Iván García, 12 September 2024 — After midday, Dr. Geiser, 28, arrives sweating at the ramshackle doctor’s office in the neighborhood of Santos Suarez, in the municipality of Diez de Octubre, south of Havana. Before putting on her white coat and attending to patients, she keeps a bag of soft bread, two avocados and five pounds of pork ribs she bought at a farmer’s market on her way to work.
The family doctor’s office is supposed to open at nine o’clock. But the shortage of supplies and medicines is one of the reasons why Ismary, the nurse, sleeps until eleven o’clock in the morning and, after eating a snack, walks the two kilometers between her home and the office. When she arrives, six patients are waiting in the anteroom. The place is in a dilapidated state. The floor is dirty, most of the plastic chairs in the foyer are broken, and a white light bulb hanging at an angle from the ceiling threatens to fall.
There is no lighting in the nursing room. There is only iodine and mercurochrome on the medicine shelf. A small piece of equipment for sterilising needles and aerosol nozzles, donated to them, has long since broken. In the lobby hangs an outdated poster showing public health statistics in 2003. “It seems like a century ago. The health service in the last twenty years is a disaster when you compare those numbers with today,” says a man with a burn on his right arm.
In 2003, according to the poster, Cuba’s public health institutions had 286 hospitals, of which 83 were general, 34 clinical-surgical, 26 paediatric, 18 gynaecobstetric, 18 maternal and child, 64 rural and 43 specialised. In addition, there were six cardiocentres, 289 maternity homes and 1,961 well-stocked pharmacies. The infant mortality rate was 4.8 per 1,000 live births and life expectancy for both genders was 77.79 years, while for women alone the number exceeded 80 years of age. Some 99.1 per cent of the population was served by the family doctor’s offices, which were part of the primary health care structure.
A lot of water has flowed under the bridge since then, says a MINSAP (Ministry of Health) official, “infant mortality is over nine per thousand live births and in many provinces it rises as high as twelve or thirteen percent. More than a third of the hospitals have been closed or do not provide the services for which they were designed. Sixty percent of the family doctor’s offices are no longer functioning. The number of doctors, nurses and health technicians has fallen by more than 75,000 compared to 2003.”
As an example, “Between 2022 and 2023 alone there are 46,000 fewer health workers. Out of that number, 12,000 are doctors. Fifteen years ago, community polyclinics had weekly consultations with medical specialists. Today, patients have to travel, even from one province to another, to be seen, and consultations are usually every two months. Stomatology clinics are either closed or run informally as private entities. Life expectancy has fallen to 73 years for men and 76 for women. Food and medicine shortages contribute to this decline. Only emergency surgery is being performed. Hospitals are short of everything from disposable needles to adhesive tape. It’s an absolute disaster,” he says.
Dr. Geiser tries to do her job with hardly any medical supplies. “We can carry out some treatments thanks to the help of neighbors who have donated a little cotton and gauze. When people come for injections, they bring their own disposable needles. Most of the treatments I prescribe are based on green medicine. It’s very painful to treat the child of a low-income family or an old person who gets a pension of 1,500 pesos and who can’t buy the antibiotics for treatment in private businesses because they don’t have the money.
On a piece of paper from a school notebook, Dr. Geiser writes down the medicines to be taken and the treatment to be given. The pens are given to her by her patients. “We keep things going thru sheer willpower. My salary of 6,000 pesos is equivalent to 20 dollars. The nurse’s salary is 4,000 pesos. We open the clinic two or three times a week. The rest of the days we have to go out on the streets, to get food for our homes. Although it’s wrong, most doctors and health workers earn extra money by treating patients on the side. It’s the only way to avoid starving. The other way is to find work abroad.”
“Although the government keeps 80 percent of the salary in foreign currency that they pay you, you can at least get between 7,000 and 10,000 dollars, depending on the length of your stay and the country you go to. The best destinations are Italy, South Africa, Qatar, Mexico. The worst are Haiti and Venezuela. If you want to get a good posting, you have to pay two or three thousand dollars under the table”, explains the doctor.
Although medical service exports managed by the government bring in billions of dollars annually, most of the hospitals serving the population in Cuba are in fair or poor condition. Hygiene leaves much to be desired, as does medical care. Patients admitted to medical facilities must bring sheets, towels, a fan, drinking water and a bucket for washing, among other things.
According to the MINSAP official, “between 2008 and 2015, between 7 and 11 billion dollars were earned every year from export of medical services. Enough money to maintain the quality of the health system on the island. But GAESA (a military-run conglomerate) uses that money to build hotels and other businesses.”
According to figures for the first six months of 2024 published by the state-run National Statistics and Information Office (ONEI), the leisure and tourism sector received a budget fifteen times higher than agriculture, livestock and forestry. And 17 times more money than Public Health and Social Assistance, which received 769 million pesos. Although there were 46,000 fewer health workers in 2023 than in 2022, the regime has more than 22,400 Cuban health workers in 59 countries. And it is negotiating new contracts with other countries.
The shortage of medicines, poor diet, and the ageing population, with nearly 25 percent of the population is over 60 years of age, all contribute to the progressive deterioration of the health of the population. For over ten years, more people have been dying in Cuba than being born.
Dania, a psychologist with two decades of professional experience, says that “suicides and suicidal behaviour have increased by 23% in the last four years in the Diez de Octubre municipality, the most populated in Havana and the third most populated in the country after the municipalities of Santiago de Cuba and Holguín. A worrying fact: if a decade ago most of those who took their own lives, or attempted to do so, were elderly people, mainly men who lived alone, in recent years the suicide rate among young people and adolescents between the ages of 12 and 35 has skyrocketed.”
“Historically, suicide in Cuba is among the first ten causes of death. The rate per hundred thousand inhabitants has remained above 12 and 15 percent. But since 1972, the level has grown to be among the highest in the world and the fourth highest in Latin America. In 1982, a grim record was reached when suicides increased to 23.2 percent. We do not have updated figures now. But I see many cases of patients who have made an attempt on their lives due to frustration and lack of future”, the psychologist points out.
For the Castro regime it is more important to build hotels than to buy medicines.
Translated by GH
