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

No sporting achievement outshines the work Cuban doctors have devoted to reducing the island’s infant mortality (Photo: Raquel Perez).
No sporting achievement outshines the work Cuban doctors have devoted to reducing the island’s infant mortality (Photo: Raquel Perez).

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.

Even with 20 thousand of its medical doctors working abroad, Cuba has one of the best doctor-to-patient rations in the world. (Photo: Raquel Perez).
Even with 20 thousand of its medical doctors working abroad, Cuba has one of the best doctor-to-patient rations in the world. (Photo: Raquel Perez).

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.

Hundreds of thousands of Latin Americans have regained their sight thanks to the work of Cuban ophthalmologists (Photo: Raquel Perez).
Hundreds of thousands of Latin Americans have regained their sight thanks to the work of Cuban ophthalmologists (Photo: Raquel Perez).

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.


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

  • November 13, 2013 at 11:15 pm
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    Oh my! How could a hospital be operating without even a
    plaster on hand? How could the medical team treat an emergency patient when it
    lacks the necessary supplies? It would surely be so hard.

    SouthTexasInsuranceAgent.com

  • October 9, 2013 at 1:20 am
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    You conveniently skip over the fact that nearly 100% of people in Western Europe have access to medical services. 95% of Cubans – all of the people except the elite – have patchy access to medical services of very poor quality.
    Cuba was at part with Western Europe before Castro. Castro’s rule has been a disaster for Cubans.

  • October 6, 2013 at 1:46 pm
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    It’s more like 12.5% or 38 million Americans. It’s bad enough at 12.5% for the richest country in the world, you don’t need to exaggerate.

  • October 6, 2013 at 7:09 am
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    Moses conveniently skips over the fact that almost 40% of the US citizens have no medical insurance. And the cost of treatment in US hospitals is staggering. Trying to bring benefit to the majority through “Obamacare” has shut down the government. Cuban health care may have flaws – all health care around the world does so – but at least the first question is not whether you can afford the service.

  • October 6, 2013 at 5:24 am
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    The US and Europe have wide state and private funding for deserving students. In most European countries there are systems with very low tuition fees. Their education is very good as well.
    The middle classes are very well represented in these systems as they value education very highly. Deserving kids from lower income brackets have access to scholarships in all systems.
    In all countries but Cuba they are then free to work and go where they want. Any debts they may have incurred are paid back proving the investment in education was worth it.
    A Cuban doctor in Venezuela “pays” 120,000 dollars a year to the regime. that is 75% of the median debt of a US student. After two years he has paid a lot lmore then even a student from a private university in the US.
    http://gradschool.about.com/od/medicalschool/f/MedSchoolCost.htm
    Lots of doctors serve others in free clinics and through charities like MSF (Doctors without Borders).
    The Cuban doctors could also provide care abroad if they were allowed to emigrate. Brazil offered them places and $4000 a month for them and their families. the Cuban regime doesn’t allow them to emigrate. They are – as Yoani Sanchez put it – the serfs of the Castro regime. They aren’t free. The price of an education as doctor in Cuba for a Cuban is lifelong slavery and servitude: a much higher price than any US or European student pays.

  • October 5, 2013 at 5:10 pm
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    Dan, most top medical schools will never refuse any student who has qualified for admission based on a lack of funds. As a result, it is true that many young residents will have racked up $100K in student loans but within 10 years, these loans are paid off or forgiven. There are very few ‘poor’ doctors in the US. There is simply no comparison today between the quality of medical care in the US and the care most Cubans receive in Cuba. My Cuban-American children were born years ago here in the US in a private room with a sofabed for visitors and a 40-inch flatscreen TV. My cousin-in-law just gave birth to a beautiful healthy baby girl in Guantanamo in a room with 12 other women with no privacy screens, no air-conditioning and one over-filled wastebin. My wife sent sheets and towels by DHL so that her cousin would have clean sheets. Trust me, no comparison!

  • October 4, 2013 at 1:51 pm
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    How many middle class and poor go to med school in the US ? Do Americans not graduate from med school indentured to the student loan creditors ? Then what ? Even if they got into the field for altruistic reasons they are forced into working for the venal, corrupt, broken US healthcare system. The Cubans at least are providing invaluable care to the poor of the world. Bravo for Cuba.

  • October 4, 2013 at 3:22 am
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    The Cuba health official are no more than Castro’s indentured labor. Castro’s serfs said Yoani Sanchez. Mr. Ravsberg is again “forgetting” the fact that in Cuba the health service for Cubans in Cuba is a disaster. A disaster that has a well funded and equipped “commercial” part of the apartheid system often in the same hospital only 100 yards away. He forgets the rampant corruption in the system. He foregst the reduction in family doctors. the lacl of staff in polyclinics and hospitals as they are on “missions”.
    He also forgets to mention that these “internationalists” that go all over the world earn between 30,000 and 130,000 dollars annually for the regime. Money of which the doctors themselves receive a very small part. He forgets the pressures these doctors are put under facing scarcity and the humiliation of earning less than a waiter in a tourist hotel. He forgets the need of their families and the blackmail of the system that forces them to accept “missions” abroad. He also forgets that doctors – even under the new system – can not freely travel abroad as they need a permit from their employer (MINSAP) to do so.
    Mr. Ravsberg again forgets lots of the essential parts of the story.

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