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The psychiatric clinic of Dr. Edmundo Chirinos is in a once genteel residential district of Caracas, just down the street from a row of love motels. On the day I visited, several manic-looking men whom I took to be junkies were loitering on the sidewalk outside the entrance. Inside, the waiting room was humid and jungly, full of ferns. There was a five-foot-high waterfall in one corner, and a smaller one in Dr. Chirinos's office. Water streamed over stones and plaster sea horses and plastic shells. "It's meant to be relaxing," Dr. Chirinos said. "Do you find it unsettling?"
Dr. Chirinos is a small man in his late sixties, with carefully combed thinning hair, impish eyes, and bushy eyebrows. He was wearing a white coat, and he kept his hands clasped on his desk. Dr. Chirinos's patients include many highly placed professional people and political figures in Venezuela, and he told me that he has known all seven of the men who have held the office of President since 1958, when Venezuela became a multiparty democracy. Some of the men were his friends and some of them were his patients. The current President, Hugo Chávez Frías, whom he referred to as Hugo, is both. Dr. Chirinos said that Chávez is the only honest President he has known.
Dr. Chirinos was willing to talk to me about President Chávez and, after thinking it over, he said that perhaps the most discreet way to get at the subject was to use a questionnaire that one of his colleagues had devised. The questionnaire listed fifty personality traits that could be attributed to either Simón Bolívar—El Libertador of Latin America—or Hugo Chávez, or to both men. As Dr. Chirinos read through the list, he emphasized the similarities between Chávez and Bolívar: "He is ill-humored and difficult when he feels frustrated. When least expected, he shows his sense of humor, speaks with familiarity to strangers and friends alike, makes jokes and entertains people. At times he is unjust in his judgments, at other times he is overly tolerant. His character is unpredictable and disconcerting. We can know him in depth only if we join the criticism of his adversaries with the idolatry of his followers and strain them through the colander of logic and objectivity. He prefers to embrace dreams that seem impossible to achieve rather than confronting the harsh realities of life."
When Dr. Chirinos came to trait No. 14—"He has a tendency to be vain"—he stopped. "This is true," he said. "Hugo has traces of narcissism." No. 15: "He displays an unrestrained authoritarianism that predisposes people against him." Chirinos looked up and said, "Yes, this characteristic is very pronounced in Hugo." And so on, through the document. By employing this technique, Chirinos described Hugo Chávez as a hyperkinetic and imprudent man, unpunctual, someone who overreacts to criticism, harbors grudges, is politically astute and manipulative, and possesses tremendous physical stamina, never sleeping more than two or three hours a night. "He is a deeply sensitive man, in private," Chirinos added in a confidential tone. Chávez had wept in his presence on several occasions. As I got up to leave, Chirinos said that he wanted to stress that the President is mentally healthy, completely normal. "Except for his power, he is no different from you or me."
La Casa Natal de Bolívar, the single-story house where Simón Bolívar was born in 1783, is one of the few old buildings remaining in the hectic and dilapidated heart of Caracas. The house looks out on a small plaza where children play and old men sit on benches. It is flanked by other colonial houses, several of which have been turned into party-supply shops specializing in gaudy piñatas. Large yellow papier-mâché Tweety Birds and Disneyish creatures hang from the awnings. Just next door to the Bolívar house is the Bolivarian Society, where historians and aficionados gather for talks and lectures about the great man. On the afternoon I visited the house, which is now a museum, an indigent woman was sprawled out on the curb across the street, breast-feeding a baby. Inside, the fastidious curator, Ramón Valecillo, showed me the white marble bathtub Bolívar had bathed in as a child, the gilded and ornately carved carriage that had belonged to his mother, and the austere room where he was born. The room was haunted, Valecillo said. He himself had seen the ghost. Sometimes horses' hooves could be heard clattering in the cobbled stable yard at the rear of the house.
Almost every town square in Venezuela is named Plaza Bolívar, and in the center there is usually an equestrian statue of El Libertador, who is depicted as a thin man with long sideburns, wearing Napoleonic garb. Street venders in Caracas sell posters of Bolívar and the Virgin Mary alongside those of more recent cult heroes like Che Guevara, Ricky Martin, and Marilyn Manson. Venezuela's national currency is the bolivar. On July 28th, Hugo Chávez celebrated his forty-seventh birthday, just four days after Bolívar's. The milestone brought Chávez to within a few months of the age Bolívar was when he died, in December, 1830, the lonely and repudiated architect of a plan to politically unify all of Latin America, from Mexico to Tierra del Fuego. Bolívar had liberated the present-day states of Venezuela, Colombia, Ecuador, Peru, and Bolivia from Spanish rule, but the larger unification effort turned out to be, he said bitterly, like "plowing the sea." A hundred and seventy years later, the Latin-American republics he dreamed of seeing joined are scarcely closer than they were then. In the intervening years, they developed distinct national identities, and nearly all of them have fought bloody territorial wars with one another.
After Hugo Chávez took office, early in 1999, he officially renamed his nation the Bolivarian Republic of Venezuela. He often quotes Bolívar and invokes his accomplishments, and he says that he wants to fulfill Bolívar's dream of a unified continent. (Which could mean a genuinely revolutionary confederation of states or something akin to the European Community. It's hard to pin Chávez down on this.) He initiated a vast national development program, the Plan Bolívar, to build roads, schools, hospitals, and low-income housing for Venezuela's poor citizens. The new Bolivarism is a response to what Chávez calls "savage neoliberalism," a phrase commonly used in Latin America to refer to the kind of free-market policies that were instituted in Chile in the mid-nineteen-seventies under Augusto Pinochet and in Argentina in the nineteen-nineties under Carlos Saúl Menem. "Neoliberals" favor wage controls, reduced government spending, and the privatization of state-held enterprises. They are against price controls, tariffs, and restrictions on exports and imports. World Bank or International Monetary Fund austerity packages in return for debt renegotiation are central to neoliberal programs. Chávez also says that market-driven arrangements like NAFTA (which when it was instituted in Mexico gave rise, in part, to the Zapatista insurgency) serve mainly to benefit the "global hegemony" of the United States while not adequately addressing Latin America's basic problems.
Few modern Latin-American leaders have been as provocative as Hugo Chávez, or have harbored such grandiose dreams. His loyal constituency is Venezuela's poor, who represent some eighty per cent of the country's twenty-four million people. Chávez's popularity rating is now at fifty-six per cent—less than it once was, but still impressive, especially since poverty, unemployment, and violent crime in Venezuela are at record levels. In the last two and a half years, more than two hundred thousand members of the upper and middle classes have emigrated to the United States, Australia, and Western Europe, taking their money with them. Around eight billion dollars was removed from the country last year. Chávez blames the corruption and negligence of past governments for Venezuela's problems, and he begs for time by quoting Bolívar: "Stand firm and firmer still; have patience, and more patience."
Chávez acts like a man who is on the campaign trail, which, in a sense, he is. He has called, and won, eight referendums. These have allowed him to design a new constitution and to secure an extended term in office for himself. His present mandate expires in 2007, but he can be reëlected for a six-year period. Previously, Venezuela's Presidents were limited to a single, five-year term. He also has a new Supreme Court and a unicameral National Assembly that, since he abolished the old Senate, is stacked with his allies. Chávez has given Venezuela's armed forces an unprecedented role in his government, handing out key posts to senior officers.
Chávez's enemies say that he is becoming a dictatorial caudillo like Juan Perón or Fidel Castro. He is Castro's closest ally in the Western Hemisphere. He irked Washington by making a friendly visit to Saddam Hussein a year ago, and by prohibiting U.S. drug-surveillance flights over Venezuela's territory. He opposes the $1.3-billion program, consisting mainly of military aid, to combat the drug trade in neighboring Colombia, both because he thinks the program will lead to a wider war, with more refugees coming into Venezuela, and because he doesn't think the United States should be involved.
Last year, Venezuela was the United States' No. 2 foreign supplier of crude oil and petroleum products. The state oil company, Petróleos de Venezuela, has six refineries in the United States, and it owns Citgo, which has the franchise for nearly fourteen thousand American gas stations. Chávez was instrumental in OPEC's decision to cut back production in 2000, driving up fuel prices and providing twenty-one billion dollars in extra revenues for Venezuela, which is the third-largest oil producer in the organization, after Saudi Arabia and Iran.
Dennis Jett, who was the U.S. Ambassador to Peru from 1996 to 1999, calls Chávez "the greatest threat to democracy in Latin America, with the possible exception of the FARC"—the Revolutionary Armed Forces of Colombia guerrilla group. Earlier this year, U.S. diplomats in Caracas leaked word to several reporters that, under certain unspecified conditions, Washington might green-light a coup against Chávez. But that sort of rhetoric has died down. Despite all his inflammatory language, Chávez has not actually done much to alter Venezuela's economy, and he has encouraged foreign investment and made overtures to American leaders. He has visited the U.S. seven times to meet with businessmen, newspaper editors, and politicians. The elections that brought him to power are generally regarded as having been fair, there are no political prisoners in Venezuela, the press is not curtailed—it lampoons Chávez regularly—and opposition political parties operate freely. It is difficult for the Bush Administration to act against him. "The bottom line is that we don't have a policy in Venezuela," a former diplomat in Bush père's government said to me. "Hell, we don't have a policy in Latin America. The policy is not to have a policy, because we don't know how to rein Chávez in without breaking the crockery. And he sort of carries the crockery closet around with him."
