About La Rural
Graduating as a physician in Venezuela means relinquishing all hope of calling the shots over your job, making a decent living, or, in some cases, not breaking the law.
Original illustration: @ArtOfGonzalez
It came out of the blue, on a lazy Saturday morning.
“Marica, did you get the call? They’re calling everyone, well not everyone, Juan told me they called him. What about you, have they called you yet?”
This happened over a year ago, but I still remember it like it was yesterday: my phone kept ringing like mad.
“No, marica, they haven’t called me yet.”
One could only be so innocent to think life as a general practitioner begins when some rector signs your diploma. Ojalá.
I was freaking out, my heart was racing, I was shitting my reciengraduada pants. It had only been a week since my fabulous walk down the Aula Magna’s bazillion year-old staircase, the ink on my diploma was still fresh. I certainly didn’t feel ready to get The Call.
Soon enough, my phone started ringing. Caller ID showed a Movilnet cellphone: “Que pirata!” I thought to myself. But I picked it up immediately.
“Is this Dra. Cantor? We are calling from CORPOSALUD.”
And so it began, the first day of any physician’s career in Venezuela. One could only be so innocent to think life as a general practitioner begins when some rector signs your diploma. Ojalá. It begins and ends (like pretty much everything else in this country) by the will and the power of a secretary sitting comfortably in her government office while juggling her social media feeds.
“Yes, this is her speaking,” I said. “What can I do for you?”
This was future calling, for better or for worse. Someone had already decided how, when and where my first job would be and there was nothing I could do about it. I, as the rest of my class, had waited for this call for over two months and it had just now stormed in, so inconvenient and almost unwanted.
The first day of any physician’s career in VenezuelaIt begins and ends by the will and the power of a secretary sitting comfortably in her government office.
“You’ve earned a position as rural physician for the state,” the voice said. “You are expected at CORPOSALUD’S offices first thing on Monday morning, the institution’s director will provide you with further detail.”
Our fates were sealed, we had an appointment with none other than our own regional health minister office’s head honcho. El chivo que más mea.
That day, we sat in old dusty chairs, about 80 of us. The mood was tense, El Comandante’s eyes were everywhere, even that infamous picture of him holding a stethoscope.
You are privileged wealthy people, all of you with your fancy cars and cellphones. You don’t care for the patients’ needs, you don’t know what it’s like to be hungry or sick
In came the big boss, the regional head of the Sistema Nacional Público de Salud. He had some things to say and a desperately attentive audience. Every worker in the building was there: he held the next several years of our lives in his hands. Himself an Universidad de Los Andres (ULA) graduate and therefore our colleague, he nonetheless launched into a hypocritical attack on the quality of our education. He almost had the nerve to call us dumb and say that M.I.C’s were (Médicos integrales comunitarios, our Cuban-style quickie “doctors” from Universidad Bolivariana) better.
“I know most of you want to stay close to your homes, you want the papitapelada”.
“You are privileged wealthy people, all of you with your fancy cars and cellphones. You don’t care for the patients’ needs, you don’t know what it’s like to be hungry or sick…”
We just needed to fulfill our Artículo 8 to move on from this.
That’s why we’re here, really. Article 8 of the Law on Medical Practice, el bendito artículo 8, put our whole future in his greasy, communist hands.
Artículo 8. Para ejercer la profesión de médico en forma privada o en cargos públicos de índole asistencial, médico-administrativa, médico-docente, técnico-sanitaria o de investigación, en poblaciones mayores de cinco mil (5.000) habitantes es requisito indispensable haber desempeñado por lo menos, durante un (1) año, el cargo de médico rural o haber efectuado internado rotatorio de postgrado durante dos (2) años, que incluya pasantía no menor de seis (6) meses en el medio rural, de preferencia al final del internado.
There’s no point translating word for word, what it means is clear enough: for the first one or two years of our careers, the state owns us. It gets to tell us where to go and what to do, and we have no say in the matter. It’s a monopsony buyer of our services. Logically, it pays us a pittance.
Just another chavistic nightmare, then? Not at all. Various forms of Rural Service for new doctors had been around since the 1940s, and Article 8 as such has been written into the Law on the Medical Profession since 1982.* Friggin’ Luis Herrera. I mean, they have changed so many other aspects of the way our health system is organized, but this particular article survives. It suits them for it to survive.
As with everything else that was screwed up before, the revolution’s main role has been to make it worse. Once upon a time a young person could live comfortably with what you got paid doing La Rural. Most health centers were equipped with a residence for the rural physician and even provided food.
These days? You’re on your own, under a labor contract that has not been discussed since 2003, and with a basic salary that has been at times embarrassingly close or even actually less than the minimum wage.
Back in the room of dusty chairs, it was finally time to be awarded la asignación. The “sorting hat” moment. Slowly, they called each of us by last name. Some people already knew what hospital they had been assigned to, la rosca, you know. They called my name and I felt a punch in my stomach.
You’re on your own, under a labor contract that has not been discussed since 2003, and with a basic salary that has been at times less than the minimum wage.
Normally, one would have a chance to decline a bad job offer. Not here. If you decline your assigned position you get blacklisted and God knows how long until you got another offer from the state. The system was known to be anything but fair or meritocratic. It was yet another case of my enchufado is better than yours. If you’re with el proceso, the definition of “rural” becomes conveniently flexible. A modern outpatient clinic with easy hours, located less than a couple of miles from your home in an urban setting might be your spot…if you have the right friends.
Some of my classmates had already purchased an airplane ticket before graduation, so they could leave the country with their diplomas even though, for most of them, practicing abroad wasn’t in the cards. They’d rather be extravagantly over-qualified waitresses or babysitters in Miami than hungry doctors in La Azulita.
The moment I realized there was nothing right about this process, I felt at ease. I gave them their letter back and, today, I work at a hospital where I never in a million years though I would, and I’m as pelabola pero feliz as anyone in Maduro’s reign. I could work in the private health sector, illegally of course, as the requirement for private practice is La Rural. Since it is impossible for a physician with a single state job to provide for herself, let alone for a family, breaking the law is my only alternative to straight-up hunger.
Nowadays, staying on as a general practitioner is rare. We’ll all get our Artículo 8 and then move on to grad school to become pediatricians or surgeons. Private clinics still need general practitioners to treat and triage ambulatory patients so they’ll play it to their favor.
My classmates would rather be extravagantly over-qualified waitresses or babysitters in Miami than hungry doctors in La Azulita.
And even if you do get a job illegally, it won’t pay well. You’ll be hawked off as a consultant or a substitute and, for the most part, it will be impossible to establish a stable working relationship. The clinic is watching its back, you will have to watch yours. That’s scary, especially if you make a mistake in your practice, which, let’s face it, is likely given that you just graduated like, five seconds ago.
Between all of this and the health crisis with even the milicia stealing the drugs that patients have to buy for themselves but can’t really afford, praying before my shift feels like the most helpful thing I do.
I pray I don’t make any mistakes.
I pray I treat my patients to the best of my abilities.
I pray nobody dies on my watch.
*Correction: An earlier version of this story had La Rural being born in 1982. In fact, it’s Art. 8 specifically that dates from 1982.
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