The Myth of Free Medical Care in Cuba

The Website of Carlos Whitlock Porter

THE MYTH OF “UNIVERSAL FREE HEALTH CARE” IN CUBA

Few topics are the object of so many contradictory claims as the Cuban health care system. Simply to list these claims would take 100 pages. It is simultaneously claimed that the country has universal free health care; that the country has no free health care; that the country has no reliable health care; that it has reliable health care only if one is a member of the Party bureaucracy; that the country has super-sophisticated “cutting-edge” high-tech equipment and pharmaceuticals; that it has almost no equipment and pharmaceuticals at all; that it has wiped out want; that it rations beans; that there is a doctor within walking distance of every house; that physicians receive sub-standard training, are paid twenty dollars a month, and cannot afford toilet paper; that the country has abolished race and gender discrimination; that it practices police brutality against blacks; and so on and so forth. Before attempting to make head or tail of any of these allegations, I will simply list a few of them, from standard medical and other literature.

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An article in Worker's Solidarity, no. 40, 1993, an anarchist-socialist publication, entitled “Cuba: Socialist Paradise or Castro's Fiefdom?” is extraordinarily negative, concluding: “There is little to be said when you find out that there have been sugar shortages in a country where about 50% of the economy is based on this crop. The embargo is blamed for everything, covering vast areas of inefficiency”.

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An article in Worker's World, May 7, 1998, entitled “U.S. Report Admits Blockade of Cuba Causes Suffering, Death”, by Lyn Neeley, describes the conclusions of a report by the American Association for World Health, entitled, “Denial of Food and Medicine: the Impact of the US Embargo on Health & Nutrition in Cuba”. The report states that Cuba now has access to less than half the medicines on the world market.

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An article entitled “Repression Saved Lives”, by Joseph Mutti, of the Amigos Project, Havana, is an excellent article on the HIV-positive sanatorium system (now voluntary) which is said to house 80% of diagnosed carriers, preventing many infections.

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“Primary Care in Cuba: Low and High-Technology Developments Pertinent to Family Medicine”, by Howard Waitzkind, MD, PhD, and four other specialists, is a complex and extremely detailed description of the Cuban system of “green medicine”, “thermalism”, biotechnology, pharmacology, transplantation surgery, HIV treatment, medical software and pharmaceuticals, as well as an enlightening discussion of jineterismo, a form of Cuban part-time prostitution (condoms are said to be “relatively unavailable”, adding, “In view of the major investments in high technology, the scarcity of this low-technology product is surprising”). There is also a discussion of the so-called “Doctor Diplomacy” policy: “Because the production of physicians came to exceed the country's internal requirements (Cuba's physician per population ratio is 1 per 255, as compared to 1 per 430 in the United States), Cuba has been able to export primary health care practitioners and specialists for periods of service in other Third World nations. Decisions to send doctors abroad have responded to official requests by the governments of these countries. More than 10,000 Cuban physicians have served abroad, with as many as 1,500 at a single time.”

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C. Gaither, writing in El Nuevo Herald, on June 12, 2000, in an article entitled Deserción en Zimbabwe empaña la ‘diplomacia médica' de Castro [Desertion in Zimbabwe Jeopardizes Castro's Doctor Diplomacy], describes the desertion, and narrow escape from kidnapping, of two physicians on service in Southern Africa. According to these articles, the “Doctor Diplomacy” policy is a large earner of foreign exchange for the Castro regime, which receives an estimated 1.2 million dollars a month from Zimbabwe alone. A small fraction of the revenue received, amounting to a mere subsistence wage, is paid to the physicians and their families.

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The Lancet, 1998;351:439-440, in “Cuba: Doctors Imprisoned”, describes the arrest and imprisonment of Dr. Desi Rivero. An article in the same magazine entitled Omar del Pozo Marrero, Physician Prisoner of Conscience, by A.M. Gordon (the Lancet 1995, August 19;346 (8973): 509), describes the arrest and imprisonment of another physician.

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O.C. Miranda, in an article entitled Recursos humanos en salud de Cuba [Human Health Resources in Cuba], in the publication Educación, Medicina, y Salud, 1986;20(3):375-381, describes the “doctor diplomacy” policy. The statement is made that “the doctors serving in these units are essentially under surveillance all the time, and any change in their plans not consistent with the orders given from Havana invariably leads to the involvement of police or paramilitary forces”.

