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Fascist Junta Strangles Chilean Health Care
by Charlotte Ryan
The author of this article lived in Santiago, Chile, during Allende’s term in office. In February, 1974, she returned to Chile with the Women’s International League for Peace and Freedom (WILPF) fact-finding delegation, which investigated repression in Chile since the coup.
“On September 17th [six days after a right-wing coup toppled the Chilean Popular Unity (UP) government] a military operation ordered the entire hospital staff of the Barros Luco Hospital to line up along a corridor. The lieutenant in charge, with collaboration of a National Party (far right) doctor, began one by one identifying the Allende supporters from the long row of doctors, nurses, aides and janitors. Those singled out were escorted to the outer patio where they were executed immediately. I was the second-to-the-last person on the line and was standing in front of the doors to the Hospital Chapel. Silently, a nun grabbed me and three other male doctors and snuck us inside the chapel where we hid for one day. As we hid, we heard at regular intervals the shots that took the lives of our fellow hospital workers.”
(From a letter sent anonymously to the United States. Facts corroborated by direct testimony to the Women’s International League for Peace and Freedom delegation, Santiago. February 1974.)
Since the coup, the health care system in Chile has been subjected to fierce attack by the military junta, and health workers have been especially targeted for repression. The reasons for this are many, but they mostly boil down to the junta’s reasoning that the health care system is essential to any plans to exterminate resistance and control the people of Chile.
The right wing has thus far used the health system for two main ends:
- for direct military purposes—to identify and liquidate health workers or patients who are leftists, and to use health skills and facilities to actively oppose and suppress resistance.
- for broader political ends, namely the return of the health care system from an increasingly socialist orientation to a capitalist orientation.
Health Care as a Military Weapon
The Chilean junta has received military and technical training from the U.S. and Brazil on a long-term basis. As in Brazil, medical doctors in Chile are being used to perfect scientific torture. For example, Dr. Tuane was thrown out of work during the Allende government for torturing prisoners. He is now assisting the military in the development of more sophisticated uses of sodium pentathol (a truth serum). Political exiles have repeatedly testified that doctors present during interrogation and torture informed the torturers as to how far they could go without actually killing the prisoner. For example, Bautista von Schoen, a medical doctor and member of the Central Committee of the MIR (Revolutionary Left Movement) has been systematically tortured with the assistance of the chief doctor in the hospital in which he is “recuperating.”
Lt. Col. Charles R. Webb, M.D. (U.S.A.) stated in Military Medicine, (Vol 605-8, 1967) that an “important facet of medicine in Internal Defense and Development is the denial of medical resources to insurgents.”
Just as common is the denial of medical care to political prisoners when this is deemed convenient. During the first days of the coup, doctors worked under armed guard to assure that soldiers were cared for before any civilian casualties, and to assure that leftists seeking medical treatment were captured. Jose Toha, a 6’4″ former Popular Unity minister weighed 75 pounds at the time of his death. An autopsy showed his “mysterious ailment” to be severe prolonged malnutrition produced by his stay in the concentration camp for high Popular Unity officials on Dawson Island. Daniel Vergara, another former member of Allende’s cabinet died of gangrene resulting from an untreated arm wound. Common causes of death in prison camps are from untreated bleeding ulcers, “cardiac arrests”, and negligence of other pre-existing medical conditions.
The military junta is also using doctors for spying purposes. Surveillance of working class and poor communities (poblaciones) is being conducted through right-wing loyalist doctors who have replaced leftist doctors who worked in the neighborhood clinics during the UP. As Lt. Col. Dr. Webb suggests, “people under treatment are frequently very cooperative in revealing information.” One angry left-wing doctor exclaimed, “During the UP they wouldn’t set foot in a poblacion. The rightist doctors wanted to do their hospital work and scurry off to their private practices as quickly as they could. Now they’re there to watch for gunshot wounds and to keep their ears open for trouble in the neighborhood.”
