Ivan Garcia, 4 March 2017 — Twenty years later, Nivaldo (names changed), 43, an orthopedist, still remembers the hot morning when his parents said goodbye to him in the old train station in a small village in the depths of Cuba.
The economy of his native village, with narrow streets of cracked asphalt and the small of cane juice, revolved around the sugar mill and the usual thing was that grandfathers, fathers and grandsons worked in the sugar industry.
It was a sugar mill town like many others. Squat brick houses half plastered, a handful of white wood houses, guarded by five or six grungy prefabricated buildings, built after Fidel Castro’s Revolution.
The present and future of the village was to drink alcohol distilled from cane, playing baseball on scrub ground and taming some lost mare around some stinking green creek.
But Nivaldo wasn’t a cane cutter nor a worker at the mill. He graduated as a doctor on a rainy night in 1997 and after completing his social service in a mountainous area of Santiago de Cuba, specialized in orthopedics.
When he stepped in Havana for the first time, like almost all the country people, he took a photo at the base of the Capitol, and used a finger to count the number of floors in the Habana Libre Hotel or the Fosca Building.
“My dream was to be a doctor. Have a family and live according to my professional status. I’m a specialist, I have a marvelous family, but in order to maintain it I do things I’m not proud of.”
“I have been on international missions in South Africa, Pakistan and Venezuela. Not out of conviction but simply to earn money and repair and furnish my house. In Cuba it’s hard to find a doctor who hasn’t violated the Hippocratic oath, and accepted gifts or money to maintain his family. In the countries where I have worked, I’ve seen patients under the table who have paid me. In Cuba I have groups of patients who’ve given me gifts, a box of beer that costs sixty Cuban convertible pesos, according to the seriousness of their suffering.”
On the Castro brother’s island a lot of things don’t work. You can wait an hour and a half to get from one part of town to another because the chaos that is public transport.
From the time you get up in the morning the problems accumulate. There’s no water in the tank. There’s no money to buy a pair of shoes for the kids. Or you have to eat whatever there is, not what you need or desire.
Let’s not even talk about other things, also important for human beings, like freedom of expression, the right to join a party other than the communist party, or to elect the president of the Republic.
But healthcare, universal coverage, was the pride of the autocrat Fidel Castro. It worked well as long as the former USSR was sending checks worth millions and connected a pipeline of petroleum coming from the Caucasus.
Later with the fall of Soviet Communism the deficit came. Ruined hospitals, nurses looking like police agents and missing medical specialists. The Raul Castro regime tried to keep the the flagship of the Revolution afloat, but it was taking on water everywhere.
The first ones who become fed up are the doctors. If not all of them, at least a broad segment. The causes vary, but the keys are the low salaries and the lack of recognition for their work.
Migdalia, a dermatologist points out that “for six years I earned 700 Cuban pesos — about 35 dollars — and the salary was barely enough for me to buy fruits and vegetables at the market. Now I get 1,600 Cuban pesos — almost 75 dollars — and it’s not enough either. So I accept patients who give me bread and ham, or a piece of clothing, or money in cash, and I give them personalized attention.”
Joel, an allergist, wonders why, if what the international media says is true and the government gets between 7 and 8 billion dollars from the sale of medical services, “they don’t pay us salaries consistent with the inflation in the country. I was in Venezuela two years. The neighbors gave me food and gave me gifts of clothing and things. Rather than a doctor, I looked like a merchant buying stuff to sell when I came back. I got to Cuba, after three years on a mission, between business and the money I saved I had some four thousand dollars, not even enough to rebuild my house. Now I’m chasing a mission in Trinidad and Tobago or Qatar, but to get it you have to pay some official at the Ministry of Public Health (MINSAP) some 400 or 500 bucks for them to put you on the list. For these reasons, among others, many doctors decide to emigrate.”
If we credit the statistics, a little more than three thousand doctors have deserted in the last seven years. Venezuela is a destination that puts their lives at risk. The delirious criminality in the South American country has provoked, according to a statistic from 2010, the deaths of 67 Cuban health professionals.
The lack of high-quality specialists makes it difficult to care for patients in Cuba. Daniel has been looking for an ear specialist for six months to diagnose and treat a problem.
“They only treat you as am emergency in a hospital if you’re dying. Diseases and symptoms that require lab tests, exams with equipment such as cat scans or x-rays. can only be obtained quickly by paying with money or gifts. Preventive medicine on the island is in crisis,” Daniel affirms.
Twice a month, Marta pays 10 Cuban convertible pesos (CUC) to the dentist who sees her daughter. “It’s the only way to get high quality care. If you don’t pay, and try to work through the system, they don’t fix your mouth or they do it badly.”
Aida, who works for a bank, waited almost a year to get an appointment with an allergist. “Her appointment at the polyclinic was once a month. But she never went. With two little bites of ham, two soft drinks and 5 CUC I was able to get an allergist to see me. Then, if they see that you have resources, then they stretch out the attention to get more money out of you. Some doctors have become hucksters. It’s painful.”
When you go to appointments at hospitals, you see that the majority of patients are bringing gifts for the doctor. But it can be a gift in kind. Though many prefer cash.