Cuban Health Care: Doctors Without Bandaids

We had heard so much about Cuba's health system – one of the greatest successes of the never-ending Cuban revolution. More doctors per capita than even most western nations, health clinics in every neighbourhood, town, small village, health care free for all, and a world-renowned pharmaceutical industry. Our experiences uncovered a somewhat different reality.

On our first trip to Cuba I met a Cuban obsterician/gynecologist in a cafe in Havana. We enjoyed a long discussion about maternity care in Cuba, his work in the hospital in Havana, and his family – his wife and two young girls. When it was time to part, he took my hand, looked straight into my eyes, and said: “Please, I am wondering if you could give me some money. I do not get paid much for my work – not enough to support my family. Please, if you could help.”

On another trip I again met with a Cuban obstetrician/gynecologist. We had a wide-ranging discussion, during which it became clear that although he had been fairly well trained, his knowledge was limited by the fact that he had had very limited access to modern obstetrical or gynecological texts. At the end of our conversation, this doctor said: “I do not ask you for money. I ask you for information. Please, if you can send me information. Here it is so difficult to get.”

The doctor told me he was unable to get any obstetrical or gynecological journals, and was permitted only one hour a week of internet access – and even that was restricted. He therefore had almost no way of keeping current with advances in his field, or of getting information about specific disorders, problems or issues he was encountering. And he is a 'specialist.'

We frequently saw people with nasty open wounds and sores in Cuba. On several occasions I asked them if they'd been to a clinic to have the wound treated. The answer was either “yes, but they had no ointment and no bandages” or “no, I didn't bother - they have nothing there.”

On one occasion we were helping a group of carpenters with a community project when one of the workers gashed his finger. The cut looked like it was almost to the bone: the last joint of his finger was hanging at a sickening angle. He went to the local clinic where the wound was cleaned and sutured, but the clinic had no gauze or plasters to cover it. Within a few minutes back at work, the unprotected wound re-opened. All of the sutures had given way. Franco was adamant that he would not return to the clinic.

I offered to help, using limited supplies from our travelling first aid kit. I applied a liberal glob of antibiotic, antibacterial ointment to the gash and used some gauze and a couple of well-wrapped band-aids to protect the wound and hold the finger-tip straight with the rest of his finger. Franco went back to work.

We saw him several days later, in town. He ran over to show us his finger. It was healing very well. The cut was closed, and the finger was straight. I gave him another couple of band-aids to keep the finger protected as he worked. Wherever we went in that town from then on we were greeted with big smiles and hand-shakes. The story of the gringos who had effected the miraculous healing of the carpenter's finger had spread by Cuban 'telephone' – word of mouth – surely one of the fastest communication systems in the world.

On another occasion we were walking near a pharmacy. A young man approached us and asked if we would give him the money to pay for a prescription. We asked him if he couldn't get his prescription for free. “No, nothing is 'free' here in Cuba. It doesn't cost much, but anyway I don't have the money.” As it turned out, the drug he needed didn't cost much at all, by our standards. But on his salary, $8 or $9 a month, even $2 was too much. We bought him the prescription.

At one of our bed and breakfast places, the woman's daughter had insulin-dependent diabetes. She had great difficulty controlling her diabetes not because she couldn't get the insulin – it was available. The problem was that the diabetes centre in central Havana, although it had the testing kits needed to determine one's blood-sugar level, almost never had any testing strips. The kits are useless without the strips.

So for the woman's daughter, as for other diabetics in the country, treatment of diabetes is based on guess-work. What do I think my blood-sugar level is? How much insulin do I think I need? This is a dangerous way to treat diabetes. And diabetes rates are reportedly high in Cuba, likely due to the low protein and high carbohydrate nature of the Cuban's limited diet.

In Havana we met a traveller from Finland who had a truly awful throat infection. He had been seen by a Cuban doctor at an ''international clinic,' and been given a prescription for a antibiotic muscular injection. A clinic nurse had given him the first shot – in the butt. He said it was extremely painful – a burning sensation that went right down his leg and lasted long after the needle was withdrawn.

I looked at the vial of medication. It was an antibiotic that's meant to be given intravenously, not intra-muscularly. I offered to give him the rest of his injections, but warned him that regardless of the technique of the puncturist, the shots were going to hurt.

The clinic had provided him with enough disposable needles and syringes for five more shots, all of which I gave him (and all of which hurt, but not as much as the first one – I injected the drug slowly). As a medical practitioner, I was concerned about safe disposal of the needles. We were all staying in a casa particular where one of the family members was a doctor. I asked her if she could dispose of the needles. “No hay problema!” she replied. No problem.

When I gave the used needles to her, she turned around and tossed them into an open waste basket in the corner of the room she shared with her two small small children. They were playing on the floor not a few feet from the waste basket. I wondered how needles were disposed of in Cuban hospitals and clinics... .

On our last trip to Cuba we were told about Fidel's arrangement with Bolivia. Bolivians come to Cuba for eye surgery. Once it's done, they stay at one of the all-inclusive resort hotels to recover for a few days, or a week. The same hotels that are off-limits to Cubans.

We asked a few Cubans what they thought about the 'free' health care and hotel stays for Bolivians. They all expressed pride in Cuba's modern – and obviously superior – health care system, and in Cuba's generosity in providing this service 'free' to Bolivians. Only a couple of them seemed aware that the Cuban government was in fact being paid.

The Cuban government also has an arrangement with the Venezuelan government – doctors for oil. Cuban doctors, having received their education courtesy of the state, must pay it back by going to Venezuela for two years – or more – to work. This often results in the separation of families – mothers and fathers leaving husbands, wives, babies and children behind in Cuba as they go off to Venezuela for their tour of duty.

The Cuban doctor in Venezuela does get paid for his or her work – and very well by Cuban standards: around $50 a month. For their families, this is a tremendous benefit. The doctors can also, while they're in Venezuela, buy all sorts of things that are simply not available in Cuba: electronics, kitchen appliances and utensils, clothes, shoes, cosmetics, jewelry – and food, glorious food.

But regardless of the perqs, the Cuban doctor is indentured to the state. When he or she is 'invited' to go to Venezuela, it's an invitation that can hardly be refused. We met several doctors who had gone to Venezuela for more than one two-year stint. One of them had been away from their family for six years. The doctor was estranged from his wife, and hardly knew his own children, nor they him.

Despite its undeniable successes, the Cuban health care system has some serious problems and short-comings. Unfortunately these cannot begin to be addressed until the Cuban government is willing to listen to concerns and criticisms from within the system, and to accept help and advice from outside.