Cuba Surgeons Write to Raul Castro About Disastrous Health Care System

Calixto Garcia hospital from:

Open letter from the General Surgery Department of the “Calixto Garcia” Hospital to the First Secretary of the Cuban Communist Party and President of the Councils of State and Ministers, Army General Raul Castro Ruz

To be good is the only way to be happy.
To be cultured is the only way to be free.
But, given human nature, one needs to be prosperous to be good.
José Martí

The “Calixto Garcia” hospital in Havana takes as its mission to provide specialized preventative-curative medical care and rehabilitation without interruption to the population through high-quality medical care and high professional standards [1]. With its 100-year history it has been a permanent school of surgeons in the country, and an important element in our country’s struggle for independence; many of our professors were clandestine combatants [2] and brilliant doctors on international medical missions of great importance.

Surgeons at the hospital, respecting the Hippocratic Oath [3], have historically been characterized as being critical and self-critical, but especially combative in the face of difficulties, bad decisions taken, and the multiple errors that affect our nation, and that little by little are endangering the future, taking health as a pillar of the transformations arising in the Revolutionary period, and our duty to provide a professional and dignified medical care, in accord with the scientific advances of the 21st century.

After countless reports to the head of the service, hospital management, discussions within the core of the Cuban Communist Party, and our long standing inability to participate in discussion at other levels with the leaders of the ministry, where medical personnel present their uncensored opinions [8] and ways to solve the major problems currently plaguing the health sector, which include everything from training to direct care, a group of surgeons felt it their elementary duty [8, 9, 10] and agreed to send this letter to the head of the service, for the sole purpose of informing him of the extremely serious elements in healthcare delivery to the Cuban people, which apparently at this time when it is happening in public health in general, and in our hospital in particular, the lack of immediate plans to resolve them are unknown by the top political leadership of the country, contrasting inversely with the official discourse of our media.

Medical care, and especially surgery in our center is a great disaster, characterized by:

  • A hospital with a destroyed physical structure, due to its age and innumerable poor quality and short-term repairs.
  • A lack of important resources for the care of patients, because of inadequate distribution, insufficient management, or excess work because of the reduction of this activity in other hospitals for similar reasons.
  • Human mental deterioration accompanied by the loss of the minimum attention to the person, who spends long days of free labor for a significant number of hours, and in a country where the “free perks” have been ended, and where working conditions are below those of any poor place in the world.

In our hospital the surgical services have been declining and the number of operating rooms has been reduced from about 30 for all specialties to no more than 10 at present, which although greatly destroyed still provide this vital service to the people. The irregularities in these operating rooms, their constantly broken air conditioning, lack of water, lack of adequate equipment in some of them, means that cancer patients cannot be operated on in time in our institution, others with benign conditions, susceptible to immediate treatment when diagnosed, develop complications because of delays in the resolution of their problems.

And as if that weren’t enough, the urgent conditions also present great difficulties. These, which constitute an important number of cases, are referred from some other place in the city, many times transferred poorly, which puts the lives of these patients in danger and even kills them when theoretically this could have been avoided. Despite the fact this this is the only surgical priority this hospital serves a good part of the time, they must sometimes wait more than 24 hours between their arrival and their emergency surgery, mainly because of the lack of available operating rooms and of sufficient and adequate personnel, but also because of the physical exhaustion of the doctors who raise these issues and raise them again and discuss these problems at every possible level and/or a good part of the time put the responsibility on the orderlies, cleaners, and in addition put the full responsibility for sick patients on their families, the sick patients themselves, and society.

The deficiencies in the health care system are so serious, in our opinion, that we are forced by these issues and others of resources that continue in a temporary or permanent way, to provide care to our people that is not professionally ethical or dignified, as is our sacred duty.

Moreover, the repairs undertaken at our hospital, that have been underway for more than 10 years, have done little to change the unviability of a horizontal hospital in current times; the majority of the repairs are putting make-up on old buildings, performed with terrible quality and, of course, lasting a short time, which increases the frequency of new repairs.

Rooms that have waited 10 years for repairs, today crumble four months after they open, with the first downpour; leaks, collapses of the false ceilings, and a number of important areas declared inhabitable, are a daily fact of life in our work and our patients’ stays.

The suspension of operations because of the weather, water, insufficient rooms, or whatever cause, is no longer unforeseen but rather is commonplace. As the operating rooms are no longer available to solve the problems of the patients, now it is us, the surgeons, who must prioritize one or another patient in an an unfortunate and exhausting search for surgical opportunities for a Cuban whom we only know, sadly, because of his illness.

