Under observation

Cuban health care
Under observation
An outbreak of cholera tests a much-praised health system
Jul 14th 2012 | MEXICO CITY |

CHOLERA was eradicated in Cuba more than half a century ago. But on July
3rd the government announced that the disease had returned, infecting 53
people and killing three in the south-eastern province of Granma. Since
then unconfirmed reports have said that up to 15 may have died, and that
the outbreak has spread to Havana, at the opposite end of the island.

The most likely source is Haiti, which since 2010 has suffered an
epidemic that has killed more than 7,000 people, plus 363 in the
Dominican Republic, its neighbour. Only 50 miles (80km) of sea separate
Haiti from Cuba, which has sent hundreds of doctors to help the Haitians
control the outbreak (and who may inadvertently have brought the illness
back). Tests are expected to establish within days whether the Cuban
cases match the Haitian strain.

So far Cuba's celebrated health-care system seems to be coping. "The
response is generally excellent in containing outbreaks of disease,"
says a European diplomat in Havana. Health workers have distributed
chlorine drops and rehydration salts in Granma province.
State-controlled media have reminded people to boil water, keep food
refrigerated and wash their hands frequently. Nevertheless, the
communist state's habitual lack of openness has generated rumours.

Until recently, Cubans were justifiably proud of their health-care
system. Life-expectancy matches that of Americans, who are eight times
richer. Infant mortality ties with Canada's as the lowest in the
Americas. Measles jabs have been near-universal for more than 20 years,
putting Cuba ahead of many rich countries.

But Cuba's crumbling economy has put this system under stress. Though
the state still trains armies of doctors, a third of these are deployed
overseas in "soft-power" missions. Pharmacies are generally ill-stocked.
In many hospitals patients must provide their own sheets, food and
dressings. Neglect of infrastructure means that almost 10% of the
population lacks access to clean drinking water. The American embargo
against the island does not help: equipment for radiology, mammograms
and cancer therapy is hard to replace, says Julia Sweig of the Council
on Foreign Relations, an American think-tank.

Raúl Castro, the president, who this month visited China and Vietnam, is
trying to revive the economy by cautiously transferring chunks of it
into private hands. The next step, reported this week, will be to let
transport and other service workers form co-operatives, currently
restricted to farming. If the health service is to thrive again, this
sort of economic surgery will need to speed up.

http://www.economist.com/node/21558613