Health Care in Cuba 50 years after La Revolucion
Dr. Paul Drain is currently a physician in the Department of Medicine at Stanford University and a former Peace Corps Volunteer. He recently spent a year in Tanzania conducting clinical HIV research with Harvard University as a Fogarty Scholar. His first book, called Caring for the World: A Guidebook to Global Health Opportunities, was published in December 2008 by the University of Toronto Press. Dr. Drain can be reached by email at pkdrain@stanford.edu.
Walking through Old Havana last month felt like traveling back to 1959, when Fidel Castro and ‘Che’ Guevara wrested control of Cuba. Big, classic cars my grandparents once drove puttered down empty streets between colonial buildings badly needing repairs. Musicians gathered on sidewalks and in the bars Ernest Hemingway frequented to play the Cubano music of previous generations. Fine cigars and smooth rum flowed as abundantly as government-sponsored preaching of socialism and solidarity.
I drank a mojito while sitting on the veranda of the Hotel National de Cuba, close to where Castro established his new government, and reflected on Cuba – now 50 years after La Revolucion. Fidel’s whereabouts and condition were unknown. Nobody dared discuss his health or reflect on his policies, but his legacy – everywhere outside Cuba – is now open for debate.
Castro’s difficulty growing the economy was due in some part to the long-standing U.S. embargo on trade and travel, which was last tightened by President Bush in 2004. Prolific sugar cane plantations had been replaced with plans to promote tourism and trade physicians for Venezuelan oil. The continued existence of the libreta (ration card), which provides monthly allowances for rice, beans, and oil, provided further evidence that Castro’s socialism hadn’t brought economic prosperity.
I was visiting Cuba to see their health care system, which Castro managed to turn into one of the most efficient in the world. Today, Cubans live as long as Americans, but they spend only 5% of the money we spend on health care for the average American.
This discrepancy, I realized during my visit, was partly because Cubans have the most accessible health care in the world. Amidst dilapidated buildings, local physician-staffed health clinics, called polyclinics, were deliberately arranged every few blocks throughout the neighborhoods. The polyclinics are as abundant as a Starbucks in Seattle. But, they never close. Furthermore, they don’t even charge their customers a single Cuban Peso.
Each Cuban is scheduled to visit a polyclinic twice a year for a check-up. If a patient fails to make the appointment, a health worker goes looking for them. As a result, Cuba’s rates of vaccinating children and providing safe births are both higher than in the U.S.
However, what was most revealing about the Cuban system was not what they did domestically, but their service around the world. Despite their poor economic development, Cuba has become the top supplier of physicians to developing countries. Starting in 1961, the same year President Kennedy started the Peace Corps, Castro sent Cuban physicians to Algeria as the French colonialists were exiting. Since then, Cuba has reported sending over 125,000 physicians to over 100 countries. By comparison, Peace Corps has sent nearly 200,000 people – mostly recent college graduates with few transferable skills (myself included) – to over 130 countries. Like Peace Corps Volunteers, Cuban physicians have reached the deepest jungles of Latin America, most remote deserts of Africa, and highest mountain communities of Asia.
More recently, in 1999, after Hurricanes Mitch and George devastated parts of Central America and the Caribbean, Castro took foreign medical assistance to another level. Cuba opened a new medical school, called Escuala Latinoamericana de Medicina (ELAM), to train non-Cubans as physicians. When I visited ELAM, there were 6,000 students from over twenty countries, including the U.S.
"It’s a great program," a female African-American medical student from Oakland told me. "Our education is totally free. They also give us room and board, and a modest living stipend. I'm very grateful I came here."
The first American students enrolled in ELAM in April 2002. Since then, 17 young physicians have returned to start their residency training in the U.S. Most American students I met in Cuba were ethnic minorities from disadvantaged backgrounds. They all cited the importance of primary care, as emphasized in Cuba, and planned to return to their neighborhoods of Oakland, Atlanta, and the Bronx to fills gaps left by overspecialized American-trained physicians.
Judging Cuba’s health system fifty years after La Revolucion, it’s apparent that Castro’s pursuit to address health issues within its borders and around the world has been unparalleled. Castro’s legacy will be as a leader in global public health.
Given this legacy, perhaps it’s time for President Obama to end the embargo against Cuba. Doing so might actually lead to more primary care doctors working in Oakland and better health care around the world.
The opinions expressed in this article are not necessarily those of the FICRS/F program.