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El Nuevo Herald, presumably of Miami, September 13, 1999, in an article entitled “El Gobierno pone trabas a los viajes de médicos y dentistas” [The Government Places Obstacles in the Way of Travel by Doctors and Dentists], says that, since 1999, Cuban physicians have not been permitted to leave Cuba even with proper documentation and permits according to Cuban Ministry of Health regulation no. 54.14, which requires all medical doctors and dentists to serve 3 to 5 years in designated areas in the island before being considered for permission to leave the island.

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An article the copyright to which is held by Blue Cross and Blue Shield of Massachusetts, “Alternative Health Care Flourishes in the Caribbean”, by Barbara Jamison describes the Policlínica Moncada in Havana, where Tai Chi, acupuncture, and homeopathic remedies are utilized due to the shortage of pharmaceuticals. “Cuban doctors were overwhelmed with a health crisis in the making. Without seeds, without gasoline for its tractors, the country was unable to plant sufficient crops. There wasn't enough food in the markets or on the tables. Many people survived on semi-starvation diets, enduring up to 12-hour blackouts and water shortages. More than 50,000 Cubans, particularly children and old people, developed nerve-related disorders (neuropathies) from lack of vitamins. China tried to help by shipping two million bicycles to Cuba… Normally cycling would be good exercise, but it's not recommended on an empty stomach.” Dr. Díaz Mastellari, M.D., a psychiatrist who organized an international conference in Havana known at BIONAT 2000, is said to “make his principal meal of the day a bowl of warm broth and herbs. Then, to quiet his hunger in order to get to sleep at night, he would drink water laced with plenty of sugar...”

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A similar article in The Washington Post, March 29, 1999, entitled “With Drugs Scarce, Cuba Tries Natural Cures: Alternative Medicine Clinics Provide Herbs and Homeopathic Remedies”, by Serge F. Kovalevski, describes Havana's Clinic of Traditional and Natural Medicine, stating that, “many pharmacies, their shelves bare of modern drugs and other medical supplies, are stocked with herbal and homeopathic remedies”, including, for example, the use of “passion flower as a treatment for high blood pressure”.

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An article in the American Journal of Public Health, 1980, 70(1):23-28, by R.M. Seywell, J Studnick, JA Bean, and R Ludke, entitled “A Performance Comparison: USMG-FMG [US Medical Graduate-Foreign Medical Graduate] House Staff Physicians”, indicates that only 25% of Cuba-trained physicians pass their exams the first time to practice in the United States.

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D. Stetton, writing in the Bulletin of the New York Academy of Medicine, 1973; 49(4):285-288, in an article entitled ‘The Medical School Curriculum: The Indoctrination of the Medical Student”, alleges that all medical students in Cuba, regardless of nationality, are subject to heavy political indoctrination. The student is told he owes his education to Fidel Castro, is encouraged to become a Communist, and swears to improve his skills as a Communist in parallel to his skills as a physician, a process which culminates in an oath to “be like Che Guevara”.

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An article entitled “Blacks Question Conciliation Toward Cuba. Network Cites Abuses and Anti-Black Racism by Communist Regime”, by David Almasi, a member of Project 21, dated June 23, 2000 questions support for Cuba, asking, “If life is so good in Cuba, why are there so many people in rubber rafts?” The article points out that Decree 217 of 1997 controls immigration to the city of Havana in a manner reminiscent of the South African "pass laws".
(Note: In a recent, well-publicized case, a small vessel full of Cuban “boat people” was spotted by Cuban Coast guard authorities as it attempted to leave the island illegally; the boat was allowed to get out of sight of shore, and was then deliberately rammed, as a result of which the “boat people” all drowned. The waters are shark-infested).

