The Battered Health System / Fernando Dámaso

Photo: Rebeca

The Cuban health system has many followers in different countries, those who contemplate it and hold it up as an example, based more on its image to the outside, a strange mixture of humanism and propaganda and political proselytism, where it is not very difficult to determine which weighs more, this inner reality vs. the chronic suffering of most citizens. It is assumed, by these advocates, that the healthcare system is an original creation of the Cuban regime, and that previously there was absolutely nothing, that health problems were not addressed nor treated. Nothing could be further from the truth!

The Cuban health system, existing in the nineteen fifties, included first-aid, municipal, provincial and national hospitals, and mutual and private institutions, as well as research laboratories and schools for the training of doctors, nurses and other health professionals, equipped with relevant technology and staffed by recognized and capable professionals.

Moreover, there was an extensive network of laboratories for the manufacture of drugs and pharmacies stocked with all necessities. On top of this system, organized and functional, they built the new one. The land, therefore, was well-tended with deep roots and the trunk was healthy. It was only necessary to treat it responsibly and continue developing it.

The system established in the early years operated during the so-called revolutionary period, before falling in a process of deterioration, which continues to this day, where many of the hospitals, except those catering to foreigners (for political reasons or hard currency) and to leaders, officials and their relatives, are in critical condition, both from the construction point of view as well as hygiene, with their equipment in disuse due to breakage and lack of spare parts, and patient care leaving much to be desired, adding to the latent discontent of the population, which due to its magnitude, has not been possible for the press, government agencies and the party to ignore, where it is a source of concern and debate.

As a reminder, here are some indicators of the health system at the time of the Republic:

  • Cuba was ranked 22 among 122 countries, with 128.6 doctors and dentists per 100,000 inhabitants.
  • With 6.6 million inhabitants, Cuba had twice as many physicians (6,401) as all other Caribbean nations combined, with 19 million inhabitants.
  • In 1948 Cuba had 3,100 doctors (one per 1,650 inhabitants) and in 1957, 6,401 (one per 1,021 people), in proportional growth placing it second in Latin America.
  • The average life expectancy in 1958 was 63 years (third in all of Latin America), having increased in the first half of the century from 38 to 59 years, a higher 12 year increase than the average for the region.
  • Infant mortality (0 to 1st year of life) was 32.34 per 1,000, the lowest in Latin America. Uruguay was the closest with 53.6 per 1000. West Germany was 33.8, Austria 37.5, and Spain 43.7 per 1000. There had been a gradual improvement since 1935-39,when the mortality rate was 99 per 1000.
  • Mortality between 1 and 4 years of life was 2.8 per 1,000 in 1957 – the best in Latin America. Argentina was the closest with 4.9 per 1,000.
  • Maternal mortality in 1955 was 145 per 100,000, and in 1958, 115.5 per 100,000.
  • The mortality of the population in 1933 was 51,000, with a population of 3,960,000 inhabitants; in 1943 it fell to 50,000 with 4,779,000 inhabitants and in 1953 to 37,000 with 5,829,000 inhabitants. The annual average in this respect, was 9.6 per 1000 (second in Latin America).
  • The number of inhabitants per health care bed in 1952-53 was 1 bed per 300 inhabitants (fifth in Latin America). In the late fifties it was 1 bed for 203 inhabitants. In 1958 there were 337 hospitals in full operation.
  • The distribution of doctors by area was as follows: urban areas, 1 per ​​263 residents; rural areas, 1 per 1,750 inhabitants. Taken together (1 doctor per 1,001 inhabitants), it was the best in Latin America with the exception of Argentina (1 doctor for 681 inhabitants). It should be noted that 70% of the Cuban population lived in towns and cities and only 30% in the countryside.

As you can see, health care existed and was successful. It is true that there were places lacking services, mainly due to the lack of roads and transportation, but nobody can deny that it was in constant development and from year to year indicators substantially improved. There was no immobility or paralysis, and a significant annual national budget was devoted to it.

I consider it healthy to expose these realities, given so much manipulation, although for some it may seem wrong to criticize the health care system, one of the flags of Cuban socialism. As not all that glitters is gold, nor is all that is offered gold, so it is with the current Cuban health system.

The important thing is not to do hundreds of transplants and thousands of operations in Cuba and abroad (mostly outside of Cuba), or to publicize it constantly in all mass media, but to know how many were actually effective (which is almost never spoken of). Size has never been synonymous with quality. Furthermore, while I believe in providing assistance to other countries, we can’t tend our neighbor’s crops while ignoring our own, it is the same as if the shoemaker’s son were always to go barefoot.

Today, health care for Cubans is highly deficient, with long delays in treatment and a great shortage of drugs, forcing patients to offer the well-known and widespread gift (or bribe) before and after, to receive care, as well as obtaining drugs in the so-called black market at high prices. This is how the health problems of most citizens are really resolved, contrary to what is declared and published by our friends outside. I aspire to a health system such as existed in the fifties, enlarged and improved with the technological and scientific achievements of the past fifty-three years.

1 August 2011