Chávez is a mestizo Creole—just as Simón Bolívar was, despite the many portraits that depict him as a white man. Chávez's features are a dark-copper color and as thick as clay; he has protruding, sensuous lips and deep-set eyes under a heavy brow. His hair is black and kinky. He is a burly man of medium height, with a long, hatchet-shaped nose and a massive chin and jaw. Chavez is physically demonstrative and seems to have a nearly photographic memory, flattering people he has met only once by remembering their names and personal details. He is also an inveterate, and not always tactful, prankster. In May, when he met Vladimir Putin in Moscow, he adopted a mock karate stance before shaking Putin's hand. Putin looked startled, but he composed himself and smiled thinly as Chávez swung an imaginary baseball bat. "I hear you have a black belt in karate," Chávez said. "I'm a baseball man myself."
I spoke at length with President Chávez for the first time in his official residence, a hacienda-style mansion that is called La Casona, the Big House. His personal assistant, a young lieutenant named Antonio Morales, led me to a colonnaded wraparound veranda. It was about nine at night, and Chávez was on the lawn, sitting under a large mango tree at a round wooden table. He was wearing sneakers, black jeans, and a long gray collarless tunic shirt with epaulets. A stack of papers, some highlighter pens, and a couple of cell phones were on the table. A servant brought us demitasse cups of espresso, glasses of mango juice, and some grapes and crackers. Chávez is a caffeine addict. One of his assistants told me that when the staff realized he was drinking twenty-six cups of espresso a day they started cutting him off, and have got him down to sixteen.
Chávez lit up a cigarette—not part of his public image. Lieutenant Morales hovered nearby, occasionally going into La Casona and coming back to whisper something to Chávez or to give him a yellow Post-it with a message on it. Most of the time, Chávez ignored these intrusions. He listened attentively to my questions, and appeared to be only slightly uncomfortable when I quoted his harshest critics. "Generating extreme sentiments in people is a consequence of the situation here," he said reflectively, in a manner quite different from the hyperbolic style of his public pronouncements. "I believe, just as Marx and Bolívar did, that men as individuals don't make history; we aren't the defining thing. Bolívar said, 'I am but a weak piece of straw caught up in the revolutionary hurricane.' " Chávez leaned toward me and added, "And a hurricane was unleashed here, you know."
Chávez was referring to the events of 1989, when anti-government riots erupted in the slums of Caracas and spread to the rest of the country. During a three-day frenzy of violence, many hundreds of civilians—nobody knows precisely how many—were killed. The carnage, which is known as El Caracazo, traumatized Venezuelan society. Two parties, the social-democratic Democratic Action and the Christian-democratic COPEI, controlled the government then, as they had since 1958, when the Pact of Punto Fijo was negotiated. Puntofijismo was designed to marginalize the left and reduce the ability of minor parties to grow. The system was incredibly corrupt, but it worked as long as the economy flourished, which it did while oil prices remained high. By the late eighties, however, the price of oil had been dropping for a decade and the fiscal mismanagement and outright thievery of successive Venezuelan governments had taken a toll. In February, 1989, President Carlos Andrés Pérez agreed to an economic-reform program requested by the I.M.F. One of its first effects was an increase in public bus fares. This precipitated the riots, and Pérez called out the Army, which opened fire on looters.
"I was just a simple soldier then," President Chávez said to me as we sat under the mango tree at La Casona. "Just a soldier, with a good future, and everything going along well, but then I had to ask, 'What do I do with this rifle, where do I point it?' It was a terrible crisis of conscience. Now that the hurricane is unleashed, what do I do? Do I throw my rifle on the ground and run off, and stop being a soldier, or do I point it at the miserable peasants? Or do I point it against those who have led the people to this situation? My comrades and I took the road of Bolívar, who said, 'Damned be the soldier who turns his weapons against his people.' "
In fact, Chávez had been conspiring since 1982, when a group of junior officers began to discuss a revolutionary junta. They called their group the Movimiento Revolucionario Bolivariano. El Caracazo took Chávez and his fellow-conspirators by surprise, but they saw it as a signal that their moment was approaching. In February, 1992, when most of them had been placed in command of troops at strategic locations around Venezuela, they attempted a coup d'état. Several key garrisons and cities were captured, but Chávez, who was supposed to take the Presidential palace of Miraflores, found his position surrounded by loyalist troops. After several of his soldiers were killed, he decided to surrender, as he tells it, to avert a larger bloodbath. (Seventeen people died during the revolt, including several civilians.) Chávez was taken into custody, and a few hours later the military high command allowed him to speak on national television and attempt to persuade his fellow-rebels to lay down their arms. Chávez's appearance, which lasted thirty-two seconds, was broadcast live.
Wearing his uniform and his paratrooper's red beret, Chávez spoke calmly, praising the rebels for their courage. "Comrades, the objectives we set for ourselves have not been possible to achieve now"—por ahora—"but new possibilities will arise again, and the country will be able to move forward to a better future. . . . I alone take responsibility for this Bolivarian military uprising." The words "por ahora" were lost on no one, and at that moment Chávez became a national hero. The rebellion was over, and he and the other officers were court-martialled. Chávez was sent to Yare prison, about thirty-five miles from Caracas.
Yare is an awful place. The worst inmates are left to their own devices in two dirty-white, bullet-pocked blocks at the rear of the prison grounds, where black curtains of excrement from broken toilets slide down the walls and the ground is carpeted with an oleaginous mass of raw sewage and suppurating garbage. In the jagged open spaces where the bars on windows have been wrenched out, shirtless prisoners perch like vigilant crows. I visited Yare on a hot, breezeless day, when the prison's stench clung like poison in the air. Inspector Manuel Lugo, a senior Venezuelan corrections official and a former warden of Yare, had offered to show me around, but only from the outside. As we drove along the perimeter of the prison grounds, I saw that the guard towers were also riddled with bullet holes, and as we drew adjacent to the white blocks Lugo stepped on the gas. "We can't hang around here," he said. "They might shoot at us." He explained that many of Yare's eleven hundred inmates have weapons. "There are only six guards on duty inside at any one time," he said. There was no budget to hire more guards. "It's an impossible situation."
A generation of youths who were born into poverty and who have access to drugs and weapons keep crime levels staggeringly high. Lugo said that of the ninety-odd homicides recorded in Venezuela every weekend, when violent crime peaks, a third are probably extrajudicial executions by policemen. Many cops see no other way to do their job. This was why Lugo was a Chávez supporter. Emergency measures were needed to fix Venezuela's problems, and Chávez was the only person who seemed prepared to tackle the job.
Out of firing range of Yare's cellblocks, Lugo introduced me to Virginia, the secretary of the prison psychologist. Virginia is a tough-looking woman in her late forties, with short-cropped hair dyed an auburn color. She is missing a couple of teeth. Virginia said that she had got to know Chávez well when he was incarcerated in Yare. Every morning, he sat in a chair in the open-air caged yard that had been built specially for him outside his cell. There was a plaster bust of Simón Bolívar there, and he would speak to it. Lugo interrupted to say that he, too, had seen Chávez do this: "He used to turn the head of Bolívar around to face him." Virginia nodded.
Virginia was writing a letter to Chávez. She wanted him to help her rent one of the low-income Plan Bolívar houses being built near Yare. She needed her own place, she explained, because she was estranged from her husband, a National Guardsman, and they were still sharing a home. Virginia attributed the breakup of the marriage to her husband's jealousy over her friendship with Chávez. Virginia laughed raucously when she told me about this. "I don't look at Chávez as a lover," she said. "I admire him because he's got a big enough bicho"—penis—"to stand up for the country."
In November, 1992, nine months after the first coup attempt, a group of Air Force officers, including several of Chávez's allies, tried again to overthrow the government. This effort also failed, and it was much bloodier. The Miraflores palace was bombed from the air, and the rebels and the President's loyalists fought in street battles. An armed attempt was made to free Chávez from Yare. It, too, was unsuccessful. In the end, more than a hundred and seventy people died, including scores of civilians. Order was restored, but Venezuela's political system had begun to unravel. In June, 1993, Carlos Andrés Pérez, the President, was impeached by Congress after his own party withdrew its support from him. He was placed under house arrest, pending trial on corruption charges. Later that year, an elderly politician, former President Rafael Caldera, won the Presidency on an independent ticket, with twenty-nine per cent of the vote. The country's two main parties, COPEI and Democratic Action, found themselves out of power for the first time in thirty-five years. In March, 1994, Caldera signed an order freeing Chávez and his fellow-rebels from prison. With his military comrades and some leftist civilian parties as coalition partners, Chávez launched a new party, which he called the Movimiento Quinta Republica (Fifth Republic Movement). In December of 1998, he was elected President with fifty-six per cent of the vote.