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Amy Ridenour, President of the National Center for Public Policy Research, 777 N. Capitol St. NE, Suite 803, Washington DC, states flatly: “Cubans have no reliable health care. The Castro government devotes a small portion of its budget to health care than other poor nations, such Jamaica, Costa Rica, and the Dominican Republic.” She goes on to claim that “health care is so under-funded that medical supplies are often unavailable for ordinary citizens, who must even bring their own bed linen with them if they are hospitalized”. The U.S. Department of State, in a publication entitled “The U.S. Embargo and Health Care in Cuba: Myth Versus Reality”, calls the system “medical apartheid”, alleging that it “funnels money into services for a privilege few, while depriving the health care system used by the vast majority of Cubans of adequate funding”. Citing an article in the Miami Herald, December 23,1999, Ms Ridenour goes on to allege that “because Castro wishes to claim that certain diseases, such as syphilis, have been eradicated on the island, official policy is that if a patient has syphilis, he simply isn't treated and is never told”. Again citing the Miami Herald, Ms Ridenour further claims that all Cuban teenagers are forced to leave their homes and attend “schools” hundreds of miles away, where they pass half the day at manual labour, where STDs and abortions are common, and where conditions are alleged to be “appalling”.

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Cuba News, on January 23, 2001, again, presumably of Miami, made the following claim: Matanzas, January 19, Lux Info Press, ‘No way health care is free in Cuba', said Felix Valenzuela, after having paid 15.40 dollars (323 pesos at the current exchange rate) for a medicine to combat his wife's parasitic infection ...… Valenzuela said he had to pay for the medicine in dollars because it was not available in the pharmacy that sells in Cuban money. He added that it had taken him some time to get the money together, since he lives on a 140-peso-a-month pension. He said, ‘Health care may be free for the leaders, but for average Cubans, it is very expensive”. (Note: The name “Felix Valenzuela” is presumably a pseudonym.)

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Cuba Free Press, Inc., PO BOX 652035 Miami, Florida, 33625-2035, in an article entitled “Social-Economic ‘Conquests' of the Communist Experiment in Cuba”, by Alberto Iglesias, provides the following statistics: “In 1958, Cuba had the lowest infant mortality rate in all of Latin America, with 40 deaths per thousand live births. The Cuban rate was significantly lower than the corresponding statistics for France (41.9), Japan (48.9), and Italy (52.8). Although by 1994, worldwide advances in medicine had made it possible for Cuba to substantially reduce the rate to 9.9 per thousand, it had fallen behind the same three countries indicated above, with France showing an index of 7.0, Japan 4.0, and Italy, with a per thousand infant mortality rate of 8.0. Cuba's reduction in the infant mortality rate [to 9.9] was made possible by a large drop in the birth rate as well as a notable increase in the rate of abortions. During the period 1990-1995, Cuba had the lowest birth rate in all of Latin America, and double the abortion rate of all of the countries under consideration. World Health Organization data show that for 1950-1954, Cuba had one physician for 960 inhabitants. Compared with 30 other countries, this meant that Cuba had surpassed Scotland (970), Belgium (980), England (1,200), Brazil (3,000) and Mexico (2,400). Consequently, during that period Cuba occupied the 10th highest rank in the entire world as far as this vital public health indicator was concerned. At present, Cuba still has the most favourable physician/inhabitant ratio in all of Latin America, but its ranking among the rest of the nations of the world dropped to 24th place. When physicians and dentists are considered as one group, in 1957, Cuba ranked third in Latin America, surpassed only by Argentina and Uruguay. According to the United Nations statistics for that year, Cuba had 128 physicians and dentists per 1,000 inhabitants. This placed it at the same level as Holland, while surpassing England (122 per 1,000).” The article concludes with a reference to the “enormous reduction” in the country's standard of living, “as a result of the senseless and cruel experiment to which it has been subjected over the last 40 years."

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An article published in the MEDICAL SENTINAL, The Official Journal of the Association of American Physicians and Surgeons, 1601 N. Tucson Blvd, Suite 9, Tucson Arizona 85716-3450, entitled “Cuba's Doctor's Diplomacy”, dated October 11, 2000 and signed by 11 physicians, contains a lengthy discussion of the Cuban infant mortality rate. “While Castro pointed out that Cuba has an infant mortality rate of 7.3 deaths per 1000 live births, he did not disclose that the mortality of children in Cuba in the age group from 1 to 4 years is 11.8. This latter figure is 34 percent higher than the equivalent health statistics for the United States, despite the fact that Cuba has the most comprehensively organized health service in the Americas. “ With regards to the infant mortality rate figure of 7.3 deaths per thousand, a footnote states: “This figure is highly open to question and does not agree with US government figures as published elsewhere. For example, I suspect that ‘live' is subject to Fidel Castro's interpretation. See Tom Carter, “Cuba was ‘Advanced' Before Castro Took Over”... The Washington Times, March 29, 1998, p. 23. [citing] an infant mortality rate of 12 per 1000 live births, according to Cuban government figures.”

