CUBA-HEALTH: “The Doctor is Always Available”

By Dalia Acosta Reprint | | Print |

Dalia Acosta

HAVANA, Mar 4 1997 (IPS) - Cuba’s public health system and the gains of the past few decades have miraculously survived the worst economic crisis of the century and the 36-year U.S. embargo, even though some sectors of the population have been hit hard.

Hospitals are plagued by a constant shortage of medicines, physicians have to “ration” X-rays and pharmacy shelves are perenially understocked.

But Cuba’s public health system has been largely successful in defending the country’s impressive health statistics. The infant mortality rate last year was 7.9 per 1,000 live births, compared to 11 per 1,000 in the United States and 9.0 per 1,000 in Germany, while life expectancy in 1992 was 74 for men and 79 for women, compared to 72 for men and 79 for women in the United States.

“It is hard to explain how we have avoided the outbreak of an infectious epidemic in the past few years,” says Lupe Vazquez, a doctor who works in a poor Havana neighbourhood. “Everything is scarce, and the sanitation in the capital leaves a lot to be desired.”

The study ‘The Impact of the U.S. Embargo on Health and Nutrition in Cuba’ by nine physicians of the Washington-based American Association for World Health (AAWH), released Monday, states that a humanitarian catastrophe has been averted only because the Cuban government has maintained a high level of budgetary support for a health care system designed to deliver primary and preventive health care to all of its citizens.

More than 95 percent of the population is covered by a neighbourhood-level system of family physicians. “People complain about the doctors because they prescribe medicines that can’t be found in the pharmacies,” says a 58-year-old Havana resident. But, she adds, the doctor “is always available, at any time of the day or night, to attend any problem at all – free of charge.”

Nevertheless, the embargo has taken a “tragic human toll” in Cuba, the report states, especially among women, children, the elderly and people with chronic diseases. Because of the blockade, Cuban doctors have access to less than half of the new medicines available on the world market.

In a letter to the United Nations, Foreign Minister Roberto Robaina said the collapse of the east European socialist bloc joined with the U.S. blockade to turn daily life for Cubans into “a real headache.”

“It has become impossible to provide the funding necessary to maintain the levels of functioning of the health services and the availability of medicines and nutrition” that Cubans had become used to over the past few decades, he stated.

U.S. policy towards Cuba, stiffened in 1996 with the enactment of the Helms-Burton law, restricts the country’s access to markets and leads to a scarcity of inputs essential to the functioning of key sectors. Officials here estimate that since the early 1990s, the embargo has cost Cuba 60 billon dollars.

But “the decline of the health system was curbed in 1996, in spite of still limited resources,” according to a report on a meeting held to analyse the performance of the local health system, published Monday in the daily ‘Granma’, the publication of the governing Communist Party.

Public Health Minister Carlos Dotres said the latest statistics on maternal and child health, surgical activity and progress in the implementation of a medical emergency system indicate that the health system is in better shape than before the crisis, which broke out in 1990.

According to government figures, 126.5 million dollars were earmarked for the public health sector last year, nearly double the 66.9 million allocated at the peak of the crisis in 1993.

The Public Health Ministry reports that in 1996 the incidence of contagious diseases dropped. There were no reported cases of rabies in humans, measles or malaria, while whooping cough and rubella (German measles) were gotten under control, and there were only 13.3 and 19.2 cases of tuberculosis and leptospirosis per 100,000 inhabitants.

More than 800,000 surgical operations were performed last year, and in 1995, Cuba could still boast of an average of one doctor per 193 inhabitants – compared to one per 370 in Germany and 420 in the United States.