Cuba’s Public Health Budget and Rafael

By Fernando Ravsberg*

HAVANA TIMES — Rafael Botalin Diaz is 15 years old and suffers from a high-grade cerebral AVM that could kill him at any moment. It was detected in April, when he experienced convulsions and blacked out for half an hour.

He was treated at the Santiago de Cuba Children’s Hospital. There, on determining the seriousness of the case, the Ministry of Public Health placed him on a plane headed for Havana, accompanied by his parents and a nurse that was to see him at the Neurology Institute.

Physicians in the capital confirmed the diagnosis and decided that, given the complexity and gravity of the condition, he could not be treated in Cuba. The teenager requires multiple embolizations and radiosurgery, in view of which they recommended sending him to Spain.

Rafael’s father explained to me that there is a commission that reviews each of the cases that must be sent abroad for medical attention. This commission approved the patient’s transfer to a specialized care center abroad.

All trip and medical expenses are covered by the Cuban Public Health Ministry. They include anywhere from 30 to 50 thousand euros for medical attention and the round trip tickets for the child and his mother. She is also given money for the hotel, food and transportation.

“I have no complaints about the medical attention my son has received, the problem is that the trip is being delayed and no one is giving me an explanation,” his father, whose name is also Rafael Botalin, tells me.

He explains to me that, after his first meeting with the official responsible for these types of cases, he has never again been able to see anyone. He adds that the few times he has managed to get this person on the phone, he has received a very curt reply: “we have no new information for you.”

Rafael has requested a meeting with the Vice-Minister for Public Health several times to get an answer, but he has never been able to get past the secretaries, who always tell him their superior is on vacation, at a meeting or simply away.

He said that, finally, one of the secretaries took pity on him and informed him, over the phone, that the true cause of the delay is that the year’s budget for sending patients abroad has run out and that he would have to wait until January of 2015.

Rafael again consulted with the doctors, who reiterated that the case is very serious and should be treated as soon as possible. The problem is that the malformation is very complex and is aggravated by the changes a person experiences during adolescence.

They explained to him that another episode like the one he suffered in April could cause permanent damage and even death. Getting no answers from the Ministry of Public Health, the father is writing dozens of letters – to UNICEF, the WHO and the Central Committee of the Communist Party, among others – but no one replies.

Finally, he wrote my blog, Cartas desde Cuba (“Letters from Cuba”), in an attempt to make the case public, believing that he is facing mere bureaucratic hurdles, unwilling to have his son’s life depend on that. “If the budget’s run out, then they should get the money from less important health programs,” he said to me.

“Cuba invests money to help couples who suffer infertility and I think that’s very good, but they can’t prioritize that over the life of children who have already been born,” he added, arguing with as much passion as reason.

Without a doubt, Cuba’s economic resources are limited and sending patients abroad to receive medical attention at the expense of the Public Health Ministry is commendable for a Third World country.

It is advisable for the different sectors of the economy to restrict their spending to a given budget, but there are some sectors, such as health and education, in which flexibility is of the essence, in order to avoid having a child die of a curable disease or be left without a teacher.
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(*) Visit the blog of Fernando Ravsberg.