Healthcare & Education

Articles, Opinions and Papers

July 2018
OTTAWA—The federal government is defending its response to the mystery attacks in Cuba that have left some Canadian diplomats and family members suffering health problems, insisting that it moved fast to have those affected assessed by medical professionals.
June 2018
In the countryside of western Havana, during the fall, rickety yellow buses carry first-year medical students from the Latin American School of Medicine. Wearing short-sleeved white smocks and stethoscopes, they go door to door, doing rounds, often speaking to their patients in broken Spanish. “Even people whose houses I wasn’t visiting sometimes would ask me to take their blood pressure, because they just saw me in the street,” Nimeka Phillip, an American who graduated from the school in 2015, told me.
Science works best when qualified people can evaluate evidence without political pressure to draw poorly founded conclusions, say 15 neuroscientists and physicists.
March 2018
NAIROBI — Kenya has agreed to accelerate a health agreement it signed with Cuba last year and bring 100 doctors from the country to fill gaps in Kenyan hospitals. Fifty Kenyan doctors will also be sent to Cuba for specialized training.
BOGOTÁ, Colombia- Dayana Suárez, a Cuban dentist, arrived in Colombia a year ago with the hope of starting a new life here.
She defected from the Cuba medical team she was assigned to in neighboring Venezuela after the Obama administration halted a special program that welcomed medical professionals like her to the United States.
February 2018
The University of Miami doctor who traveled to Havana to examine American diplomats and others who were allegedly victims of health attacks, has ruled out Cuba’s suggestion that the symptoms were the result of mental angst.
January 2018
Five months ago Andy Gómez, founder and former senior fellow at the University of Miami’s Institute for Cuban and Cuban-American Studies, returned as interim director of the research center. His last day was Friday, with the future of the embattled institute still up in the air and a permanent director yet to be selected.
December 2017
HAVANA--Cuba now exports vaccines, diagnostic kits and drugs developed by its Center for Genetic Engineering and Biotechnology —the largest research center on the island — to 51 countries. But except for a small shipment for a clinical trial, the United States isn’t one of them.
Scientists at the Center for Genetic Engineering and Biotechnology say they have developed promising drugs, including one that could save the limbs of diabetics, but they face hurdles getting them into the U.S. market.
HAVANA--When Dr. R. Lee Clark, then president of the University of Texas’ famed M.D. Anderson Cancer Center in Houston, visited the island in November 1980 as part of a delegation, the late Cuban leader Fidel Castro wanted to hear about the latest advance in cancer treatment.
WASHINGTON (AP) — Doctors treating the U.S. embassy victims of suspected attacks in Cuba have discovered brain abnormalities as they search for clues to explain hearing, vision, balance and memory damage, The Associated Press has learned.
August 2017
The latest assessments of the attacks injuring Americans and Canadians in Havana, Cuba, by U.S. intelligence analysts point to inaudible sound as the culprit -- ultra- and infrasonic waves -- according to a source familiar with the incidents that began in November 2016. However, the source says analysts are still working to rule out other technology.
Maribel (not her real name) was the deputy principal in a state-run primary school in Cuba. She had worked there since graduating, and had been promoted fast.
For the past few months, there has been a great deal of controversy over the university’s stance on relations with Cuban institutions, particularly government-run universities.
Following a private meeting Friday with 17 representatives of the Cuban exile community, the University of Miami announced that it will not establish agreements with Cuban universities or other institutions run by the Cuban government.
July 2017
The Institute of Cuban and Cuban-American Studies is at the center of a controversy between its outgoing director, Jaime Suchlicki, and the University of Miami, which has been its home for almost 20 years.
HAVANA--For a dollar, Cuban podiatrist Serafin Barca will spend a half hour cutting the corns off a senior citizen’s foot, or nearly an hour removing a stubborn wart.
May 2017
HAVANA--Men sit on the steps and play a hand of cards, women chat outside barred windows, stray dogs missing tufts of fur trot by.
Cuba said on Thursday 1,847 residents had so far contracted the mosquito-borne Zika virus, warning that certain provinces on the Caribbean island still had high rates of infestation despite a series of measures to stave off the epidemic.
April 2017
Bolivian President Evo Morales underwent successful throat surgery in Cuba and must rest his voice for about a week, a government official said Saturday.
March 2017
LA PAZ, March 28 (Reuters) - Bolivian President Evo Morales said on Tuesday he is returning to Cuba to have a small nodule in his vocal cords removed, in what would be the socialist leader's second trip to the communist-ruled nation for medical attention this month.
HAVANA — Cuba has offered Colombia 1,000 medical school scholarships to support a peace accord in which the South American country’s largest rebel army will relinquish its weapons, officials announced on Thursday.
February 2017
They say necessity is the mother of invention and nowhere is that more true than in Cuba, where tech startups are popping up across the island nation despite very low internet connectivity. That intrepidness is on display with the visit of some young high-tech entrepreneurs to Silicon Valley. Jessica Aguirre reports.
A joint venture between the Roswell Park Cancer Institute in Buffalo, New York and the Center for Molecular Immunology in Havana could open its doors to new U.S. investors as early as April.
MEXICO CITY — Cuba is giving parental leave to the grandparents of newborns, the country's latest attempt to reverse its sagging birthrate and defuse a demographic time bomb.
Cuba’s healthcare system is a source of pride for its communist government. The country has well-trained, capable doctors, the sector has become an important export earner and gives Cuba valuable soft power – yet the real picture is less rosy. A lot of health infrastructure is deteriorating and there is a de facto two-tier system that favors those with money.
Soon after the feds broke up a family-run chain of clinics that tried to steal $130 million from Miami-Dade Public Schools and a string of major U.S. companies, a trio of Cuban immigrants fled to Mexico and eventually back home to the island.
Two dozen Cuban health professionals who deserted from medical missions abroad arrived in Miami Monday afternoon on a flight from Colombia.
January 2017
BOGOTA, COLOMBIA--Since 2003, Cuba has been sending battalions of doctors to Venezuela in exchange for cash and crude.
As Cuba slowly opens up its economy to the rest of the world, more and more Cubans are learning English. The Cuban government has made proficiency in English a requirement for all high school and university students. As Will Grant reports from Havana, that approach differs from the Cold War, when Russian was the preferred foreign language.
November 2016
More than 99.5% of Cuban children attend an early childhood education programme or institution. Kary Stewart visits Havana to speak to families, doctors and teachers about a Latin American success story
October 2016
The Food and Drug Administration has approved the first clinical trial to test a Cuban drug in the United States — a lung-cancer vaccine developed in Havana.
When Dr. C. William Keck sat down to write an editorial in the New England Journal of Medicine, imploring Congress to end the United States’ Cuba embargo so that Cuban and American researchers could better collaborate, he had no idea that the U.S. Treasury Department’s lift of sanctions was just days away.
September 2016
Japan's Prime Minister Shinzo Abe became the first Japanese leader to visit Communist-ruled Cuba on Thursday, landing in Havana to hold talks with Cuban President Raul Castro on topics from boosting trade to curbing North Korea's nuclear program.

Cuba Fights Off Zika

September 18, 2016

The number of confirmed cases of Zika continues to climb in Central America and the Caribbean, except for Cuba. Cuban officials say that only three people there have contracted the virus from local mosquitoes.
Japan and Cuba are getting ready to announce plans for a medical specialist training center in the Caribbean nation that will feature Japanese technology and equipment, according to informed sources.
August 2016
As soon as the rain stops, mosquitoes flood the guard house of an upscale tourist resort near Cuba’s Bay of Pigs. Without hesitation, one of the guards reaches under his desk to pull out a device that looks like a very large hair dryer. “Mosquito gun,” he says. He walks around, spraying a thick, white cloud of fumigant that engulfs the booth. Slowly, the mosquitoes disappear.
(CNN) On what appears to be a residential street on the outskirts of Havana, the tan building with a guard gate seems out of place.
June 2016
Cuba has successfully held off the Zika epidemic and in the process all but eliminated Dengue fever and other mosquito-carried illnesses, state-run media reported on Tuesday.
Annie Rodríguez Alvarez, a physical rehabilitation specialist from Ciego de Ávila, was arrested last week along with her 1 year-old daughter in the Colombian municipality of Turbo, Antioquia, while trying to join hundreds of Cubans en route to the United States who are stranded in a temporary shelter in that small village in the Gulf of Urabá.
The United States said Monday it will collaborate with Cuba on health issues, the latest step in an historic rapprochement between the one-time bitter adversaries.
March 2016
The debates about what constitutes a real relationship with Cuba continue on the eve of President Obama’s trip Sunday. Should the embargo be lifted? Should the U.S. close its base at Guantanamo? How should human rights be addressed?
HAVANA (AP) — "This is a conversation between two children," Graciela Lage Delgado tells a rapt class of third-graders, tightly enunciating each English word from a textbook called "Welcome to America."
Secretary of State John F. Kerry has canceled a tentative trip to Cuba two weeks before President Obama visits the communist-ruled nation as diplomats haggle over which Cuban dissidents the president will be allowed to meet.
Cuba announced Wednesday that it had detected the first case of the Zika virus on the island, which had been one of the last nations in the Western Hemisphere free of the disease.
October 2015
The US embargo on Cuba -- which the UN General Assembly votes on Tuesday -- is not about international politics for Elizabeth Navarro. As far as she's concerned, it's just what keeps her daughter from getting the cancer drug she needs.
September 2015
Now that Cuba has restored diplomatic ties with the US, teaching English in schools will be a priority, the communist partynewspaper Granma reported on Monday.
July 2015
Cuba has a promising new lung cancer vaccine called CimaVax that may soon be coming to the United States. More than 50% of patients die within a year of being diagnosed, making lung cancer the number one cancer killer in the United States.
Cuba has become the world's first country to eliminate mother-to-child transmission of HIV and syphilis, "a major victory in our long fight against HIV and sexually transmitted infections, and an important step towards having an AIDS-free generation," the World Health Organization announced today.
June 2015
As Cuba and the United States begin to normalize relations, interest is keen on both sides to strike academic partnerships as well. But amid the sensitive politics of the U.S-Cuba breakthrough and the gulf between the countries over questions of academic freedom, American colleges and universities must tread carefully.
May 2015
(NEWSER) – Closer American ties with one of the world's major cigar exporters could actually be good news in the fight against lung cancer.
February 2015
A recently-discovered form of HIV in Cuba has been found to progress into AIDS some three times faster than the most common strains of the virus, according to a recent study.
November 2014
A Cuban doctor who contracted Ebola in Sierra Leone arrived in Switzerland for treatment and was able to walk off the transport plane, a Geneva medical official said Friday. Felix Baez Sarria arrived on a flight overnight and was transported in a specially outfitted ambulance with a police escort to Geneva University Hospital.
Secretary of State John Kerry and the American ambassador to the United Nations, Samantha Power, have praised the work of Cuban doctors dispatched to treat Ebola patients in West Africa. The Centers for Disease Control and Prevention recently sent an official to a regional meeting the Cuban government convened in Havana to coordinate efforts to fight the disease. In Africa, Cuban doctors are working in American-built facilities. The epidemic has had the unexpected effect of injecting common sense into an unnecessarily poisonous relationship.
Just a few months ago we experienced an avalanche of official propaganda targeted to attacks on the United States Agency for International Development (USAID). Those initials came to represent the enemy with whom they frighten us from our television screens, platforms, and even classrooms. However, to our surprise, this week we've learned that some Cuban doctors arriving in Liberia will work in a field hospital financed by this "terrible agency."
October 2014
Cuba is an impoverished island that remains largely cut off from the world and lies about 4,500 miles from the West African nations where Ebola is spreading at an alarming rate. Yet, having pledged to deploy hundreds of medical professionals to the front lines of the pandemic, Cuba stands to play the most robust role among the nations seeking to contain the virus.
April 2014
Cuban authorities say they have eliminated more than 100,000 jobs in health care, considered one of the pillars of the 1959 revolution.
December 2013
Cuba expects to finish this year with a slight rise in HIV cases, but the number of people being diagnosed with the disease remains stable and the island is on the list of the 18 countries with the lowest transmission rates for the virus, Instituto de Medicina Tropical Pedro Kouri director Jorge Perez said.
August 2013
HAVANA — Cuba has reported a cholera outbreak to international health monitors, with 163 new cases this year associated with three provinces.
HAVANA TIMES – I’m afraid to go to Old Havana. Not because the police might ask for my I.D., or the Cubans might take me for a tourist, but because of the disabled, the lame and the mutilated who have begun to form part of the landscape all along Obispo street.
June 2013
Cancer in 2012 became the chief cause of death in Cuba for the first time, accounting for 25 percent of all fatalities while exceeding heart disease and cerebrovascular illnesses, the official daily Granma said Saturday.
May 2013
April 2013
Havana, April 25 (IANS) Cuba's biotechnology industry is expected to double over the next five years, bringing in more than $5 billion in export revenues, an official said.
The treatment is now poised for a global premiere. Cuba's state pharmaceutical company, Labiofam, recently began mass-producing a homeopathic version called Vidatox. A handful of countries have registered it for sale, and a small black market to move the product around the globe has emerged.
When Cuba's benefactor, the Soviet Union, closed up shop in the early 1990s, it sent the Caribbean nation into an economic tailspin from which it would not recover for over half a decade.
Cuba and Vietnam have signed an agreement to strengthen bilateral cooperation on education, Cuba’s government announced on Thursday.
January 2013
HAVANA (Reuters) - Cuban authorities are scrambling to contain a cholera outbreak that has sickened dozens of people in Havana, the capital city of 2.2 million residents and a popular tourism destination. In a brief communiqué issued on Tuesday, the Health Ministry said the outbreak was first detected on January 6, and was being contained.
December 2012
CARACAS (Reuters) - Venezuela's Hugo Chavez underwent surgery in Cuba on Tuesday for a cancer recurrence that has thrown his presidency into jeopardy and upended politics in the South American OPEC nation.
It's the disease that the government doesn't acknowledge, because it might deter tourists from coming to the island.
November 2012
The number of people diagnosed with AIDS in Cuba from 1986 to Oct. 23, 2012 totals some 17,224, of whom 80 percent are still alive, official media said Monday.
A revolutionary medicine for diabetes developed by Cuban scientists is set to be tested in late-stage clinical trials in Europe next year.
October 2012
HAVANA — Cuba shuttered hundreds of medical facilities last year, including 54 hospitals, as the country reorganizes its health care sector. The number of medical installations nationwide fell from 13,203 in 2010 to 12,738 last year, a decline of 3.5 percent, according to figures posted online in recent days by the National Office of Statistics. The reductions included everything from general hospitals to family clinics, the small medical outposts that are ubiquitous across the island.
HAVANA - Cuba shuttered hundreds of medical facilities last year, including 54 hospitals, as the country reorganizes its health care sector.