During that first evening on the lawn at La Casona, Chávez's wife, Marisabel, an attractive, fair-skinned blonde of thirty-six dressed in sweatpants and a T-shirt, wandered across the lawn to where we sat. She was accompanied by Rosinés, their three-year-old daughter, a pudgy girl with tousled brown hair. Rosinés tumbled up to her father and began making funny faces, looking for attention. Chávez swept her into his arms, and sang a song to her. His wife stood a short distance away, watching them. She was talking into a cell phone, and after a few minutes she walked over and told Chávez that she had learned that her father, who had undergone open-heart surgery three nights before, had pneumonia. She was worried about him. Chávez muttered something in response, but he seemed distracted. Just then, Morales handed him more Post-its with notes on them. While he and Morales conferred, Marisabel and I chatted. Then she went back to the house with Rosinés. In a magazine interview published a few weeks earlier, Marisabel had said that being the President's wife was difficult and lonely. In the photograph on the cover of the magazine, she was crying.
As she has told the story, Marisabel met Chávez late in 1996, when she was working as a social columnist in the city of Barquisimeto and he was campaigning there. Marisabel pressed a note into his hand. They were soon having a love affair, and Marisabel became pregnant with Rosinés. Chávez and Marisabel were married in a private ceremony with family and friends in December, 1997, when Rosinés was three months old. Marisabel has a young son from a previous relationship, and Chávez has three children—two daughters and a son—with his first wife, a woman from his home town in the rural state of Barinas, whom he divorced soon after he got out of prison. Chávez's detractors speculate that once he decided to run for the Presidency he realized that he needed a more glamorous wife. The blue-eyed, blond-haired Marisabel seemed better suited to be First Lady, although shortly after the 1998 Presidential elections she was hospitalized for stress.
"The truth is, Hugo has terrible problems in his marriage," one of Chávez's friends told me. He said that he worried about Chávez's emotional well-being. He had "communication difficulties" with his three older children. "The two girls resent him for leaving their mother, and he is also having problems with his son." As a short-term solution, he explained, Chávez had sent them to Cuba to study, where they could be looked after by his friend Fidel.
I remembered Dr. Chirinos's remarks about Chávez's sensitivity and his tendency to weep, and I asked the President if he shared Bolívar's tragic view of life. Chávez speaks often of a willingness to die in the service of his country, and there has been some speculation that he has a martyr complex. I had thought about that a few days earlier, during an official wreath-laying ceremony at Bolívar's tomb. Chávez was there with the Presidents of Mexico and Colombia, both of whom were wearing bullet-proof vests. Chávez was not, and I asked him about it. "I never wear one," he said. This drives his security people crazy, and Castro has also warned him, he said, "thousands of times," to take better care of himself. "It is possible I have something of this . . . tragic sense of life," he acknowledged. He recalled that on the eve of the 1992 rebellion he had said goodbye to his wife and three children, and led his soldiers out of their barracks. He was the last to leave. After locking the big front gate, he threw away the key. "I realized at that moment that I was saying goodbye to life," Chávez said. "So it is possible that one has been a bit . . . imbued with that . . . ever since, no?" He told me, a little ruefully, that Castro had repeated his concerns for Chávez's safety during a speech before the Venezuelan National Assembly. "Fidel said—and I don't want to believe that this is true—'Look after this man for me, because without this man this revolution will be over immediately.' " Chávez laughed. "Since then, wherever I go, people on the street come up to me and say, 'Cuídate' "—"Take care of yourself."
Venezuela is nearly twice the size of Spain—three hundred and fifty thousand square miles. It extends from South America's Caribbean coast southward into the Amazon Basin, where it is linked to Brazil by a single road through the jungle. Colombia and the Andean mountains lie to the west, and to the east is the tiny former British colony of Guyana. A sizable portion of Guyanese territory has been claimed by Venezuela on and off since the early nineteenth century; maps refer to it as a "disputed zone." Most of Venezuela's heartland is occupied by immense llanos, the tropical floodplains that feed the headwaters of the Orinoco River and are virtually uninhabited except for a few indigenous communities, some dismal agricultural towns, and gigantic cattle ranches.
More than eighty per cent of Venezuelans live in a string of cities near the Caribbean coast, and mostly around Caracas, which has a population of five million. There are only a few traces of the small place that Caracas was less than fifty years ago. Parrots fly overhead, squawking, just before sunset, and here and there, amid the welter of red brick condominiums that are replacing the old suburban neighborhoods, are a few old villas with gardens. Caraqueños, as the people of Caracas call themselves, have adopted a distinctly North American approach to living. Those who can afford it drive cars, carry cell phones, eat fast food, and shop in malls. The city has a thriving beach culture and many health clubs. Billboards offer weight-loss programs, liposuction treatments, and weekend escapes to Margarita Island, Curaçao, or one of the other Caribbean beach resorts that lie just offshore.
Brick-and-tin shanties surrounded by uncollected garbage cover the hillsides at the edges of the city, and indigent people, some of them wild-haired and filthy, and clearly mentally ill, wander in the parks and sometimes along the highways. They camp among rubbish and light campfires on the median strips of major thoroughfares, underneath bridges, and along the edges of the Guaire River, an open-air sewage trough that runs through the heart of Caracas. Wealthy caraqueños live in gated communities protected by armed guards, video surveillance cameras, electrified fences, loops of razor wire, and motion sensors. Because of the extreme social divisions, Caracas has become one of the most dangerous cities in Latin America. While I was there, the daily newspaper TalCual ran an article dispensing kidnap-survival advice to its readers: "Although it may be difficult, try not to get depressed. The abduction period may be long and anguishing. You may be held incommunicado and spend months without receiving messages from your family. Remember that the most important thing is that you can survive this. Statistics demonstrate that 95% of kidnapped people return alive."
Venezuelans are great believers in miracles. Among the middle class, the best-selling books are predominantly Yankee imports of the New Age and self-help variety. Angels are also very popular; in a mall in Caracas, I saw an exhibition of ornamental effigies of angels, mostly gilded cherubic toddlers with wings and beatific expressions. It had drawn a huge crowd. Venezuelans' fascination with such things has a foundation in spiritism, sorcery, and syncretic faiths. The most dynamic, and widespread, syncretic faith is the cult of María Lionza, a mythical goddess who is depicted as a naked white woman with flowing hair mounted on a tapir. The cult blends elements of Catholicism and Afro-Caribbean religions. There are a variety of lesser deities who represent various categories, or "courts," one of the more powerful of which is the Liberator Court, venerating Simón Bolívar. Yolanda Salas, a cultural sociologist who is a María Lionza expert, says she believes that President Chávez is aware of this phenomenon, and exploits it. "In the minds of ordinary people, Venezuela's patriotic and sacred histories occupy the same space," she said. "There isn't a clear boundary between them, and this is the space Chávez moves in."
Like Fidel, who replaced the bourgeois form of address señor with the more egalitarian-seeming compañero, Chávez has come up with a new term for Venezuela's citizens. They are el soberano—the sovereign. Enthusiastic supporters of Chávez identify themselves also as chavistas, or bolivarianos, just as those Cubans who still support Castro call themselves fidelistas and revolucionarios. Chávez has elevated the status of Venezuela's million-odd street children, who used to be called los niños de la calle. They are now niños patrios, children of the fatherland. Similarly, damnificados, the Spanish-language term for people made homeless by natural disasters (such as the catastrophic mud slides that killed between thirty and a hundred thousand people in the Venezuelan state of Vargas in December, 1999), are now dignificados, dignified ones.
On April 19th, Venezuela's Declaration of Independence Day, Chávez was scheduled to speak to el soberano in Caracas's Plaza Bolívar. He had been away for a few days in Colombia for a meeting with other Latin-American leaders, but had said that he would fly home for the event. Then, at the last minute, he changed his mind and flew directly to Quebec, where the Americas Summit was soon to convene. I had heard the news on the radio early that morning, but I decided to go to the Plaza Bolívar anyway. A thousand or so people were gathered there when I arrived, and I could see that they didn't know of the change in plans. They were jockeying to get as close as possible to the speaker's podium. Groups of supporters who had travelled from towns deep in Venezuela's interior stood in the plaza holding up banners that said things like "Chávez: We Are Peasants from the Forest Reserve of Ticopolo in Barinas State and We Want to Talk with You." I asked one of the banner-holders, a sturdy-looking farmer named Jesús Eduardo Méndez, what it was that he and his friends wanted to talk to Chávez about. "We need better schools for our children," Méndez said. He hastened to add that his presence was not intended as a criticism of President Chávez, who surely had no idea of the situation.
As a military band played patriotic music and dignitaries began assembling on the stage, I moved to the front of the crowd and joined one of the squirming, body-to-body sweat-drenched masses of humanity that engulf Chávez wherever he goes. Most of the people were women clutching envelopes containing letters to Chávez describing their problems. Ana Álvarez, a careworn woman of thirty-four, had come by bus all the way from San Cristóbal, a town on Venezuela's western border with Colombia. A year earlier, she said, she had been unfairly fired from the local social-security office. She had written to Chávez several times about this but had heard nothing back. So now she had come to Caracas, hoping to see him personally to give him a letter and explain her case. Ana had very little money and had to return home the next day. She asked me if I thought Chávez was going to show up soon, and I told her, as gently as I could, that he wouldn't be coming at all. "Are you sure?" she said. I nodded, and she began to weep. I tried to comfort her, and told her that I would probably be seeing Chávez within a few days and, if she wished, I would give him her letter. Ana calmed down and handed me an envelope. Within minutes, I was being accosted by other women who begged me to present their cases to Chávez. They insisted that no one else in the government would or could help them.
