A visit to the Altos de Lidice Commune in Caracas shows how a community is developing a self-organized healthcare system.
By Cira Pascual Marquina – April 5th 2020
We recently visited the Altos de Lidice Socialist Commune on the slopes of the Waraira Repano mountain, in western Caracas. Our objective was to see first-hand how this young commune, with a grassroots healthcare system, is addressing the COVID-19 crisis.
Getting there wasn’t easy. First, we had to convince the police to let us cross three barricades placed to limit mobility in these times of lockdown. Venezuelanalysis credentials helped.
We had arranged an early meeting with Doctor Gutierrez in his office in the Vista Hermosa sector of Altos de Lidice. To arrive there, however, we had to go through a maze of steep stairs, walking up through the narrow alleys for some ten or fifteen minutes, as the doctors who work in the commune do every day.
The doctor’s office is in the home of Jonathan Nuñez, a neighbor who made the space available for the Communal Healthcare System initiative. The office, very humble but affectionately decorated by the Health Committee, opens onto an extraordinary view of the city.
We interviewed Doctor Gutierrez just before his weekly house-to-house visits and later put questions to Nurse Del Valle Marquez and Luz Marina Viloria from the Communal Health Committee.
After the interviews, we accompanied the team on their house-to-house visits. Many of the households we entered were very poor, some pauperized. It was quite disturbing to find such pockets of extreme poverty in Caracas, just ten minutes away from Miraflores Palace. At the same time, the extraordinary work of Doctor Gutierrez and his team moved us.
In a household with a tin roof, fabric walls, and a dirt floor, the doctor attended a 47-year-old man who had recently had a foot amputation due to diabetes-related gangrene. Doctor Gutierrez reviewed his medication and extended his prescriptions. In the afternoon, the Health Committee would deliver the medication following the doctor’s orders.
Later, in a poor but more consolidated home, Doctor Gutierrez followed up on a patient who had a recent respiratory condition with symptoms similar to those of COVID-19. Two days before, the doctor had sent the patient to be tested in the closest hospital. Fortunately, the test came back negative. Doctor Gutierrez and the Committee celebrated the good news with the family.
While going house-to-house, we passed through the homes of dozens of people. They were all delighted to receive the doctor in their households. The Health Committee took notes on every home we visited and the doctor extended prescriptions when needed. Again, in every case, the Health Committee committed itself to delivering the medicines in the afternoon.
Later in the morning, we had a conversation with Jesus Garcia, the key spokesperson for the Altos de Lidice Commune. He gave us a broader perspective on the commune and the role of international solidarity in these times of crisis.
Doctor Gutierrez, a disciplined professional, was waiting for us in his office. He is a 29-year-old graduate of the Integral Community Medicine Program, a university network training doctors under the supervision of Cuban teaching physicians.
Gutierrez is not only a committed professional but also displays great care and devotion to his patients.
Let’s begin by talking about the Altos the Lidice Commune and the Communal Healthcare System.
The commune was created some two years ago with the goal of organizing the community. The communal organization integrates all spheres of life, from production to healthcare. However, here in Altos de Lidice, healthcare has become a key motor for communal construction.
The commune here consists of seven communal councils. Each communal council has a doctor’s office. The doctor works hand in hand with the community, particularly with the Health Committee.
Through this process of integration, we collectively map and prioritize the chronic cases, from hypertension and diabetes to thyroid pathologies and asthma, etc. We also work on prevention, and our visits today are mostly going to focus on imparting knowledge to people so that they don’t become infected by COVID-19.
Can you tell us about the communal pharmacy, which is something unique in this community?
We have a communal pharmacy that was developed by the healthcare personnel together with the commune. It is also through a collective process – carried out between the Health Committee and the doctors and nurses – that we evaluate case by case and prioritize patients who are confined to their homes due to a chronic illness or because they have a disability. We also prioritize low-income families.
Many of the medicines that we are able to deliver are high cost ones, and we can provide them thanks to international solidarity.
The pharmacy here is self-managed. The Venezuelan state does not stock the shelves. The core of the support comes from Chile, but we also get donations from Italy and Russia. The Health Committee receives donations, classifies them, and then provides us information on what is available.
How did the community receive the Communal Healthcare System?
When all this began, there were pockets of resistance. As it often happens, some people reject new forms of organization in the beginning.
I can safely say now that the entire community is committed to this new way of dealing with health problems. In general, the whole community is with the communal proposal. The Communal Healthcare System is now a consolidated initiative. Before the project was implemented, there was a clear separation between the doctors and the community. There was a tall wall between them. We have overcome that division through work and organization… but we should emphasize that the seed for all this is in the community itself, which took the first steps.
