Cuba Needs More Doctors and Better Hospitals / Ivan Garcia
Ivan Garcia, 29 April 2015 — The urology ward at Calixto Garcia Hospital is a bleak scene. Patients in soiled pajamas wander through the halls like zombies with serum on their hands, in search of a urologist, who hasn’t come through the intake room all morning.
Ubaldo, sitting on a granite bench outside the room, chain smoking, waits for a nurse to change his bag full of discharge and urine after emergency surgery for an intestinal blockage.
The old hospital, built in the early years of the twentieth century, is being remodeled at a snail’s pace. But work has not yet reached the urology suite. Nevertheless, Ubaldo claims that Calixto Garcia is one the best hospitals.
“Of those existing for the people, only Amejeiras Brothers is better. It’s true that many of the rooms in Calixto Garcia are dilapidated. But because it’s a teaching institution, the quality of doctors is high. I live in Manzanillo and compared to a hospital there or in another eastern province, Calixto is a five-star hotel,” he says.
Is it commonly said that patients cross their fingers when entering a hospital on the island. The people come carrying buckets, cleaning rags, bedding, electric fans, and even televisions. As if they were going on a trip.
Families with means bring lunch and dinner to the patient, and sometimes also to the attending doctor or nurse.
“Now doctors and specialists earn around 1,500 pesos a month (60 CUC, roughly US$55-60), but many are still struggling. Senior medical students who serve internship receive a paltry stipend. So you try to give them gifts in money or things; the sacrifice of our doctors is tremendous. There should be two monuments erected in Cuba: one to the people, for putting up for so long with a system that does not work; and the other to physicians, who go to work leaving behind piles of problems at home,” says Alina, whose father has been admitted to the surgical clinic.
In Turcios Limas, a specialty clinic in Reparto Sevillano, a half-hour from downtown Havana, a small line starts forming at 6:00 a.m. to check on the availability of dermatology services.
“Supposedly they have to be available every Monday. But for two weeks the specialist hasn’t come. In the last year, four or five dermatologists have passed through here. They last no longer than a marshmallow in a school door. Then they go on a mission abroad and leave the patients in the lurch. I’ve complained to the neighborhood delegate and to MINSAP (Ministry of Public Health), but neither one has done anything for me,” an elderly woman complains.
One doctor, a specialist in burns, acknowledges that it is absurd to send doctors to Brazil or Venezuela, thereby causing a shortage in Cuba. “The doctors are going to these missions to be able to improve their own quality of life. The Ministry of Public Health should guarantee relief coverage. Medical collaborations are the principal business of this country, earning between eight and nine billion dollars a year. So the result is to export doctors and screw the people,” she says.
Chile was the first country to receive medical cooperation from the newly established revolutionary government. That first medical team was sent after the strong earthquake and tsunami of May 22, 1960, which devastated southern Chile. In 1963, after seven years of war against French colonialism, Algeria asked for healthcare assistance from Fidel Castro. Flights left for Algiers carrying 28 physicians, 3 dentists, 8 technicians, and 15 nurses.
Since then, Cuba has used doctors as a spearhead in its foreign policy. In poor countries in Africa or Haiti, the costs are borne by the World Health Organization or the Cuban regime, which with these collaborations secures a safe vote in the Human Rights Council and conclaves of the UN.
“It is very difficult for those countries to accuse Raul Castro of dictatorship when Cuban doctors have saved the lives of thousands of its citizens. The strategy is to buy political will. And they have succeeded,” says Robert, a retired doctor.
Despite the olive-green autocracy appropriating 70 percent of the salary paid to Cuban doctors in Brazil and Venezuela, the signup list for missions abroad is extensive.
“In Brazil you’re left with $1,200 of the $4,200 per month that [Brazilian President] Dilma Rousseff pays [the Castro regime for each doctor]. True, it’s robbery. But with what you can save in three years, you can buy an apartment or a car when you return to Cuba. We’re probably poorest doctors in the world,” says Raciel, an anesthesiologist.
Until 1989, the health system in Cuba was a gem. In a country with blackouts and rationing, Fidel Castro strutted on the platform, statistics in hand, displaying the unquestionable level of Cuban medicine.
But it has rained a lot since then. And the reversal is remarkable. The family-doctor program, a government strategy to place one physician and one nurse in each neighborhood for primary care, is now barely functioning.
Most of the clinics that were built are closed or have become uninhabitable. The few that are functioning have to serve a large number of patients.
In recent years they have started repairing hospitals and specialty clinics, but the quality and slowness of the work leave much to be desired. The shortage of specialists requires residents of other provinces to come to the capital for medical care.
Then there are the abuses of the regime. This is the case of those serving in Brazil. As required by the Mais Doctors Plan, implemented by the Brazilian government, the doctors can live with their families. But Cuban authorities only allow the families to stay for three months, angering those serving in that country.
“Within the medical staff there are fifty or sixty guys, obviously from State Security, whose mission is to monitor what we do,” says a doctor who had to return from Brazil for health reasons.
Today Cuba has health personnel in 67 countries, and about 50,000 doctors and specialists providing their services abroad.
In “More Doctors, More Health,” an article by Frei Betto published on April 20 in Cubadebate, the author of the book Fidel and Religion says that in Brazil there are 18,247 Cuban professionals scattered over 4,000 municipalities of his country, 14,000 of them in locations that are the poorest and most distant from urban centers. He estimates that in 2015 Cuban doctors will attend to some 63 million Brazilians.
Meanwhile, in Cuba there is a significant shortage of specialists, many hospitals are filthy and dilapidated, and the quality of care is in freefall. At the same time, there are exclusive clinics for foreigners, ministers, and generals. But that is another story.
Photo: Conditions in the bathrooms of Hospital Freyre de Andrade, Centro Habana, best known for Emergency Hospital. Fernando Freyre de Andrade (Cuba 1863-1929), military, lawyer and politician, was the seventh mayor of Havana. Photo by Julio Cesar Alvarez taken from CubaNet.