This is not an idea that is unique to unsophisticated women from the provinces. Chávez is generally thought to be sincere about his ideas and his plans for the country, but there is a feeling that he is incapable of delivering on them because his government is composed of well-meaning incompetents, outright opportunists, and scoundrels. "Chávez's biggest problem is his lack of follow-through," said Pastor Heydra, a Democratic Action Party representative in the National Assembly. Heydra and I met over lunch at a Caracas restaurant. He was wearing an automatic revolver in his belt, and he put away three triple whiskeys in less than an hour and a half. Despite his world-weary cynicism about the new Bolivarian revolution, he expressed a kind of backhanded compassion for the President. "Chávez is the only revolutionary in this thing," he said. "He's a romantic. Nobody else believes in this shit."
Chávez is a natural showman. During his regular radio and television shows, "Aló, Presidente," which are broadcast live and go on for hours, he scolds his critics, threatens his enemies, sings (with gusto but badly), recites poetry, cracks jokes, and generally hams it up. He tells his viewers, in excruciating detail, what he has done, or is going to do, reminisces about his childhood, quotes John Kenneth Galbraith (he admires Galbraith's theories in "The Affluent Society" about the social inequities of modern capitalism, and he calls himself a Galbraithiano), Marx, the Bible, and, most of all, Simón Bolívar. If he has been travelling, Chávez usually points out on a map the places he visited, gives folksy pocket histories of them and extolls their natural beauty, and describes the people he met. After he visited the rural town of Zárate in late March, for instance, "Aló, Presidente" included a video of him assisting military doctors during an operation. (He held a flashlight.) Turning to the audience, Chávez quipped, "You see? Now I can even do surgery!"
This kind of thing plays well with poor Venezuelans, but others find his monologues irritating. "Did you see our Clown Prince last night?" is a typical response. Many white middle-class Venezuelans despise Chávez, and there is a cruel, self-comforting snobbery implicit in their comments about him. For example, "El peón ha tomado la finca"—"The peon has taken over the farm." A prominent financier of impeccable Iberian ancestry invited me to lunch at his house, and, as his black servant brought our drinks, he told me, his face stretching with disgust, how "embarrassed" he felt to have ese mono—that monkey—as his President. Chávez is isolated from most of the business leaders in Venezuela because, as a former State Department official said to me, "I don't think they know how to talk to him. They've probably never met anybody like him before, except maybe their houseboy."
Last year, Chávez signed a five-year renewable agreement to provide Cuba with a third of its oil needs at heavily discounted prices. In partial repayment, Fidel agreed to dispatch hundreds of Cuban teachers, doctors, and athletic instructors to Venezuela. The first three hundred Cuban sports instructors showed up in April, and Chávez welcomed them in an open-air stadium in Caracas. "The arrival of the Cuban sports instructors is part of a strategy," he said to the crowd there. "Just as Cuba took its own revolutionary path, with its own characteristics, forty years ago, the Bolivarian revolution is taking its first steps today."
A week earlier, I had attended a rally protesting Chávez's education-reform bill, which calls for the expansion of specially funded public schools for impoverished children. Several hundred Cuban teachers are already at work in such schools. The crowd at the rally, about three thousand people, was solidly white and middle-class, except for one dark-skinned man who was selling coffee. They had assembled in an outdoor shopping arcade in front of a McDonald's. As an antichavista civic leader spoke from a stage, the demonstrators milled about, took videos of one another, and held up little plastic Venezuelan flags and signs saying "We Want Citizens, Not Militiamen," "Don't Mess with Our Kids," "No to Cubanization," "Education Yes, Indoctrination No," and so forth.
Opposition to Chávez is still disorganized and fragmentary, although there have been protests and strikes by trade unionists who feel that he is trying to dilute their power. When he is challenged, Chávez becomes defensive and calls his critics "oligarchs" and "liars," and accuses them of conspiring to sabotage the government. After a rancher was murdered by a group of peasant land invaders this spring, spokesmen for the Venezuelan cattlemen's association blamed Chávez for inciting the violence with his constant talk about the needs of Venezuela's landless farmers. They warned that if the invasions continued they would defend themselves with guns. Chávez threatened to arrest any ranchers who tried to organize Colombian-style paramilitary vigilante groups. "There is only one legal armed force in Venezuela," he warned in a television address. "And I am its only commander-in-chief. Don't forget that."
Rumors of a move by the armed forces against Chávez are always circulating in Caracas, but they seem to be coming mostly from the Frente Institucional Militar, or F.I.M., an organization of retired Venezuelan military officers. The F.I.M. is led by an ex-general named Fernando Ochoa Antich, a large, formal man in his late fifties. He lives in an apartment that has armed sentries and a sign outside saying that illegally parked cars will have their tires punctured. "There is a growing movement within the opposition to unseat Chávez by means that are neither conventional, electoral, nor democratic," Antich said. "The hope is that this situation will not bring about a military coup, that it will be dealt with using constitutional means." What he meant by "constitutional means," Antich explained, was a scenario in which Chávez voluntarily "resigned" from the Presidency. He acknowledged that he didn't see this as a likely prospect, and added, "I am one of those who believe that eventually the armed forces will be the destabilizing factor of the regime of Hugo Chávez." How would this come about? I asked him. "I don't know," said Antich. "But that is what will happen, because that is what has always happened in Venezuela. We are convinced that a pluralistic and democratic Venezuela cannot exist with Chávez. There are no alternatives possible as long as Chávez is on the stage."
Chávez claims that most members of Venezuela's armed forces are loyal to him, although he acknowledged to me that he knew this was not "a hundred per cent." Early this year, when rumors of a coup grew particularly strong, he reshuffled his top military brass and named his Foreign Minister, José Vicente Rangel, a trusted colleague, as Venezuela's first civilian Defense Minister in seventy years. He then moved the day-to-day running of the government into the armed-forces headquarters of Fuerte Tiuna, on the outskirts of Caracas. He raised salaries across the board, promoted new officers to key positions, and disbursed large sums from Venezuela's extra oil earnings to the military's Plan Bolívar civic-action program.
Before Chávez became President, he was denied entry into the United States because of his role in the attempted coup d'état in 1992, but after he was elected he was granted a visa. He threw the first pitch at a game at Yankee Stadium, pounded the gavel at the New York Stock Exchange, and was received by President Clinton in the White House. John Maisto, who was Clinton's Ambassador in Caracas, advocated supporting Chávez, because he left U.S. business interests in Venezuela intact and encouraged foreign investment. "Watch what Chávez does, not what he says," Maisto advised. The Clinton Administration's policy was to avoid a confrontation in Venezuela that could endanger oil imports and other oil revenues. The Venezuelan state owns the oil and the state oil company controls exports and sales, but exploration and extraction are partially privatized, and foreign companies make hundreds of millions of dollars in Venezuela."Bill Clinton and Dubya haven't wanted to mess with Chávez," a Bush adviser said to me. "As long as Houston and Big Oil are happy, we're not going to say anything to fuck things up."
Robert Bottome, a Venezuelan economic analyst who publishes a newsletter for subscribers, believes that the price of oil will determine Chávez's policies. Oil accounts for three-quarters of the country's exports. "If oil prices go up, I think that Chávez will Cubanize the economy," he said. "If prices go down, he won't be able to do that. He will have to open up the economy more." But Bottome also worries that Chávez will keep on a leftward path no matter what. "His discourse is straight out of the sixties, and his economic advisers are straight out of the sixties, too. They are people who have been in university ivory towers for the past forty years, talking to each other, and they haven't learned anything about the outside world."
The most extreme leftists with whom Chávez is accused of having some kind of relationship are the Marxist guerrillas of the FARC and the smaller National Liberation Army, E.L.N., in Colombia. Chávez says that Venezuela is neutral in the war that the Colombian Army, various paramilitary organizations, and the guerrillas have been fighting for forty years, and he has offered to mediate in peace negotiations. Last year, however, the Colombian Army seized a cache of assault rifles from a group of guerrillas who were said to have received the arms from Venezuelan Army stocks. A few months later, two high-level FARC representatives were invited to talks in Caracas, and an E.L.N. guerrilla who was wanted in Colombia on hijacking charges turned up in Venezuela, purportedly under official protection. The leader of the FARC, Manuel Marulanda, denies that there have been direct contacts between his organization and President Chávez, but he says that he would be interested in "working together in the future."
