Health Care in Cuba: Excellence, but with Flaws

Rosa Martinez

Havana's Maternidad-Obrera Hospital Photo: Caridad

HAVANA TIMES, Oct. 30 — The Cuban government allocates many millions of dollars annually in a tremendous effort to provide excellent health care services to the more than 11 million residents of the island.

Notwithstanding, there is much dissatisfaction.  This relates to everything from shortages of medical supplies to medical personnel and paramedics, who —far from alleviating patients’ suffering— make conditions worse with their poor treatment and incorrect procedures, not to mention those who require a “gift” to do their jobs in a quality manner.

I want to share with the readers of Havana Times what happened to a 39-year-old Guantanamo resident who decided after two decades to have her third child.  Fortunately the child was a girl, therefore she could name her Idaliana in honor of a friend who died recently.

During the 40 weeks of her pregnancy, Ana Maria Gonzalez received all the necessary attention provided through the Infant-Mother Program (PAMI).  Though she’s very grateful to all the medical personnel who supported her, she feels sorry that —unlike in the soap operas— the happy ending to this story never came to be.

Her first trimester was the most difficult stage.  She suffered the common bouts of vomiting experienced by many women during this stage, as well as recurrent headaches.  She tried to eat the best she could as indicated to her by the family doctor, who fortunately was the same one attending her to the end of her pregnancy, something we no longer see often.

Ana was admitted into hospital ward 4E for five days in April for a seasonal cold that caused her a shortage of breath.  Also, since the AH1N1 virus had entered the country, she remained under special observation along with other expecting mothers as well as those who had recently delivered and their newborns.  In this ward she felt at home; those who are hospitalized there are usually very well attended.

Her second time, she was admitted to the perinatology ward for arterial hypertension.  Working there was Dr. Neysel Jardi, who she remembers with great affection, but who unfortunately for Guantanamo is now serving on an internationalist medical mission in Nigeria.  Jardi remained well aware of her condition, as he did of those of the rest of the patients in that ward.  He is a competent specialist and someone who knows how to work with people who are hospitalized.

Ana had been expecting to give birth to her baby since the week before.  At any moment she could have felt the first sign.  Sometime after midnight on Sunday her daughter startws kicking, as if to say, “Mommy, here we go – I’m coming out.”

Everybody running

Quickly, her sister called for an ambulance, since at that hour not even bicycles pass by where she lives, on the south side of the city.

Fortunately the vehicle arrived rapidly.  In less than five minutes she had been picked up and taken to the provincial hospital.

Mother and daughter. Photo: Irina Echarry

She was received by the emergency staff and from there directed to the pre-childbirth unit.  Now she was ready to bring her little girl into the world.  “This delivery will be easier,” said her sister consolingly, “After the second, the third is a piece of cake.”

Ana Maria arrived in the pre-childbirth unit with those words in mind.  The pain felt like she was being eaten alive, but she knew that her daughter soon would be in her arms.  That single thought gave her the power to tolerate the spasms and all the hands rummaging through her insides.

After the first trimester, her baby had become well disciplined – it didn’t want to leave ahead of time and didn’t cause any serious nuisance or acidity.  “I’m sure she’ll continue being obedient and will come through without a major complication,” thought Ana.

But it wasn’t like this

At the last moment Idaliana shifted position in Ana Maria’s abdomen, and the medical staff had to perform an emergency Caesarean section to deliver the baby.  “Great,” she thought, “My only girl and it will have to be delivered by force.”

Dr. Mena was the one who carried out the successful Caesarean operation, but it was the anesthesiologist who became the best friend that a suffering woman could have during the 40 minutes of the operation.  Her words were not only those of confidence and encouragement, they were a balm for Ana’s soul.  They were more effective than the injection into her spine and that anesthetized the lower half of her body.

Following the Caesarean, Ana Maria was sent to the post-operative unit for the established 12-hour period.  From there she went to the burn unit ward when it turned out that there wasn’t a bed in the cesarean area.

“And here is where the problems started,” said her sister, who had been able to remain with her to the post-operative room.  Ana remained in the burn unit for three days while her baby girl was under the care of nurses in the pre-partum unit that whole time.

She eagerly waited for three days to hold and breastfeed her newborn, and finally the moment arrived.  They transferred her together with her baby to cesarean area. She experienced her first displeasure when she went to change the girl; the baby had a red vulva, which hurt her to see it.  Ana didn’t want to blame anyone; she was only concerned about how to cure the condition and to alleviate any discomfort the baby might feel.  Finally she was with her daughter, and that was what mattered.

The bathrooms were dirty because there hadn’t been water in the hospital for several days, but soon she would be able to go home.  She knew she had to remain calm.

That night she could hardly shut her eyes.  There was the pain on the one hand and the newborn that was not satisfied with her milk on the other.  With all this she couldn’t rest.  That morning, after using the bathroom, she took advantage of the cool air and slept for a while.

The time came for the visit by her doctor, who woke up her.  “Have you had any tests done in this ward?” he asked.

Still half asleep, Ana responded, “No, not here, but…”

Not allowing her to finish, he then added rudely, “You didn’t hear what I asked?

Then, quite awake, she told him, “Yes, I heard you, and I was trying to explain to you that when I was in the burn ward…”

“But Ma’am,” shouted the doctor, again interrupting: “Limit yourself to what I ask you.  I’m not interested in what you did in the burn unit.  I’m asking you for a third time if any tests were done on you in this ward.”

The mother, now extremely upset and also yelling back, responded saying, “What I’m trying to explain to you is that they already did the tests on me in another ward and that as far as I know this is a single hospital.”

“You’re the people?” said the doctor, referring to the eight mothers in the room -“You’re the ones who they give any test and you always score a big zero.

Perhaps those words didn’t matter to the other mothers, but Ana Maria —who graduated in educational science 16 years ago— turned red with anger.

She was so mad that she collected her belongings and, without listening to the advice of her family members there, left for her home without receiving a medical discharge.

Perhaps you’ll agree with me that the mother’s attitude wasn’t the most intelligent, especially for her baby.  But I wonder if confronted with such an insult and similar abuse whether you might have done the same thing?

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