The only thing we need to add to this depressing picture is the working conditions of the doctors and the personnel in general, starting with wages that are not enough to support a family, degrading working conditions; including lack of a place to rest during long days of surgery or work, the several miles walked between rooms, in the dust, the sun, and many times the rain; the terrible quality and quantify of food; the lack of a decent place to take care of one’s physiological needs; and no showers to cool off in the intense heat or to clean up before contaminating a surgery, almost force us, when they become permanent, to change our mentality.

The fatigue leads to well studied complications [4, 5, 6, 7]; if on top of that we add the ridiculous figure of 2-1/2 gallons of gas a month for those fortunate enough to have cars, not even enough to go to and from work for the first week of the month, among many other mistreatments; it all completes the picture of deteriorations that definitely have a bearing on the medical care that is offered to the people.
Today it is impossible to ask doctors, even with a car, to come to the hospital in the middle of the night to check on their surgical patients, or to come on Sunday, as was common among surgeons historically; and what’s more it’s impossible to ask them to perform a new operation on a patient with complications at 10 PM and you don’t have to be very intelligent to know what happens with a case when a patient has been repeatedly operated on five times by different surgeons.

We believe that this situation generates unquestionably disastrous complications in patients, where studies show that after six hours of work of a surgeon’s complications multiply [4, 5, 6, 7]; and of course, that’s talking about working with appropriate comfort. Also in many cases, death, which we cause when we have a terminal patient with almost no hope; it is not ethically dignified because we can’t do for him what he deserves or should have, at the time it should be done: we have multiple examples from all the surgeons who work in this hospital, and the great number of the population who observe and criticize, that what is said in the media has no connection to our country and our hospitals.

We think that our government has a commitment in all this, because it exists to meet the needs of the people, to solve the problems of the people, of the workers, simply because they are responsible for maintaining the hospitals, for properly training the workers in a high quality and fair educational system, for developing an ethical education consistent with the work they will be doing, or anyone thinks why do doctors, engineers, builders undertake the missions they do in their work: they do it because their work makes things better, for their family and the society they live in, but unfortunately that is only achieved in our country by leaving it, leaving the country that gave us birth [10], which is ours by right, and nobody, absolutely nobody, has the right to take away our identity under any circumstances, and for which we must give even our lives for our nation to remain independent.

The misfortunes narrated here do not come alone, they come about slowly when the investment is maintained for years in the living standards of the people with their ability and dedications, the socialist law well known by everyone: “to everyone according to his work.” When the leaders, with their laws, decrees, special circulars, and their decisions and provisions, are compromising the future, how long will we thank the centenary generation for having fulfilled their duty and obligation of liberating Cuba, while our generation wants to fulfill its duty to develop and give our families, our children, our Cuban brothers, the life they deserve, while the destructive tracks of corruption run riot with a singular debauchery on every side of society where we turn our gaze?

As José Martí said: “given human nature, one needs to be prosperous to be good.” The government is responsible for all this, not only for knowing it, but also for fixing it. So, and before it’s too late, leading to events like those at the Mazorra hospital [where 40+ patients starved and froze to death], we decided in this group of doctors, sacrificing, hard-working, dedicated, ethical, and above all badly treated, to report to you and to those responsible all of our concerns, in our modest opinion serious ones, from this place so undervalued on the social scale, which is the heroic and historical general surgery service of the oldest hospital in our beloved country.

[3] Juramento Hipocrático.
[4] Editorial. Revista Canadian Medical Association Journal
[5] Journal of the American Medical Association

[8] “Now whomever wants to speak will speak, good or bad, but whoever wants to will speak. Not as happened here, when only those who spoke evil spoke, there will be freedom.” Speech by Fidel Castro. Parque Cespedes, Santiago de Cuba, on January 1, 1959.

[9] “… How can we say ‘this is our homeland’ if the homeland does not have anything? ‘My homeland’, but my homeland does not give me anything, my homeland does not sustain me, in my homeland I’m starving. That’s not a homeland! Will the homeland be for a few, but not a homeland for the people. Homeland does not mean only a place where one can shout, talk and walk without being killed; homeland is a place where you can live, homeland is a place where you can work and earn an honest living, and also earn what is fair pay for your work. Homeland is where the citizen is not exploited, because if they exploit the citizen, if you take away what belongs to him, if you steal what he has, that is not homeland.” Speech by Fidel Castro Ruz, at the Town Square of Camagüey, the January 4, 1959.

[10] “… it is precisely the tragedy of our people not to have a homeland. And the best evidence, the best evidence that we have no homeland is that tens of thousands of children of this land are leaving Cuba for another country to live, but they have no homeland. And not everyone who wants to leave goes, only those who can. And that’s true and you know it.” Speech by Fidel Castro Ruz, at the Town Square of Camagüey, the January 4, 1959.

Taken from, 22 September 2012