The number of medical installations nationwide fell from 13,203 in 2010 to 12,738 last year, a decline of 3.
The Cuban public health system closed 465 medical centers during 2011 and laid off the personnel who worked there, a move made in keeping with the government's ongoing "readjustment" to reduce costs and more efficiently utilize resources.
HAVANA - Cuba shuttered hundreds of medical facilities last year, including 54 hospitals, as the country reorganizes its health care sector.

The number of medical installations nationwide fell from 13,203 in 2010 to 12,738 last year, a decline of 3.
Caracas, Venezuela - Going for a medical check-up at an unassuming red brick clinic in a working class Caracas neighbourhood, pensioner Maria Vivas could be considered a foot solider of Venezuela's Bolivarian Revolution, never mind her bad knee.
September 2012
The Cuban government hasn't confirmed any new cases since Aug. 28 when it said an outbreak in eastern Cuba was over.
August 2012
Cuba’s Public Health Ministry has announced that an outbreak of cholera has ended and put the final tally at three deaths and 417 cases — an inexplicably higher number of confirmed cases than its last official totals.

Cuba's Public Health Ministry has announced that an outbreak of cholera has ended and put the final tally at three deaths and 417 cases - an inexplicably higher number of confirmed cases than its last official totals.
HAVANA — Cuba is warning of high mosquito concentrations and asking islanders to help stamp out potential breeding grounds to fight the spread of infectious diseases, amid rumors of serious dengue and yellow fever outbreaks.
July 2012
They treated private patients in public hospitals, ran post-surgery clinics in private homes
Many people who claim the U.S. healthcare system is broken point to Cuba as a country that spends little on health but gets high returns. Michael Moore's documentary Sicko even visited Cuba and claimed that it could be a model for a single payer system in the U.
The total number of confirmed cholera cases in Cuba now stands at 170 while eight more cases are suspected.
Dissident in eastern city of Santiago de Cuba says government is hiding eight cholera deaths
A Cuban government official claims the cholera outbreak in eastern Granma province is under control.
HAVANA - A rare cholera outbreak has killed three elderly people in Cuba and sickened dozens more.

The Communist Party daily Granma says 53 people tested positive for the disease in Manzanillo, 430 miles (700 kilometers) east of Havana.
Cuba has sold millions of dollars in anti-malaria medications in Africa but some malaria experts on the continent have begun to question the effectiveness of the Cuban products.
May 2012
Cuban leader Raúl Castro's push to carry out needed economic reforms has led to reduced enrollment at universities and departure of some foreign companies.
July 2011
SÃO PAULO, Brazil —President Hugo Chávez of Venezuela returned home from Cuba late Saturday after completing a second phase of cancer treatment and said that his doctors in Cuba had not detected any malignant cells in his body.
HAVANA — About 16 percent of Cubans are online in some capacity with access to email, the island’s intranet or the worldwide Web, a government agency says.
CARACAS, Venezuela — President Hugo Chávez stunned this nation on Thursday night in an unusually concise 15-minute address on state television in which he acknowledged that he has been battling cancer. Mr. Chávez made the revelation from Cuba, where he has been in seclusion at a medical facility for the last three weeks.
HAVANA — The ashes of a U.S. pastor who led annual relief pilgrimages to Cuba in defiance of Washington’s decades-old trade embargo have gone on display at a seminary on the island.
February 2011
HAVANA -- More than a dozen employees and officials of Cuba's largest mental health hospital have been convicted of negligence and other charges in the deaths of 26 patients during a cold spell last year.
May 2010