[Note: in a speech at the 10th Ibero-American Summit, Panama City, on February 17-18, 2000, Fidel upped the ante and claimed to have achieved an infant mortality rate of 6.4 per 1000 during the first year of life and 8.3 for children up to the age of 12.]

The article goes on to accuse Castro of manipulating the statistics, stating “These official data from the Pan American Health Organization (reference: Health Situation in the Americas… (Source: Basic Health Indicators 1999. PAHO/99.01, Washington DC), suggest that Castro has organized the MINSAP (Cuban Ministry of Health) services with one goal in mind: to lower the infant mortality rate without effective consideration to other important health parameters.... The importance of infant mortality is that it correlates with the overall health, education, nutrition, standard of living and well-being of the population. In Cuba, this is not true. Cuban health services are organized and structured so that the resources, support, and services are directed to reach a lower infant mortality (death from the time of birth to 12 months). Therefore, in Castro's Cuba, life support may be artificially instituted ... to achieve a numerical goal in the infant mortality of a particular health sector or region. This is done without consideration to other health services that are rationed, denied, simply ignored, or blamed on the CIA, obscure reasons, or the improperly called American embargo.... Infant mortality cannot be a measure of the well-being and the standard of living in the population under these circumstances... Consider, for example, a health parameter linked to infant mortality, maternal mortality. The maternal mortality rate of Cuba in the last three years has been 26 to 33 deaths per 100,000 live births. This health statistic is not low despite the fact that Cuba has the lowest birth rate in Latin America (12.5 births per 1000 population). Cuba's maternal mortality rate is in fact 4 to 5 times greater than the equivalent parameter for the United States (8.4). .... The article concludes by mentioning what it calls the system's “hidden liabilities”: “Widespread alcoholism, sociopathic behaviour, low birth weights, endemic giardiasis, growing incidence of hepatitis E infection, widespread venereal diseases, very high abortion rates, high maternal mortality, double to triple the deaths from unintentional injuries and accidents.” The same article claims that there are restrictions on what may, and may not, be written on a death certificate; doctors who fail to toe the line are simply jailed. This fact alone, if true, would prove the unreliability, if not utter worthlessness, of all Cuban health statistics.

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“The Poverty of Communism”, by Nick Eberstadt (Transaction Books, 1988), notes that the Cuban Ministry of Health is solely responsible for producing and checking the figures used to verify its own effectiveness. In the late 1980s, the Ministry claimed that infant mortality had fallen 40% between 1975 and 1985. Yet its own figures showed that reported acute diarrhoea had increased 52%, food poisoning 63%, acute respiratory infection 146%, German measles 220%, and chick pox 406% over the same period. All have a high correlation with infant mortality. Life tables (an indirect and more reliable way of calculating and checking life expectancy) showed that Cuban infant mortality rose substantially during certain periods of the 1970s. In 1977, Castro told a delegation of visiting Congressmen that the Cuban literacy rate had risen from 25% to 99% since the Revolution. Yet literacy at the time of the Revolution was 79%. The regime subsequently changed its definition of “literacy” to include only those groups most likely to be literate. Literacy was 25% in the year 1900.

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The U.S. State Department, in a study entitled “Zenith and Eclipse: A Comparative Look at the Socio-Economic Conditions in Pre-Castro and Present-Day Cuba”, concludes that “Cuba has at best maintained what were already high levels of development in health and education....

Among the findings: Since 1957, Cuba's infant mortality has slipped from the 13th lowest in the world to 24th, even though deaths per thousand have declined from 32 to 12 per live birth. The report attributes the infant mortality decline to a “staggering abortion rate – twice that of other Latin American countries. ... Cubans today have less access to cereals, tubers and meat than in the late 1940s. While the Cuban government blames this on the US embargo, the report concludes that “the facts suggest that the food shortages are a function of an inefficient collectivized agricultural system”.

