Flooding and landslides in Venezuela's Vargas state in December 1999 killed up to 30,000 people. Just 10 months into his first term in office, president Hugo Chavez launched a major rescue effort. Cuba sent a 450 strong medical Brigade including 250 to assist. At the Venezuelan's request they remained after the emergency. In October 2000 Chavez and Fidel Castro sign their first cooperation agreement, which included Cuban assistance and improving the Venezuelan Healthcare system. Cuban doctors be sent were needed in Venezuela and deliver Public Health education. Venezuelans would train in Cuba as doctors, nurses and medical technicians and Venezuelan patients would receive medical treatment free of charge in cuba. Cuba would sell its medical products and equipment to venezuela. By 1998, when Chavez was first elected president, 17 million Venezuelans out of a population of 24 million, that is 70%, lacked regular access to medical care, and over 4 million Children and adolescents suffered from malnutrition, 1.2 million with severe malnutrition. The situation did not sufficiently improve during the early years of Chavez's presidency. In 2004 Hector Navarro, then the Venezuelan minister of higher education, describe the situation as a humanitarian crisis an estimated that 20,000 Physicians were acquired to tackle it. In 2003 a pro Chavez mayor in Caracas proposed the Barrio Adentro health program to introduce free local Health Professions to slums in Libertador municipality. The Venezuelan medical Federation instructed its members to boycott the initiative, so the mayor appealed directly to the Cuban Embassy for help. The program was subsequently launched in April 2003 with 58 Cuban doctors. In may, another 100 arrived and were spread throughout caracas. Following the program success and popularity, it was extended nationwide. Cuban healthcare workers poured into Venezuela to staff it. But December 2003 over 10,000 Cuban medical professionals, half of them women, were in Venezuela and had conducted 9 million patient consultations and 4 million Health interventions. They set up local practices and poor neighborhoods with one doctor for 250 families, living on the premises, as in Cuba