Marulanda said that since Chávez has been in office, relations along the border have improved, but, in fact, Venezuelan cattle ranchers still complain of harassment by Colombian guerrillas who cross over to steal their livestock and extort money from them. Like ranchers whose land has been invaded by organized peasant groups elsewhere in the country, the ranchers on the border say Chávez has done nothing to protect them, and some have resorted to vigilante tactics. In the town of San Cristóbal, I met a man named Otto Ramírez, who claims to be starting up a Colombian-style paramilitary death squad to fight the guerrillas. Ramírez is a small, balding former veterinarian in his late fifties who says that he turned to vigilante tactics two years ago, after guerrillas invaded his ranch and murdered his caretaker. Ramírez, who came out of hiding for our interview, claims that he is in contact with Colombia's paramilitary warlord, Carlos Castaño, whom he greatly admires. He hinted that Castaño had sent him some fighters to "help out." Castaño has an eight-thousand-man army that is known for torturing its victims and decapitating them with machetes. Ramírez boasted that he and his "boys" were active. When I asked him what he meant, Ramírez said, "A few eliminations, mostly low-profile stuff"—of guerrilla messengers and liaisons. He winked and grinned, and said he could say no more. He wasn't worried about being arrested. "When the time is right, I'll cross over to Colombia," he said. He could direct his operations from there.
In El Nula, a small border town a few hours' drive south of San Cristóbal, I met with a woman named Elizabeth (a pseudonym) who works as a liaison for the FARC and who one assumes would be a target for Otto Ramírez's boys. She was an active-duty FARC guerrilla from the age of twelve, but three years ago she was arrested by the Venezuelan Army at a roadblock outside of town. Until then, she had been the FARC's local tax collector and had led a gang of young men who had, at times, roved deep inside Venezuela to carry out their duties. On the day she was captured, Elizabeth was on her own and was unarmed, but she had a balaclava in the car, which was all the evidence the Army needed. "I got caught because I was stupid," she said. After taking her into custody, the Army tortured her. Elizabeth's hip was permanently damaged, and she walks with a limp. A military tribunal sentenced her to twenty-eight years in prison for "military rebellion," but last year she was freed in an amnesty.
"The FARC and Chávez have an understanding," Elizabeth said. Since Chávez came to power, she explained, the FARC had agreed to cease its money-raising operations inside Venezuela proper, but it still exercised power and acted as an arbitrator in problems that cropped up along the porous border. "It's mostly problems over horses and cows and land," she said. Recently, for instance, a wealthy rancher had asked her to have the FARC get rid of some land invaders for him. "He came to us rather than the Venezuelan Army," Elizabeth said proudly. "He's rich and educated and goes to Miami a lot, but he prefers us; he says he trusts us more." She had gone to the FARC on his behalf, and three fighters came to chase off the land invaders. Several Venezuelans I spoke with in El Nula confirmed Elizabeth's story, and credited the guerrillas with making El Nula a much safer place to live than most other Venezuelan towns. Santos Moncada, who owns a cattle ranch outside town, said that in his opinion the guerrillas were fair, on the whole, in their dispensation of justice. "Because of the authority of the FARC, people can leave their cars unlocked and walk around with jewelry on without worrying about it," he said. "You could never do that in Caracas."
Elizabeth doesn't like the term "narcoguerrillas," which is used to describe the FARC. "I never saw any drugs in my life until I went to prison," she claimed. "The FARC doesn't traffic in drugs; it just makes the traffickers pay a tax to raise funds for the boys, who don't receive salaries, to buy them boots, uniforms, and food." The money for the war effort had to come from somewhere. Elizabeth said she had only one regret, which was that her injury had ruined her chances of being a guerrilla comandante. "I believe I was born to be a leader," she said. I asked her if she worried about being arrested again. "There's nothing the Army or the police can do to me," she replied in a sassy way. "All I do is carry messages back and forth, which isn't a crime. And, besides, I have a Presidential pardon." I asked what she thought of President Chávez. "I like him," she said. "He wants equality between the social classes." She paused, and then, a big smile spreading on her face, she added, "He's a guerrilla, that's what he is."
Hugo Chávez was the second of six sons born to Elena Chávez Frías and her husband, Hugo de los Reyes Chávez, poor primary-school teachers in the western state of Barinas. Hugo, Jr., was an avid baseball player and reader of history. He joined the Army as a junior cadet at the age of seventeen and graduated from Venezuela's military academy in 1975 with a degree in military arts and sciences. He was assigned to a battalion that had been ordered to crush an uprising in Barinas led by a neo-Maoist organization, Bandera Roja.
Chávez has said that during the Barinas anti-guerrilla campaign he began to feel sympathy for the people he was fighting and for the revolutionary cause. He says that he and his friends didn't have the least idea of what they were going to do, but in the early eighties they formed the secret Movimiento Revolucionario Bolivariano. It was around this time that Hugo's eldest brother, Adan, a Marxist university professor, introduced him to Douglas Bravo, one of Venezuela's most famous former guerrilla leaders. Adan Chávez was a member of Bravo's Partido de la Revolución Venezolano, which advocated a Marxist revolutionary takeover in Venezuela in an alliance between civilian activists and military officers. Adan Chávez is now his brother's private secretary. He is an elusive figure, but we spoke several times, and once, in an uncharacteristic moment of candor, he said that he had named one of his sons Ernesto, after Che Guevara, whom, he said, he admired greatly.
Hugo Chávez worked with Douglas Bravo until shortly before the 1992 coup-d'état attempt, when they broke off ties. Bravo told me that Chávez had sold out his leftist principles in favor of a purely military coup. President Chávez tells a different story, which is that Bravo broke with him much later on, after he decided to seek power by means of the ballot box instead of the gun. In any case, the break with Bravo is emblematic of Chávez's problems with some leftists in Venezuela, who have qualms about his military background, his pro-business policies, and his friendships with people of varying political philosophies—including, bizarrely, Norberto Ceresole, an Argentine neofascist and Holocaust denier who was asked to leave Venezuela after Chávez became President. "There are people with rhetoric that is even more radical than ours, who are operating on the margins of this process, and who could abort it with their actions," Chávez's Interior Minister, Luis Miquelena, said to me.
In April, a group of students occupied the administrative offices of the Central University of Venezuela, the largest school in the country. The students complained that the university was run by a "professorial aristocracy." Douglas Bravo was with the protesters the day I visited the campus. Bravo is a short, dapper man in his late sixties. He was conferring with young men wearing Che Guevara T-shirts. One of them, Pavel, an engineering student in his early twenties, explained what they were fighting for. "The university has not fulfilled its social role," he said. "It is divorced from the society around it. It has become a mummy, a sepulchre, and we want each classroom to be linked to the society outside the campus." Bravo explained that the university takeover was an essential step forward in what he called "the interrupted process of the Bolivarian revolution." What happened next depended to a large extent on Chávez. "He allies himself either with the forces of globalization," Bravo said, "or with the masses."
In some of Caracas's worst slum districts, restless leftist militants have formed an armed, quasi-guerrilla underground. So far, they have devoted themselves to "social cleansing" activities, such as executing drug pushers and other miscreants. A chavista deputy in the National Assembly, Marelis Pérez Marcano, who is a former guerrilla herself, told me that she worries about the slow pace of change. "My greatest fear is that the revolutionary climate generated by President Chávez will begin to fall away. We need to stimulate the people, to keep the flame of revolution alive." She was helping to organize a network of Fuerzas Bolivarianas, citizens' committees. "With these mechanisms in place," she said, "the revolution will be irreversible. The people are behind Chávez, but if—God forbid—others try to remove him from power by force, the people will be able to go out and defend him."
Luis Enrique Ball Zuloaga, a Venezuelan businessman in his early forties, describes Chávez's political radicalism as an inept continuation of the big-government, free-spending policies of the puntofijista governments that preceded him. Carlos Andrés Pérez nationalized the oil business when he was President, in the nineteen-seventies, and unprofitable government-owned industries were bankrolled. "Absolutely everything ended up in the hands of the state," Ball Zuloaga said. "It was practically the Sovietization of Venezuela's economy. And we used to have one of the most open economies in the world. This used to be like Hong Kong!" Ball Zuloaga said that until fairly recently the Van Cleef & Arpels store in New York had a plaque that read "New York, Paris, Caracas." Of course, he added, the Caracas shop has long since closed.
Ball Zuloaga lives in a huge house built by his grandfather in the Spanish Cantabrian style, with stone fasciae and a peaked terra-cotta roof. He went to Choate and studied economics at Carnegie Mellon before returning to Venezuela to help administer the family's businesses—banks and insurance companies. Until two years ago, he was the president of the Venezuelan Confederation of Industrialists. He said that his successor had been trying to make an appointment with Chávez, without success. "I don't know anyone who can get close to him. I would say he is the most isolated leader Venezuela has had in forty years. He thinks like a soldier, and is surrounded by people who supported him either in his coup attempt or in his political campaign." Things cannot continue as they are for much longer, Ball Zuloaga said. "Chávez has two options, either to open up to the private sector or to radicalize further. I believe he will opt for radicalizing. I think Venezuelan society will have to live through disaster before it can go back to being a prosperous and forward-looking country."
Chávez was born in a dirt-floored adobe house in Sabaneta, a little town surrounded by grazing Zebu cattle, royal palms, and mango trees, but his family moved long ago to the city of Barinas, the state capital. In 1998, while Hugo was running for President, his father campaigned for governor of the state and won. Hugo, Sr., has not been well (he was operated on recently for prostate cancer), and his sons help with the governor's duties. Narciso, a businessman; Argenis, an electrical engineer; Aníbal, an English teacher; and Adelis, a banker, have been characterized as a gang of sticky-fingered petty thieves whose activities have greatly embarrassed Hugo Chávez. He was said to have dispatched Adan to Barinas several times to reprimand them, but when I told the President that I'd like to meet his family he said he thought it was an excellent idea, and he instructed Adan to make the arrangements.
