezuelan officials.
The program also points to Chávez's capacity to change policies in the face of fierce domestic criticism. Facing an outcry from Venezuelan ophthalmologists, the government has sought to carry out more procedures within the country than in Cuba, training doctors and equipping dozens of hospitals to receive greater numbers of Venezuelan and foreign patients.
The Nicaraguans who arrived in this Caribbean city this month are part of this new phase of medical diplomacy. They came from around Nicaragua and were identified by volunteers sympathetic to Ortega, the Sandinista leader who has forged an increasingly strong political alliance with Chávez.
Many of the Nicaraguans were supporters of Ortega, but not all. Some were critics, like Araoz. Others were apolitical but appreciative simply of the chance to improve their eyesight or travel on an airplane for the first time. They all stayed five to a room in Guayquerí Suites, an aging hotel in Porlamar's gritty Llano Adentro district.
"These are five-star conditions as far as I'm concerned," said Marden Espinoza, 69, a retired mathematics teacher.
Not everyone speaks glowingly of the program, which has treated patients from 18 countries. Mirtha Noguera, president of the Venezuelan Ophthalmology Society, said she admired any effort to improve basic health services, but that Mission Miracle prioritized political objectives while neglecting other pressing health needs in Venezuela.
"Doctors are emigrating because they cannot earn decent salaries," said Noguera, adding that a lack of post-operation care was a major problem with Mission Miracle. Still, she said, the government had made strides in improving the project to allow more Venezuelan doctors and hospitals to participate.
Precise figures on how much Venezuela spends on Mission Miracle are hard to calculate, since the services of Cuban doctors in the program are considered barter in exchange for subsidized Venezuelan oil sent to Cuba. Health Ministry officials in Caracas did not respond to requests for interviews.
But Provea, a human rights group, estimated that Chávez's government spent a modest $16.3 million on the project in 2006. In 2007, Mission Miracle grew more ambitious, with more foreign patients arriving in Venezuela and with Cuban doctors performing more surgeries in countries that are allies of Venezuela, like Bolivia.
Political tension has followed this strengthening of the project. In Peru, President Alan García, who has verbally clashed with Chávez in the past, responded last year by creating a program to provide similar procedures for 5,000 Peruvians a year.
And in Argentina, medical associations expressed alarm this month at reports that 17,000 Argentines were taken across the border to relatively poor Bolivia in the past two years for eye surgery by Cuban doctors. Argentine ophthalmologists claimed the Cubans lacked proper training.
But this bickering matters little to the program's beneficiaries, with cataract or ptygerium surgery costing more than $1,000 in private hospitals. And directors of the program express pride that it is spreading, while humanitarian aid from the United States becomes less prominent in Latin America.
"Of course politics is an important part of Mission Miracle," said Juan Guzmán, 50, an epidemiologist who directs the program here. "What's so wrong with attempting to strengthen ties with our brothers around Latin America when people benefit from this process?"
In Nicaragua, Mission Miracle and other Venezuelan aid projects are bolstering one of Chávez's closest allies. In a visit to Caracas last month, Ortega said Nicaragua's economy "would have collapsed" if not for the Venezuelan aid, which is expected to reach almost $400 million for 2007 and part of 2008.
Critics claim the surge in aid has lifted inflation in Nicaragua to a nine-year high of 17 percent, accompanied by a lack of transparency into how funds for Mission Miracle and other projects are distributed. "Ortega has created spaces for the corrupt management of these funds," said Mónica Baltodano, an opposition lawmaker in Nicaragua.
Such complaints stand in contrast to the enthusiasm of the Nicaraguans gathered here in Porlamar. "It's as if our revolution is being resurrected thanks to Venezuela," said Arlen Fernández, 25, a Nicaraguan anthropologist and political activist who helped organize the trip. "What is more beautiful than allowing people to see again?"
Sandra La Fuente P. contributed reporting from Caracas and Ivet Cruz from Managua, Nicaragua.
http://www.iht.com/articles/2008/02/25/america/venez.php