What can you tell us about the response to the global COVID-19 crisis?
Since the coronavirus pandemic broke out, the organized community committed to carrying out a social quarantine. This, however, requires organization and developing a plan to address the needs of the most vulnerable sectors of the community. If we don’t address that situation, particularly their food and medicine needs, the community will not be able to carry out the confinement, and the risks will grow.
In addition to that, since Tuesday, we have been focusing on giving prevention talks in our house-to-house visits. Since we have “mapped” the community over the past few months, we’ve located the most vulnerable, the elderly, and those with respiratory afflictions. Reaching them is one of our objectives in this phase.
Our main goal now is prevention. However, for it to be effective, we must understand where we stand and address the needs of the most vulnerable people immediately.
We are also developing a plan for psychological support so that we don’t face a situation of collective panic.
Nurse Del Valle Marquez
Nurse Marquez, is from the Vista Hermosa sector in Altos de Lidice. A committed Chavista, she became involved with grassroots community organization years ago and was involved in implementing the Barrio Adentro program years ago, when the first Cuban doctors arrived.
She has been accompanying Doctor Gutierrez for some six months now, “working with him and for the community” as Marquez said herself.
What is your perspective on this process, from the arrival of the Cuban doctors some seventeen years ago to the current blooming of the Communal Healthcare System?
When the Cuban doctors arrived, that was a government program and Chavez was its key spokesperson. The community’s reception was very good: we opened our doors to the doctors, they lived with us, they ate with us, and they worked among us.
We had never had a doctor near us and we were very aware that having medical attention directly in the community was a big step forward.
When the transition to the Venezuelan doctors happened, and later when the system became autonomous and self-managed by the commune, there was a bit of resistance. Little by little, however, the pockets of resistance dissolved. Now the neighbors are not only welcoming, but there is also a sense of pride.
Luz Marina Viloria, Communal Health Committee
Luz Marina Viloria is a grassroots organizer. One of the key figures in the Communal Health Committee, she also works in the CLAP food distribution system. Every week, Viloria devotes many hours to her community. Her work, like that the whole Communal Health Committee, is driven by a militant commitment to the community.
What is the organizational process in the Communal Healthcare System?
The Health Committee meets on Mondays and sometimes Fridays. We work together with the Food Committee to coordinate and prioritize needs. There are three main pillars to the Communal Healthcare System: healthcare per se, food, and sanitation (access to water and gas, wastewaters, and waste disposal).
There is a weekly planning exercise. In the meeting, we debate objectives and processes, and we develop a plan.
The committee organizes the pharmacy, accompanies the doctors in their visits, cares for the doctors’ offices, etc. What can you tell us about that work?
I would say that our main role is to work with the community, win them over, and create conditions so that they open the door to the doctors. That, of course, happens mostly through real, on-the-street work.
We also work to organize the pharmacy, distribute medications as prescribed by the doctor, and prepare and care for the doctors’ offices.
This office is inside a family’s house. How did that come about?
In Vista Hermosa there was no Barrio Adentro module, so we had to make a call to the community to make a space available. Jonathan Nuñez offered this room, which we painted, prepared, and decorated as a doctor’s office.
In a way, we are going back to the first days of Barrio Adentro, except that now the initiative is more grassroots.
Jesus Garcia, Altos de Lidice spokesperson
Jesus García, who goes by “Gsus,” is a barrio-born youth, raised in Altos de Lidice. He is now the driving personality behind the commune. Most of his political education comes from listening to Chavez. We interviewed Garcia outside of the Victorio Orlando Medina CDI [Integral Diagnostics Center, part of Mision Barrio Adentro], a nearby community center.
The Altos de Lidice Commune is a young organization. Can you give us some information about how it was built?
Our commune, as you say, is very young. It will turn two in June. The process hasn’t been easy. This is a commune which was born in the most difficult moment in our country’s history. It wasn’t created when the oil barrel was at US $100. It was founded in times of crisis, when the government wasn’t placing its bets on the communes [as a solution to the country’s crisis].
But the commune was born strong, and it adopted Chavez’s strategic plan of being self-governed. It was committed to building all that had to be built from the ground up. I think that one of the important things that people understood here is that commune building goes beyond dogmas and slogans. Hard work and creativity are required every day.
Commune building is a matter of creating – democratically, with autonomy, and with a clear program – better collective living conditions that will lead to social emancipation.
What is the organic process governing the Altos de Lidice Commune?
