Cuba: the health excellence

Cuba: the national health system guarantees care and prevention for the population. A scientific power at the service of world emergencies and calamities

The arrival in Crema, Lombardy, of 35 Cuban doctors and nurses, arrived in order to support the strife against Covid-19, surprised many people in Italy, despite the fact that it has not to be considered an extraordinary event. Indeed, Cuban doctors are at work, currently, in 31 States in the world. However, it is the first time that are sent to face a health emergency in a European country. The global engagement of Cuba in the health sector finds its roots in the very beginnings of the 1959 socialist revolution.

The global engagement of Cuba in health emergencies

The Caribbean nation at that time had about 6,000 doctors, almost all settled in Havana, at the service of the rich US tourists. After the revolution, half of them abandoned Cuba, where a consequent health crisis exploded. The commander Ernesto Che Guevara, doctor and revolutionary, laid the foundations of a national health system, which, for the first time, would have had to address the needs of the poorer and rural areas. In Che Guevara’s opinion, the scope of the revolutionary doctor, and of public medical science, was to “not think about profit, but to take into account only the single individual wealth, in relationship with the community’s one”, with a vision that included also education, alimentation and work.

In 2014, this health system, born in the ruins of the Fulgencio Batista’s regime, was the third in the world for the density of physicians, after Qatar and the Principality of Monaco. A remarkable goal, which appears a titanic enterprise if we consider the scarcity of drugs and of medical equipment because of the US embargo and the country’s objective poverty. For precisely these reasons, the Cuban health system focused the majority of its resources on the prevention, creating – a unique case in the Americas – a network of family doctors’ in order to monitor the whole population. We are not speaking of “paper-pusher” doctors, with the only job of writing prescriptions and of recommending them special treatments. These are doctors which have also a social protection role, with regards with vaccinations, pregnancies and elders’ assistance, and aid in case of emergencies. This physicians’ network is in turn connected to the 452 small and big hospital structures of the island. One of the great results of the Cuban system, certified by UNICEF in 2016, was the reduction of the infant mortality under the five deceased every 1,000 new-borns, leading the country among the first 40 nations in the world.

The academic research

Furthermore, the Cuban health system is supported by a network of academic researchers and by a local drug industry of excellent level. In 1985, was invented in Cuba the first and only vaccine against meningitis B, and new treatments to fight hepatitis B, diabetes and psoriasis were found. In addition to this, a vaccine effective on lungs’ cancer was perfectioned, currently only in experimentation in the US. Cuba was also the first country in the world to eliminate the HIV transmission mother-to-son. Public health is a true priority for the State, which invests in it the 11% of its GDP – compared to the 8,8% of Italy.

These achievements, together with a continuous training of a true army of doctors and medical personnel, consented to Cuba to manage a tool unthinkable in the past: the international health assistance. Both an act of solidarity (for example in Haiti), both a mean to gain profit (as in Chile), or even in exchange for oil (the case of Venezuela), the Cuban medical personnel at work abroad send to the country 8 billion of dollar every year: an amount of money of which Cuba is always in need. It is also, however, a unique opportunity for doctors, who, instead of earning 50 dollar as in Cuba, earn 1000 dollar when working abroad. Which is a considerable amount in relationship to the cost of life, and a reason for many young to study medicine.

The case of Haiti

This unique reality is based on the “Brigada Medica Henry Reeve” – a New Yorker who, in 1876, died fighting for Cuba’s independence. The Brigada Reeve was established in 2005 to support Angola and is now formed by thousands of professionals which distinguished themselves for their work on the ground, bringing assistance after the Pakistan, Chile and Haiti earthquakes and fighting Ebola in Congo and Sierra Leone. It is formed by doctors specialised in many fields: surgeons, epidemiologists, gastroenterologists, cardiologists and also psychiatrists and paediatricians.

Only 85 kilometres of sea divide Haiti from Cuba, but the distance between the health systems of the two countries is immeasurable. When, in 2010, the Cuban doctors immediately arrived in the neighbouring island to provide help in the humanitarian emergency followed to the earthquake. They found a collapsing local health system. Two thirds of the already few hospitals were collapsed. On the island were present just 900 doctors and 3,000 nurses, 80% of them working only in the cities. More than 125 municipalities had no health structures at all. Furthermore, in Haiti, the 45% of the population had no access to drinkable water and the 83% was with no health insurance at all.

These are data to take in consideration when the Haitian reality is compared to the Cuban one. In the regional context, Cuba’s health system coexists with the ones of Haiti and the Dominical Republic. This last, sharing with Haiti the island of Hispaniola, despite being richer than the neighbouring republic, has only 15,000 doctors and 8,000 hospital beds for 11 million inhabitants. Cuban medical assistance to Haiti was free and continued also during the cholera outbreak and it is still guaranteeing at least the pandemics’ management.

The health sector today

Obviously, not all that glitters is gold in the Cuban health system. Today, according to critics, the system is divided in three parts: the cutting-edge medicine for foreigners, which pay with cash special treatments in Havana’s clinics for VIPs; the medicine for Cubans, of good level but with poor infrastructures and means; and finally, the exporting medicine, specialized in emergencies. A further sore point would be represented by the doctors’ training, former flagship of the country, which would be now growingly rapid and superficial, given the high request of interventions from abroad.

All these are surely well focused critics that, however, do not detract from the essential role played by the Cuban medical assistance in many countries.

Indeed, Cuba has proved itself able to succeed in an operation never attempted by anyone that is to invest massively in its citizens’ health without practically no costs for the State. It is the health system itself, indeed, that generates resources with the foreign patients and the international interventions. Within a world growingly destructured, where even in Europe, birthplace of universal healthcare, the privatisation processes led to a severe reduction in the capacity to react to emergencies, Cuba is therefore able to provide a precious tool. Especially because, in the while, pandemics are multiplying in a world where in the relationship between man and nature is more and more unstable.

The Cuban Civil Protection

The key to Cuban success in the reaction to the pandemic has to be find in the health militarization, referring to the chain of command and the roles’ definition to face emergencies. Not only in Cuba every citizen can rely on a family doctor, but, in case of emergency – as the frequent hurricanes –, also on an extended network of paramedics whose task is to visit patients and deliver home supplies. A service which is dramatically absent in the current European pandemic crisis, which is instead the very base of the Cuban Civil Protection. This last has very poor means in comparison with Western counterparts but is based on a very strong organization and on a precise definition of roles when calamities occur. The same hurricane that causes thousands of people in Haiti, leads to few deaths in Cuba (usually people with previous health problems).

There is a lot to learn from Cuba on this aspect. Or better, to remember, since organization, prevention and know-how in case of emergency proved to be more important than modern technological tools and economic resources. In Cuba, the health system works as an orchestra and, despite the last years distortions and the Donald Trump’s tightening on the embargo, it continues to operate. These are the reasons why the arrival of Cuban doctors in Crema was not a surprise.

This article is also published in the June/July issue of eastwest.

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