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CARACAS (Reuters) - In some of Latin America's largest slums ringing the Venezuelan capital, Cuban doctors vaccinate children, monitor pregnant women and conduct free eye tests where no medical services existed before.
Along with literacy and education programs and subsidized food, the clinics were part of an oil-for-doctors deal with Cuba's communist government that helped President Hugo Chavez win a second term with a landslide four years ago.
High oil prices meant the former soldier turned leftist revolutionary could drive down poverty to below 50 percent in South America's top crude exporter.
But many feel Chavez has not done enough during 11 years in power to change life in the teeming shantytowns where more than a million people live in red-brick tin-roof houses clinging precariously to the hills.
"Nothing has changed. All governments have been the same," said Felicia Blanco, 63, a resident of the eastern Caracas slum of Petare who is scared to leave her home.
Facing a test in September legislative elections, Chavez risks losing ground in his main bastions of support where garbage piles up, sewers leak and running water becomes scarce higher up the hillsides.
In 1999, a mudslide wiped out whole neighborhoods, killing more than 10,000. Chavez vowed to build decent housing and move people from the slums, which rampant crime make among the most dangerous in the hemisphere. He is far behind his targets.
"This is the most populist government we have ever had in terms of handing out free things in return for votes," said Father Alejandro Moreno, a Spanish-born Salesian priest and sociologist who has lived in the Petare slum for 30 years.
In one hillside slum in central Caracas, Chavez's government built a flashy cable car to ferry residents down to subway train stations. And in the staunchly pro-Chavez westside of Caracas, pots of paint have been handed out to volunteers to paint the shanties the three colors of the Venezuelan flag.
"These barrios have always been very pro-Chavez, because people hope for improvements and stopping all the oil money going to the rich," Moreno said. "That hope is still alive, but people are realizing it is false and are starting to react."
In local elections in 2008, an opposition party dealt the charismatic leader a blow by winning the state of Miranda and the Sucre municipal district, which includes the massive Petare slums and some of the more affluent neighborhoods of Caracas.
Since then, economic recession, high inflation and electricity and water shortages have dented his popularity further, although Chavez still has a near 50-percent rating in the OPEC nation.
At the entrance to Petare, government activists in red T-shirts tidy a square as loudspeakers blare out socialist slogans to roaring salsa music, though the pro-Chavez graffiti wears thin on the walls a few blocks into the slum.
"The health situation has improved here. We even have a Cuban instructor for dance-therapy classes, so the girls can lose some weight," said Raiza Blanco, a Chavez supporter who sells government-subsidized gas cylinders at half-price.
A sports complex built by the Chavez government has helped draw youths away from crime and drugs, Blanco said.
A report in February by the Organization of American States criticized Chavez for curbing freedom of expression, yet it acknowledged his government had improved healthcare, eliminated illiteracy and reduced poverty.
Chavez's critics say life in the Caracas slums has gotten worse because he spends more time on political speeches than helping the poor, and disillusionment is setting in.
In March, in the midst of a severe drought, Petare slum dwellers caused mayhem by blocking the main motorway for two hours to protest the lack of water for more than a month.
When the government rationed electricity, the uproar in Caracas was such that authorities quickly lifted the measure.
"The government is afraid of Caracas, because when it rises up it can overthrow governments," said Moreno.
Sucre Mayor Carlos Ocariz said Venezuelans are growing tired of listening to Chavez and not seeing results although he admits some programs have helped.
Despite Chavez's control over institutions, he believes the opposition can make important gains in September, and in 2012 presidential elections, by engaging Venezuela's poor.
"In 2008, we handed out flyers with ideas, while they handed out refrigerators, washing machines, mattresses," said the 38-year-old engineer.
Ocariz once had to run for cover from a shoot-out while campaigning in Petare. Since taking office, he has increased police patrols sixfold with better paid and trained officers, reducing the Sucre homicide rate by 20 percent, he says.
"This district was all red. Today, the slums of Sucre are no longer Chavista."
Reporting by Anthony Boadle, editing by Frank Jack Daniel and Eric Beech