Cuba’s medical diplomacy

May 14, 2010

Financial Times- Andrew Jack

When word reached Juan Carrizo that Hurricane Katrina had struck New ­Orleans on August 29 2005, he reacted with military precision. From his office in a former Cuban naval base just west of Havana, while Washington um-ed and ah-ed over its own response, he began mobilising specialists to assist the thousands of Americans affected by the disaster. Cuba itself had been scarred by Katrina, but Carrizo’s focus at the former Granma Naval Academy – a concrete campus on a balmy, palm-­lined beach – was the other side of the Gulf of Mexico, as he helped to ­­co-­ordinate an unprecedented humanitarian mission to his country’s giant neighbour and arch political rival. Within three days, Carrizo, dean of the Latin American Medical School (Elam), had assembled 1,100 doctors, nurses and technicians, and 24 tonnes of medicine, all ready to fly to ­Louisiana. They were dubbed the Henry Reeve Contingent, in honour of a New York-born Cuban hero who fought against the Spanish in the 19th century. Fidel Castro, still president of Cuba at the time, said in a speech he made later that month: “Our country was closest to the area hit by the hurricane and was in the position to send over human and material aid in a matter of hours. It was as if a big American cruise ship with thousands of passengers aboard were sinking in waters close to our coast. We could not remain indifferent.” But the US didn’t respond to the offer of assistance. It didn’t even acknowledge it. “We prepared more than 1,500 doctors with all the necessary knowledge, equipment and supplies, who were ready to start work as soon as we entered the country,” recalls Carrizo, shaking his head. “The US government didn’t accept them, and many people died who could have been saved. That was a sad day for medicine, and for American society.” Since 1998, when Hurricanes Georges and Mitch devastated the ­Caribbean and Castro resolved to train one doctor for every person killed by the storms, Carrizo had been set to work establishing Elam, the Latin American Medical School. It has since trained more than 33,000 students from 76 countries, who then return home to practise, largely among poor patients. This year, for the first time, some of its foreign graduates formally joined Cuban medical specialists on Henry Reeve Brigade missions to Haiti and Chile, following the most recent earthquakes. Such “medical diplomacy” has been part of Cuba’s foreign policy almost since the revolution – and has grown in intensity over the past few years, fuelled above all by strong demand from Venezuela. In some of the most remote and neglected parts of the world, where western countries have “brain drained” away most of the medical expertise, Cuban personnel are winning friends while helping to fill a desperate need. In the past half century, some 130,000 have worked abroad, and today, 37,000 – half of them doctors, the rest nurses and other specialists – are spread across more than 70 countries. Now Elam is training many more from these nations too. Havana’s approach irritates many, including doctors in other countries who feel undermined by rivals parachuted in to provide free services, and western nations whose health systems are very differently structured. At home, Cuban doctors face modest pay and limited choices, tempting them to volunteer overseas despite regrets about abandoning their own communities and concerns over intimidation while abroad. Some have even defected, although Cuba’s tough emigration controls ­seriously weaken the impact of the brain drain that prompts so many of their low-paid peers in other countries to pack their bags. Medical diplomacy is a potent form of “soft power” – but one with a hard edge. A short walk from Havana’s historic Plaza de Armas, Dr Jose Anido Gusman sits in a two-room office awaiting patients, a fan easing the afternoon heat. On the wall, one poster describes several herbal medicines and their uses; another urges safer sex. Most strikingly, a chart at the rear lists relevant statistics for everyone in his neighbourhood: 3,390 residents in total; 1,191 at risk; 619 smokers; 321 sedentary. “We visit every family at least once a year in their home,” says Anido Gusman, two years out of ­medical school. “That includes the healthy ones.” This is not new: it has been going on almost since Castro seized power. But it has intensified sharply in recent years as medical staff – whether Cuban or Cuba-trained – set about recreating this same model in their host countries. “The doctor is like a member of the family,” says Dr Maria Fernandez Oliva, director of the nearby Thomas Romay polyclinic. From her office, decorated with posters of Fidel Castro, his brother Raúl (who became the country’s ­president in 2008) and Che Guevara, she oversees Gusman’s clinic and dozens of others across the district. She also manages the specialists in her own larger centre, a maze of rooms with rudimentary equipment ­colonising an old mansion block. “Doctors know patients socially, politically, religiously,” she says. “They understand the biological, psychological and social aspects of illness. The key to the ­system is prevention. We solve 90 per cent of the population’s problems here. If we can’t fix a problem within a few hours, we send them to hospital.” The approach is labour-intensive, although less costly than it would be elsewhere because doctors’ salaries average just $25 a month, ­forcing many to moonlight to make ends meet. Coupled with an exhaustive programme of vaccinations and broader efforts to tackle poverty, the system has led to sharp reductions in the rates of infectious diseases that remain significant killers in other parts of the Caribbean. The result has been to extend lives and create a pattern of illness and death very similar to that in the west. As Cubans joke, they live like the poor but die like the rich. “We are more worried about chronic diseases: obesity, hypertension, diabetes. Just look at me,” says Fernandez Oliva, gesturing towards a body squeezed with difficulty into her white coat. Not everyone accepts the figures supporting Cuba’s strong health performance, and critics of the regime argue that Castro’s revolution set back a country that was already reporting progress in tackling disease. But the statistics of the 1950s were also partial, taking little account of the extremes of poverty and ill-health found in rural areas. The improvements over the half-century since came through centralisation and aggressive politics, implemented in the teeth of the disruption triggered by Castro’s overthrow of the Cuban dictator Fulgencio Batista, the economic restrictions imposed by the US embargo and the evaporation of financial ­support from the Soviet Union after its collapse in 1991. Cuba’s medical history might appear an esoteric footnote, but it remains central to the leadership’s contemporary political rhetoric, a symbol of pride and a tool in its international and domestic affairs. In the Havana convention centre last November, four rows of VIP seats quickly filled with senior representatives of the capital’s embassies. They had come for the closing session of the Global Forum for Health Research, a meeting of academics, funders and policymakers, to hear José Miyar Barrueco, Cuba’s minister for science, technology and environment. “One of the tasks of the leadership of the revolution was training health personnel,” he began. “Half the doctors left. I don’t have to tell you where to.” Health has played a big role in the politics of many countries, but rarely more so than in Cuba. In Havana’s Museum of the Revolution, the former Presidential Palace, exhibition panels laud Antonio Guiteras Holmes, the US-born founder of the 1920s Revolutionary Union movement; he studied pharmacology in Cuba. Extracts from Castro’s famous 1953 “history will absolve me” speech proclaim: “The state is most helpful – in providing early death for the people … Society is moved to compassion when it hears of the kidnapping or murder of one child, but it is indifferent to the mass murder of so many thousands of children who die every year from lack of facilities, agonising with pain.” An entire room in the museum is devoted to the world’s most famous “medical guerrilla”, Che Guevara, who studied as a doctor in Argentina before becoming a revolutionary in Cuba. He and his companions looked after not only their fellow fighters but also the local peasants with whom they forged links as they prepared to overthrow the government. They attempted to repeat the exercise elsewhere, including in Bolivia, where Guevara met his death in 1967. His “revolutionary medicine”, urging a new generation of poor Cuban students to train as doctors and return to rural areas to fight disease, helped directly to save many lives. After the revolution, inspired by the state-controlled, centralised Soviet system, the new leaders established a network of polyclinics emphasising preventive care across the country. They also began providing allies with medical help alongside military support. In 1963, Cuba went to the aid of Ben Bella’s regime in Algeria, sending 58 doctors and nurses to accompany soldiers in border skirmishes with Morocco, and bringing the injured back to Cuba for free treatment. Two years later, Guevara joined local insurgents trying to overthrow Moise Tshombe in Zaire, and while there helped launch one of Africa’s first mass immunisation campaigns. More than a dozen missions followed in subsequent years, from Angola to Zimbabwe. The medical support was often more successful and enduring than the military assistance. It forged long-term links with Havana, which more recently has conducted clinical trials and supplied medicines to the continent as its own fledgling pharmaceutical industry grows. Cuba’s tough border screening for HIV, introduced in the mid-1980s, also provided an early warning system to its foreign allies. In autumn 1986, Castro pulled Uganda’s President Yoweri Museveni to one side at a ­conference of non-aligned nations to warn him that 18 of the 60 top ­Ugandan officers sent to Cuba for training had tested positive for HIV, suggesting the epidemic would kill more of his people than conflict. The alert kickstarted one of Africa’s earliest and most aggressive Aids ­prevention programmes. ­ Dr Mayda Guerra Chang appears firmly rooted in her community clinic in western Havana, but like many of her colleagues, her most formative experiences took place abroad. In 1990, just after graduating, she was one of 300 Cubans to travel to Zambia, many assigned to tiny villages to help build the health system under President Kenneth Kaunda. “I wanted to go to Africa because of the conditions: you never face health problems like that here,” she says. “The local doctors had quit to go into the private sector or to other countries. The hospital I worked in had a good building, but it was empty of staff and there was not much equipment. There were no syringes and very few drugs. You had to do your best and pray.” Her experience was typical of Cuban medical solidarity after the initial revolutionary era. As Africa’s health systems crumbled through decolonisation, underfunding, poor management and the emigration of tens of thousands of local doctors and nurses to Europe, Australia and North America, Cubans helped to fill the growing void. The fiercest clashes Guerra Chang faced were not military but ideological – cheap Cuban ­specialists were viewed suspiciously by local doctors who were often ­practising privately or agitating for higher public-sector wages. She recalls the irritation of Zambians striking for pay rises. “They said the Cubans were strike-breakers, and we were not helping them. I understood, but when you are working on the health of people you prefer not to strike.” Such resentment towards Cuban doctors abroad is particularly vocal in Latin America, where Havana has co-ordinated a growing number of medical secondments over the past few years, capitalising on the proximity, common language and growing political solidarity of the region. Local medical associations have complained that their counterparts lack the ­requisite skills and fail to co-ordinate with their members’ activities. They also see the Cubans as a threat to their own jobs. Dr Israel Nolasco Cruzata laughs off such criticism. Now practising back in Havana, he spent three months in Honduras, and then five years in Venezuela, which has become the largest single destination for Cuban medical staff – up to 30,000 are currently employed there. “Cuban doctors go to the worst places, where there are the worst problems,” he says, ­stroking his pencil moustache. “I worked with people who had never seen a doctor, and I came back a better person. Local doctors looked at patients just for money. We are taught that you are first of all the friend of the patient. Health is not just something for us. We know about it and want to give it to the rest of the world. If I am asked to go again, I will.” There is a more direct incentive for the Cuban doctors to work abroad, too. They earn up to 10 times their local salary, and have the prospect of better housing and jobs on their return. Most of their money is held in escrow until they come back, and they are expected to visit once a year. Their families usually have to stay in Cuba. Yet, in spite of the penalties, several thousand Cuban medics have defected over the years, complaining about repressive supervision, being treated with suspicion while on a posting, or being put under pressure to speak out as political advocates. For most, however, fleeing is not an option. Meanwhile, medical services are one of Cuba’s most important sources of foreign currency. Most nations provide a modest return: the host government pays for travel, accommodation and a stipend of up to $200 a month per doctor. Richer countries – from Angola after it found oil in the 1960s, to South Africa under the ANC – ­contribute more. Cuba has even begun offering medical support for commercial fees in countries such as Qatar. And no partner is more important than Venezuela. The secondments enabled President Hugo Chávez to point to a rapid rise in the numbers of medical specialists when seeking to justify his social revolution. The financial terms are ­confidential, but the quid pro quo includes heavily subsidised oil supplies to Cuba. As Fidel Castro once put it: “We provide doctors to ­Venezuela on a humanitarian basis, and Venezuela provides us with oil on a ­humanitarian basis.” But some Cubans complain that foreign assignments have stretched doctors at home too thinly between poorly equipped clinics. John Kirk, a Canadian-based academic, concedes that money and ­diplomatic influence are among the benefits of the programme to the country. But his recent book, Cuban Medical Internationalism, concludes that the motives are far more complex. “Fidel Castro [was] just obsessed with public health,” he says. “There’s a very different approach to the liberal western model – a belief that Cuba needs to share its wealth. As the saying goes, Cubans either don’t quite reach their goals or – as with the ­doctors – they go way over the top.” In December 2008, in the final days of the Bush presidency, health secretary Michael Leavitt gave a speech at the Centre for Strategic and International ­Studies in Washington, DC. His theme was the challenges for global health, but one of his main targets was not malaria, Aids or cancer, but Cuba. “Health is a legitimiser of governments and of ideologies,” he said. “Health also legitimises revolutionary socialists. Fidel Castro has very little hard power on that small island of Cuba, but he has become a master at the use of health diplomacy to create soft power. “The doctors become trusted members of the community and they become quite influential political organisers among the poor and the ­disadvantaged. They have stature ... They become politically active. They feed the discontent and then they’re given a small salary and Castro even makes some money on the deal. It’s actually a very clever strategy. I suggest to you that it’s not a good thing for the United States to have central American governments dependent upon Cuba… Healthcare is a litmus test for these governments on whether they are legitimate and whether they are effective. Using healthcare to discredit democracy and the ideologies of liberty is a tactic that is right out of the insurrectionist’s handbook.” He was not alone in his views. In 2001, the US and other countries ­dismissed a Cuban offer to staff an ambitious international programme to treat HIV, in exchange for funding and supplies of drugs. In 2006, Washington launched an accelerated asylum programme for Cuban doctors, encouraging them to defect while serving abroad. At least 2,000 have. While Barack Obama has made more positive remarks about Cuba’s health diplomacy, the US embargo and asylum system remain in place. However, Elam has set up a shorter-term migration programme in the opposite direction, bringing thousands of foreigners into Cuba to train as doctors. Because it does not charge its students, it has bypassed the long-standing US embargo and attracted some applicants from the least expected places. Damian Suarez, who grew up in New Jersey, is one example. He says he preferred to study medicine in Cuba rather than follow in the footsteps of his brother, who is serving in the US army in Afghanistan. “We get to study on the beach, go to school and save lives,” he says. Ian Fabian, a lanky, bearded student from New York also studying at Elam, agrees: “This is a project for the world. The US is a nation without universal access to healthcare although it spends twice as much per head on health as most other countries. I heard about Fidel’s speech in Harlem, [in which] he talked about third-world conditions in a first-world country.” Fabian grew up in the poor Hispanic neighbourhood of Washington Heights in New York, and says he would never have been able to fund his way through US medical school. He now plans to fulfil his dream of working as a doctor in a public hospital in his home neighbourhood. “Here [in Cuba] they train you, pay your expenses and don’t even ask you for a promise with a handshake in return. They hope your ethics as a professional mean you will go back to serve your community.” Andrew Jack is the FT’s pharmaceuticals correspondent.
October 2009