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Again, the US Department of State “Cuba Consular Information Sheet” alleges that “Cuba's ‘Law of Protection of National Independence and the Cuban Economy' contains a series aimed at discouraging contact between foreign nationals and Cuban nationals. These measures… may be used against any foreign national coming into contact with a Cuban. The law provides for jail terms of up to 30 years in aggravated cases. US citizens travelling in Cuba are subject to this law, and they may unwittingly cause the arrest and imprisonment of any Cuban with whom they come into contact”. Illegal entry or exit to or from Cuba is punishable by 4 years imprisonment.

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An article by Leah Gardner entitled “Lab Student Moss Gets Firsthand Look at Cuba's Health System”, is an excellent, short, and extraordinarily well-balanced summary of the Cuban health care system. Carolyn Moss, a sophomore at the Bloomberg School of Hygiene and Public Health at Johns Hopkins University, traveled to Cuba with nine other students from the Woodrow Wilson Research Program to study Cuba's public health system. According to the article “in Cuba, the primary focus and the primary source of care is a network of family doctors. The ratio tends to be about one of these family doctors, housed in what is known as ‘consultorios', per neighbourhood. Their job is to care for the people only in their neighbourhood. Moss stated, “People are desperate for money. To put it in perspective, taxi drivers make more than doctors in Cuba”. She said that an average salary for doctors is around 22 dollars a month. Despite the lack of funding, however, the Cuban public health system is quite an effective one. For example, there is virtually no AIDS epidemic. The Cuban methods for controlling the epidemic are not, however, what the United States would call humane. Up until 1999, for example, the Cuban government quarantined AIDS patients in sanatoriums. Another example of controls imposed on the AIDS epidemic is that in order to receive ration booklets, everyone is required to take an HIV test, Moss said'”.

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Another extraordinary short article by Florencia Halperin, a first year student at Harvard Medical School, entitled “A Medical Student Looks at Cuba. A Country of Contradictions”, states, in part, as follows: “Sofia and her husband, who have two small children, are both physicians.... After six years of medical school and three years of service to the government as community physicians, Sofia and her husband each earn twenty dollars per month. Their house belongs to the government, their education and their children's (including their textbooks!), as well as their health care, are absolutely free, and they get food rations from the government. As a family, they receive six pounds of sugar, eggs, rice, beans, milk, and one small bar of soap per month. They say they are happy with their home, proud of their education and their health care system, but what they get to eat is not enough. If they want meat (or laundry detergent, or clothes) they have to purchase them at import prices similar to what we pay here in the United States. Forty dollars a month does not stretch very far for all of these things. As well-educated as they are, this family cannot afford the luxury of toilet paper, and uses the day-old newspaper instead. “ Miss Halperin describes a 20-mile tourist trip with a Cuban friend. “Our driver..., in desperate need of the few dollars we offered, could not bring our friend Miguel, because if he were stopped by the police with Cubans and Americans in his car, he would be fined a large sum…Most Cubans cannot eat out in restaurants or rent accommodations when they travel, because they cannot afford it. But even if we wanted to pay for our friend, by law, he is not allowed to eat, or even sit at the table, with tourists, and he is not allowed to sleep in the Cuban homes where we rented rooms... If “el Inspector” (a neighbourhood Party representative) discovered Miguel at a restaurant or in a rented room, they would be subject to hundreds of dollars in fines. Although the laws have been under the pretext of preventing hustling and prostitution, I wondered if the hidden agenda was to prevent the exchange of ideas....” The article concludes in part as follows: “I struggle with an image of Cuba where people are not free to tell their friends what they think, where people go hungry, where well-educated honest folk turn to illegal tourist activities because it is the only way to earn enough to clothe their children, and yet where every person has a home, every person is taught to read, is given some food, and has their medical needs met. Indeed, in Cuba, everyone has access to health care, and there is one doctor in every neighbourhood. Physicians are trained to emphasize prevention; their job includes visiting patients at home, and ensuring public health standards are met. For example, they verify that if animals are kept, they are clean and separate, or that electrical outlets are covered if there are young children in the home. The infant mortality rate is one of the lowest in the world; Cuban children are vaccinated, and all women have access to regular Pap smears and mammograms…” The article is generally positive, though confessing, “In many ways I came to understand those who risk their lives every day to flee Cuba...”