The governor's mansion in Barinas, a smaller version of La Casona, is a rambling house with a colonnaded veranda and a garden filled with shade trees. The governor's office contains a wheezy air-conditioner, a large portrait of Bolívar, and two carved wooden busts—one of Hugo Chávez and one of Christ. On a side table there is a photograph of Hugo's mother, Doña Elena, with Daniel Ortega, the former Nicaraguan Sandinista leader. Ortega has his arm around her. I was entertained first by the youngest Chávez brother, forty-year-old Adelis, a pleasant-looking man with a wide jaw and straight black hair. Adelis was wearing a gray business suit and a pink floral tie with a gold tiepin. He also wore a gold vanity bracelet, a gold ring with a diamond inset, a gold pen in his suit pocket, and a gold lapel pin.
Adelis, who had recently become a corporate vice-president at the Banco Sofitasa, said that he had learned to "immunize" himself from the political gossip that swirled around the family, and especially around his brother the President. But he was indignant, he conceded, about being called a thief, as had happened not long ago, when he bought a new house. "I bought it with my own savings, and with credit from a bank, and not the bank I work for," he said. I asked Adelis if he had any political ambitions of his own. He smiled and said no, he was quite content to remain in the private sector for the foreseeable future. He had recently won the state franchise for a major Venezuelan mobile-telephone network. "I had no idea these phone concessions were so lucrative," he said. "It's a really profitable business!"
After Adelis left, Don Hugo and Doña Elena came into the office. The Governor, a gray-haired man with dark skin, appeared to be tired. I could see that Hugo Chávez inherited his skin color from his father, but his full face and thick jaw clearly came from Doña Elena, a small, sturdy woman with fair skin and penetrating eyes. She was dressed in slacks and a floral shirt. Doña Elena did much of the talking. "You know, sometimes I think Hugo has been sent by God to do these things to help his people," she said. "But he is so alone there. I pray that God and the Holy Virgin will take care of him for me, because he has enemies." Don Hugo interrupted to say that he was concerned about "infiltrators and opportunists" within his son's government. He said that he was convinced that if there was a confrontation the Venezuelan people—el soberano—would fight to defend the revolution. He and Doña Elena had recently returned from Cuba. It had been their first trip outside of Venezuela, a wonderful experience. They had been treated magnificently by Fidel. Don Hugo had asked his son to send eighty Cuban sports instructors to Barinas. Soon, Don Hugo added, some Cuban doctors would be arriving as well. "The Cubans go wherever they are ordered to go," he said, "because they have been conscientisized. The Cubans will help us conscientisize"—raise the consciousness of—"the Venezuelans. That's the idea."
A few days later, the President invited me to accompany him on a trip to the interior. Our first stop was Barinas, where Chávez opened a new section of highway. When our helicopters touched down, people broke through the security cordon and swarmed around Chávez, screaming his name and holding up placards and letters addressed to him. Chávez dispensed kisses and handshakes as he made his way slowly toward a speaker's pavilion in a large dirt square. Free refreshments were being handed out in tents. Twenty freshly slaughtered cows were being roasted on spits. Soldiers were standing at attention, together with a couple of hundred men in clean khaki uniforms and tan rubber boots. The men in khaki held picks and shovels as if they were rifles. They belonged to one of Chávez's new volunteer "reservists' battalions," which are made up of former military conscripts. The volunteers are given a small salary, a uniform, and refresher courses in soldiering before being sent out to work on roads, state-owned cattle and sheep ranches, and construction jobs. After reviewing the troops, Chávez spoke about the need for an equitable distribution of land and lauded his audience as "the people who have been suffering, beaten down, and humiliated but are now dignificados!" The crowd cheered.
It took Chávez five minutes to walk to his jeep through the press of people, and another fifteen for him to drive out of the square. As the vehicle inched forward, two soldiers standing behind Chávez filled shoulder bags with the letters being shoved at them. I had followed the progress of a man in a wheelchair through the frantic waving gestures of one of his relatives, who was holding up an X-ray in one hand and a placard in the other. It read, "President Chávez: Help me, please, I have a broken spinal column and I need your help." Eventually, the X-ray was passed over the crowd, hand to hand, and made it into one of the bags of Chávez's bodyguards. A great cheer went up. "And they call this a dictatorship," Jorge Giordani, Chávez's Minister for Social Planning, murmured.
It was past midnight when we returned to Caracas, after further riotous stops in Sabaneta, where Chávez inaugurated a Bolivarian computer center, the first of a thousand he wants to open across Venezuela, and in another rural town, Cojedes, where crowds of peasants greeted him with signs begging him to give them land to farm. The next morning, I went to see Jorge Giordani in his office. He is an unusual-looking man, with a large forehead and a very wide face with pale skin and a white beard. He wears glasses that make his blue eyes appear huge. Giordani and Chávez met in the early nineties, when Giordani was a professor of economics and social planning at the Central University of Venezuela and Chávez was in prison. He asked Giordani to become his teacher. "The plan was for Chávez to write a thesis on how to turn his Bolivarian movement into a government," Giordani said. "He never finished the thesis, though. Whenever I ask him about it, he just tells me, 'That's what we are doing now, putting theory into practice.' "
Giordani spoke with me at length about the plans he and Chávez have for Venezuela's revolutionary future. He used the word "utopian" a lot. He showed me maps and charts for a series of "self-sustaining agro-industrial communities" that they were going to build in the interior. The Venezuelan Army had already begun working on the first ones. The communities would eventually become small cities, with populations of up to fifty thousand people. "We want to get rid of the shantytowns, to repopulate the countryside," Giordani said. He conceded that the idea might seem unrealistic. "But in social planning one moves between utopia and reality." Anyway, he added, "this isn't something that is going to happen tomorrow. This is a fifty-year plan."
The next day, at the Maracaibo Country Club, a patch of green lawn surrounded by red-baked wasteland where Chávez was to be picked up and driven to a nearby rest home, two dozen or so peasants had gathered to stare at him through a chain-link fence. The peasants were skinny, with black hair and angular features. Their clothes were frayed and soiled. There was a woman, several men, and eight or nine children. Chávez said hello and asked them if they were Guajiro Indians. Yes, replied the woman. From Colombia? Chávez asked. Yes, she said. Were they indocumentados—illegals? Yes. Chávez pulled out his wallet and showed them his own identity card. "Look, here's mine," he said. "Oops, it's expired! Guess that makes me illegal, too!" The Guajiros laughed at this.
"Listen," Chávez said, "we are all brothers here, Colombians and Venezuelans. We are the same people." He touched the children's fingers through the rusty fence and kept up his questions. He asked them how they survived and what they earned. They were sharecroppers on the land, a yucca farm—the woman gestured behind her—that belonged to a retired colonel, and they were given half the harvest in return for their work. They had earned a million bolivares—approximately thirteen hundred dollars—she said, for eight months' work. "A million!" Chávez exclaimed, and did some quick calculations on his fingers. "But that's much less than the legal minimum wage. What is the name of the landowner?" She told him. Turning to one of his aides, Chávez snapped, "Find out about this man. I want de-tails on him. Check out his land titles, too." Chávez asked if the children in the group went to school. The woman said they had been told that since they had no identity papers their children couldn't go to the local school. Chávez asked where the school was and who the administrator was. The woman pointed in the distance.
"Under our new constitution," Chávez said to the Guajiros—and he pulled out a copy of the constitution, a small blue book, which he keeps in his breast pocket—"this book here, everyone in Venezuela has the right to go to school, whether or not they have papers." He told them that they were being exploited. "Do you understand me?" They nodded their heads, and Chávez turned to General Cacerez, the Maracaibo regional Army commander, who stood behind him. "Listen. I want the land tenure around here investigated," he said. "I want them to own their land, to have a school, and a clinic." General Cacerez looked flustered. "Sí, mi comandante," he replied. Chávez's aides were scribbling furiously in notebooks, and the Guajiros were wearing disbelieving expressions. The woman who had been doing all the talking said to Chávez, in a dreamy way, "I knew when I saw you that you would come over to us." Chávez entwined her fingers in his through the mesh. "I love you people," he said. She pressed her face against the mesh and replied shyly, "And we love you, too, Chávez." Then, after more instructions to his aides, Chávez took his leave, telling the Guajiros not to worry, he would be back one day soon.
