“Prosperity Begets Kindness”: On Cuba’s Public Health System

Fernando Ravsberg*

HAVANA TIMES — Recently, I made use of my Cuban medical insurance for the first time. The medical attention I received at the hospital was excellent: in a couple of hours, I was seen by a physician and two other specialists. The problem came up afterwards, when I was told I would have to wait around two additional hours for paperwork.

What the hospital needed at that point was for someone at the insurance company to answer the phone in order to confirm I had paid my annual fee. “These are regulations Asistur [Cuba’s insurance agency] imposes on us, and they’re extremely slow getting back to us,” the clinic’s administrative secretary explained to me.

Ultimately, one of the head doctors at the clinic showed up, decided to disregard the bureaucratic rules and suggested I went home to rest, assuring me she would assume all responsibility for this, as “the patient’s health comes first.”

Months ago, I had to take a Cuban friend with a sprained ankle to Havana’s clinical-surgical hospital. At the emergency ward, she was seen by an orthopedist who conducted a meticulous exam, explained to her the treatment and instructed the nurses to place her foot and ankle in a cast.

That’s where the problems started: the technicians told her they had run out of plaster. The physician then said to them: “you best see what’s going on with the supplies, because my patients can’t do without them.” A short time later, the missing plaster turned up.

A Lack of Doctors?

In confidence, a government official complained about the state of Cuba’s public health and told me that the shortage of doctors in the country had been brought about by sending thousands of these professionals to work abroad.

Cuban citizens ought to be able to decide on this issue, cognizant of the fact that brining their medical doctors back home would mean, among other things, going back to the days of massive power-cuts, as these doctors are the ones paying for the oil coming from Venezuela, the oil that keeps our light bulbs on today.

What’s more, the numbers don’t exactly convince me: there are no more than 20 thousand Cuban health professionals working abroad, including those who are to work in Brazil and Ecuador. That is to say, there are still 55 thousand medical doctors still on the island, one for every 200 inhabitants. This is one of the best ratios in the world.

That said, those who complain are in the right: Cuba’s public health system isn’t working as it should. When compared to other countries in the region, these criticisms may strike one as rather excessive, but they are justified when we compare the system today with what it once was in Cuba.

Cubans had become used to better, quicker and more equipped medical attention. The country’s public health system, what’s more, never even cared to calculate the monetary value of its services (to this day, Cuba’s institutions are unaware of the real costs of these services).

For decades, the system spent what needed to be spent and more (sometimes much more). The problem is that Cuba can no longer rely on the “selfless aid of the Soviet Union” and has to do with what it’s got at home.

There are more than enough doctors, the basic monetary resources, equipment, facilities, scientific infrastructure and medication needed. What’s missing is efficiency, organization, control, decorous salaries, outpatient services and the rational use of resources.

Achievements outside the Sporting World

Inexplicably, the salaries of Cuba’s medical professionals are miniscule. Though these professionals contribute more hard currency to the country’s economy than any other sector in Cuba, they are paid less than US $ 1.00 for a 24-shift at an emergency ward where they must treat hundreds of patients.

All the while, the Ministry of Public Health spends its budget on hospital buildings that end up having water leakages, windows that won’t open, contaminated operating rooms and roofs that collapse. Or it lets equipment worth thousands of dollars break down to save on a 300-hundred-dollar air conditioner.

To raise salaries, it would suffice to tighten the Ministry’s belt, forcing it to make better use of its resources, create efficient bureaucratic mechanisms, establish effective controls, spend rationally and demand a minimum of quality in the services it hires.

The Ministry could also be asked to control the medications it imports and produces, those it sells at subsidized prices and later disappear from hospitals, pharmacies and laboratories to swell the black market and the pockets of speculators.

The government has just announced that athletes will be able to enter into contracts in other countries and keep all of the money they earn. I think this is an excellent idea, as it is the only way in which the sporting achievements that made Cuba famous can be maintained.

But no Olympic medal has made Cuba prouder than the work of its medical professionals in over 100 countries around the world, including the reduction of infant mortality on the island to one of the lowest levels in the planet and having given thousands of Latin Americans back their sight.

No one is more entitled than Cuba’s health professionals to receive recognition for their work, beyond the official diplomas and speeches. A mere 2% of the hard currency these professionals bring in for the country would suffice to pay them salaries above the absolute minimum needed to survive.

Cuban independence hero Jose Marti once said that “in order to be good, one needs to be prosperous.” He may have been right, but this maxim does not seem to apply to Cuban doctors, for their kindness is infinitely greater than the prosperity they have seen in the last 20 years.
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 (*) An authorized HT translation of the original published by BBC Mundo.