The severe shortness of medications in Cuba, far from getting fixed, threatens to become an “irreversible” malignancy.
Cubanet, Miriam Celaya, Havana, 15 November 2017 — The pharmacy, in the middle of Avenida de Carlos III in the Cuban capital, was crowded with people. The line extended outside the premises and formed a human conglomerate in the front, obstructing the entrance to the adjoining apartment building. “I have not been able to sleep for a week for lack of my medicine!” screams a frustrated patient when she finds out that, after waiting for her turn for more than an hour, they have run out of the medication alprazolam (Xanax), prescribed by her psychiatrist to treat her anxiety and her sleep disorder.
“I have been going from pharmacy to pharmacy in the 15 municipalities for days and nothing! Nobody cares, nobody knows when there will be medicine, nobody solves the problem! Here, for the person who does not have lots of money, or a relative abroad who sends him the medicine, all is left for him to do is to die. And then turn on the news and hear how good the Cuban health system is. It’s a mockery and a lack of respect!”
The impassive clerks behind the counter continue to dispatch the few products there are, and the woman emerges from the pharmacy like a furious whirlwind. As she moves away, she continues to unload her impotence loudly on the sidewalk, carrying on against “this damn shitty country” and waving the useless prescription in the air. The people in line are mumbling their own particular misfortunes. A hypertensive man complains that two months ago he could not buy enalapril or chlorthalidone, a cardiologist attests they are missing antiarrhythmics such as atenolol and nitrosorbide. Everyone comments on the shortage of duralgin, aspirin and meprobamate.
This is an everyday scene. The severe shortage of medicines which has continued to intensify in Cuba in recent months, far from being solved, has become a trend that threatens to become as much of an “irreversible” disease as the sociopolitical system that generates it. Even the official press has acknowledged the lack of medicines, which includes at least 160 drugs, but it has not pointed to a solution to the problem or a probable date for the normalization of supplies to pharmacies.
This shortage, however, is neither an isolated nor a recent phenomenon. Since the anguishing 1990’s, after the collapse of Soviet communism, there was not only a dramatic fall in the national production of drugs, but the importation of medicines that were not generated within the Island also decreased significantly. In fact, most of the medicines that were sold freely through the pharmacy network, without the need for an optional prescription, became “controlled,” which meant that they started to be sold only against a properly generated doctor’s prescription.
Since then and until today, the list of rationed drugs also includes some of the most basic analgesics, healing supplies, ointments, thermometers and other items, all of which have significantly declined as a part of the family medical kit of the common Cuban.
It was precisely in the midst of the crisis of the 1990’s when the “super ration card” was implemented; a personal file containing names, identity number, and private addresses designed to guarantee in the corresponding pharmacies the necessary medications for patients with chronic diseases – those with diabetes, hypertension, heart disease, neuroses, etc. – upon presentation of the medical certificate that accredited their disease.
It is fair to acknowledge that the measure achieved its purpose, at least while the pharmacies’ regular supply of medicine remained stable. However, the current drug crisis affects even this growing sector of chronic patients, for many of whom it is vital to have access to the drugs indicated for the treatment of their diseases.
The issue becomes all the more serious because the Cuban population presents an unstoppable tendency to aging, and a significant increase continues in high-risk diseases for life, such as hypertension, cardiovascular diseases, diabetes and hypercholesterolemia.
Meanwhile, and as invariably happens in every hardship situation, a robust and intricate network of illegal markets in medicines has developed over the years, in whose broad current flow both certain administrators and pharmacy clerks – given their direct access to product – as small occasional merchants, like those who thrive in neighborhoods by trafficking in anything reasonably marketable, even some unscrupulous doctors and “cadres,” bureaucrats of the national health system, who have access to blank prescription pads at their discretion. Because, as it is generally known, corruption and poverty are directly proportional: they grow at par.
Of course, the law of supply and demand works perfectly on the black market, so that, as the shortages have increased, the price of medicines has skyrocketed. Some products double, if not triple, their previous price in the illegal market itself. For example, a blister of 10 tablets of the highly demanded duralgin (dipyrone), an analgesic with a price tag of 40 cents in national currency in the pharmacy network and 5 (CUP) until recently on the black market, now is often quoted as 10 (CUP).
The same happens with psychotropic drugs, also in high demand in a country where stress and depression are part of everyday life. Chlorodiazepoxide, diazepam, and alprazolam, among others, have become so expensive as to be out of the reach of those of those who need them most: the poorest.
So far, the authorities have avoided going deeply into the subject, which they have barely mentioned tangentially. A few days ago, the announcement in the official media about dedicating a transmission of the TV program “Roundtable” to analyze this delicate issue created expectations in the population. However, for unexplained reasons, this program has been postponed.
For the time being, the crisis continues, and according to the testimonies of some doctors, who have opted to remain anonymous, in hospitals like the very renowned Hermanos Ameijeiras, located in the Centro Habana municipality, talks and lectures will soon be given to doctors about the benefits and advantages of homeopathic medicine, which indicates that the shortages of truly effective medicines are here to stay.
But the crisis is as irritating as the “solution” that is provided in the Letters to the Editor column of the publication Juventud Rebelde. Under the title of “Medications, Anguish and Strategies,” the reporter Jesús Arencibia Lorenzo reproduces a letter in which a reader complains that he never gets to buy his hypertension medications – that is, drugs controlled by “the super ration card” and supposedly guaranteed by the network of pharmacies – because, while he’s working at his job, there are people who do not work and lineup and “hoard” the medications, so that “the same people” get the medicines every month.
The reader in question comments that “each minute, hour, day and month that goes by” without the medications he suffers “deterioration of the organism and propensity to suffer cerebrovascular or myocardial accident,” all of which is strictly true and reasonable, but not so his proposal for a solution. The aforementioned reader assumes that, given the insufficient distribution of the medicine, the right thing to do is “at least to divide it in half: one month for you, one for me.”
That is, his proposal does not consist in demanding that a way be found to solve the shortage of medicines, but to be able to access the drugs at least in alternate months: the month in which “it’s his turn to get the medicine” he would be safe from a heart attack, next month (when “it’s someone else’s turn”) he would be at risk of dying. That is, this subject does not even hope to have medicine every month, like “the hoarders,” but for him, the maximum expression of justice would be for them to get as screwed as him.
An assumption supported by the journalist Jesus Arencibia, when he harangues: “In the midst of deficiencies whose solution is often not immediately at hand, what should not be lost, at least in a social process like ours, is the meaning of justice and kindness, so that bonuses and penalties get distributed with the greatest fairness, in each case.”
And in closing, he adds: “Perhaps when we advance to the maximum transparency scenario,” in which the access to drugs at the pharmacies and the registries of patient records become accessible and public documents for the citizenship – as he calls it, the “popular control scenario” – “maybe we can prevent a few from benefiting while others continue to wait in the danger zone.”
All of which suggests that, at the end of the day, medications that keep us painfully alive in this absurd Island could continue to go missing, but what cannot be missing is “the kindness” that allows us to multiply the miseries. And there are still those who wonder how it is that the Castro regime has managed to survive for more than 60 years!