One of our strengths is that this commune departs a bit from the methodologies used in many communal councils and communes, where tiresome meetings and long debates overshadow real work and actions. For now, we are focused on action and we have fewer meetings.
Of course, that does not mean that we don’t meet and debate. In fact, we have weekly committee meetings, but they are goal-driven. We meet to plan, coordinate our ideas, and solve problems. We are very aware that one has to produce real results and real actions.
So, reflecting on our communal construction process, I would say that there are two keys to understand our success. The first is having a methodology that is conducive to action and results. The second is having a clear project centered on being self-governed and self-sustained.
You talk about self-governance and self-sustenance. Would you say that there is a relation marked by both tension and cooperation between the commune and the state?
There are two things to take into account. First, because of the crisis and the US blockade, it is clear to us that the government can’t provide everything. We try to solve our problems through self-management. We have the pharmacy, which is autonomous and self-run but also dependent on international solidarity. And we have a Communal Savings Fund, which is there not only to keep the community clean but also to solve infrastructure problems.
The second thing to keep in mind is that there are some reformist tendencies within the government. That is no secret to anyone! That means that we are the ones who have to keep Chavez’s communal dream alive… It’s no small responsibility!
We just accompanied the Health Committee’s house-to-house visits in Vista Hermosa with Doctor Gutierrez. We’ve seen that the Communal Healthcare System is hard at work. Tell us about the process of preparing for the impending Coronavirus crisis.
For many years, we have prepared ourselves for this situation, and we have prepared ourselves on the ground. The pueblo has been able to overcome so many difficulties, from food shortages and blackouts to coups, attempts to assassinate the president, and the constant threat of military intervention. It is my belief that at the local level, where popular power is organized – whether in communal councils, communes, worker councils, etc. – we have better tools to face the current crisis.
Obviously we don’t have all the medicines and infrastructure that we need to confront the Coronavirus pandemic. That is why we are focusing on prevention right now.
As you know, our commune has a Communal Healthcare System that is autonomous. Through it, we work collectively so that all the health needs in our area are addressed in an integral manner.
This means that our doctors conduct weekly house-to-house visits. Now, since the Coronavirus crisis broke out, the doctors and Health Committee are focusing on closely monitoring the health condition of the elderly and those that suffer some pathology that could make them particularly vulnerable to COVID-19.
Additionally, as you just saw, we are implementing house-to-house teaching visits so that our neighbors know how to prevent contagion and are able to read the signs of the virus when it first manifests itself. We are also doubling our efforts to get the medication to people who are immunologically challenged for one reason or another.
In this conjuncture, we have all come together to develop a coherent and unified plan. We are aware that the government, which is doing everything it can to avoid the spread of the pandemic, will not be fully able to address the situation if COVID-19 hits us hard. That is why social quarantine and prevention efforts are particularly important.
At the end of the day, the current circumstances show us that communal organization and self-management are key to a dignified and healthy life.
How do you understand the importance of internationalism at a time when Venezuela is under siege?
Chavez created a way of interpreting the world that goes beyond the frontiers of one country. In so doing, he fostered two-way solidarity.
In our area, the pharmacy is actual evidence of concrete internationalist solidarity. The Eloisa Diaz Medical Group in Chile supports us with medicines for the pharmacy. Friends in Italy also collaborate. This is all very important, particularly since the crisis and the sanctions limit access to medicines.
Right before the pandemic, we were starting a fundraising campaign for the commune. Our country is under a criminal blockade, which makes resources very limited, and the government, with its reformist tendencies, doesn’t always favor communal construction. On top of that, oil prices have fallen beneath production costs, making the economic panorama for the pueblo rather bleak.
International solidarity has become really important now. Receiving support is going to be key to keep some of our initiatives alive… What someone pays for a Starbucks coffee can utterly transform a family’s condition.
But beware: we are not asking for charity. In these times of crisis and potential global revolution, solidarity is very important. Some day, Venezuela will be in the condition to be autonomous and help other peoples, as we did when Chavez was with us.
It is time to call for tangible solidarity. Organizing for the sanctions to come to an end? Yes, that is necessary, but in the meantime, the communal initiatives require solidarity. We are making a call to support popular power and communal construction. We are talking about class solidarity beyond borders.
If you wish to make a solidarious donation to the Altos de Lidice Commune or the Communal Pharmacy, contact Jesus Garcia, Altos de Lidice spokesperson. WhatsApp: +58 416 902 6783 / Email: firstname.lastname@example.org.
Featured image: Doctor Gutierrez, part of the Altos de Lidice Communal Healthcare System, during a house-to-house visit. (Venezuelanalysis)