Insufficient compensation, the high cost of living, and increased demand have also influenced the health care sector in Cuba.

Increase in medical tension – or in medical attention

By Dr. Eduardo Herrera Duran.*

News media inside and outside of Cuba highlight the functioning of the Island’s health care system. They consider it exemplary, and even compare with developed countries.

Many of my medical colleagues and I have been discussing the condition of medical care in recent years. The majority of us agree that it has been deteriorating for more than 20 years. Contrary to what the Cuban state communicates.

The lack of professional, technical and service personnel in the public health centers – something that militates against good care – is evident. At the wards that receive a great number of patients, often one can find only one nurse – even in intensive care units, where the ratio should be one nurse per patient. In general, each nurse is tending to two or three very gravely ill patients at a time.

Nor can we find nurse assistants, nor cleaning staff; in the best of cases, these are not sufficient to the task. All of which causes the hygiene in the various departments to not be what it should be in a center for treating the sick.

The number of physicians has been gradually diminishing because of their recruitment for the so-called “missions,” which generate juicy revenues for the government. All of which increases the number of patients for each doctor to see, which adversely impacts the quality of care.

To all this, let us add the shortages of necessary medications, supplies and equipment that we do not have on hand when we are treating patients. This affects not only the patients and their families, but also the public health personnel who find themselves unable to provide good service.

Insufficient compensation, the high cost of living, and increased demand in the country have also influenced the health care sector, which is among the most essential for maintaining the well-being of our citizens.

Unquestionably, these factors have influenced the sector’s deterioration. Officials from the Public Health Ministry, during their scheduled visits to the health care centers, see only what they want to see, and do not reflect the reality of what is occurring in their reports to the citizenry. They say that although there are fewer health care centers, medical care has increased in quality.

Referring to what the Public Health Minister said in the most recent meeting of the National Assembly of the People’s Power, one of the physicians, with whom I conversed, Dr. Dayte, said (with humor despite the adversity we face), “Possibly, when they refer to medical attention, there is some misunderstanding, and it is really medical tension that has increased.”

*Dr. Edward E. Herrera Duran. He is a physician, specialist in surgery, living in Cuba and works at the University General “Calixto Garcia” in Havana, Cuba. He writes articles about health to Hablemos Press Agency.

Source: Hablemos Press and Translating Cuba. Translated by: Alicia Barraqué Ellison

Being a health professional in Cuba, a doubtful advantage.

Cuba Increases Control over Its Doctors

by Roberto Jesus Quinones.*

The exodus of Cuban health professional does not stop, and the Ministry of Public Health (MINSAP) apparently has decided to act to counter a phenomenon that is damaging domestic medical services but much more the country’s income.

A document attributed to the senior management of MINSAP, adopted in a meeting held in mid-March of this year, has been making the rounds in the e-mail of health professionals in which the sector’s new policy is expressed. This event was confirmed to CubaNet by an official from the Provincial Management of Public Health in Guantanamo, whose identity we do not reveal for obvious reasons.

The document has 18 instructions. The first three are focused on the re-organization of services and the re-location of professionals as a result of the staff review carried out last year.

The other 15 are directed to curbing the exodus of health professionals through private contracts or other avenues and steering the application of the measures in each case.

The document

One of the most controversial, instruction numbers 4 establishes that Cuban doctors in Angola must be relieved, but without increasing the collaboration with that country, until its authorities stop handing down measures that discourage the hiring of Cuban professional in private clinics or institutions.

Another measure, number 5, directs the withdrawal of the passport, in the airport itself, of professionals who later return from the completion of a mission.

Measures 6, 7 and 8 aim to get the private clinics of other countries to hire Cuban doctors through MINSAP, an agency that claims the right to review the professional’s individual contract, obviously so that the doctors pay the corresponding tax to the Cuban government and in no way receive all the money that is due them from the agreed upon wage.

