Public Health in Cuba

Rene Gomez Manzano

When talking about the Castro brothers’ regime in Cuba, it is common to hear not only about the results attained in education or sports, but also on the so-called "achievements" of the country in public health. What is the truth on this matter?

In comparison to pre-revolutionary Cuba, the Castro regime established quantitative differences, but not qualitative. In Cuba, before 1959, medical assistance in numerous hospitals was free of charge. We Cubans, in that respect, never faced the difficulties that American citizens did.  

However, it is true that before Castro, hospitals were concentrated mainly in the city of Havana, and although some were in other cities, in rural areas they practically did not exist.  Therefore from the very beginning, the triumphant revolution led by Fidel Castro began to amend that unjust situation.
The Cuban government quickly adopted Marxism-Leninism and aligned itself with the Soviet Union; immediately economic assistance began to flow from the Soviet Union, who was rapidly growing throughout the years. In lieu of the economic disaster that was set on the island by the new regime, the economic assistance from the Soviet Union was really indispensable in offsetting the negative economic effects caused by the regime.

Totalitarian socialism applied to Cuba destroyed almost all that had been accomplished during decades of free enterprise.  In this respect, our country has not been substantially different from other countries suffering the so-called "real socialism," with the exception that the vices the Cuban regime had developed have been carried out in Cuba to greater, more elaborate extremes.

An eloquent demonstration of the extent of the effects of Cuba’s "real socialism" is that the island, formerly known as "the Sugar-Pot of the World", now hardly produces enough sugar to satisfy its own needs. In recent years, the Cuban output of sugar has been similar to that of a century ago. The same thing has happened (due to different problems) within tobacco and coffee industries, as well.

Economic matters may seem to have nothing to do with the theme of this article, however that it is not so because having a solid and sustainable health system is only possible when based upon a strong economy.  Germany is an example that proves the thesis that a solid health system requires a strong economy; these economic conditions have been absent in Cuba.

The evidence provided thus far affirms that the so-called "achievements" of our (Cuba’s) health system are really not so. The "achievements" were based on the multi-billion dollar Soviet subsidies, which kept afloat the ailing insular economy. The Soviet subsidies were what really sustained all the hospitals’ infrastructure and what financed the sprouting of new health centers.

In noting the past dependency on Soviet subsidies, it can be easily understood that at the beginning of the nineties when the Soviet Union and its satellites suspended the abundant help given to Cuba, Cuba then entered a profound crisis, which was perceptible—and with great force—in the field of public health.

The regime’s propaganda used to describe the country as a so-called "world medical power", but later they chastely ceased to employ such an ambitious and inexact designation. During the score of years elapsed since the end of Soviet subsidies, the deterioration on health care in Cuba has only become more and more evident.

During the past two decades, the situation has become worse in regards to insufficiency or complete lack of indispensable medical materials, such as anesthetics, scalpels, dispensable syringes, or even elementary medicines such as aspirin or nose drops.  Those unlucky enough to have a relative interned in one of our hospitals are forced to bring the commonest of items, such as sheets, pillows, pajamas, a bucket or an electric fan; all such things - and even water - are usually lacking in Cuban hospitals.

Concerning the use of more or less sophisticated medical appliances, sanitary authorities make a virtue out of a sin. Doctors are requested to limit their use of medical appliances to the strictest minimum, including for example, magnetic resonances and even a mere X-ray exam. Ridiculous Communist propaganda masks the lack as it affirms that the measures taken demonstrate how the State is interested in the people’s health because it avoids the use of "aggressive techniques".

An obvious demonstration of the poor state of Cuban public health is the proliferation of illnesses which were not even known before Castro. For example dengue fever, which has become endemic, and cholera, which was not an epidemic in Cuba since the nineteenth century, are now both illnesses existing in Cuba.

Another figure which constantly fools public opinion is the proportion of medical doctors in the country. The proportion was praised again recently by the Minister of Foreign Affaires in front of the UN’s Council on Human Rights: one doctor for every 137 inhabitants. Opinions coincide on one point: in recent years, the high number of medical graduates is achieved thanks to the low level of their qualification; nevertheless, it is a fact that the output is high.

What that propaganda does not say is that tens of thousands of those graduates exercise their medical careers away from Cuba in the so-called "internationalist missions"; consequently, their practice does not benefit Cubans. Such missions are the reason for the long queues in hospitals and clinics to receive medical attention. Therefore the impressive statistic (1 for every 137) is nothing but a Communist fantasy.

The main motivation for those doctors who accept to work abroad is economical because the salaries they receive in Cuba amount to less than a dollar a day. Low salaries and very bad working conditions are the reasons why a good proportion of medical graduates, while marooned in Cuba, prefer to perform unqualified handy-man’s works in hotels and other places so as to obtain a higher income, especially if they have access to tourists’ tips.

When abroad, Cuban doctors and nurses become the object of fierce exploitation by the Communist government. For example, in Venezuela, where there are tens of thousands of Cuban doctors and nurses, the doctors and nurses receive approximately less than ten-percent of the amount paid to the Cuban government for their work.

In spite of all the plunder, Cuban doctors accept to be far away from their families for years and to work in inhospitable and even dangerous places because it is the only way they can acquire some goods and own appliances of which, in Cuba, due to their meager salaries, they cannot even dream.

In sum, we can cite the Castilian adage on this matter: not everything that gleams is gold.  The high number of medical graduates might “gleam”, but if that is the case, it does not happen in Cuba. Castro’s propaganda is very far from the truth when it brags about the supposed marvelous levels reached by the health service in Cuba.  

Havana, May 16, 2013
René Gómez Manzano