Illegal Dental Work on the Rise in Cuba
Daniel Palacios Almarales* (Café Fuerte)
HAVANA TIMES — Today, Cuba’s dentistry field is characterized by generalized corruption, poor services and the migration of specialists and technicians towards the private sector.
Though this is by no means unique to dentistry, the fact of the matter is that having your teeth worked on has gone from being a free to a paid service. In Havana, the cost of a dental procedure can be anywhere from 10 to 150 CUC (1 USD is equivalent to 0.87 CUC, and the average monthly salary in the country is 18 CUC), depending on the complexity of this procedure.
Cuba’s legislation stipulates that services offered at any dental clinic are completely free of charge. In effect, primary care offered in the more than 200 clinics of this kind around the country is free.
Securing an appointment, however, can be a long and painful process and, no few times, people are forced to lose many days of work because of the many problems that undermine the quality of this service.
“I’ve come to the clinic three times to get a filling, and it’s always a different story: they have no running water, the instruments haven’t been sterilized, the power is out or there isn’t enough filling paste to treat all of the patients,” said Amarilis Soler, a single mother who works as a cashier at the electrical company.
Soler explained the reasons why Cubans resort to private services, in spite of the high prices.
“Sometimes you get lucky and you don’t have to wait long to see the dentist, because it so happens they’ve got all they need that day. But, in most cases, they’re out of one thing and you get an incomplete service. That’s why those who have the money go to private clinics, because the procedure is much quicker there,” she explained.
Illegal Clinics
Generally speaking, dentists with private clinics are specialists or technicians from the field who continue to work for the State or quit their day jobs in search of financial improvement. They have clinics with basic conditions at home and no license to operate. In fact, no one is authorized by the government to offer health services privately, as a self-employed professional.
Another practice consists of offering dental appointments and diagnostic procedures outside State clinics, in private residences, and conducting the actual surgery in the government institution, using the equipment and supplies there illegally.
“Our salaries aren’t enough to live on and we’re forced to make a living anyway we can. That’s why we set up our own dentistry businesses and, in most cases, use the supplies from the State clinics, which are taken from the workplace and used for private procedures,” a source involved in this business, who wished to remain anonymous, explained to us.
“Me,” he added, “I have ‘connections’ [contacts] in warehouses and I get all of my supplies before they’re inventoried. Making a huge effort and facing many problems to earn 20 dollars a month and making 10 dollars for one dental cleaning in the comfort of your own home are very different things indeed.”
Our source added that some people continue to avoid going to private clinics for more complex surgical procedures, but that this situation is rapidly changing.
“We’re seeing more and more people unwilling to go through the disastrous experience of a State clinic and come to us every day,” he said.
Waiting for Dentures
The preparation and production of dentures is one of the public services facing the greatest number of problems in the field. Many a time, material shortages lead to long waiting times. Most of the materials used to make dentures are imported and are included under the health services subsidized – and rationalized – by the State.
A lack of qualified personnel to make these dentures has also resulted in the suspension of these services at different clinics for prolonged periods of time. According to several people interviewed, the waiting time for these dentures can be as long as two years – something which forces many to resort to the quicker and far more efficient private services.
“A few years ago, a denture cost you 70 Cuban pesos or less, and you got them in no time. Now, sometimes you have no other choice but to pay a good buck at a private clinic, which, many a time, offer their services in the very premises of the State clinic,” said Roberto Mirelles, a self-employed worker who claims to have paid 20 CUC for a lower jaw implant.
“I don’t know where they get their materials from exactly. What I can tell you is that they do high-quality implants and they do what you actually need them to do,” Mirelles added.
Despite efforts to contact the National Dentistry Office, under the Ministry of Public Health, we were unable to get a statement on this situation from any public official.
Patients from Abroad
Rosa Hinojosa, a Cuban residing in the United States, paid 150 CUC for an upper jaw denture and a cleanup.
“This may be expensive for people living in Cuba. But I didn’t have to wait forever for an appointment and didn’t have to pay 300 CUC at a State clinic that offers services (to foreigners) in hard currency. I got everything done at someone’s home, where they had all of the equipment, anesthesia and materials they needed. I’m pleased.” Hinojosa declared.
In the United States, a complete denture costs around 800 dollars.
The growing number of specialists and technicians who are leaving their government jobs and gravitating towards the private sector, be it to offer illegal dental services or become involved in other activities, is a growing trend.