Cuba's lauded healthcare system is a hoax

October 5, 2009

Miriam Marquez, Miami Herald

Teresita died on my birthday almost five years ago. I didn't grow up with my older cousin -- she stayed behind in Havana after the revolution and my father, her uncle, was wise enough to leave. But when I met Teresita and her son and daughter during a monthlong reporting trip to Cuba in 2002 it was an instant connection. The grainy black-and-white photos of a beautiful teenage Teresita at my baptism, with her long black locks and beaming smile, came to life in the color of five decades of regrets. What if she had left when my parents started making arrangements to bring her to Miami, instead of falling in love, at 18, and deciding to marry and stay? Why did she wait too long to leave during the Mariel boatlift? Why didn't we keep in touch all those decades? MAKING UP FOR LOST TIME After our bittersweet encounter we tried to make up for lost time. I would send her antacids every month, and money when I could. She complained about digestive pains a lot, and after I visited her home in the historic and crumbling section of Havana and saw the filthy cistern where trucks delivered the water I had a queasy feeling about the possibilities. Except I never realized that Teresita's yellowish-brown color might not be from biking to her accountant's job every day in the hot tropical sun. She had a liver disease, undiagnosed for years. When she became severely ill, I was alerted and told to send all kinds of special prescriptions. I was hunting for the medicine when the call came. Maria Teresa Marcos had died, as so many Cubans do, because the communist island's much-lauded healthcare system is an evil hoax. For years she had been complaining to doctors about her digestive problems. For years they told her to try to get antacids from family or friends abroad. No scans were done. No blood tests were taken -- until her liver was so dysfunctional it became her death sentence. A transplant? For Fidel, sure. Maybe for a hard-core member of the Communist Party. But for my cousin, a typical Cuban who lived in a ramshackle building, where the top floor had crumbled and the water likely had amoebas, nada. At least she was able to bring new bed sheets to the hospital -- the ones I had bought her and my cousins. Teresita became another statistic, collateral damage in a revolution that promised elections and prosperity and delivered dictatorship and desperation. `SICKO' MISSES MARK That's the real Cuba that lefty propagandist Michael Moore doesn't want to see. The ``documentary' filmmaker of Sicko gloated about the lack of healthcare insurance for millions of Americans by taking American rescue workers with respiratory problems from the 9/11 terrorist attacks to get ``free' treatment in Cuba at one of its swank hospitals that serve tourists. The film, which was shown at Doral Middle School last week to a social studies class looking into the healthcare systems of Canada, France and Cuba, is hardly an educational tool. But perhaps the teacher had that in mind. The school system went by the book. Students had to have signed forms from parents if they did not want to see Sicko, and two decided not to watch. What irks me is that they are still required to know what's in the movie. How can they without watching it? The discussion the class should have is what Sicko didn't show. In Teresita's memory, please do.

Cuban civil defense teams keep swine flu at bay

October 5, 2009

James Anderson, Miami Herald

HAVANA -- Cuba is ready to use just about everything at its disposal, from its well-oiled civil defense system to the soldiers of a totalitarian government, to keep swine flu cases to a minimum. Everything but a vaccine. As the U.S. prepares an extensive health survey for side affects from its massive inoculation plans, Cuba's No. 2 health official says relying on a shot to contain a world pandemic is risky as best - and demoralizing at worst. "Nobody knows if it would work," Dr. Luis Estruch told The Associated Press in an interview. "How safe would it be?" Cuba's sophisticated public-monitoring system and geographic isolation as an island have kept swine flu cases to just 435 in a country of 11 million - and no deaths to date. That's roughly one in 25,000 people, compared with one in 6,900 in the U.S. and one in 4,000 in Mexico. Swine flu plans for the new season involve all ministries, including the armed forces. If necessary, the government will isolate neighborhoods or entire villages, shut down highways and dispatch medical teams to communities affected by swine flu, Estruch said. Soldiers can go door-to-door to enforce mandatory quarantines and evacuations - and authorities think nothing of severing areas from all contact with the outside world. "In a matter of hours, we can determine what resources to send," Estruch said. "We've thought it out. ... We've considered what to do if we have to paralyze a town, if we have to stop public transit, if we have to close the schools." It works - but only at the cost of individual freedoms, said Jose Azel, an economy specialist at the University of Miami's Institute for Cuban and Cuban-American Studies. Cuba "certainly has advantages to do what it wants to do that we can't - commanding people," he said. Globally, the virus has caused at least 3,205 deaths since it first appeared in Mexico and the U.S. earlier this year, the World Health Organization says. More than a quarter-million cases worldwide have been confirmed, though most are mild and don't require treatment. This fall, the U.S. government plans to track possible side effects as it attempts to vaccinate more than half of the 300 million population in just a few months. It's not that Cuba isn't up to the task of developing a vaccine. Cuba's Center for Genetic Engineering and Biotechnology makes nearly 100 products, including more than three dozen drugs to fight infectious diseases. The island also has 12,000 registered scientists, impressive for a tiny and poor nation, reflecting the importance the government places on medicine and science. "If we had confidence in a vaccine, we would get it," Estruch said. "Immediately." But he warned against promising a cure for a flu strain that can evolve at any time. And he cited the 1976 U.S. campaign to vaccinate millions against a swine flu epidemic that never happened. Hundreds of U.S. citizens blamed that vaccine for other illnesses, including Guillain-Barre Syndrome, a neurological disorder that generally is reversible but can cause permanent paralysis and in some cases is fatal. Lawsuits cost the U.S. government almost $100 million. Instead, Cuba has its civil defense system, which has proved invaluable in carrying out mass evacuations and saving lives during hurricanes that batter the Caribbean island nearly every year. Its disaster-response machine - overseen by President Raul Castro and the armed forces - is organized at the block level in every town, and the government collects health data daily from its extensive network of neighborhood clinics. "When it comes to hurricanes, there are people in each area who are responsible for keeping track of everyone - who will need assistance, pregnant women, the elderly, which buildings are vulnerable," said Wayne Smith, a former top U.S. diplomat in Cuba who is now with the Center for International Policy in Washington. "It's sort of the same thing with the health system." That's how the island detected its first swine flu cases. For two weeks after Mexico reported the outbreak on April 24, Cuba's health ministry monitored everyone who arrived from that country before instituting the monthlong travel ban with almost no advance notice on May 1. Ten days later, Cuba confirmed its first cases: three Mexican students who had recently arrived from Mexico and were studying in three different locations. "We detained them in a matter of hours," Estruch said. The students were treated and allowed to stay in Cuba. Also working in Cuba's favor is its health care system. Treatment is free at clinics in most neighborhoods, though the island's brand of universal coverage faces unspecified cuts to stem what Raul Castro called "simply unsustainable spending" in an August speech. "When a person goes to the neighborhood clinic with a cold he's checked for the virus. And that's how we're going to confront the second wave," Estruch said. "I'm not saying there isn't an epidemic in Cuba. There is. But it's limited." What Cuba won't do this time around is close its borders again. The May travel ban was "totally necessary at that time" because nobody knew what they were up against, Estruch said. Today, passengers arriving at Havana's Jose Marti International Airport are still greeted by customs workers wearing face masks. They are asked if they have flulike symptoms and are subject to a thermal imaging scan. Airline pilots are required to report if any passengers were sick. Dr. Jarbas Barbosa of the Pan American Health Organization praised Cuba's close collaboration with international health agencies. But he questioned the government's methods of isolating people to stem the spread of the virus. "In general, we have no evidence that they work," said Barbosa, who is chief of health surveillance and disease management. "And they can produce a profound social and economic impact." .
August 2009

Castro says Cuba to cut spending, communism secure

August 3, 2009

Will Weissert, Miami Herald

HAVANA -- Raul Castro announced Saturday that Cuba will cut spending on education and health care, potentially weakening the building blocks of its communist system in a bid to revive a foundering economy. The former defense minister who took over the presidency last year called state spending "simply unsustainable" and said the cash-strapped government would reorganize rural schools and scrutinize its free health care system in search of ways to save money. But he vowed that the island will not see fundamental change even after he and his older brother and predecessor, Fidel Castro, are gone. "I wasn't elected president to return capitalism to Cuba," Raul Castro said, "or to surrender the revolution" - the armed uprising that toppled dictator Fulgencio Batista a half century ago. "I was elected to defend, build and perfect socialism, not destroy it," he said to a standing ovation from lawmakers in Parliament. He framed those remarks as a response to U.S. Secretary of State Hillary Clinton, who has said Washington wants to see economic and social reforms in Cuba before doing more to improve relations. Castro reiterated his willingness to negotiate better relations with the United States and acknowledged a "decline in the aggressiveness and anti-Cuban rhetoric" during the Obama administration. He said he was ready to talk about "everything here in Cuba, but also everything there in the United States," referring to Washington's 47-year-old trade embargo. Castro said Cuba "won't negotiate our political or social system and we won't ask the United States to do so. We should mutually respect our differences." Raul was Fidel Castro's hand-picked successor for decades and took power from his brother without an election in February 2008. Cuba argues its system is democratic because voters ratify a slate of official parliament candidates, and lawmakers in turn choose the Council of State, the supreme governing body. The parliament list is drawn in part from municipal leaders who are picked during neighborhood gatherings where participants vote by show of hands. Raul Castro made an unusual mention of the mortality of his ailing, 82-year-old brother - something top officials almost never do in public - scoffing at those who think Cuba's political system will crumble after "the death of Fidel and all of us." "If that's how they think, they are doomed to failure," Castro said. Defiant guarantees for the future came only after a heavy dose of grim economic news. Without mentioning specifics and while insisting education will not suffer, he said some students and teachers in rural areas will be reassigned to nearby cities, saving time and money needed to transport 5,000 educators long distances between home and work. He also said cuts were in store for the universal health care system, which, along with free education through college, subsidized housing and food provided on a monthly ration system, forms the basis of the communist way of life that the Castro brothers have spent 50 years building. Before Castro spoke, lawmakers established a new office of government finances to crack down on corruption and keep better watch on the state's often mysterious spending patterns. The new comptroller's office is a break from the past, when Fidel Castro lorded over the national treasury. Cuba's former "Maximum Leader" often raided it for pet projects after taking power in 1959 and continued to micromanage minuscule spending details in subsequent decades. Taking scrutiny of Cuba's economic books away from the presidency reflects the businesslike, military mentality of the younger Castro, an army general who has demanded better accountability from all leaders. Cuba's government dominates well over 90 percent of the economy and pays an average salary of about $20 a month, meaning some employees steal food, electronics and anything else they can at work and sell them on the black market to make ends meet. While it may help limit graft, the new office likely will do little to fill sparse state coffers. Three hurricanes last summer caused more than $10 billion in damage and wiped out grain that the government had stockpiled to protect against rising commodity prices. The global recession has since cut into export earnings and caused budget deficits to soar, leaving Cuba short of cash. Things are so dire that on Friday, authorities postponed a Communist Party congress that would have been the first of its kind in 12 years. At the same time, the government decreased the projection for 2009 growth to 1.7 percent. As recently as December, central planners boasted Cuba would grow 6 percent this year, but they count as output government spending on social programs. Tourism has remained strong, with the number of foreign visitors on pace to slightly exceed last year's record 2.35 million, which generated $2.7 billion. Still, Tourism Minister Manuel Marrero said revenue from those visitors is down about 10 percent in 2009. "Tourism is growing, tourists keep coming, but they have changed the way they travel," Marrero said outside the parliament meeting. "They are coming for less time, trying to come with a lot of discounts, and that has caused a decline in profits." .
July 2009

