Favoritism in Cuba’s Health Care System

Erasmo Calzadilla

Any Cuban will have lots of stories similar to the one I’m about to tell.

I went with a friend to a suburban hospital for her to get an ultrasound exam of her reproductive organs.  At six o’clock in the morning, women began to line up for the test.

Since they each arrived with a full bladder (which is required for the exam) and they all had the strong urge to use the bathroom, we zealously organized a line.  We figured that even one person cutting ahead would slow things down too much once the yearned for moment to urinate came.

By the 8.00 a.m. starting time, all those women were writhing, jumping up and down and groaning in pain as they tightened their muscles to hold themselves back.  We were afraid that the medical staff would come late, so it was a great relief when the doors to the consultation room opened on times.

They then begin seeing the patients, but which ones? – those in line?  No, not them, but the ones who were either friends of the doctor or who had previously cut deals with her and her ill-mannered smoking secretary.  Another hour later, the first of the early arrivers had still not been seen.  Instead, even more “buddies” were being attended to while a bunch more of them waited for their chance.

The early arrivers were restless and furious, but not one of them dared to protest or complain.  After getting what I “deserved” I understood why.

By 9:00 I couldn’t take any more, I went into the consultation room to ask when they were going to see the others.  The smoking secretary responded “now!”  But from her insolent tone and the grimace on her face, I could tell that what she really meant was “when you leave me the hell alone.”

I’ll summarize what happened next.

For my having asked this several times, the specialist took it out on my comrade.  She humiliated my friend and emotionally trampled her with a histrionic ability that’s difficult to describe.

She wasn’t going to let a companion or a patient question her that way, since that was the way things were done there.  My friend suffered through the experience crying, but when she managed to string a few words together, her sweet complain wasn’t heard.

However when the doctor saw her tears streaming down, it seems the physician became sensitized.  She apologized and told my friend that she would attend to her.  She wouldn’t have to keep poking her head in and she won’t have to get in line.  By this point my friend was in no mood to argue.

The hospital is public, sustained by the people’s money, but doctors and patients behave as if it were private and the medical attention were a gift.

It doesn’t always happen this way, though it occurs often enough.  The mechanisms are too tortuous for people to exercise some control over the functionaries and the specialists – who should supposedly serve them.

This problem is so frequent that it has now been established in common thought as something normal, making it now much more difficult to of extirpate.  People don’t fight it; they accommodate the best they can.

The alienation stemming from “state socialism” and “capitalism” takes place despite having taken different roads, and they wind up looking pretty much alike.  The question now is “what is to be done?”

One thought on “Favoritism in Cuba’s Health Care System

  • “The hospital is public, sustained by the people’s money, but doctors and patients behave as if it were private and the medical attention were a gift.”

    Here is a different solution to the same problem. Imagine that each person in Cuba is given an allowance for medical expenditure (this will be the people’s money you talk about) and imagine also that they are allow to expend this allowance anywhere for medical treatment. When they spend that allowance in a place that place can redeem the allowance and then pay their doctors and nurses correspondingly. So it will be natural to think that in that case it will be in the very best interest of any doctor and nurse to treat the patients right. Do you agree? Because if they do not then people will know and they will simple vote with their allowance and go to some other place that is better!

    Problem solve! What do you think Erasmo about my solution?

    Yes the problem you describe is a systemic problem. Happens because the system allows it to happen. You could potentially solve it by creating inspectors who check on this etc but that will be the wrong solution. It is easier using demand and offer.
    Using that you will also get that the best doctors will get a lot more patient than the bad doctors who people will avoid. So it is sort of like a natural selection similar to Darwin happening. Is that bad? I say no.
    It does incentivate the bad doctors and nurses to be better at what they do and do the work that is required from them in the first place.


    Let me know if you like my solution or if you see an issue with it. Best to you.

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