One such professional (who chose to remain anonymous) graduated as a dental technician in 2009 and has been working at home since last year. He alternates between being a “private dentist” and a licensed watch repairman.
“My relatives send me some of the supplies I need from the United States. There are some that are expensive over there and I have to find some way of getting those from State clinics,” the dentist said.
He added that this is a fairly common practice.
Irregular Services
“Most do what I do, and when supplies are deviated to private clinics, you get shortages in the State clinic. People therefore turn to the private sector for their dental services. It’s a vicious circle and the only way to break out of it is to respect the work of dentistry professionals and pay them a proper salary. Failing that, we will continue to have two options: a free but inefficient service and an illegal and costly but effective and prompt private service,” the dentist explained.
Similarly, dental technicians who work at State clinics and offer private services illegally make use of the government workshops where they work, using the materials and equipment from these clinics, particularly to make dentures.
Long waiting times for appointments, the lack of sterilized instruments or equipment needed for certain procedures and incidents such as loss of power and water supply prevent most Cuban dentistry clinics from offering the public a quality service.
Increasingly, patients must line-up outside State clinics in the early hours of the morning in order to be seen by a dentist, for, as the day progresses, it is not uncommon for supplies to run out and for services to be suspended as a result of this.
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* Former journalist for Cuba’s Juventud Rebelde newspaper and author of the blog “Visor Cubano”
Russian trolls again trying to create unnecessary propaganda that has nothing to do with this article. Such a shame that these trolls have the time to create such poorly stated non facts that have no existence. Just look at what Brian noticed.
I went to a dentist in northern new Mexico usa : I walked out when i saw dark brown stains on the instruments and tray they were on. Yes, assistant confirmed this was dried blood. Apologised to me saying “oh we forgot to clean instruments. ” what I have seen of clinics in cuba: Yes,some supplies are iffy, or difficult to get, but this is in part one of the challenges due to the us and world restraints. Yes, some rooms may be old and damp (humidity is a problem everywhere). But everything looks relatively clean.
Are you kidding? Look at that photo. As a practicing dentist, the US would take away my license practicing in those conditions
Does anyone here know whether amalgam (“silver”) fillings are used commonly or rarely in Cuba? Or mostly the white plastic sort? Thanks.
Some people have suggested reading or commenting on this site is to engage in anti-Cuba and pro-US propaganda. Perhaps often true, but I keep hoping Cubans and others interested in learning about and helping improve life for all Cubans will make use of this forum.
This article raises some of these issues. First as a consumer of US dental services and with years of practice trying to get these services for family, friends and clients, let me say the dental services in the US are far worse than what is described in this article. Why is that relevant? Because one reason for Cuba’s historic struggle to get all medical services to average Cubans has been so difficult and uneven is that the rich and powerful in the US never cared about universal quality care for Cubans – or citizens of the US. If you don’t recognize that fact, then we live in different realities.
Anecdotally, there are terrible and excellent health providers and clinics in both countries. More importantly, we in the US could easily provide high quality care, including dentistry, for all if there was a political willingness in the seats of power. If we had dental care for all, and most of the poor and elderly in the US do not receive free (pre-paid by insurance or social services) dental care. If they are fortunate to have insurance coverage from employment (a declining %) or afford private care, wonderful. But such care is the exception for millions in the US.
In Cuba, as this article explains, providing equal and needed care to all, is difficult because of the past poverty for most and recent efforts by the US to make Cuba’s economics fail. Now corruption favors the privileged and punishes the average citizen. I have utilized both normal and commercial medical services in Cuba and both had pluses and minuses – just like my medical experiences in the US and elsewhere.
I believe that ordinary citizens would be better off (as health statistics around the world have shown) if all citizens were covered with payment at the time not a factor. It is a tragic and murderous fact that the health and medical care needed by ordinary people all over the world are susceptible to political manipulations. Some of want it to be better for all, some only care about themselves. You decide which side of this struggle you want to be on.
One fights against the Big Lie with truth. Every time.
You have made this comment many times in the past and it never gets old. Well worth repeating.
In Cuba, dental services, as with medical services and education, are never free. Theses service cost money to provide and that money must come from somewhere. The average Cuban salary is less than $20 per month, which means in effect, the Cuban worker is hit with a 95% income tax before they even see their pay. That is how the Cuban people pay for their so-called “free” services.
Calling these services free is a con job, it’s as if a slave owner boasted about all the free food, lodging and chains he provides his lucky slaves.