Sudden deaths of 11 Cuban cancer patients called medical negligence

July 9, 2009

Wilfredo Cancio Isla, Miami Herald

Miami Lakes resident Norma Flores still can't make sense of the unexpected death of her sister, Marisel Gutiérrez, who was satisfactorily recovering from a cancer operation. 'She felt well. She was a beautiful and healthy woman,' said Flores, looking at recent pictures of her sister. ``What they did to her was a crime.' Gutiérrez, 56, was one of 11 cancer patients who died suddenly in June at the municipal hospital in Morón, in the central province of Ciego de Avila, as a consequence of alleged medical negligence in the use of serums for chemotherapy. According to testimony from medical sources, relatives of the deceased and residents of Morón, the deaths occurred during the first three weeks of June, after numerous patients at Roberto Rodríguez Hospital were treated with a defective cytostatic serum. Cytostatic medications combat the growth of tumors. 'There was a serious problem with the chemotherapy serums being applied, and deaths occurred due to effects collateral to the treatment,' a doctor at the hospital told El Nuevo Herald, on condition of anonymity. The doctor declined to confirm a version that alleged that the cytostatic serum given to the patients had expired. 'The affair is under investigation,' he said. But two other hospital employees and relatives of the deceased, in Morón and Miami, said the chemotherapy serums came from international donations and bore old expiration dates. 'Treatment with expired cytostatics becomes ineffective in the battle against cancer and can bring about a serious toxic reaction,' said a medical assistant at the hospital. ``Everything indicates that in those cases the collateral effects and the complications produced by the medicine had deadly consequences.' The deaths have not been reported in Cuba's official media but are well known among the people of Morón, a city with a population of 63,000 about 280 miles east of Havana. During a telephone call last week to the municipal offices of the Ministry of Public Health, a secretary who declined to identify herself acknowledged that 'there have been some difficulties at the hospital' but did not give details about the deaths. Residents of Morón reached by phone say the events have caused some outrage and intervention by municipal and Communist Party leaders. 'I know that there have been several meetings between the Party and the people from Public Health,' said María Julia Esteban, a resident of Morón . ``It seems that several male nurses and doctors were disciplined because of the problem.' Meanwhile in Miami Lakes, Flores struggles to accept the tragic death of Gutiérrez, her only sister, and repeatedly goes over the details of the incident. Gutiérrez underwent breast surgery in March. The operation was a success and she was prescribed cytostatic treatment beginning in May. After the second application of serum, she had to be returned immediately to the hospital, where other patients were being readmitted because of severe reactions to the chemotherapy. Gutiérrez died June 7 and was buried three days later at Morón Cemetery. 'They gave her the serum, and three days later her mouth began to break out. She was rushed to the hospital, suffered convulsions and died of internal hemorrhage,' Flores said. 'My brother-in-law is crushed,' said Flores, who emigrated from Cuba in 1967. ``He can't understand what happened and has complained to the government authoritiesBut everybody [in Morón] fears to speak out and complain about what has happened to their relatives.' .
June 2009
HAVANA (AFP) — Cuba confirmed its fifth swine flu case Sunday, that of a 62-year-old Canadian tourist who was responding favorably to treatment, the Health Ministry said. The woman arrived Tuesday in Santiago de Cuba on a flight from Toronto, the ministry said in a statement published by the daily Juventud Rebelde. The first symptoms of A(H1N1) flu was detected at the airport and she was immediately taken to a hospital where she was isolated and given treatment, it said. "All the other travellers are still under epidemiological surveillance," the ministry said. The first four cases of A(H1N1) flu in Cuba all recovered. Among them was a 22-month-old Canadian toddler, who later returned home with his parents. The World Health Organization, in its latest tally on Friday, put the number of confirmed cases worldwide at 21,940 in 69 countries. So far, 125 people have died of the flu, according to the WHO.
May 2009
HAVANA (Reuters) - A Mexican studying medicine in Cuba has been diagnosed with the island's first confirmed case of H1N1 flu, the government said on Monday. The student had returned from vacation in Mexico in late April when he came down with the illness that has infected thousands of people in at least 30 countries, the Public Health Ministry said in a statement read on state-run television. No details were given on the student's condition. The ministry said that, in all, it had found 84 people from eight countries with flu-like symptoms and that they and 511 other people who had contact with them had been tested for swine flu. Those tested include 14 Mexican students, all of them studying in a Cuban medical school, but only the one case had been confirmed so far. The Cuban government has taken a number of measures to prevent the H1N1 flu virus from reaching the Caribbean island, which has a population of 11.4 million and is located 115 miles across the Yucatan Channel from Mexico, epicenter of the swine flu outbreak. Cuba has stepped up medical vigilance at airports, ports and marinas and on April 28 banned flights from Mexico. The suspension of flights upset Mexican President Felipe Calderon, who said in a television interview last week that he might cancel a planned trip to Cuba "as one of the unforeseen consequences of decisions that have no technical basis." In an Internet column published on Monday night, former Cuban leader Fidel Castro took offense at Calderon's threat to cancel. Castro said the trip had already been suspended for reasons unrelated to the flu outbreak. "What was the Mexican president complaining about, with relation to the measures that Cuba adopted according to established norms and without the slightest intention of affecting our Mexican brothers?" he asked. About the flu, Castro wrote, "The only thing that can be confirmed now is that it wasn't brought here by the CIA. It came from Mexico." The 82-year-old Castro was replaced as president last year by his brother, Raul, but retains a powerful voice through columns published in state-run media. In recent years, Cuba has become a popular tourist destination, receiving 2.3 million visitors from around the world in 2008. Communist-led Cuba prides itself on its free healthcare and the government often acts aggressively to keep people safe during natural disasters like hurricanes. (Reporting by Jeff Franks; Editing by Eric Walsh) .
December 2008

Cuban embodies changing face of HIV

December 4, 2008

Daniel Shoer Roth, Miami Herald

'I only take action, and I don't accept myself as a victim,' says the former Cuban dancer, Alberto Lamas, upon leaving the doctor's office. Closing the door, he says, ``I leave my problems at the doctor's office.' 'A positive attitude helps,' he continues. Indeed, Lamas, 55, has not only buried his closest friends but also his brother -- all of them dying of AIDS over the course of the last 20 years while he was also suffering from the virus. 'I concentrate on one thing at a time, without letting my illness destroy me emotionally,' he explains without bitterness. Lamas' perseverance, combined with scientific advances, has allowed him and countless others who contracted HIV during the 1980s to escape the death sentences many thought they had been handed. This week, which marks the 20th anniversary of World AIDS Day, they remember 545,000 people in the United States who weren't so lucky. Lamas doesn't know when he was infected, though he believes it was after coming to Miami in 1986. He was born in Cardenas, Cuba, where he lived a humble but pleasant childhood, until he began exhibiting feminine traits at age 11. Though he faced discrimination, he took courses in ballet and folk dance and scored his first role at the age of 21 with the cabaret Parisienne of the Hotel Nacional in Havana. His artistic career flourished: taking the stage at the Copa of the Hotel Riviera and the emblematic Tropicana. By the mid-1980s, the Castro regime tried to recruit him as an informant and he felt the urgency to emigrate. He left the island thanks to his brother, who was gay and living in Miami. Here, Lamas had to start over, but he got a role in a transvestite show that played on Calle Ocho and another gig with comedian Nestor Cabell. During the next five years, Lamas saw his friends fall like dominos. In 1989, he took an HIV test and the results came back positive. Healthcare options were scarce so he tried alternative therapies he heard about: taking cat's claw, oxygenating his blood and injecting cucumber extract. 'The time came when I didn't even know where I stood or what to do with my life,' recalls Lamas. It was then that he succumbed to alcohol and drugs. While dueling with death, he was forced to face the stigma of AIDS. 'People didn't want to shake your hand, and even gays would isolate you. You had to keep it absolutely secret,' recalls Lamas, who also suffers from diabetes and blood clots. It was impossible to cover up. Anti-retroviral therapies damaged his face and a mound of fat accumulated on his neck. Thanks to the advent of pharmaceutical cocktails, he slowly recovered. Last week, I was with him when he received wonderful news: his CD4 blood cell count was like a healthy person's and his viral load was very low. But destiny doesn't always smile on him. His leg bothers him and although his health care and living expenses are covered, he receives just $637 from Social Security a month. Just the same, he takes walks in Miami Beach, spends time with friends who care for him and participates in a twelve-step program that has helped him remain sober for more than a year. 'I've been to hell and back ,' sighs the former dancer. ``How did I do it? Only God knows.' .
September 2008

At least 7 babies died from hospital bacteria

September 5, 2008

Miami Herald

HAVANA -- At least seven newborns died in the maternity hospital Hijas de Galicia here due to a bacterial infection they contracted in the operating room, medical sources said. El Nuevo Herald confirmed seven deaths and the infection of some 10 children during June and July. The infection was caused by the bacteria acinetobacter in the operating room of the facility, the sources said. The acinetobacter bacteria is very aggressive and resistant to antibiotics. A medical source who did not want to be identified said the children 'were born completely healthy.' However, a few hours after birth they developed respiratory problems, with sneezing and coughing, as well as a change in skin tone, lack of energy, fever, breathing difficulty, inflamed lungs and meningoencephalitis. For several weeks, authorities at the Ministry of Public Health (MINSAP), kept silent and continued the normal routine. But news of the initial deaths spread and forced MINSAP to close the pediatric services at the Hijas de Galicia at the end of July. To date, the authorities have not said anything about these cases..
April 2008
HAVANA (AP) — Cuba has replaced its education minister in the first Cabinet change since Raul Castro assumed the presidency two months ago, the official newspaper announced Tuesday. Castro has suggested that a major Cabinet shake up is expected later this year to streamline the government by eliminating ministries that duplicate tasks. The new education minister is Ana Elsa Velazquez, rector of the government's Frank Pais Garcia Institute of Advanced Teaching Studies in the eastern city of Santiago, the Communist Party newspaper Granma said. She replaces Luis Ignacio Gomez Gutierrez. Raul's brother Fidel Castro announced in July 2006 he had undergone emergency intestinal surgery. Raul Castro assumed the presidency Feb. 24..

