Fernando Dámaso
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
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