Measure number 10 requires concluding the process of cancelling the diplomas of the 211 professionals who left service without authorization, and number 11 directs MINSAP’s vice-minister of International Relations to carry out a study of the existing rules in the International Labor Organization (ILO), the World Health Organization (WHO) and the Pan-American Health Organization (PAHO), as it relates to the migration of the sector’s professionals.

Punishing the “undisciplined”

Rule 12 considers it a serious breach for a health professional to not return to Cuba upon fulfillment of his mission abroad without good cause verified by MINSAP, and it requires final separation from the profession by those who engage in said conduct, with the subsequent withdrawal of the degree.

Meanwhile, Rule 13 orders the creation of records of disqualification for those professionals who violate the established procedures for leaving the country. If any of them repents and returns, Rule 14 directs that they cannot be re-located in their previous workplace but in an inferior status.

Another cage for the army of white coats

Rules 16 and 17 of the document are intended to promote meetings with ambassadors of the countries where Cuban health professionals travel, largely for the purpose of discouraging their being recruited to remain and practice in that country.

The heads of Cuban medical teams and ambassadors have received that same instruction. Besides interfering in the internal affairs of other countries, this shows one of the thus-far-discouraged facets of Cuban medical collaboration, which is none other than exerting pressure over the countries receiving these types of services to make them faithful to the regime’s policy, which is clearly established in instruction number 4 with respect to Angola.

Finally, number 18 establishes a monthly coordination between MINSAP and the Department of Identification, Migration and Foreign Affairs of the Interior Ministry so that it will report to MINSAP on the doctors who leave the country as well as those who have begun proceedings for that purpose, in order to take appropriate measures.

Being a health professional in Cuba, a doubtful advantage

The above measures show the doubtful advantage of being a health professional in Cuba, although the same could be said with respect to other professionals.

Determined to provide the country with qualified personnel, the government never concerned itself with steadily encouraging the efforts of the professionals themselves. That explains their massive exodus to foreign countries and other better paying jobs with the consequential social loss.

At the dawn of the 21st Century, renowned Cuban professionals have been subjected to a financial exploitation that not even the fiercest capitalist would have dared to impose. Paid miserable wages, many times they sign unfair contracts that the government offers for them to work abroad because it is the only chance they have of improving their housing or getting housing, or acquiring a car or having some savings for their retirement.

In doing so, at a sometimes irreversible familial cost, they damage their freedom and self-esteem in service to a government for which they are only a source of income that allows it to continue dominating the people.

*Roberto Jesús Quiñones Haces was born in the city of Cienfuegos September 20, 1957. He is a law graduate. In 1999 he was unjustly and illegally sentenced to eight years’ incarceration and since then has been prohibited from practicing as a lawyer. He received the Vitral Grand Prize in Poetry in 2001 with his book “Written from Jail” as well as Mention and Special Recognition from the Nosside International Juried Competition in Poetry in 2006 and 2008, respectively. His poems appear in the 1994 UNEAC Anthology, in the 2006 Nosside Competition Anthology and in the selection of ten-line stanzas “This Jail of Pure Air” published by Waldo Gonzalez in 2009.

Source: Translating Cuba. Translated by MLK 

Well, it is generally accepted that Cuba has one of the best medical doctors in the world. The country's health experts have a much broader role than simply catering for the local population, as the nation exported over 140,000 doctors to the poorest regions across the globe since 1963. Cuba is also home to the best and the largest medical institution with nearly 13,000 students from 124 countries. Our Maimuna Jallow looked at the role the Cuban experts play in enriching country's economy in this report: https://www.youtube.com/watch?v=pQj_IsxY5H4

HUMAN RIGHTS FOR PHYSICIANS IN CUBA.