Cuba reorganizes family doctor program

April 8, 2008

Reuters- Mark Frank

HAVANA, April 8 (Reuters) - President Raul Castro's government will close more than half of Cuba's family doctor offices and boost staffing at the rest in a major reform of its vaunted free health care system, medical sources said. The overhaul of one of the pillars of the health system came in response to public complaints, the sources said, and is another step by Castro to improve life since he succeeded his ailing elder brother Fidel Castro as president in February. Cubans complain that the family doctor program has been short on staff since the communist government began sending thousands of doctors to Venezuela in 2000. In the provinces, family doctor offices will now be staffed by a doctor and nurse the entire day, instead of just in the mornings, health care sources said. "There has been a lot of movement in recent weeks. They are painting the offices, developing a system to insure a proper lunch for staff and more equipment is arriving at the clinics as well," a nurse in central Cuba said on Tuesday. Like others interviewed, she asked not to be named because she was not authorized to speak to a foreign journalist. There is a similar plan for Havana, a city of 2.2 million people, but it will take more time because doctors and nurses are in short supply. For now, some of the doctors offices will open in the mornings only. Cuba has the best health care system in Latin America, according to the Pan-American Health Organization, boasting the region's highest longevity and lowest infant, child and maternal mortality rates. But family doctor offices were left in poor condition and understaffed when Cuba was plunged into deep economic crisis by the collapse of the Soviet Union in 1991. Fidel Castro launched programs six years ago to rebuild crumbling hospitals and expand community clinics. But he also sent tens of thousands of doctors and nurses to work in poor neighborhoods in Venezuela after his main ally President Hugo Chavez came to power. The export of medical services to Venezuela went in return for vital supplies of oil that helped keep Cuba's economy afloat. Some 40,000 Cuban health professionals are working abroad in 81 developing countries, more than half in Venezuela. OVERWORKED, UNDERPAID Raul Castro, 76, took over day-to-day control of Cuba when Fidel Castro fell ill in July 2006 and then formally succeeded him on Feb. 24, becoming the first new leader in almost half a century. In public debates fostered by Raul Castro last year, authorities heard frequent complaints that family doctor offices were empty or open only in the mornings. They were told medical staff were overworked and underpaid, and forced to use some of their time in other activities to make ends meet. Under the new reforms, all medical school students will now do their sixth year residency at a family doctor office to reinforce staffing. "There will be fewer offices. Most are already vacant, but those that are open will be easier to supervise and better staffed," a Havana doctor said. Since becoming president, Raul Castro has moved quickly to lift some of what he has called "excessive prohibitions" on daily life. Cubans now can buy DVD players, computers and other consumer goods, stay at tourist resorts and use cellular telephone services -- all off limits before. More importantly for most Cubans, who cannot afford cell phones and luxury hotels on average salaries of $17 a month, it is now easier to fill drug prescriptions, changes are being made to the health care system and the government is also reviewing complaints about education. Cuba's family doctor program began with much fanfare in the 1980s with a family doctor for every 500 to 700 residents, coordinated by larger community-based clinics. The family doctors were given the task of preventing illness by getting to know every family under their care and identifying health problems early on for referral to medical specialists. Now each family doctor office will cover up to three times as many residents, between 1,500 and 2,000, a doctor said. (For special coverage from Reuters on the changes in Cuba, see: here) (Reporting by Marc Frank; Editing by Kieran Murray).
March 2008

Cuban education program reaches millions worldwide

March 12, 2008

Miami Herald- AP

HAVANA -- (AP) -- A Cuban literacy program has taught more than three million people -- about half of them in Venezuela -- how to read and write over a little more than a decade, Education Minister Luis Ignacio Gomez said Tuesday. Gomez offered new statistics about the program while announcing a literacy congress to be held in Havana in June. The 'Yes, I Can!' program, developed in Cuba nearly 12 years ago, has been praised by the U.N. Educational, Scientific and Cultural Organization. Cuba has since sent about 700 educators to 28 countries, including Argentina, Bolivia, Haiti, Mexico, Mozambique, Panama, Nigeria and East Timor. Educators in those countries get materials in the local language and a teaching method..
January 2008

Author disputes Cuban healthcare `myths'

January 11, 2008

Miami Herald- John Dorschner

Before Katherine Hirschfeld went to Cuba for post-graduate studies, she read dozens of academic research papers on the country's healthcare system. All were glowing reports about how the Castro government offered good care for everyone, and that's what she expected to find. Then she went to Santiago de Cuba for an extended stay and saw the system for herself, including three days in a hospital when she came down with dengue fever. The result is a highly critical book -- Health, Politics and Revolution in Cuba since 1898 -- which she will discuss Thursday night at the University of Miami. Her stays were mostly in Santiago, from 1996 through 1998, when she was a graduate student at Emory University and Cuba was in the midst of a dengue fever epidemic that the government tried to hush up. When she experienced the symptoms -- aching joints, fever, nausea, sore throat -- she was taken to a Santiago hospital and placed in a large ward guarded by a man with a gun. She asked to make a phone call to tell people where she was. The guard said there were no working phones. ' `Oh my God,' I thought to myself. 'This place doesn't exist,' ' at least not officially, because the epidemic was a state secret. NO DOCTOR IN SIGHT During her stay, she says she never saw a doctor. She was given one pill -- a vitamin. Fortunately, she had a mild case. Because there were few nurses, she and other patients who were able did what they could for the sickest, especially those who were bleeding or vomiting. Now an assistant professor of anthropology at the University of Oklahoma, Hirschfeld says living with a family in Santiago while doing her research made a big difference in her viewpoint. 'Most academic work about Cuba is based on little or no field research,' Hirschfeld said. U.S. academics often rely on official government studies or do short stays on the island, spending perhaps two weeks, sleeping in government-approved facilities. She found women in Santiago gravitated to the kitchen, where she learned that even preparing a meal was revealing about the economy. 'Lunch is sometimes a counter-revolutionary event,' because of how the family had to scramble outside the rationing system to find enough to eat. Hirschfeld found even more basic public health problems, such as a lack of running water in the city. Residents compensated by catching rain water in barrels -- breeding grounds for mosquitoes, which transmit the dengue virus. Cubans who needed treatment often used social networks or bartered favors to have doctors see them outside the official clinic settings. If people had to go to the hospital, they tried to prepare in advance, getting surgical thread and bandages on their own, even obtaining drugs from the United States if they could. Hirschfeld says her research showed that healthcare in pre-Castro Cuba was of mixed quality. Many people in the cities received inexpensive, regular care through memberships in clinics, but those in rural areas and those of African heritage were less likely to get care. A clean water supply was problematic because corrupt officials often stole the money rather than using it to maintain and improve the system. When she finished her doctorate dissertation about the problems in Cuba's healthcare, she says it was not initially well received by her review committee, which pointed out that most other academic researchers disagreed with her. She believes her unusual views delayed her getting her doctorate by at least a year. FROM BAD TO WORSE Since Hirschfeld did her research, most experts say Cuban healthcare has gotten worse, primarily because 36,000 doctors and other healthcare professionals are now working overseas, many of them in Venezuela, according to official figures. A dissident doctor in Havana, Darsi Ferrer, told The Miami Herald last year that because of the shortage, ``One doctor now has to take care of four or five offices.' The situation has become so bad that last month the vice minister of public health, Joaquín García Salaberría, took the highly unusual step of admitting on Cuban television that there were shortages of doctors and nurses. 'It's not guaranteed that doctors and nurses will remain in the doctors' offices, as had been promised,' García said. Join the discussion The Miami Herald is pleased to provide this opportunity to share information, experiences and observations about what's in the news. Some of the comments may be reprinted elsewhere in the site or in the newspaper. We encourage lively, open debate on the issues of the day, and ask that you refrain from personal comments and remarks that are off point. Thank you for taking the time to offer your thoughts..
November 2007

Cuba's vision-care 'miracles' not without costs

November 23, 2007

Miami Herald- James McKinley Jr.

HAVANA -- A shiny new tour bus pulled up to the top eye hospital in Cuba on a sunny day this month and disgorged 47 working-class people from El Salvador, many of whom could barely see because they had thick cataracts in their eyes. Among them was Francisca Antonia Guevara, 74, a housewife. She said she had visited an eye doctor at home but could not pay the $200 needed for artificial lens implants, much less the surgery. 'As someone of few resources, I couldn't afford it,' she said. ``With the bad economic situation we have there, how are we going to afford this?' Cuba's economy is not exactly booming, either, yet within two hours Guevara's cataracts were excised and the lenses implanted. The Cuban government paid for everything: including air transportation, housing, food -- even the follow-up care. The government has dubbed the program, started in July 2004, Operation Miracle. For the hundreds of thousands of people from Venezuela, Central America and the Caribbean who have benefited from it since, it is aptly named. Yet the program is no simple humanitarian effort, and it has not come without a cost. The campaign against vision loss serves as a poignant advertisement for the benefits of Cuban socialism, as well as an ingenious way to export one of the few things the Cuban state-run economy produces in abundance -- doctors. Cuban doctors abroad receive much better pay than in Cuba, along with other benefits from the state, like the right to buy a car and get a relatively luxurious house when they return. As a result, many of the finest physicians have taken posts abroad. The doctors and nurses left in Cuba are stretched thin and overworked, resulting in a decline in the quality of care for Cubans, some doctors and patients said. The Cuban authorities say they have treated more than 750,000 people for eye conditions like cataracts and glaucoma since the program started. Cuban doctors have also set up 37 small eye hospitals in Latin America, the Caribbean and Mali, 25 of which are in Venezuela and Bolivia, whose leaders have close ties to the Castros. The hospitals are staffed with more than 70 top-notch eye surgeons from Cuba and hundreds of nurses and ophthalmologists. Dr. Sergio M. Vidal Casali, 84, has worked at the Ramón Pando Ferrer Cuban Institute of Ophthalmology for more than 50 years, specializing in retina diseases. He said the heavy flow of foreign patients through the hospital combined with the exodus of several physicians to other countries had hurt his department. 'I don't like it, really,' he said. ``It's wonderful for the people, but not for us. It disturbs our work.' Dr. Reynaldo Ríos Casas, director of the institute, said the early days of the program were hectic. Eye surgeons worked in three shifts. It was not uncommon for a single surgeon to perform 40 operations in a shift. 'It was really heroic,' he said. ``We were operating day, afternoon and night.' Since then, Ríos says his hospital has been training new eye doctors at an astounding rate of 2,100 this year, half of them surgeons. The hospital's budget has been increased tenfold and its equipment upgraded. It now has 34 operating theaters with state-of-the-art equipment, including two outfitted for advanced laser surgery. One advantage of the program is that it has given young surgeons a steady flow of patients on whom to hone their skills. Just this year, they have performed 394 cornea transplants at the hospital, Rios noted. 'Our specialists have an incredible amount of experience,' he said. ``What specialist in the world can do dozens of cornea transplants a year?' The program has allowed Cuba to use its doctors as barter for subsidized Venezuelan oil and to forge closer relations with other countries in the region, including those, like El Salvador, that have not been historically close to the Communist regime here. Of course, the people who have their sight restored could not care less about the political and economic repercussions of the program. For them, the offer of free surgery was a dream come true. Guevara, whose husband is a retired construction worker, said she had given up hope of seeing again. She heard about the Cuban project on a Mayan radio station. 'I never imagined anyone would help me the way they have,' she said as she waited for surgery. ``I thought I was going to end up blind.' Downstairs in the cafeteria, Manuel Agustmn Isasi, 33, a professional fencing coach from Islas Margaritas in Venezuela, was eating a lunch, able for the first time in three years to see his food with both eyes. He had been whitewashing his home when he accidentally burned both corneas with a bucket of quicklime. The accident ended his fencing career. Among the first cornea transplant recipients in the program who had a second transplant in early November, he was unabashed in his praise for the Cuban government and for President Hugo Chavez of Venezuela. 'I would have remained completely blind,' he said. ``Vision is half of one's life.' .
October 2007

