BOGOTA, Colombia �� Since 2003, Cuba has sent battalions of doctors to Venezuela in exchange for cash and oil.
The program, known as Barrio Adentro, offers free medical care to some of the nation's poorest people. It's been credited with saving more than a million lives and is one of the pillars of the socialist revolution.
But according to health workers who have defected from the program, Barrio Adentro has been hollowed out by fraud. And they say they were under such intense pressure to hit quotas that they've been faking statistics for years.
As a dentist in the program, Thaymi Rodriguez said she was required to see 18 patients a day, but often only a few showed up at her clinic. Medical workers who didn't hit their daily quota were threatened with having their pay docked, being transferred or, in extreme cases, being sent back to Cuba.
To make up for the patient shortfall, Rodriguez said she and her colleagues would routinely fake paperwork and reinforce the fiction by throwing out anesthesia, dental molds and other supplies.
"I worked for 3 { years as a dentist in Venezuela, and it was horrible dealing with the statistics," said Rodriguez, who defected from the program late last year and is in Colombia awaiting a U.S. visa. "I might see five patients a day, but I had to say I'd seen 18, and then throw all that medicine away, because we simply had to."
Trashing medicine in a country where it's desperately needed was painful, doctors said. But if they were caught giving it away _ or, worse, selling it _ they would be kicked out of the mission and sent back to Cuba. And regular audits of their supplies meant they needed them to match their patient count.
The claims are difficult to verify, and calls to Venezuela's Ministry of Health seeking comment went unanswered. But the Miami Herald spoke to three different groups of health workers who had abandoned the program, and all told similar stories.
The quota pressure stems from Cuba's economics. Desperate for hard currency, the government sends health workers abroad under contracts that let the administration keep most of the revenue.
According to an article published by the Wharton School at the University of Pennsylvania, there were 37,000 Cuban health professionals working in 77 countries in 2015. Citing unidentified Cuban officials, the document claims the health workers generated about $8 billion in foreign exchange revenue for the island that year.
Venezuela's state-run PDVSA oil company, which pays for the program, says it pumped $28.8 billion into Barrio Adentro from 2003 through 2015.
There's no doubt the clinics (there were 7,287 of them in 2015) have saved lives. The World Health Organization, among others, has praised the program for helping reduce infant mortality, and President Nicolas Maduro says the Cuban doctors have saved more than 1.4 million lives since the program started.
But it's also clear the program is less effective than the administration would like the world to believe.
A Cuban IT expert who oversaw medical missions in four Venezuelan states said it was his job to transmit patient logs and other statistics back to Havana. The technician spoke on the condition of anonymity because he's been told there are arrest warrants for him in Venezuela and Cuba for stealing data from the medical mission.
Venezuela pays Cuba based on the number of patients that are seen, or educational workshops that are given, he said. And Cuban authorities don't want anemic patient turnout to impede revenue.
"You have to understand that Venezuela pays Cuba based on statistics, not based on what's really happening in the clinics," he said.
In the four states under his purview _ Aragua, Yaracuy, Guarico and Carabobo _ he said there were about 6,800 Cubans on different "missions," including 5,900 medical workers.
As he compiled his monthly reports, it was clear they were fabricated, he said. Dentists were regularly logging 18 patients a day and doing five educational workshops a week. In addition, they had to fill out extensive paperwork on each patient. There simply weren't enough hours in the day, he said.
"I'm an IT worker and a mathematician and like all my data to make sense," he said. "And none of this made sense."
Dentists are particularly under the gun because Venezuela pays for their services in cash, as opposed to crude, workers said. But nobody was immune from the quotas.
Ibrahim Mustelier, an ophthalmologist, said he was required to deliver six patients every Thursday for cataract surgery.
But he could not find that many patients.
"What I would see in my practice were infections, conjunctivitis ... things that didn't need surgery," he said.
When he didn't have enough cases, his bosses would send him out knocking on doors to fill the beds.
"My supervisors would say, 'Doctor, you know you're going to be punished because we have to meet these quotas _ and these orders are coming from the highest levels,' " he said.
The pressure on doctors may be one of the reasons they've been defecting in large numbers. Thousands of them received expedited visas to the United States under the Cuban Medical Professional Parole program, which was canceled Jan. 12.
Barrio Adentro has also been a victim of Venezuela's economic crisis, which includes shortages of food and medicine. Doctors said that even as they dumped some medicine, others, particularly antibiotics, were impossible to find.
