Hail Cesar, the Gladiators About to Die Salute You

Pharmacy in Mayari, Holguin after supplies are delivered.

By Eduardo N. Cordovi Hernandez

HAVANA TIMES – There’s a series of medications that require the presentation of a doctor’s prescription here in Cuba in order to purchase them at a pharmacy. This may be because of their importance for the user; or perhaps due to the possible danger they present to someone who doesn’t have to take them; or because they’re earmarked for a reduced sector of the population.

In the case of certain medications that the patient should consume daily for their entire lives – such as diabetics, hemophiliacs, those with chronic high blood pressure etc., a yearly registry has been implemented. Using this system, the patient can acquire them through a special card, and not have to bring in a new prescription for the same thing every month. We call this access card the Big Card, although it’s not large, and it must coincide with a list that’s kept in the power of the pharmacy and that is updated annually via a medical certificate.

Hypertension and diabetes are two non-infectious degenerative illnesses that are so widespread that they could be considered epidemics, at least in the western countries. But they’re equally common in all the large cities anywhere in the world. Because of this, they’re considered modern ailments, or ailments of civilization, since they have a lot to do with the habits or lifestyles that scientific-technical development has imposed on us. These include the quality or types of foods known as processed, and the sustained over-stimulation of our attention. The latter problem – which we summarize with the English word “stress”- is due to the fear induced by the constant presence of different risk factors, such as being always in a hurry, excessive work, and diverse worries.

Arterial hypertension and diabetes are fatal diseases, but, it’s not an indispensable requirement to be suffering from one of them in order to die as a consequence of that ailment, or even of both together. A person can have high blood pressure for different reasons, among them diabetes, since  diabetes often leads to hypertension, among various other consequences such as erectile disfunction, blindness, yeast infections, kidney problems. However, by readjusting one’s habits and with the recommended medications, the patient can succeed in controlling their condition and prolonging their life, to the point of dying in old age and of other things.

For months now in Cuba this 2023, there’ve been difficulties in the supplies of certain medications in the pharmacies. One I know about with certainty is Enalapril, an angiotensin-converting enzyme inhibitor used in the management of hypertension and congestive heart failure. An enormous population of people who suffer from high blood pressure depend on it to control the stability of their health. I know now that it’s not only this medicine – but many others are also in the same situation.

Sometimes for work reasons you’re not in your neighborhood the day the medications come in, or you forget to go pick them up. Previously, if you were registered and had a card to obtain them, you could buy them anytime within the month. That’s no longer true, since the complete amount of medicine for everyone doesn’t arrive. There’s not enough to go around: even though you have the big card; even if your blood pressure is elevated that day; even though they didn’t supply any the month before.

Hence, the day they’re giving out the supplies, people form a line. If you arrive a little late, it could be that you don’t get any. Nonetheless, there are people who are selling – not the box that contains three blister packs of ten pills, or the little plastic case of thirty, at the regular price of about 20 Cuban pesos – but they’re selling every blister pack for the astronomical price of two hundred fifty Cuban pesos. It’s the market of your life, the enrichment of some at the cost of your fear of having to go through a bad time in which your blood pressure rises to the point that you could also die.

Some days ago, I went by the pharmacy and asked if by any chance they had Enalpril. They told me that there’d been some available, but that they couldn’t go pick it up due to transportation problems. There’s no gasoline. At times, I’ve had to solve the problem by buying some over-priced pills, or through friends who can get me a blister pack with four pills over here, while someone else can give me two more over there. And I save them by taking half a pill instead of the whole one. I drink enough water, avoid becoming upset, exercise nearly every day, use little salt, and a minimum of sugar, never the refined kind… And so on.

Another day, I went back to the pharmacy again. Another girl was there behind the counter that day, and I asked her the same question. The young girl looked me up and down, lowering the corners of her mouth to form an arch, but raising an eyebrow before repeating in an exaggeratedly questioning tone: “E-na-la-PRIL??” I couldn’t tell whether she was really asking me, or if it had surprised her that I’d asked her. However, it was clear to me that, apparently, there’s not going to be any for some time.

It’s no longer just Enalapril, but all kinds of medications. In fact, many pharmacies that always had someone available to dispense medication, no longer have night hours. Soon, there’ll be nothing left to sell, and they’ll close too. The shelves, racks and ledges are all empty.

I’m certain that, blessed be God, our leaders are exempt from these medicine shortages. In all of them you can observe excess weight, obesity, and enough abdominal fat to diagnose insulin resistance and oxidative stress. Their lives are spent in long airline trips, meetings, interviews, symposiums, and other international events, where the need for punctuality and protocol elevate the levels of demand for appearance, diction and a long list of etcetera’s. I’d also have to include the obstacle of not being understood at times, nor recognized for the outsized efforts they’ve made in the functions they carry out.

While I write this, I’m listening to a radio station called “Popular Encyclopedia Radio”, to an instrumental piece called “Poor people of Paris”.

Read more from the diary of Eduardo N. Cordovi aquí en Havana Times