Cuban education criticized

October 24, 2007

Miami Herald- Isabel Espronceda

Cuban education is passing through a crisis, and the reforms enacted by Fidel Castro in recent years have worsened the system, according to a study by a group of Cuban and Slovakian specialists unveiled in Miami. The study, titled What is the Future of Education in Cuba, was done by the Slovakian-based People in Peril, which since 2005 has been working with teachers and parents on the island. 'Cuban education is destroyed,' Eliska Slavikova said. She coordinated the study with Suzana Humajova, who visited the island in 2006 and met with teachers, Christian groups and others. The two women recognized the difficulties of analyzing the Cuban system in depth, because the statistics provided by the Education Ministry ``do not come from reality but from the formations in a [government] plan.' Their 77-page study, which was sponsored by the University of Miami's Institute for Cuban and Cuban American Studies, concluded: • There has been a 'pronounced' departure of teachers to other jobs because of low salaries and the lack of social recognition. • Many teachers have also left their jobs because of the government's growing ideological pressures. The primary objective of education in Cuba is the formation of future revolutionary Communists. • The great majority of schools lack equipment and installations needed to provide a good education. • High school graduates are sent to teach after only an eight-month special course. But much of the teaching now is done through educational TV channels.
July 2007

Living on Cuban food ration isn't easy

July 3, 2007

Miami Herald- Anita Snow

HAVANA -- No one on this communist-run island dies from starvation, but every month Cubans on the "universal ration" must use ingenuity and organization to ensure everyone gets enough to eat. For 30 days, I lived on a similar program. I spent less than $17 for a month's sustenance, dropped nine pounds and learned - like Cubans - to budget carefully, plan meals ahead, buy only what was necessary and never throw food away. Most importantly, I realized that like most Americans, I take food for granted, assuming I'll always get what I want when I want it. Cuba's ration system began in 1962, to guarantee a low-priced basket of basic foods just as the U.S. cut off trade with the island, sparking food shortages. Initially characterized as temporary, the program remained as Cuba struggled to feed its people, turning to the Eastern bloc for most of its food. Today, Cuba spends $1 billion a year to give the island's 11.2 million citizens a subsidized ration including rice, legumes, potatoes, bread, eggs and a small amount of meat. The government estimates the ration provides a third of the 3,300 calories the average Cuban consumes daily. The rationed products, which cost consumers about $1.20, would cost more than $58 if purchased at the overpriced Cuban supermarkets for foreigners known as the "shopping," or about $50 at the average U.S. grocery store. For my project, I allotted myself the same items on the ration, plus an average salary of $16.60 to buy the rest of my food. During June, I ate little animal protein, no dairy products, very little fat, but probably consumed more rice and beans than I had in a year. When I could, I ate fruit and vegetables daily. Limited in what they can eat, Cubans spend much time thinking about their next meal. I found myself obsessing about food as well. Would I have enough money at the end of the month to buy vegetables? Would all those potatoes make me fat? Cubans told me the farmers markets were expensive, but I didn't realize just how costly until I lived on their limited plan. A big papaya costs more than a day's wages. More than half of Cubans have access to some foreign currency, whether from tips from tourists or remittances from abroad. With $50 a month, a family can buy additional cooking oil, pork or even a rare piece of beef at the "shopping." But the rest of Cubans have to be creative. Neighbors trade and buy and sell rationed products to get what they need. They purchase milk, butter and yogurt sold surreptitiously outside the government bakery. Some engage in petty theft, such as restaurant workers who skim cheese off sandwiches. I traded someone a pound of squid for six eggs. When I ran out of coffee, I bought rationed coffee from people who preferred extra food. I learned firsthand how Cuba's tightly woven society ensures that relatives, neighbors, friends, and co-workers always eat. Several Cubans gave me part of their rations, refusing money or food in exchange. A Cuban colleague offered to share her homemade spaghetti lunch. A friend said his family invited the same elderly neighbor to lunch every day for years. Despite their generosity, Cubans remain anxious about food, especially those who remember the "Special Period" - wartime-like austerity measures imposed in the early 1990s after the Soviet Union collapsed and the island's gross domestic product plunged by 35 percent. Cubans experienced true hunger during those years, missing many meals, eating very small and unappetizing ones, going months without meat or fresh produce. But the ration ensured no one starved to death. The crisis eased after 1993 when the government broke up state farms into smaller cooperatives and individual farms, and opened farmers markets where producers could sell crops at unrestricted prices after meeting government production quotas. Cheap meals at workplaces and schools and affordable street food also help. Still, stereotypes about Cuba's food situation persist. Visitors are often surprised to find a somewhat plump population, and recent government studies show 30 percent of Cuban adults are overweight. With all the starch on the ration, and high produce costs, it would be easy to gain weight. With my American phobia of carbohydrates, I gave away most of my four pounds of potatoes early into the month. Without those carbs, and without access to the cheap meals many government workers get, I dropped nine pounds in 30 days. I marked the end of the month modestly on Sunday with a small dinner for Cuban and foreigner friends, cooking a mixed bean soup with sausages and a tomato base that my late mother loved. I also made corn bread, a watercress salad with tomatoes and avocados and a pumpkin flan. Today, I return to a modified version of my diet for another month in hopes of losing more weight. Legumes remain my primary protein source as I add some fish and chicken. I'll stay away from most beef, pork and dairy products, but will now add nonfat yogurt to my diet, along with more fruit and vegetables. Most importantly, I'll eschew the chocolate bars, microwave popcorn, and potato chips I love. And I'll try to stop taking food for granted..
June 2007

Cubans go to street to augment rations

June 13, 2007

Miami Herald- Anita Snow

HAVANA -- Cubans may not have McDonald's or Jack in the Box, but they do have pizza in a basket. Customers shout orders to a terrace kitchen atop a 1930s-era two-story building and the pizza is lowered to the street in a rattan basket. Pizza Celina is among the more inventive places that Cubans go for street food to augment government food rations. Elsewhere in Havana, self-employed street vendors hawk peanuts, popcorn and a snack known as "chicharrones de macarones" - macaroni pork rinds - made by boiling pasta, drying it the sun, then frying it. Near the University of Havana, students line up at lunchtime outside a building with peeling pink paint to shout orders for pizza with tomato sauce and cheese for 8 pesos, which is about 38 cents. A little bit more buys a ham or sausage topping. Minutes later, a basket on a rope drops for payment. Money collected, the basket comes down again, bearing hot pizzas, grease soaking through butcher paper wrapping. There is no soda, or napkins. The basket-on-a-rope delivery method is popular among those who share and sell goods in apartment buildings without working elevators. "We come here because it's good, it's fast and it's cheap," said Laura, a 20-year-old history student. Like many Cubans, she wouldn't give a last name, uncomfortable talking with a foreign reporter about an issue as political as food. She said she often eats for less money at the university cafeteria, but the food there isn't as good as at the privately run Pizza Celina. "This is a bit expensive for us but we come when we can," she said. A recent increase in the monthly government stipend for students, from 20 to 50 pesos (about $1 to $2.50), means she can now afford to visit the pizzeria once a month. Laura lives on the other side of Havana, and it's impractical to go home to eat. There are few nearby places to buy cheap food, save for a nearly empty state-run vegetarian restaurant. "I've never gone in there," Laura says. The only thing close to a fast-food chain in Cuba is the state-run Rapidito or the food counter at Cupet gas stations, which both sell hot dogs and fried chicken most Cubans cannot afford because they are priced in the "convertible pesos" used by foreigners. Government workers are paid in regular pesos, which trade at about 24 to the convertible peso or 21 to the U.S. dollar. A Rapidito hot dog at 1 convertible peso costs more than a day's pay for a Cuban earning a typical monthly salary of 350 pesos ($16.60). Under the communist country's 45-year-old universal ration system, Cubans get a heavily subsidized monthly food basket of beans, rice, potatoes, eggs, a little meat and other goods. That, along with other subsidized meals such as workplace lunches, provides about two-thirds of the 3,300 calories the government estimates Cubans eat daily. Cubans use their salaries and any other income to buy the rest of their food at farmers markets and overpriced supermarkets or through black market purchases and trades. If they have enough money, or no way to get home for lunch, Havana residents go to the street for low-priced snacks. That often means bustling Obispo Street, the capital's largest concentration of stands and vendors selling food for pesos. Elderly men walk down the cobblestone street hawking 1-peso (5-cent) paper cones of raw peanuts, clutched like floral bouquets. A teenage boy at a weathered wooden cart asks 2 pesos for "granizados," small plastic cups of ice drizzled with strawberry-flavored syrup. Another vendor sells homemade popcorn in plastic bags for 3 pesos. Many street vendors are licensed, and the government runs storefront stands selling pizzas, hot dogs and pork burgers for 10 pesos. And government stands offer a cold glass of "guarapo," or sugar cane juice, for 1 peso. Similar foods are sold at Obispo's "tencen" - poorly stocked government shops that evolved from American-style five-and-ten stores of the 1950s and whose nickname is an adaptation of "10 cents." The "tencen" are among the few places Cubans can buy food and other items in the national currency they earn. The shops also have lunch counters serving fried chicken or pork steak and a bakery offering sugary cookies. Then there is the "frozzen," a 1-peso cone filled with a smooth, cold vanilla mixture with a synthetic taste - a snack sold at the "tencen" and government storefront windows. Just a block away, a convertible peso store sells imported frozen treats made from dairy products most Cubans cannot afford. There, the Nestle's Crunch chocolate ice cream bar is 1.10 convertible pesos - about 26 regular pesos, or $1.20..
April 2007

Cubans face difficulties but still have long lives

April 25, 2007

Miami Herald- Will Weissert

'Fidel: 80 More Years,' proclaim the good wishes still hanging on storefront and balcony banners months after Cubans celebrated their leader's 80th birthday. Fidel Castro may be ailing, but he's a living example of something Cubans take pride in -- an average life expectancy roughly similar to that of the United States. They ascribe it to free medical care, mild climate, and a low-stress Caribbean lifestyle, which they believe make up for the hardships and shortages they suffer. 'Sometimes you have all you want to eat and sometimes you don't,' said Raquel Naring, a 70-year-old retired gas station attendant. ``But there aren't elderly people sleeping on the street like other places.' Cuba's average life expectancy is 77.08 years -- second in Latin America after Puerto Rico and more than 11 years above the world average, according to the 2007 CIA World Fact Book. It says Cuban life expectancy averages 74.85 years for men and 79.43 years for women, compared with 75.15 and 80.97 respectively for Americans. Most Cubans live rent-free, and food, electricity and transportation are heavily subsidized. But the island can still be a tough place to grow old. Homes that were luxurious before Castro's 1959 revolution are now falling apart, and many cramped apartments contain three generations of family members. Food, water and medicine shortages are chronic. But most prescription drugs and visits to the doctor are free, and physicians encourage preventive care. 'There's a family doctor on almost every block,' said Luis Tache, 90 and blind from glaucoma but still chatty and up on the news. Tache lived in New York for six straight summers starting in 1945, paying $8 a month for a furnished apartment at 116th Street and Broadway. An English teacher, he retired 30 years ago. `GOOD AND BAD' Sitting in a rocking chair in his breezy living room in Havana's Playa district, Tache said Cuban communism 'is both good and bad,' while the high cost of living in capitalist societies ``must be very stressful.' A relaxed lifestyle, which prizes time spent with family over careers, helps keep Cubans healthy, Tache said. 'It's bad for production, bad for the nation,' he said. ``But it's good for the people.' The government runs residence halls for seniors with no family to care for them, though space is severely limited. Community groups make sure older people look after one another. 'It's a very happy society. There aren't so many worries and problems and that helps,' said Alida Gil, 57, leader of a community group in Old Havana known as ``Circle of Grandmothers 2000.' Shortly after 8 a.m. every weekday, Gil leads two dozen elderly women through 40 minutes of calisthenics on the windowless, water-damaged ground floor of a state-owned building adorned with photos of Castro and his brother, Raúl. Raúl Castro, 75, took over in July after Fidel underwent intestinal surgery. Officials offer increasingly upbeat reports about his progress, but his condition and ailment remain state secrets. `120 YEARS CLUB' One of Fidel Castro's personal physicians, Dr. Eugenio Selman, in 2003 helped launch the '120 Years Club,' an organization of more than 5,000 seniors -- many 100 or older -- from several countries including the United States. They hope to reach the 120-year mark through healthy diet, exercise and a positive outlook. Selman has not spoken publicly since Castro fell ill, but had previously suggested the president could live to 120. Gerardo de la Llera, who still practices medicine at 77, is the club's vice president. He said the oldest member was a 122-year-old woman who lives in the eastern Cuban province of Granma, but he did not know her name or exact birth date. Cuba has a history of claiming very old citizens whose ages have not been authenticated. The government says it wants Cuba to become the world leader in life expectancy, vying with the 82-year average for Japan and Singapore..
January 2007

