HOME Let Cuba Live - News Update for August 2008
by Tom Whitney
Health care Cuban style has many admirers. Favorable statistical measures of health outcome vying with those of wealthy nations are one reason. Preventative strategies, health education, and universal access to care through a unique primary care system all contribute.
Improved infant mortality rates have long been followed by the writer, a pediatrician. In Cuba that measure, a sensitive marker of social support within a society, has remained for two years at a low 5.3 babies dying in their first year out of 1000 births. The most recent U.S. infant mortality rate is 6.3, with the added twist that African American babies die at twice that rate. The worldwide infant mortality rate is 52, that for the rest of Latin America is 26.
Cuban health care has been applauded too because of its international outreach. The most recent class of new doctors graduating from the Latin American School of Medicine on August 2 made for a four year total of 5960 young people from 27 nations having completed a free six year course of medical study. Presently 21,000 foreign medical students are studying in Cuba. Two years ago, 28,664 Cuban doctors were serving in 68 countries.
But just as noteworthy has been the development in Cuba of capabilities for delivering specialty care for complicated illnesses. In fact, Cuba long ago became a referral center for Latin America and elsewhere. In his survey of Cuban health care published in the New England Journal of Medicine in 1983, Robert Ubell wrote, "For some of these nations, it is not Boston, Massachusetts, but Havana, Cuba that is the center of the medical world."
That aspect of Cuban health care has gained new visibility. Cuba has developed facilities and a multi-disciplinary team for carrying out pediatric liver transplants. The Ministry of Public Health arranged for the training of specialists and devised referral networks and systems of follow-up care. Since 2006, Havana's William Solar Pediatric Teaching Hospital has performed 14 pediatric liver transplants. The government covers costs for these complicated operations—up to $200,000 each—and for immunosuppressive therapy absorbing $20,000 annually per patient.
A Havana friend told the present writer about her granddaughter afflicted with biliary atresia, a birth defect preventing bile from draining into the small intestine. The infant would have died from liver failure had not she and her mother been sent by Cuba's health ministry, along with other affected babies, to the La Paz Children's Hospital in Madrid for a new liver. Mother and child spent a year in Spain, courtesy of the Spanish hospital and the Cuban government.
The new program called for Cuban surgeons beginning in 2002 to receive training in Spain enabling them to perform the operation in Cuba. The report on the Medicc.org web site emphasizes the important contribution to the program provided in the community through the family doctor system and polyclinics.
Another success story for Cuban specialty care derives from experience there with HIV infection, summarized in an Oxfam report timed with the 17th International AIDS conference held recently in Mexico City. Cuba boasts the lowest prevalence of HIV infection by far in the Americas. Planning for surveillance, diagnosis, treatment programs, ongoing care, and nutritional support began in 1983, two years before Cuba's first patient with AIDS appeared. Since then, Cuba has developed sex education programs for all aimed at prevention. (See www.medicc.org/ns/assets/documents/Cuban)
The prevalence of HIV infection in Cuba is 52 per 100,000 adults. Comparable figures are: 456 for Argentina, 508 for the United States, 1,236 for Barbados, and 3,377 for Haiti. In Cuba, the annual mortality rate for AIDS patients fell from 24 percent in 2000 to 6 percent in 2007, a drop attributed to no cost availability of seven anti-retroviral drugs produced in Cuba since 2001. Virtually all those afflicted with AIDS in Cuba receive treatment. Worldwide, 70 percent of HIV infected persons needing treatment—10 million people—receive none.
Factors contributing to the Cuban AIDS success story, according to Oxfam, include dedication to health care as a human right; a continuum of health care from community to specialists; respect for the civil rights of persons living with HIV; and availability of nutritional, counseling, educational services in patients' communities.
by Tom Whitney, August 8, 2008
What does a victorious revolution do after a half century in power? "We shall continue to analyze with the people, particularly with the workers, with the same transparency and confidence we've always had." Speaking July 26 in Santiago de Cuba at the former Moncada Barracks, Cuban President Raul Castro promised that "We shall continue to care for, prepare and listen to our youth."
The occasion was the 55th anniversary of the attack there that launched the current phase of Cuba's long revolutionary struggle. The fact-based, pragmatic tone of Castro's remarks was appropriate to a national agenda of repair and adjustment.
Castro shifted from citing Communist hero Ruben Martinez Villena's reference to the "tenacious scab of colonization," to Ex-President Fidel Castro's 1973 condemnation of waste and depletion of resources, to cataloguing of ongoing water and road projects in Eastern Cuba aimed at renewing storm damaged infrastructure.
Castro covered oil refineries and fertilizer factories, direct distribution of milk from producers to stores, coordinated truck availability, reduced tourist industry costs, and retired teachers returning to the classroom—with pensions plus salaries—in response to Cuba's shortage of 8000 teachers. He reminded listeners that Cuba and the entire global south are endangered by food shortages, rising prices, and climate change.
The President touched upon pressing problems dealt with in other settings, particularly in his speech to the National Assembly on July 11. Government leaders and the media have reviewed origins and potential impact of problems and summarized reams of data with the object of securing people's understanding and a coordinated approach to solutions.
Food import costs, for example, are up 30 - 40 percent this year to $2.5 billion. Cuba imports 70 percent of its food. Half its agricultural land lies idle. Under Resolution 259, recently passed by the National Assembly, landless farmers may on their own use up to 33 acres, those with land up to 99 acres, both on a renewable basis. Under the legislation, the agricultural ministry was decentralized and credit made available to farmers for equipment and materials.
Another area of major uncertainty is support for retired workers. Those older than 60 years of age make up 16.6 percent of the population now, but in forty years their numbers will have risen to 30 percent. In 2025, there will be 2.3 active workers per retiree; there were four in 1990. Who will pay, asks José Alejandro Rodríguez, writing in Juventude Rebelde (Rebel Youth).
The need, he suggests, is to "energize the still insufficient work productivity in Cuba, by spurring deep transformations in our economy that come closer to offering a system of pay commensurate with appraisable results." Other commentaries stress that solutions will occur incrementally, over time. Stopgap legislation envisioned for later this year would gradually advance the retirement age for men to 65, for women to 60, between 2009 and 2015. President Castro indicated that "The process of study and consultation with all of the workers will begin next September."
Cuban leaders have introduced the notion of salaries based on productivity and work quality, with determination potentially at the work site, especially by cooperatives. Discussions on salary are ongoing throughout Cuba, in workplaces and unions.
Explanation of difficulties is necessary, according to President Castro, "So we can be better prepared to face them. We must get used to receiving not only good news." He pointed out that "We cannot spend in excess of what we have, [and] to make the best of what we have it is indispensable to save everything, foremost fuel." He called for "efficiency in the use of our economic and human resources [and] the courage to rectify the mistakes made on the side of idealism in the management of our economy."
The socialist thread in the current phase of Cuba's development is evident in state planning, popular participation in decision making, universal and equitable sharing in the benefits and pain of policies, the factoring out of profit and corporate power, and the promotion of international solidarity. And farmers use land, not own it.