The following morning, Chávez went to La Esmeralda, an outpost in the Amazon jungle at the headwaters of the Orinoco River, an hour and a half from Maracaibo by Presidential jet. La Esmeralda is in a rain forest, at the base of a great massif, one of Venezuela's extraordinary tabletop mountains, called tepuis, which are the two-billion-year-old remnants of the mountains of Gondwanaland. La Esmeralda has a Salesian mission, a National Guard barracks, a few tin-and-palm-roof houses, a river dock, and not much else. Some nuns and missionaries, soldiers, civilian officials, and a group of barefoot Indian boys and girls, some wearing grass skirts, whose torsos and legs bore hand-painted designs, waited for Chávez on the airstrip. He had come to La Esmeralda to give a fleet of fibreglass river ambulances with new outboard motors to the area's isolated Indian communities, and to inaugurate an indigenous-people's radio station, which had been set up by the National Guard. Chávez had included a sweeping indigenous-rights bill—Venezuela's first—in the new Bolivarian constitution. As the ceremonies took place, representatives of various Indian communities milled about, awaiting a chance to speak to him.
Suddenly, a group of about thirty Yanomami men appeared on a run from the forest on the far side of the airstrip. The Yanomami are an indigenous people who hunt and fish in a remote part of the jungle that straddles both sides of Venezuela's border with Brazil. They wore loincloths, and their bare torsos and legs were covered in black war paint. Their faces were smeared red, and they brandished spears and axes. They were making yipping sounds and shaking their weapons. About a hundred feet from where Chávez was delivering his speech, the Yanomami were stopped by security men and some National Guardsmen with rifles. In the middle of the group, a small Yanomami man was shouting in halting, barely intelligible Spanish. He was hyperventilating with excitement. Occasionally, he stopped to gasp for breath, and then continued shouting, in a high, reedy voice. One of Chávez's aides called out a few questions while writing things down on a notepad, but it was a futile exercise; the Yanomami spokesman was not listening. Eventually, I understood that he was issuing a complaint on behalf of several villages that had been excluded from the handout of riverboat ambulances. He concluded furiously, "For this, we are very angry!" He shoved his spear high into the air and yipped. His fellow-warriors followed suit, and began jumping and yipping, too. Then, suddenly, the Yanomami turned around as one and ran back across the airstrip and into the forest.
Chávez had been unaware of the scene with the Yanomami. He was still speechifying, telling the indigenous people gathered in the little crowd that they were the original Venezuelans and that all Venezuelans, whether Indian, black, or white, enjoyed equal rights under the new constitution. As for himself, Chávez told them, he could boast of having all of those bloods. "Soy blanco, negro, y indio," he shouted. "Just like the majority of Venezuelans!"
On the return flight to Caracas, Chávez called me into his private compartment. He pulled out his agenda, and proposed that I come to his office in Fuerte Tiuna, the military headquarters, the following morning. I told him about all the letters I had to give him. "Oh, yes, the letters!" he said, and laughed. He explained that he had a special team of assistants who typed up summaries of the letters every night. Every morning, he went over them. "All of them?" I asked. "All of them," he assured me. "The ones that seem to merit our attention, I order my people to follow up."
Nearly everything in Venezuela's Bolivarian revolution, it seems, depends upon Hugo Chávez's personal attention. The result is haphazard, anarchic. Those who are lucky enough to catch Chávez's eye—like the Guajiros outside the fence at the Maracaibo Country Club—reap the benefits. Those who don't, like the irate Yanomami warriors, are out of luck.
Chávez's micromanagement of his country's affairs made it difficult to avoid taking responsibility early this summer for the embarrassing incident involving Vladimiro Montesinos Torres, the former head of intelligence in Peru, whose corrupt practices brought down the Fujimori government. For months, Montesinos was said to be hiding in Venezuela, and there were reports that he had had plastic surgery in a clinic in Caracas. Chávez first denied that this was possible and then launched an official search, which produced nothing.
Chávez was said to be hiding Montesinos because he owed him favors. In November, 1992, some of the ringleaders of the second failed coup d'état in Venezuela, including men loyal to Chávez, flew to Peru, where Montesinos gave them sanctuary. There were also suggestions that Montesinos may have helped finance Chávez's 1998 Presidential campaign, and that Chávez was somehow involved with Montesinos's arms-trafficking activities, which included shipping weapons to guerrillas in Colombia. There was, and still is, no proof of these allegations, but the rumors persist, particularly because of the circumstances under which Montesinos was finally captured.
On June 24th, while presiding over a meeting of Latin-American Presidents in Venezuela, Chávez theatrically announced that Montesinos had been seized by Venezuelan authorities in Caracas the night before. Montesinos was bundled onto a plane and flown to Lima, where he was charged with a variety of crimes, including torture, murder, drug- and arms-trafficking, bribery, and blackmail. He was placed in a maximum-security prison cell, where he remains today. Almost immediately, however, the F.B.I. and Peruvian security officials insisted that they, not the Venezuelans, deserved the credit for tracking Montesinos down, and implied that Chávez had made the "capture" to save face. Ambassadors were withdrawn and denials were published, but Peru's new President, Alejandro Toledo, avoided saying anything that might bring him into conflict with Chávez. The Montesinos problem between Venezuela and Peru was apparently put to rest on July 28th, when Chávez showed up for Toledo's inauguration. He greeted him with a friendly embrace. "We won't permit a small group of mafiosos, extortionists, and blackmailers to perturb the sacred love between our peoples," he said. Three Peruvian congressmen chanted, "Chávez, dictator!" on the floor of the Congress after the swearing-in, and Chávez walked up to them and shouted something back. He claimed later that he had managed to shake hands with one of them.
In mid-August, Fidel Castro came to Venezuela to celebrate his seventy-fifth birthday. He and Chávez took a trip to Canaima National Park to see the most spectacular tepui mountains. They flew over Angel Falls. In a ceremony held in the Venezuelan state of Bolívar, Chávez bestowed a medal on Fidel, who said that he accepted it not for himself but on behalf of the Cuban people's struggle against the United States. The two leaders did a little business, expanding their coöperation agreement so that in exchange for its oil shipments Venezuela will receive Cuban experts in tourism and agriculture as well as in sports, medicine, and education. "It's not just a commercial deal," Chávez said. "We're not just counting up 'I'll sell you this, you sell me that.' It's coöperation from the soul, a brotherhood." A few days earlier, the small United States military mission in Caracas, which has occupied an office in Fuerte Tiuna for the past forty years, was asked to move out. The Army needed the space.
Fuerte Tiuna is a calm, clean, orderly place with clipped lawns and newly painted barracks and stables. Soldiers in crisp uniforms salute nearly everyone who crosses their paths. There is a bronze statue of Simón Bolívar on the ground level of the big atrium of the Defense Ministry building, under a stained-glass skylight depicting El Libertador on the battlefield. The balconies of several floors of offices overlook the atrium. Chávez's office is on one of the upper floors. The morning I met him there, he was dressed in a tan military uniform encrusted with ribbons and medals. I gave him all the letters I was carrying for him, and we went through each of them before he handed them over to an assistant.
"Did you know," Chávez said, "that this is the very room I was brought to as a prisoner on the fourth of February, 1992, after I surrendered? I sat on that very couch over there." He pointed to a sofa across the room. "Everything is exactly the same." He told me how he had persuaded the military commanders to let him go on live television to address his comrades, who were still fighting. Chávez said that he hadn't rehearsed anything. "All I knew was that I didn't want to appear before the nation looking like Noriega when he surrendered to the gringos, defeated and with a number hanging around his neck." He said that "an inner voice" had suddenly begun speaking for him. "I don't know what it was. My subconscious or something." The words had just spilled out of him, he said. Then he repeated, verbatim, the speech he had delivered that night.
I asked Chávez about the problems he faced, now that he was in power, and he drew a series of arrows and blocks on a piece of paper. These were his "actions" and his "obstacles." He said that he had won the first phase of the revolution, the political phase, which included the Presidential victory and the successful referendum for the new constitution. The next phase, he said, was the socioeconomic revolution, and his enemies were trying to prevent him from carrying it out. He drew a new, straight arrow and, in front of it, more blocks, and then another arrow that veered off to one side. The two arrows represented the courses he now faced, Chávez said. The straight arrow was for "revolution" and the other, pliant one represented "reformism."
"Maybe, within two years," Chávez said, "we will be able to say that the Bolivarian revolution overcame its obstacles." He pointed his pen at the straight arrow. "Or else that it was obliged to deviate, and ended up being a reformation." He stabbed at the pliant arrow. "But that," he added, "would be very damaging, not just for our process but also for our country, because the truth is, we need a revolution here, and if we can't achieve it now it will come later, with another face, other characteristics. . . . Maybe in the same way as when we came out, one midnight, with guns."
Chávez admitted that there was still some "misunderstanding and confusion," especially in the United States, about exactly what his policies were. "Until recently," he said, "what was being mooted, here as well as abroad, was the taming of Chávez. Let's treat him well, and see if we can tame him." He laughed gruffly. "But it seems that this beast isn't very tamable." He lowered his voice, and he didn't smile. "This is about an ideological conviction of mine, and nothing is going to change it." ♦


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This information is produced and provided by the National Cancer Institute (NCI). The information in this topic may have changed since it was written. For the most current information, contact the National Cancer Institute via the Internet web site at http://cancer.gov or call 1-800-4-CANCER.
Gallbladder cancer is a disease in which malignant (cancer) cells form in the tissues of the gallbladder.
