14ymedio, Mario Penton, Miami, 23 November 2017 — Under a parasol printed with a reproduction of the Tropical Gypsy, María Elena has left behind her profession as a doctor to dedicate herself to selling handicraft products that she makes for tourists in Matanzas.
She graduated in 1993 but has not practiced for more than 10 years. “They pay very little [in the health system]. They demand of you too many responsibilities, and now that there are so many doctors posted to international missions, you spend your life on duty and covering for those who are out of the country,” she explains.
The national health system is one of the sources of pride for the government. For years, Fidel Castro called it one of the most important achievements of socialism in Cuba. In 1984 he created the figure of the family doctor and thousands of doctor’s homes-cum-offices were built in the countryside and cities of the country to extend personalized preventive primary care. “It has really been a revolution,” Castro boasted in 1984. Today, 30 years later, these networks are in decline due to the desertion of thousands of doctors and the abandonment of the infrastructure.
“It was a colossal and good project, in principle, the problem was that there was no way to pay for it,” explains Julio César Alfonso, president of the Solidarity Without Borders network, a Miami-based NGO for those who have abandoned international missions and do not want to return To Cuba.
“Thousands of doctors who were initially part of that network escaped when they had the opportunity while on international missions (more than 8,000 to the United States) and many others simply took off their white coats to become drivers, artisans, artists and even street vendors,” adds Alfonso
Despite the guidelines of the Ministry of Health to reorient the health system “towards primary care and its fundamental pillar, the family doctor and nurse,” in the last six years alone their number was reduced by more than 23,000, according to official figures. María Elena, the doctor turned seller of handicrafts, believes that most of her colleagues “got tired of so many calls to sacrifice.”
“The doctor is the most exploited worker in Cuba today, [the government earns] millions of dollars, making them work abroad and paying them a stipend, and those who stay here earn less than a driver or a bricklayer. I know surgeons who still have to bicycle to the hospital to operate,” emphasizes María Elena.
According to the article The Current State Of Social Welfare In Cuba by the economist Carmelo Mesa-Lago published by the think tank Cuba Possible,”In 1989 Cuban social welfare surpassed many of the socialist countries and led the majority of Latin America,” but this changed with the demise of the USSR.
Mesa-Lago believes that such levels were possible because of “the social commitment of the government and the support of the Soviet Union,” which according to his calculations disbursed some 65 billion dollars to support its ally in the Caribbean.
The current economic situation does not presage greater economic incentives for the health sector. The Cuban GDP contracted by 0.9% in 2016, among other reasons because of the crisis in Venezuela and the 18% reduction in the purchase of professional services (especially those offered by doctors), the main source of foreign exchange income for Cuba.
“Despite economic difficulties, Cuba maintains its universal and free healthcare system,” says Mesa-Lago. However, he confirms that the number of hospitals, hospital beds and medical personnel has fallen abruptly. In the case of doctors’ offices or family doctor homes-cum-offices, the number declined from 14,007 in 2007 to 10,782 in 2016.
The number of hospitals decreased by 46.6% and that of polyclinics by 9.2%. All rural hospitals and rural and urban posts were closed in 2011, with patients referred to regional hospitals, but the time and cost of transport increases and for emergency it is more risky,” adds Mesa-Lago.
Regarding the quality of the services, the economist raises serious doubts about the deterioration of infrastructure and the reduction of diagnostics and costly tests. “There is a severe shortage of medicines (92.3% of basic products are unavailable), of supplies for surgery, and the patients must provide sheets, pillows and other necessities,” he adds.
According to the National Office of Statistics and Information, after the beginning of the Raulist reforms between 2008 and 2016, the number of health personnel has fallen by more than 22%. The number of technicians decreased by 54% and that of nurses by 16%. The number of doctors, however, increased 19%.
More than 40,000 doctors have been sent to work in foreign countries, so instead of having a doctor for every 127 inhabitants, as presumed by the Government, Mesa-Lago calculates that there is actually one for every 234 Cubans resident on the island, a level similar to that of 1993, the worst year of the economic crisis during the so-called Special Period, a time of severe economic crisis after the collapse of the Soviet Union and the loss of its support for Cuba. The situation is even worse in the specialties that have more personnel working abroad.
“The export of health professionals brings the country an income of about eight billion dollars per year, but it reduces access to medical services within Cuba,” summarizes Mesa-Lago. Hence the long lines involved in waiting for healthcare services on the island and the overall degradation of the healthcare system.
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