El presente articulo fue publicado por Physician for Human Rights a encasas dos semanas de la Primavera Negra de Cuba, e incluía información sobre los médicos cubanos detenidos en ese operativo represivo. Es por eso que en ocasión del IV Aniversario de la Primavera Negra de Cuba, lo incluimos en nuestro Blog. Una información más reciente de la campaña de Amnistía Internacional a favor de los médicos cubanos detenidos., también es incluida.
HUMAN RIGHTS FOR PHYSICIANS IN CUBA.
By: Susannah Sirkin. *
April 1, 2003
While human rights groups in the US rightly insist that the warring parties in Iraq take care to avoid harming hospitals and other medical facilities, closer to home in Cuba independent clinics and physicians have recently been deliberate targets of attack. The clampdown on dissidents across the island - which coincided with the ground invasion of Iraq - started with the dismantling of an independent medical clinic in the town of Pedro Betancourt, 150km east of Havana. Over 150 officers and paramilitaries searched and ransacked the private home of Miguel Sigler Amaya and his wife Josefa López Peña, where the clinic was housed, confiscating 90 pounds of medicines: antibiotics, pain killers and vitamins. Police also seized a metered dose inhaler, an oxygen delivery system, a glucometer, some physiotherapy equipment, parental infusion appliances and topical applications. The family's own medications were confiscated too.
The operation was carried out in front of small children and their 71 year old grandmother, Gloria Amaya, who was later hospitalized with a heart attack. Her two other sons (also dissidents) were detained as well.
While international attention is focused elsewhere, Cuba's leader Fidel Castro has ordered his State Security to lock up almost 80 people: independent journalists, human rights activists, free trade union organizers, poets, economists, photographers, teachers, and physicians.
In Cuba where achievements in health are the pride of the regime, dissent among physicians is particularly embarrassing. Yet some members of the medical community have complaints about the current system. They are concerned with the government's tendency to limit health facilities for Cubans, alleging that resources are shifted towards dollars-only "health tourism," making medicines available only for people with foreign passports who can pay with hard currency. Irrespective of their political sympathies, physicians are worried that the extremely low professional salaries in Cuba are particularly dangerous for medical personnel, who must take extra jobs to make ends meet leading to absenteeism, overwork or poor work ethics.
Under these circumstances, it is hardly surprising that an independent Medical Association started operating in November 2001 (awaiting legal registration). Physicians from across the island, some still in state jobs, others already "separated" from official medical institutions, joined forces to set up independent clinics and pharmacies where equipment and drugs prescribed by doctors from the state health system and sent from abroad, including from the Cuban Diaspora, are distributed free. The group's national coordinator is Dr. Marcelo Cano Rodríguez.
Searching for guidance on how to set up an independent group, Dr. Cano approached the unofficial Cuban Commission for Human Rights and National Reconciliation. For the past four years he has been in effect a generic "physician for human rights." On March 22, Dr. Cano was detained in Las Tunas in the east end of the island while his home in Havana was searched and medicines confiscated. At the time, Dr. Cano had been in Las Tunas to investigate the case of Dr. José Luis García Paneque, another member of the Medical Association detained four days earlier. There, too, a thorough search led to the seizure of medicines and medical equipment: four stethoscopes and three glucometers, books, documents.
Cuba's jailing of dissident doctors is not new. Among the most prominent Cuban political prisoners is Dr. Oscar Elias Biscet, a physician who served three years in detention for expressing his political beliefs only to be released and promptly detained again, this time for attempting to organize a human rights workshop. He is currently held at Combinado del Este prison.
The regime announced that the detained will be charged under the "Law 88" which punishes anyone who supports or helps to support the US economic embargo against Cuba. Many in Cuba and in the US find the embargo a counterproductive measure, but jailing physicians and ransacking independent clinics is not a way of dealing with the embargo. Whether it is Iraq or Cuba, universally accepted codes of medical ethics cannot be ignored-if they are, ultimately it is the patient who stands to lose the most.
* Deputy Director. Physicians for Human Rights
Recommended link:
Medical Action: Six physicians who are prisoners of conscience in Cuba.
Photo: Animate was made by Primavera Negra Blog