Attacks on leftists through the health system began long before the coup in September. The doctors’ gremio (the Chilean medical society equivalent to the American Medical Association) was a key force in organizing health professionals against the Popular Unity government. The Chilean Medical Society supported the anti-UP work stoppages of October, 1972 and August 1973, announcing that the last stoppage would continue “until Allende falls.” The medical society now justifies this by saying that there were no medical supplies, etc. because of the collapse of the UP economy and because the leftists were stealing all the hospital equipment and medication to build “clandestine hospitals” for the resistance. Under Allende the health system was approaching sure ruin, says the right. In this light, it is interesting that their demands did not include a single health-related issue but merely called for Allende’s ouster. Right-wing boycotts of services drained the energy of left-wing doctors and other health workers who were left the responsibility for the vast SNS (National Health Service) hospital system (90% of all Chilean hospitals) as well as neighborhood health centers. Those health workers who went to work during October, 1972 or August, 1973 were readily identifiable as leftist sympathizers. Thus, after the coup it was very easy to purge leftists from hospitals and clinics.
As of February, 1974, over 1000 out of the 6000 odd M.D.’s in Chile had been killed, arrested, fired or exiled. Many more have been demoted or are under surveillance. The professional medical union is responsible for the firing of many doctors. The government may arrest, interrogate and finally absolve a doctor only for the medical society of Chile to announce that the doctor is not a person sufficiently trustworthy. A “white list” of doctors has been drawn up, naming those doctors acceptable to the doctors’ gremio and the junta. All leftists or doctors suspected of being leftists, have been removed from positions of authority, i.e. professors, heads of services. Any M.D. who wants to work in Public Health must present five letters of political recommendation.
Doctors constantly emphasized, however, that the experience of professionals was not comparable in severity to the experience of lower-level health workers. All three people executed at one doctor’s hospital were workers. Fired nurses, nurse’s aides and other hospital dependent workers will not be able to find a job as easily as doctors who can practice on their own or more readily leave the country. In an economy of soaring unemployment, those who are politically suspect are the first to be fired and the last to be rehired.
Health Care as a Political Weapon
As in all areas, the new rulers of Chile see as a central task in health care the destruction of socialist concepts and structures and their replacement with capitalist ones. In relation to the health care system, this means changing two things: who pays for health care and who controls the health care system and decides its priorities? One obvious political priority for the military junta is to dismantle the remaining structures of the socialized national health service (formerly SNS) and to eliminate and/or discredit those who worked within the SNS.
The SNS was about fifteen years old when Allende took office. Health resources were not distributed equally within the population, however: 60% of the resources went to 25% of the population, while the other 75% squeezed by with 40% of the available resources. For upper class Chileans there was one doctor per 800 people. For poor Chileans there was one doctor for every 2300 people.
During the Allende government some advances were made toward the re-organization of the national health service along more socialized lines. For example, a night school for workers who wanted to become doctors was set up; local health committees were established representing doctors, health workers, community people and labor unions. Given that only one third of the doctors in the country had leftist sympathies, the vast majority of the School of Medicine and its quite conservative graduates worked against reforms the UP had undertaken. Despite great contradictions, gains were made: infant mortality, which had been the highest in the world, dropped from 79 to 71 per thousand; deaths from infant diarrhea were down 20%; deaths from bronchial pneumonia were down 15%; 90% of the services were free.
There were weaknesses in the nationalized health system which reflected a general weakness in the UP. Often organizations of popular control did not work well during the UP because of its own over-reliance on bureaucratic methods of work, and lack of reliance on mobilization and education of the masses of people. The reformism of the UP as well as U.S. financial and technical support of a well-prepared Chilean right opened the door to fascism.
With the coup, the SNS was abolished. The School of Public Health and the worker’s medical school were closed. Many of the leading people in the SNS and the people who had been doing health work in the poblaciones were killed or arrested.
Neighborhood health committees and community health workers were told they were no longer needed. Leading health activists were harrassed, often arrested. Some neighborhood clinics, like that of Campamento Nueva Havana were razed. The majority of clinics limp on with drastically decimated resources.
