Cuba Medicine and an Offended Doctor / Miriam Celaya

Following the publication of the post “The Broken Showcase” in this blog, in which I noted several criticisms of the Cuban health system and the loss of professional ethics by not a few doctors, a reader was kind enough to send me the letter of a doctor with the surnames Alemán Matías, which circulated on the web, not in response to my post but in response to a note which was published some time ago in the Letters section, a feature that appears every Friday in the Granma newspaper.

However, as somehow the topic is related, and as I have opposing views to those wielded by the aforementioned doctor, today I propose to my readers to comment on the letter, transcribed in full below, and whose writing, spelling and style I have respected without altering them in the slightest. I do not cite the web source because I’m transcribing directly from the message of my reader. I urge readers, in order to avoid misunderstandings, to bear in mind that Dr. Alemán refers to a letter published in Granma and not to my post of last Monday, February 6:

And the patience of the doctors?!

On Friday, November 4, 2011 was published another letter of the many that have already been published, constantly criticizing the medical staff that still has the dignity of working in the National Health System. The letter in this case, entitled “Patience of patients,” doesn’t speak about the myriad difficulties faced daily by health workers, but superficially criticized and, in a way that has become a tradition, in a non-constructive way.

In other words, the doctor has no right to speak, amid all her difficulties must remain stoic, and can not comment to her partner over a breakfast she can’t eat that morning because if she did she would miss the bus and not arrive early to attend to the patient who would later feel every right to criticize her, and so this is one of what are countless examples of what doctors could talk about that would not fit in all the pages of a newspaper.

That doctor has to have all the patience to sit and wait for a bus, to arrive at the school of her child where they tell her there is no teacher or they do not have lunch, to arrive to buy detergent for the month in CUC, a currency in which she does not receive her wages, and to wait for the clerk to finish gossiping with the one next to her, to deign to check out everything she would buy.

Patience to come and pick up the garbage cans, overflowing outside her home and on every corner, the community workers, who surely have the right and time to have pleasant conversations so that they forget they have to clean up the city trash.

I speak as a doctor, because it is because of this that I arrive at ten o’clock in the morning in the operating room without having been able to have breakfast and having to tell my co-worker next to me how hungry I am! And knowing that there is no snack and that lunch will arrive at 2:00 pm and at that hour I will be able to have lunch although it will be a taste of what they give the doctors and the rest of the workers in this section.

But the physician continues standing there, giving the best care to the patient she is operating on, and who will later have “every right to criticize all doctors” who although conversing, gave him quality medical care, which all Cuban doctors continue doing, and all which all the people of Cuba should be proud of, yet they continue to judge us without having the least idea of the inhuman conditions in which we work and how much we contribute to society.

I will end with the same question: Should we get used to this?

Dra. A. Alemán Matías

Specialist 1st grade of Anesthesiology and Reanimation.

So much for the letter-catharsis of the doctor. Now, from my personal perspective it is obvious that the evil is deeper than many thought. For starters, it would seem that Dr.Alemán understands that doctors are some particular kind of breed to be placed above the rest of humanity.That is, the vast majority of Cubans of any profession, occupation or trade pass through identical material deprivation and problems, they have to wait for the bus for long hours, often have nothing to eat breakfast, are paid in local currency and need products that are sold only in hard currency and, to round it off, they get sick. Therein lies our greatest disadvantage.

I believe that every patient is within his rights to demand better treatment and better care from the doctors, regardless of whether or not they have eaten, particularly because the patients are not responsible for the material privations and the personal problems of the physicians. Health is the most precious of treasures, which explains the concern and anxiety of the patients when they are forced to go to consultations from which they often emerge without a diagnosis, in hospitals where frequently the necessary equipment to perform complete exams doesn’t exist, or where there are no reagents for the lab tests. We have experienced going to the labs where, in addition, “they don’t have” intravenous needles, which rapidly appear when we open our wallets. It’s an irrefutable reality that happens with such regularity it’s become a tradition. Not to mention the shortage of medicines.

If the patient requires hospitalization, then his concern and that of his family members increases exponentially. You are almost always admitted using your own resources, your own bedding and personal effects in every detail, generally you must bring your medications from home and your family must guarantee your food to avoid your consuming the gastronomic offal that is hospital food. The conditions of the rooms and bathrooms are another chapter of horror: lack of water, blocked drains, cockroaches, filth, are a constant in most hospitals. And I am referring only to the hospitals in the capital, with two or three honorable and rare exceptions. I urge Dr. Alemán to disprove something of what I’ve asserted here.

