Exporting Doctors / Orlando Freire Santana

According to the government, there are 47,000 medical students in Cuba, and a doctor for every 137 persons. What is the real picture  on the national health service?

The popular Cuban refrain, when referring to the contradiction which presents itself when the person producing something hasn’t got that thing in his own home, employs the very handy saying, “In the blacksmith’s house, you find a stick for a knife.” Well, we can say the same thing on the big picture with the health service nowadays, with a large number of doctors and medical students, and on the other hand poor attention for the ordinary citizen.

A little while ago the French news agency France Press, basing its information on what appeared in the newspaper Granma, official organ of thee Communist Party, let it be known that more than 47,000 students — 10,000 of them foreigners — had enrolled in medical courses in Cuban universities in the academic year  2013/14. It then went on to emphasize that, taking into account that Cuba has more than 85,000 doctors for a population of 11.1 million inhabitants (data as at the end of 2012), which would represent a doctor for every 137 people, the island finds itself, in this sense, in a privileged position on the international level.

Nevertheless, such statistics contrast with the calamitous state of many of the health services on offer in our country. It’s the same in hospitals, health centers, dental surgeries, opticians and in the famous family health centers. These centers started up nearly three decades ago, with the intention of providing 24-hour primary health care in peoples’ home areas. But they function so erratically now that the intention in question has pretty well disappeared.

For example, in one of the constituencies covered by the Héroes de Girón health center, in the Council area of Cerro, Havana, out of four centers started in the ’80s, today only one remains offering services, leading to frequent overcrowding in the place, and the inevitable irritation both of the patients and the doctors.

Note also the case of the doctors who move out of the houses annexed to the centers, for their relatives to live in. In those cases, although the doctor turns up for the day in the center, he doesn’t any longer live next door, leading to lack of attention for patients with emergencies in the night. You have to note also the dreadful state of the building in many of these centers, and the same is true in hospitals and clinics. There are propped up roofs, leaky walls, out of service toilets…

Not long ago the newspaper Granma reported on the complaint of a doctor about the breakdown of the ophthalmic service in the eastern province of Manzanillo. In its edition of Friday August 16, the official newspaper echoed the complaint of a surgeon in the Laser Surgery Service of the Celia Sánchez Manduley hospital. The doctor pointed out that for more than a year they hadn’t practiced optical surgery in that health center due to technical problems with the air circulation equipment in the operating theatres. That’s to say, while in the context of the so-called “Operation Miracle”, the Cuban doctors give back sight to people from various countries, more than a few Cubans lack such benefits.

They say that, on a particular day, on the balcony where an old lady lives, there appeared a sign with the following text, “I’m off to Venezuela.” It was, obviously, the cry of a desperate patient who could not see the solution to her health problem within the confines of our “medical power”.

Sometimes patients have to travel great distances to be attended to by particular specialists (dermatologists, ear nose and throat doctors, cardiologists, etc.) because the health centers in their health district don’t have such specialists. Many Cubans have to give a little gift to these doctors in order to receive a quality service. Moreover, there is a scarcity of medicines in the network of pharmacies accepting “national money,” also known as Cuban pesos. Clearly, you almost always find those missing drugs in the international pharmacies, who sell for convertible pesos, the currency in which most Cubans are not paid.

And while all this is going on in the country, the “Castrismo” is going on about having more than 40,000 doctors in 58 countries. It’s not a secret to anybody that those professionals work in difficult conditions in those countries where they offer their services, and that the Cuban government repays them just a tiny fraction of what the recipient countries pay for them. Nevertheless, every time we talk to a doctor who works in Cuba, his desire comes across to go abroad to serve on “a mission.” It’s logical, since, even bearing in mind the financial robbery referred to, there will always be more than is evident in the island. You mustn’t forget that a doctor in Cuba, on average, earns the equivalent of 25 or 30 dollars a month.

Obviously not everything is the color of roses for those doctors who are sent abroad. In many places they don’t recognise their professional qualification. Right now, the first 400 have arrived in Brazil; this is out of a total of 4,000 that will be in the South American giant by the end of the year. We know about the protests of that country’s Medical Union, an organisation that casts doubt on the skills of those doctors, at the same time as they accuse president Dilma Rousseff of getting up to political games, rather than acting to improve the country’s health. In the same way, more than a few countries require an ability test for the doctors who graduate from the Latin American School of Medicine (ELAM) based in the Cuban capital.

Nevertheless the Cuban authorities take into account the obvious judgement that this huge quantity has to be balanced with quality. Every year a larger number of students are summoned to study medicine, a course which they now run in all the provinces throughout the country. Here the utilitarian consideration far outweighs the functional. The foreign medical services have become the country’s principal source of income, more than tourism, nickel, tobacco and other things. Other considerations don’t appear to matter.

 Orlando Freire Santana

From DiariodeCuba.com

Translated by GH

10 September 2013