Nation's fabled healthcare may not be so healthy

January 28, 2007

Miami Herald- John Dorschner

After Hurricane Katrina hit New Orleans, Fidel Castro was so proud of his healthcare system he offered to send hundreds of doctors to help. 'Cuba has the moral authority to express its opinion on this matter and to make this offer,' he said. ``Today, [Cuba] is the country with the highest number of doctors per capita in the world, and no other country cooperates with nations in the field of healthcare as extensively as it does.' Those statements may be true, but what that means about healthcare for Cubans is hotly disputed. Six Cuban doctors -- two still on the island, four now in Miami -- say no one should trust the country's health statistics reported to the World Health Organization. Hilda Molina, a neurosurgeon in Havana who once ran an internationally known surgery center there, told a Latin American study group that she's certain there has been a ``manipulating of the health indicators, in the function of political-ideological interests.' Carmelo Mesa-Lago, a retired University of Pittsburgh professor who has studied the Cuban economy for decades, says, 'Cuba's statistics were reliable until the crisis,' caused by the collapse of the Soviet Union in 1990. But since then, experts doubt their reliability as the country has had severe economic struggles. 'There's no way we can check those figures,' he said. A spokesman for the Pan American Health Organization, the WHO division that collects statistics in the Americas, says the group doesn't try to independently verify the numbers. 'We rely on the figures the ministries of health send to us,' says PAHO spokesman Daniel Epstein. Mesa-Lago is particularly suspicious of Cuba's claim that its healthcare costs $251 per capita. Since its peso doesn't trade globally, there's no real way to compare the peso and dollar. ``And much of healthcare is labor costs, and in Cuba salaries are extremely low.' Nestor Viamonte, who ran a primary-care clinic in Ciego de Avila, says he earned what most doctors did in 2003 -- 575 pesos, or roughly $25 a month. He sold pork out of his home to help make ends meet. Even a top physician-manager can't survive on his government salary. Roberto Ortega, chief of medical services for the Cuban armed services for 10 years before defecting in 2003, told The Miami Herald he had to rent out his 1996 Lada as a taxi on weekends to pay his bills. ``Everyone tries to survive.' UNHAPPY PATIENTS That applies to patients, too, and many are unhappy with the care they receive. 'Service is of a very low quality,' Darsi Ferrer, a dissident doctor in Havana, said in a telephone interview. People have trouble getting medications and even basic diagnostic tests like X-rays, Ferrer said. 'One doctor now has to take take care of four or five offices and is responsible for about 2,000 patients,' which could be the practice of an overworked South Florida family physician. Ferrer and others say the Cuban system has been in a severe decline in recent years at least partly because so many doctors are being sent overseas. According to the Communist Party newspaper Granma, Castro said in September 2005 that a fifth of all healthcare professionals with a university education -- 25,845 -- were serving on international missions in 66 different countries. Of these, 17,651 were doctors. About 60 percent of all Cuban primary-care doctors are now working in Venezuela and elsewhere, according to Alcides Lorenzo Rodríguez, the country's chief of primary care before defecting in 2005. These shortages have spurred a black market system for those desperate for care. 'If you are going to have an analysis, if you want to prioritize admittance to the hospital, you can pay. It's like a type of private clandestine medical care,' says Molina, the neurosurgeon in Havana who broke with the government in 1994. He says some people have had to pay the equivalent of 50 or 60 U.S. dollars for X-rays. LACK OF MEDICINE Prescription drugs are also difficult to come by. 'A child with a fever does not get medicine,' says Viamonte, who left Cuba in 2003 and is now a blood technician at Mercy Hospital. Ferrer in Havana says many persons are now relying on herbal remedies developed centuries ago by Africans or Caribbean Indians called ``green medications.' 'It's very difficult to get any kind of medicine here,' Molina says, and a black market has developed. One tablet of meprobamate, a muscle relaxant, costs $1 to $5. (In the United States, where workers earn many times what Cubans earn, that tablet costs about $1.25.) And finally, from the standpoint of those who work in healthcare, their careers are 'totally controlled' by the state, Viamonte says. In 2003, he was ordered to go to Venezuela with the health brigades, and he knew if he didn't go, he would be punished. He went -- and fled to the United States a year later. Jesús Monzón, a obstetrician in Pinar del Río, says that after a relative played a song by Miami Cuban Willy Chirino at his wedding, the authorities transferred him to a clinic 40 miles away from where he lived. He too left. Miami Herald writer Elaine De Valle contributed to this report..
December 2006

Cuba's aging society straining resources

December 7, 2006

Miami Herald

HAVANA - Regla, a 38-year-old security guard, is precisely the type of married woman the Cuban government is worried about: She had a baby 17 years ago and called it quits. Money is tight and so is housing, so she had an abortion each of the four more times she got pregnant. Her teen daughter terminated a pregnancy last year, too. 'With this economic situation, who can have more children?' Regla said. ``We're in the special period that never ends. Abortions are free and have no stigma attached. Everybody does it. Everybody.' Regla's attitude is not unusual. In a nation faced with chronic shortages of everything from housing to food, more and more women are choosing to have just one child -- or none at all. A country with one of the hemisphere's highest life expectancy rates and lowest birthrates finds itself with a dwindling population -- one that in just 13 years will see the number of retired people outnumber the labor force. The Cuban government-run media has tackled the issue in recent months, running remarkably candid coverage of a demographic phenomenon that promises to wreak havoc on an already strained social service system. As Fidel Castro -- himself 80 -- languishes in his sick bed, the effort to sustain the socialist society he built is being constantly challenged by emigration, aging adults and childless women. 'I'm 41, my son is 23, and I decided: That's it. No more,' said Idania, an office worker in the city of Santa Clara, whose last name, like others in this report, was withheld for fear of reprisals. ``You want to give your children absolutely everything in life. If you are in a situation where you can't give your child absolutely everything, then why have more kids?' Consider: • Since 1978, Cuba's fertility rate has decreased to levels that can no longer sustain current population levels. Now at 11.2 million, the Cuban media says it is unlikely to ever reach 12 million. • During the 1960s and 1970s, Cuba's annual birthrate was about 250,000. In 2005, there were slightly more than 120,000 births, despite there being 1 million women of reproductive age. MORE SENIORS • Seniors age 60 and older now make up about 16 percent of Cuba's population. The Cuban government estimates that by 2025, 26 percent of Cubans will be elderly. • If current trends don't change, Cuba will join the 11 countries with the world's oldest populations, Granma, the island's main daily newspaper, reported. 'In a few years, it is almost certain that the demand for senior citizen centers, dining halls, homes and other senior citizen facilities will exceed the new factories and schools,' Granma said. Another newspaper, Juventud Rebelde, put it like this: ``If in 10 years we haven't reached a coherent reproduction policy, we'll see each other more frequently at wakes than at children's birthday parties.' Among the causes, Granma cited 'material' problems such as housing shortages, high cost of living, lack of day-care centers and goods like children's clothing. The paper also acknowledged the outward migration of adults of child-bearing age, but said positive changes such as advances for women in the workforce and availability of birth control also contributed. But experts say Cuba's declining birthrate and aging populace is nothing new. Cuba's population rate started to slip in the 1950s, just as it did in Europe and other nations. The birthrate is 1.62 children per woman, compared to the United States' 2.04 birthrate. But about 1.4 million new immigrants enter the United States every year, while Cuba sees tens of thousands leave. With Castro sick and his revolution perhaps on the brink of radical change, the situation is particularly critical, said sociologist Mauricio Font. If communism collapses after Castro's death, Cuba is likely to witness a massive outward migration of its much-needed youth, as occurred in Eastern Europe. 'What we know of Cuba is that the young people are not particularly happy and are searching for more opportunities,' said Font, director of the Bildner Center for Western Hemisphere Studies at the Graduate Center in New York. ``People are leaving, and it's going to get worse. That's something to think about. It's going to be a huge challenge with or without a transition.' DIFFERENT VIEW A decline in population isn't necessarily bad, said Arie Hoekman, Cuba director for the United Nations Population Fund. Cuba, which suffered a sharp economic decline after the fall of the Soviet Union -- the 'special period' that Regla referred to -- probably could not sustain massive population spurts. 'A dwindling younger population and high elderly population places challenges on social systems such as health, education, social security,' Hoekman said. ``On the other hand, continued growth would not be sustainable. They are already facing challenges.' The biggest difficulty for Cuba will be to address the swelling numbers of elderly. Cuba already has about 300,000 people over the age of 80, but the government has focused its attention on other issues, such as tackling infant mortality and educating children. 'We've been seeing this coming for a very long time,' said Lisandro Pérez, a sociology professor at Florida International University. ``I think it is a problem. I don't think the Cuban health system is geared toward the catastrophic illnesses older people get.' GROWING CHALLENGE The strains are already showing. Elderly people earn less than $10 a month on their pensions, so many of the street vendors who peddle snacks and newspapers on the street are older adults who say they were forced to return to the workforce because they could not survive on their incomes. 'A lack of children is something the state has to worry about, not me. I say the thing elderly folks worry about is food,' said Víctor, a 70-year-old newspaper seller. ``Our health system is good, our education system is good, but our food situation is very bad.' He was accompanied at an Old Havana plaza one recent afternoon by Cecilia, a 73-year-old grandmother who hops a bus to tourist areas to supplement her pension by begging for contributions from foreigners. She is worried because her 25-year-old grandson has not had any children. 'I'm concerned about the lack of children, sure,' she said. ``You have to have future generations. What society will we have if there are no children?' The Miami Herald withheld the name of the correspondent who filed this report because the author lacked the Cuban journalist visa required to work on the island..