Shadows and lights of the Cuban medical system

Shadows and lights of the Cuban medical system

On March 22, 2020, 52 Cuban caregivers disembarked at Milan airport to help Italians facing the coronavirus epidemic. Cuban doctors are now deployed in 38 countries to fight the Covid-19. But how does this small tropical island, poor and subjected for decades to a severe American blockade, manage to be so successful in the medical field?

An egalitarian and free healthcare system

It all started in 1959, when Fidel Castro came to power, who put an end to the corrupt pro-American dictatorship of Fulgencio Batista and gradually established a communist regime. Health is a priority. Fidel Castro and his comrade Ernesto “Che” Guevara , who is a doctor by training , nationalize the pharmaceutical companies and set up a system of free public health for all, as proclaimed a few years later by the Cuban Constitution of 1976. Under this principle, Cuba spends more than 11% of its GDP every year on health , ranking among the top countries in the world according to this indicator. Because of this proactive policy, the island has a very good rate of doctors compared to its population: 8.19 per 1,000 inhabitants, the first rank in the world , an increase of 695% in 54 years . In addition, medical training is free in Cuba , as is medical care.

Cuban doctors on all fronts around the world

Despite the severe American embargo to which the island has been subject since the coming to power of Fidel Castro, Cuba deployed, from the 1960s, a policy of medical internationalism which benefited in particular the rebels of Angola and Mozambique who sought to put an end to the colonial domination of Salazarist Portugal. In 1975-1976, with Operation Carlota (named after a black slave who led an insurrection in Cuba in 1843), more than 30,000 Cuban advisers landed in Angola to support the struggle for independence. Cuban aid is both military and medical.

In 1981, Castro launched the Plan Frente biologico (“Biological Front Plan”) which resulted in the creation of the Center for Genetic Engineering and Biotechnology , dedicated to the manufacture of inexpensive medicines intended for Cuba but also for nearly 50 countries of the world .

Cuban doctors are on all fronts, even the most dangerous: in 1986, they were sent to Chernobyl following the nuclear accident and, in defiance of the radioactive danger, treated more than 26,000 people , including children.

In 1999, Cuba created on its soil the “Latin American School of Medicine” (ELAM), which trains thousands of medical students from all over Latin America each year.

In 2003, Cuban doctors, who developed a new drug, interferon alfa-2b , to fight dengue fever, hepatitis and certain cancers, shared it with China through the transfer of technology. The Cuban-Chinese company ChangHeber was created for this purpose. This drug is currently used against Covid-19 .

Cuban medical aid is also very active towards Latin American countries sharing the same ideological orientations, such as Venezuela or Nicaragua . Moreover, in 2011, Venezuelan President Hugo Chavez, who died at 58 in 2013, went to Cuba to seek cancer treatment, according to the advice of his ally Fidel Castro .

Cuban doctors also committed themselves in 2014 to Africa to fight the Ebola epidemic. In 2005 was created the “Henry Reeves Brigade” (named after a Cuban general of the National Liberation Army during the first war of Cuban independence in the XIX th  century) contingent of doctors specializing in the fight against health disasters and epidemics. She notably intervened in Pakistan after the earthquake of October 2005

and in Haiti after the 2010 earthquake .

In April 2020, Cuban doctors are preparing to treat coronavirus patients in the neighboring islands of Guadeloupe and Martinique . For Martinique doctor Michel Nédan, president of the Association Martinique-Cuba (AMC), “Cuba is an example, with some 150 hospitals, more than 95,000 active doctors and more than 85,000 nurses. Cubans have developed polyclinics. In fact, in Cuba, health is a culture just like education and it’s free for everyone  . ”

A system strongly criticized by liberal democracies

Cuban medicine, if it is admired worldwide, is however under fire from critics, like the whole Cuban system. In 2019, a Spanish NGO, “Prisoners Defenders” , denounced the working conditions of Cuban doctors during their missions abroad and filed a complaint with the International Criminal Court against Cuba for “slavery” . In Le Point , journalist Claire Meynial estimates that “most doctors earn barely fifty dollars a month in Cuba, and many, plunged into misery, accept missions out of necessity”.

Critics of the Cuban medical system also point to the idea that Havana’s medical internationalism is a way for the regime to expand its ideological influence around the world and make financial profits. It is true that, “in 2018, the export of medical services brought some 6.3 billion dollars to Cuba , far ahead of tourism”.

More broadly, liberal democracies criticize the lack of freedom and democracy in Cuba. Since Fidel Castro came to power in 1959, there has been no alternation, the “Líder máximo” exercising personal power and severely repressing opponents until his death in November 2016 (he was actually very weak since 2006). The succession was then ensured by his brother Raúl, who too was never designated by universal suffrage.

As well founded as these criticisms may be, the fact remains that the Cuban medical system is efficient ( life expectancy in Cuba now exceeds that of the United States ), efficient and egalitarian. The health systems of liberal democracies such as France, the United Kingdom and the United States, on the other hand, have suffered for years from budget cuts and rampant privatization which have affected their capacities . Thus, in several aspects, the Cuban system can undoubtedly be a source of inspiration for Western countries.

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