Another feature of the Cuban health system is the absolute impunity with regard to medical patients. Cubans do not have the slightest opportunity to challenge a diagnosis or to sue doctors and hospitals for mismanagement or fatal errors. The examples of silencing them abound. About two years ago a cousin of mine died in the Naval Hospital in East Havana. Unknowingly she had an ectopic pregnancy and in the face of severe abdominal pain that came on suddenly she was rushed into surgery. From there, shortly afterwards, she emerged dead. She was 40, a healthy and beautiful wife, mother of two children, and in the matter of a few hours she was dead. It was the consequences of the effect of the anesthesia, whether this was fatal or there were other complications we will never know. She, Ana Margarita Celaya, was cremated, a family left devastated, but the doctors of that unfortunate surgical intervention continued practicing. At best, what happened that day, is that they had not eaten breakfast, go figure.

My father was diagnosed with a metastatic brain tumor just five days before his death, although for more than six months we had been frequenting consultations and specialists in various branches of medicine. The scanner could not detect his illness and only the MRI, that my older brother and I managed to “resolve” — that is, arrange for — through some friends, discovered too late his impending death. Up to that moment we were wandering around hospitals, trying to figure out what strange illness was making my father lose his balance, be so confused, forget even my phone number, become more and more melancholy, suffer sleep disorders and lose control of his legs and even speech. The doctors said it was “stress,” that he had “anxiety,” and prescribed one psychotropic after another for months. Perhaps knowing earlier what he was suffering from would not have changed the outcome, but at least he would have had a better quality of life in his last months. I will never forgive the health care system — the political system, a source of many evils — for my father’s terrible agony.

For me, personally, on January 28 they diagnosed me at Calixto Garcia hospital with a kidney infection I never had. They did no analysis of any kind and prescribed me oral antibiotics. I, who was vomiting, almost dehydrated. Of course, it was my fault for coming to a consultation without “sponsors,” knowing as I do what the system is.

Dr. Alemán should convince Yoani Sanchez of the ethics of the doctor who attended her after she experienced the beating given to her in a closed car by various minions of the political police. I saw the bruises from the blows and helped my friend through her painful convalescence. The doctor, who initially recognized the marks of the blows and the bruises on Yoani’s body, soon retracted under pressure from the agents of the repressive forces. A monument to Cuban medical ethics, I think.

If I were to list here all the personal anecdotes of my friends and acquaintances in their experiences as Cuban patients, I couldn’t do it in a single blog nor in my entire lifetime. So I cannot accept that a doctor feels particularly offended by the criticisms leveled against the Cuban public health system and some doctors. It’s very bold of her to speak on behalf of all doctors when she says that patients are given “quality medical care, which all the Cuban doctors still offer.” Not true. I know that there are still doctors who provide excellent treatment to their patients with a professional zeal that is increasingly deficient in half of them, but far from “all.” Recently I heard of a doctor of Centro Habana who does not even take the blood pressure of pregnant women in his consultation “because he has to attend to many” and ultimately they even stopped paying him the 25 CUC a month that he received for having completed an international “mission.” If that is ethical I prefer to “die in my own bed” before going to a doc like that.

For the rest, I suggest to Dr. Alemán that she properly focus her anger. The best would be that she complain to her superiors about the bad working conditions, the low salary, and the dreadful food offered her during her workday. That she protest and focus her outrage upward, not downward. The patients shouldn’t have to resolve her problems, much less suffer the consequences. In any case, all doctors who ever decided to study for such a humane career and to take their Hippocratic oath, know what the Cuban conditions are. It doesn’t seem to disgust many of them to go and sacrifice themselves in Haiti or in the most remote village of some obscure country, amid the filth and disease at the risk of losing their own health, to be able to acquire household appliances, other trashy little things and a little more money. With all due respect, I am not convinced that they do if from a stroke of pure altruism. When a doctor is mobilized to some remote destination outside of Cuba, he doesn’t say, “No, I mustn’t abandon the patients of my clinic.” But if they send him to some lost village in Las Tunas or the Sierra Maestra, he howls to the heavens. And it’s that in Cuba spiritual values have deteriorated almost irreparably, faced with the material miseries of life.

No, we Cubans really don’t have much reason to feel the pride the doctor asks of us. Much less the appreciation. Instead, we feel helpless, abused and often humiliated. We feel powerless because we have no choice other than to seek the services of doctors of dubious quality. To go to a clinic at random in Cuba has now become a kind of Russian roulette: only if you’re lucky do you save yourself. I don’t play.

February 13 2012