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CONCLUSIONS: Cuba was one of the richest agricultural properties in the Caribbean for 450 years. In 1959, it was the second richest country in Latin America, with the largest middle class, the largest managerial class, the most evenly distributed wealth, and a labour movement so effectively organized that it often constituted a brake upon industrial production. Castro wrecked the economy of the country in one year, as a result of which he lost 3,000 of the country's 6,000 doctors. Today, there are allegedly 60,000 doctors; there are 21 medical schools; the health system has been expanded and modified; it has many fascinating and highly original features, some of which are worthy of imitation. But it is the product of the society which created it. The system works, if it works at all, because Cuba is an island totalitarian state which produces thousands of doctors, many of them with sub-standard qualifications, prevents them from emigrating, tells them where to live, manipulates the statistics, and pays them nothing (twenty dollars a month), while renting them out to countries like Zimbabwe.

Mortality rates are not solely the result of medical care. They also reflect a variety of other factors, including nutrition. A nation which rations beans cannot claim to have achieved a life expectancy equal to that of the United States. If the Cuban health system be judged according to its asserted real strengths – inventiveness, ingenuity, flexibility, improvisation – then it appears to function fairly well. If it be judged according to its pretensions – a system of Marxist “revolutionary socialism” capable of overthrowing capitalism and to be exported by violence – then it has failed completely. The Revolution was intended, in part, to make the country independent of the United States. If anything, sanctions represent an opportunity to prove the superiority of Cuban socialism through a sort of controlled laboratory experiment: vacuum-packed “Revolutionary Socialism, with No Added Ingredients”.

Starvation and shortages are typical of Marxist-Leninist economies with or without sanctions. If the Marxist-Leninists can't manage without American products and components at the present time, what are they going to do when they conquer the world? Why don't Communists think of these things? The following joke (mentioned in THE GREAT TERROR by Robert Conquest) was allegedly popular during the Stalin era:

Q: Why does the Soviet Union have so many airports?

A: So we can fly anywhere in the country where there is anything to eat.

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ADDITIONAL SOURCES: 1966 Collier's Encyclopedia, CUBA.

On Castro's bizarre family background and past as political gangster, thug, murderer, and Communist agent going back to 1948, see: RED STAR OVER CUBA, by Nathaniel Weyl, 1961 (A Hillman/MacFadden Book, revised, available from www.alibris.com). If anything, RED STAR OVER CUBA is even more astonishing today than it was 43 years ago. Castro's entire career has been based upon one bizarre hoax after another: the phony “attack” on the Moncada barracks in 1953, designed to sacrifice the more liberal and idealistic of Castro's followers while he and his brother escaped entirely without danger, to produce “martyrs for the revolution”, as a result of which Castro spent only 2 years in jail (upon his release, he immediately went on radio attacking the Batista government, and was simply banned from the airwaves); the farcical “campaign of armed resistance” which produced no military results whatsoever (since the Batista government collapsed, not as a result of armed resistance carried on by Fidel Castro of anyone else, but as the result of an embargo on arms and ammunition sales to the Batista government imposed by the US State Department in the delusion, peddled by Herbert Matthews of the New York Times, that Castro was a “Robin Hood” who would make Cuba more “democratic”, etc. etc.. Obviously, where “sanctions” are concerned, what is sauce for the Batista goose is not sauce for the bearded gander).

Batista did great harm to Cuba by destroying the morale of the army and citizenry, creating a vacuum. One of the principal reasons Castro was able to impose Communist rule was that, of all the anti-Batista groups, only the Communists knew what they wanted, and were prepared to lie: in 1948, in 1959, and ever since. After the Revolution, Castro shot men who had fought beside him in the mountains for years, whose loyalty was never in doubt, simply because they rejected Communism (such as the American citizen William Alexander Walker, shot in 1961). And we are supposed to take Castro's word for it on medical statistics?

CARLOS W. PORTER

FEBRUARY 1, 2002

MADE IN RUSSIA - THE HOLOCO$T

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