Gallbladder cancer is a rare disease in which malignant (cancer) cells are found in the tissues of the gallbladder. The gallbladder is a pear-shaped organ that lies just under the liver in the upper abdomen. The gallbladder stores bile, a fluid made by the liver to digest fat. When food is being broken down in the stomach and intestines, bile is released from the gallbladder through a tube called the common bile duct, which connects the gallbladder and liver to the first part of the small intestine. Anatomy of the gallbladder. The gallbladder is just below the liver. Bile is stored in the gallbladder and flows through the cystic duct and the common bile duct into the small intestine when food is being digested.
The wall of the gallbladder has 3 main layers of tissue.
Between these layers is supporting connective tissue. Primary gallbladder cancer starts in the inner layer and spreads through the outer layers as it grows.
Being female can increase the risk of developing gallbladder cancer.
Anything that increases your chance of getting a disease is called a risk factor. Having a risk factor does not mean that you will get cancer; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors for gallbladder cancer include the following:
Possible signs of gallbladder cancer include jaundice, pain, and fever.
These and other symptoms may be caused by gallbladder cancer. Other conditions may cause the same symptoms. Check with your doctor if you have any of the following problems:
Gallbladder cancer is difficult to detect (find) and diagnose early.
Gallbladder cancer is difficult to detect and diagnose for the following reasons:
Gallbladder cancer is sometimes found when the gallbladder is removed for other reasons. Patients with gallstones rarely develop gallbladder cancer.
Tests that examine the gallbladder and nearby organs are used to detect (find), diagnose, and stage gallbladder cancer.
Procedures that make pictures of the gallbladder and the area around it help diagnose gallbladder cancer and show how far the cancer has spread. The process used to find out if cancer cells have spread within and around the gallbladder is called staging.
In order to plan treatment, it is important to know if the gallbladder cancer can be removed by surgery. Tests and procedures to detect, diagnose, and stage gallbladder cancer are usually done at the same time. The following tests and procedures may be used:
Certain factors affect the prognosis (chance of recovery) and treatment options.
The prognosis (chance of recovery) and treatment options depend on the following:
Treatment may also depend on the age and general health of the patient and whether the cancer is causing symptoms.
Gallbladder cancer can be cured only if it is found before it has spread, when it can be removed by surgery. If the cancer has spread, palliative treatment can improve the patient's quality of life by controlling the symptoms and complications of this disease.
Taking part in one of the clinical trials being done to improve treatment should be considered. Information about ongoing clinical trials is available from the NCI Web site.
Tests and procedures to stage gallbladder cancer are usually done at the same time as diagnosis.
See the General Information section for a description of tests and procedures used to detect, diagnose, and stage gallbladder cancer.
There are three ways that cancer spreads in the body.
The three ways that cancer spreads in the body are:
When cancer cells break away from the primary (original) tumor and travel through the lymph or blood to other places in the body, another (secondary) tumor may form. This process is called metastasis. The secondary (metastatic) tumor is the same type of cancer as the primary tumor. For example, if breast cancer spreads to the bones, the cancer cells in the bones are actually breast cancer cells. The disease is metastatic breast cancer, not bone cancer.
The following stages are used for gallbladder cancer:
Stage 0 (Carcinoma in Situ)
In stage 0, abnormal cells are found in the inner (mucosal) layer of the gallbladder. These abnormal cells may become cancer and spread into nearby normal tissue. Stage 0 is also called carcinoma in situ.
Stage I
In stage I, cancer has formed and has spread beyond the inner (mucosal) layer to a layer of tissue with blood vessels or to the muscle layer.
Stage II
In stage II, cancer has spread beyond the muscle layer to the connective tissue around the muscle.
Stage IIIA
In stage IIIA, cancer has spread through the thin layers of tissue that cover the gallbladder and/or to the liver and/or to one nearby organ (such as the stomach, small intestine, colon, pancreas, or bile ducts outside the liver).
Stage IIIB
In stage IIIB, cancer has spread to nearby lymph nodes and:
Stage IVA
In stage IVA, cancer has spread to a main blood vessel of the liver or to 2 or more nearby organs or areas other than the liver. Cancer may have spread to nearby lymph nodes.
Stage IVB
In stage IVB, cancer has spread to either:
For gallbladder cancer, stages are also grouped according to how the cancer may be treated. There are two treatment groups:
Localized (Stage I)
Cancer is found in the wall of the gallbladder and can be completely removed by surgery.
Unresectable, recurrent, or metastatic (Stage II, Stage III, and Stage IV)
Unresectable cancer cannot be removed completely by surgery. Most patients with gallbladder cancer have unresectable cancer.
Recurrent cancer is cancer that has recurred (come back) after it has been treated. Gallbladder cancer may come back in the gallbladder or in other parts of the body.
Metastasis is the spread of cancer from the primary site (place where it started) to other places in the body. Metastatic gallbladder cancer may spread to surrounding tissues, organs, throughout the abdominal cavity, or to distant parts of the body.
There are different types of treatment for patients with gallbladder cancer.
Different types of treatments are available for patients with gallbladder cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Three types of standard treatment are used:
Gallbladder cancer may be treated with a cholecystectomy, surgery to remove the gallbladder and some of the tissues around it. Nearby lymph nodes may be removed. A laparoscope is sometimes used to guide gallbladder surgery. The laparoscope is attached to a video camera and inserted through an incision (port) in the abdomen. Surgical instruments are inserted through other ports to perform the surgery. Because there is a risk that gallbladder cancer cells may spread to these ports, tissue surrounding the port sites may also be removed.
If the cancer has spread and cannot be removed, the following types of palliative surgery may relieve symptoms:
Radiation therapy
Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. The way the radiation therapy is given depends on the type and stage of the cancer being treated.
Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping the cells from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). The way the chemotherapy is given depends on the type and stage of the cancer being treated.
New types of treatment are being tested in clinical trials.
This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Information about clinical trials is available from the NCI Web site.
Radiation sensitizers
Clinical trials are studying ways to improve the effect of radiation therapy on tumor cells, including the following:
Patients may want to think about taking part in a clinical trial.
For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment.
Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.
Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward.
Patients can enter clinical trials before, during, or after starting their cancer treatment.
Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better. There are also clinical trials that test new ways to stop cancer from recurring (coming back) or reduce the side effects of cancer treatment.
Clinical trials are taking place in many parts of the country. See the Treatment Options section that follows for links to current treatment clinical trials. These have been retrieved from NCI's listing of clinical trials.
Follow-up tests may be needed.
Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. This is sometimes called re-staging.
Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred (come back). These tests are sometimes called follow-up tests or check-ups.
A link to a list of current clinical trials is included for each treatment section. For some types or stages of cancer, there may not be any trials listed. Check with your doctor for clinical trials that are not listed here but may be right for you.
Localized Gallbladder Cancer
Treatment of localized gallbladder cancer may include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with localized gallbladder cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
Unresectable, Recurrent, or Metastatic Gallbladder Cancer
Treatment of unresectable, recurrent, or metastatic gallbladder cancer is usually within a clinical trial. Treatment may include the following:
Check for U.S. clinical trials from NCI's list of cancer clinical trials that are now accepting patients with unresectable gallbladder cancer, recurrent gallbladder cancer and metastatic gallbladder cancer. For more specific results, refine the search by using other search features, such as the location of the trial, the type of treatment, or the name of the drug. General information about clinical trials is available from the NCI Web site.
For more information from the National Cancer Institute about gallbladder cancer, see the Gallbladder Cancer Home Page.
For general cancer information and other resources from the National Cancer Institute, see the following:
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Editorial changes were made to this summary.
Call 1-800-4-CANCER
For more information, U.S. residents may call the National Cancer Institute's (NCI's) Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 a.m. to 8:00 p.m., Eastern Time. A trained Cancer Information Specialist is available to answer your questions.
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The NCI's LiveHelp® online chat service provides Internet users with the ability to chat online with an Information Specialist. The service is available from 8:00 a.m. to 11:00 p.m. Eastern time, Monday through Friday. Information Specialists can help Internet users find information on NCI Web sites and answer questions about cancer.
Write to us
For more information from the NCI, please write to this address:
Search the NCI Web site
The NCI Web site provides online access to information on cancer, clinical trials, and other Web sites and organizations that offer support and resources for cancer patients and their families. For a quick search, use the search box in the upper right corner of each Web page. The results for a wide range of search terms will include a list of "Best Bets," editorially chosen Web pages that are most closely related to the search term entered.
There are also many other places to get materials and information about cancer treatment and services. Hospitals in your area may have information about local and regional agencies that have information on finances, getting to and from treatment, receiving care at home, and dealing with problems related to cancer treatment.
Find Publications
The NCI has booklets and other materials for patients, health professionals, and the public. These publications discuss types of cancer, methods of cancer treatment, coping with cancer, and clinical trials. Some publications provide information on tests for cancer, cancer causes and prevention, cancer statistics, and NCI research activities. NCI materials on these and other topics may be ordered online or printed directly from the NCI Publications Locator. These materials can also be ordered by telephone from the Cancer Information Service toll-free at 1-800-4-CANCER (1-800-422-6237).
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
Images in the PDQ summaries are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in the PDQ summaries, along with many other cancer-related images, are available in Visuals Online, a collection of over 2,000 scientific images.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).
Last Revised: 2012-10-18
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