It isn’t sufficient to abolish organs of popular control. The junta must also discredit them in the eyes of the people. This they do by smearing the reputations of the people who worked in popular organizations through slanderous accusations of personal gains and abuses of the popular power they held. For example, the junta has accused mothers involved in the powdered milk programs under the UP of selling the milk rather than giving it to the children. The obvious (to the right-wing) conclusion is that poor people will abuse any responsibility, and that the system should be reconstructed to control them.
The junta’s plans for the national health organization that will replace the SNS at first glance seems strangely similar to the old SNS of the UP. In place of the National Health Service (SNS) they suggest the National Systems of Health Services (SNSS) and discuss at length the importance of preventive care, especially prenatal and wellbaby care and decentralization of health services. Ostensibly the new document is progressive, but fundamentally it places control in the hands of the governing military. In the entire proposal (entitled “the national health doctrine and policy, Nov. ’73) no mention is made of control by workers and community or democratic decision making. It is strongly stated that the Ministry of Health is the decisive organism in health planning. “The community”, it is stated, “has the right to receive health care and the responsibility to pay for it.”
The frightening implications of this were brought home to the WILPF (Women’s International League for Peace and Freedom) delegation when a group of women working with the junta’s Secretariat of the Woman explained that they were going to begin a massive publicity campaign in regard to birth control for poor people. “They (poor people) are scum and don’t know any better (than to have many children). Their men are brutes—they are not happy unless their wives are pregnant.” Progressive health measures in the hands of fascists have become genocidal.
Who Pays for Health Care
Colonel Spoerer, Minister of Health, Chilean Air Force, and former Rockefeller Fellow, saw as a major problem of the former health system a shortage of personnel: “Wages for doctors were too low and doctors had no incentive. They felt that everything was going to be socialized from under their feet and they would have no more power. The lack of liberty to work on one’s own created an exodus which resulted in a shortage of health personnel.”
The doctors have clamored for a return to fee for service instead of the salaried structure of the former National Health Service. The provisions of the fee scale are a blatant move from the principle of equal service to all toward better service for those who can pay more. Under the old SNS, anyone might end up seeing the top specialist in a given field if his/her case so required. Now the fee scale leaps substantially for every ten years of experience.
The junta is rapidly returning the health system to the control of private industries and the doctors’ professional associations, gremios. This means a renewed orientation toward profit-making. Antibiotics cost ten times what they cost before the coup. The drug industry had been controlled and subsidized by the government. Now that “free enterprise” has returned the cost of drugs can climb without limit. For a simple case of pneumonia, treatment would now cost ten times more than the minimum monthly wage. People are stealing medications of all kinds from hospitals not for political reasons, as much as sheer economic necessity.
Meanwhile, workers get robbed blind under newly oppressive working conditions, are starving because of an inflation that has eaten their salaries to the point where there’s nothing left, and are charged to the teeth for the little health care they still get. Workers have in the past been charged 1% of their salary for health insurance and their employer paid another 1%. Colonel Spoerer thinks that health insurance costs may have to rise to 10% or 12% of a worker’s salary.
The fascist government has moved to deny the working class even the basic necessities like health care. This is the most fundamental aspect of the new fascist government; super-exploitation of the working class in all aspects of life. Fascism is the logical form that monopoly capitalism takes when it is afraid that it cannot maintain its control through constitutional means. Fascism is not simply a repressive government or a lack of democracy. It is one more phase in the Chilean people’s ongoing struggle with the ruling class. The Chilean people are enraged and fighting back in whatever ways available to them at this point when resistance is not totally organized.
However, there is evidence that the resistance is approaching a higher level of organization. On May first, international workers’ solidarity day, the center of Santiago was flooded by leaflets that dropped simultaneously from the windows of numerous office buildings. Signed by the Revolutionary Left Party (MIR) and the Socialist Party, the leaflets announced, “The resistance has begun.”