A Cuban Doctor from the Old School

By Alexander Londres

HAVANA TIMES — She is an “old school” doctor, from the time when anybody could not just become a doctor. You had to really study back then, without computers or digital material. Getting by with the little printed literature there was, without summarized study programs.  The training came with all of the rigor and requirements that the profession needed, to be qualified to take other people’s health and lives into your own hands.

She tells me that, as a young girl, in that small isolated mountain town where she used to live, she used to play doctor and pretend that she was tending to patients and she dreamt about healing diseases. She never wanted to be anything else but a doctor.

Back then being a doctor was still a great achievement and an undeniable symbol of prestige and intelligence. She could never imagine back then the massive scale that training health professionals would take on today.

Just in her province alone, Guantanamo, 2,430 doctors graduated in 2015 and another 10,021 enrolled. And it’s no secret that this responds to the Cuban government’s current need to meet its international agreements where it exports medical services and professionals, currently the national economy’s main source of income.

Far from home, thinking about her young son who she had to leave in her mother’s care, amidst extreme shortages at her dorm, Tanya studied at university, when those all inclusive soups frequently consisted of her food for the entire day.

It’s been 23 years now since she graduated, and ever since her first experience in the field, her love and respect for her job have stopped her from maltreating a patient and she has always complied with her responsibility, no matter what the situation. She has never tolerated the laziness of some doctors in certain situations when you have to put the other person’s need above your own tiredness, your sleep, unsuitable timetables; responding to “badly-timed” emergencies with humanism.

She remembers that her Social Service – which was three compulsory years back then in order to specialize – was in the middle of the Special Period, and at that time she had to really strive to practice her profession. She had to deal with on-call shifts at the hospital in the dark because of the blackouts, and even had to deliver babies in semi-darkness with just an oil lamp; she had to learn to cross overflowing rivers; she had to get used to going up and down mountains on foot to see her patients.

Back then being a doctor was still a great achievement and an undeniable symbol of prestige and intelligence. She could never imagine back then the massive scale that training health professionals would take on today.

She is now nearly 50 years old but her smile, cheerfulness and her beautiful green eyes make her appear much younger. She is a top specialist in Comprehensive General Medicine and has gone on several international missions, once in Venezuela and twice in Nicaragua.

She confesses that the first time she had to go she went, in spite of her second daughter only being three years old at the time, in order to improve the family’s economy and to get material things that would take a long time to get with the pitiful salary they used to receive back then, which is quite a lot more today, but is still not near enough. However, she claims that she went the other two times so that she could continue to see the world and to give Cuba a good name.

She is a native country girl through and through and defines herself as a revolutionary and as a Cuban she knows how hard it is sometimes to live here. However, she is not one of these professionals – which are so many nowadays – who expect some kind of material thanks from patients for their work, for giving assistance which is public and free.

Meanwhile, she regrets that the Cuban people’s financial situation and the chance to go abroad are the most common reasons today why young people are choosing to study Medicine.

She knows that these future doctors have everything a lot easier: better study conditions, updated bibliographies, access to online scientific publications, fully-equipped labs… in summary, they enjoy a greater number of resources which are made available to them.

When she sees them losing their valuable study time, entertained by their smartphones, their earphones and their fashionable uniforms, she asks whether these “new age doctors” who are being trained without the rigor of yesteryear – and I would add a source of malpractice – will be the ones to attend to our children and grandchildren when colleagues from her generation – the older ones, like people refer to them as – are no longer active.

This also scares me, I tell her. You hear all kinds of stories, which, even if they are one-off cases, not very common, true or not, are still worrying because they call into question the prestige of our army of white coats.

My doctor suffers when she hears my words. She makes me see this.

And then she assures me that she doesn’t agree with subordinating the quality of professional training, to graduating more and more doctors just to meet certain targets which at times have proven insufficient to cover Cuba’s own needs.

Among other reasons – she explains to me – there is population aging and the Comprehensive Health Program’s wide international demand, which shares Cuban doctors with the rest of the world – nearly 50,000 active doctors in total now in 2017. And this has meant readjusting, or rather, increasing here the number of patients per doctor at times, especially in primary care.

Me afirma que ya no es válido aquello de 120 núcleos familiares por consultorio, como en la génesis del Programa del Médico y la Enfermera de la Familia, allá por el 85. Ahora el límite establecido es de 1.200 pacientes.

She tells me that the standard of having 120 family units per doctor’s office is no longer valid, like in the beginning of the Family Doctor and Nurse Program, which was created around 1985. Now the limit is 1200 patients per doctor. And when I tell her that data from the Office for National Statistics indicate that at the end of 2014, there were only 130 inhabitants per doctor, she was stunned.

She is convinced that this just a sterile collection of statistics. Because in practice, on the ground, they have to attend to a much greater number of people, she tells me. And a lot of the time, this promotes poor quality medical assistance to the population.

We doctors also get tired. Although that should never influence our work, she clarifies.

It’s Saturday afternoon. She hurries her last words and gets restless because she has to go and visit a pregnant woman. I am surprised by her energy and constant willingness to work, without skimping on her timetable or weekend.

But then I understand something: Doctor Tanya is from the old school.