Exporting Doctors

Exporting Doctors / Orlando Freire Santana
Posted on September 13, 2013

According to the government, there are 47,000 medical students in Cuba,
and a doctor for every 137 persons. What is the real picture on the
national health service?

The popular Cuban refrain, when referring to the contradiction which
presents itself when the person producing something hasn't got that
thing in his own home, employs the very handy saying, "In the
blacksmith's house, you find a stick for a knife." Well, we can say the
same thing on the big picture with the health service nowadays, with a
large number of doctors and medical students, and on the other hand poor
attention for the ordinary citizen.

A little while ago the French news agency France Press, basing its
information on what appeared in the newspaper Granma, official organ of
thee Communist Party, let it be known that more than 47,000 students —
10,000 of them foreigners — had enrolled in medical courses in Cuban
universities in the academic year 2013/14. It then went on to emphasize
that, taking into account that Cuba has more than 85,000 doctors for a
population of 11.1 million inhabitants (data as at the end of 2012),
which would represent a doctor for every 137 people, the island finds
itself, in this sense, in a privileged position on the international level.

Nevertheless, such statistics contrast with the calamitous state of many
of the health services on offer in our country. It's the same in
hospitals, health centers, dental surgeries, opticians and in the famous
family health centers. These centers started up nearly three decades
ago, with the intention of providing 24-hour primary health care in
peoples' home areas. But they function so erratically now that the
intention in question has pretty well disappeared.

For example, in one of the constituencies covered by the Héroes de Girón
health center, in the Council area of Cerro, Havana, out of four centers
started in the '80s, today only one remains offering services, leading
to frequent overcrowding in the place, and the inevitable irritation
both of the patients and the doctors.

Note also the case of the doctors who move out of the houses annexed to
the centers, for their relatives to live in. In those cases, although
the doctor turns up for the day in the center, he doesn't any longer
live next door, leading to lack of attention for patients with
emergencies in the night. You have to note also the dreadful state of
the building in many of these centers, and the same is true in hospitals
and clinics. There are propped up roofs, leaky walls, out of service
toilets…

Not long ago the newspaper Granma reported on the complaint of a doctor
about the breakdown of the ophthalmic service in the eastern province of
Manzanillo. In its edition of Friday August 16, the official newspaper
echoed the complaint of a surgeon in the Laser Surgery Service of the
Celia Sánchez Manduley hospital. The doctor pointed out that for more
than a year they hadn't practiced optical surgery in that health center
due to technical problems with the air circulation equipment in the
operating theatres. That's to say, while in the context of the so-called
"Operation Miracle", the Cuban doctors give back sight to people from
various countries, more than a few Cubans lack such benefits.

They say that, on a particular day, on the balcony where an old lady
lives, there appeared a sign with the following text, "I'm off to
Venezuela." It was, obviously, the cry of a desperate patient who could
not see the solution to her health problem within the confines of our
"medical power".

Sometimes patients have to travel great distances to be attended to by
particular specialists (dermatologists, ear nose and throat doctors,
cardiologists, etc.) because the health centers in their health district
don't have such specialists. Many Cubans have to give a little gift to
these doctors in order to receive a quality service. Moreover, there is
a scarcity of medicines in the network of pharmacies accepting "national
money," also known as Cuban pesos. Clearly, you almost always find those
missing drugs in the international pharmacies, who sell for convertible
pesos, the currency in which most Cubans are not paid.

And while all this is going on in the country, the "Castrismo" is going
on about having more than 40,000 doctors in 58 countries. It's not a
secret to anybody that those professionals work in difficult conditions
in those countries where they offer their services, and that the Cuban
government repays them just a tiny fraction of what the recipient
countries pay for them. Nevertheless, every time we talk to a doctor who
works in Cuba, his desire comes across to go abroad to serve on "a
mission." It's logical, since, even bearing in mind the financial
robbery referred to, there will always be more than is evident in the
island. You mustn't forget that a doctor in Cuba, on average, earns the
equivalent of 25 or 30 dollars a month.

Obviously not everything is the color of roses for those doctors who are
sent abroad. In many places they don't recognise their professional
qualification. Right now, the first 400 have arrived in Brazil; this is
out of a total of 4,000 that will be in the South American giant by the
end of the year. We know about the protests of that country's Medical
Union, an organisation that casts doubt on the skills of those doctors,
at the same time as they accuse president Dilma Rousseff of getting up
to political games, rather than acting to improve the country's health.
In the same way, more than a few countries require an ability test for
the doctors who graduate from the Latin American School of Medicine
(ELAM) based in the Cuban capital.

Nevertheless the Cuban authorities take into account the obvious
judgement that this huge quantity has to be balanced with quality. Every
year a larger number of students are summoned to study medicine, a
course which they now run in all the provinces throughout the country.
Here the utilitarian consideration far outweighs the functional. The
foreign medical services have become the country's principal source of
income, more than tourism, nickel, tobacco and other things. Other
considerations don't appear to matter.

Orlando Freire Santana

From DiariodeCuba.com

Translated by GH

10 September 2013

Source: "Exporting Doctors / Orlando Freire Santana | Translating Cuba"
- http://translatingcuba.com/exporting-doctors-orlando-freire-santana-2/