In the 50 years since the Cuban Revolution in 1959, Cuba has shown what is possible when society’s priority is not profit, but the needs of the people, and when those needs are met not through the anarchy of the market, but through a democratically planned economy. Without socialist planning, Cuba’s staggering achievements in health care both domestically and internationally would have been impossible. Capitalism has failed the overwhelming mass of the people in oppressed nations, leaving millions to die every year of preventable diseases. It is now failing increasing numbers in the advanced capitalist countries as well. HANNAH CALLER reports.
In 1978, the World Health Organisation’s (WHO) Alma Ata Declaration set down 38 targets for health improvement to be met by 2000. The only country to meet these targets was Cuba. Approximately 1.2 billion people do not have access to safe drinking water and 2.4 billion people lack access to sanitation services. The result? Half the hospital beds in the world are occupied by people suffering from water-borne illnesses. About 200 million people are infected with dysentery. Worldwide, diarrhoea and vomiting illnesses kill five to eight million people per year, and these are leading causes of death among children under five.
Half a million women die every year from pregnancy and childbirth related problems. Globally, the annual death rate from malaria is well over one million; 3,000 African children die every day from this largely preventable and treatable disease. Despite the WHO pledge to cut the number of malaria deaths by half by 2010, the number of victims continues to grow. In sub-Saharan Africa, millions are dying from HIV/AIDS.
And in Britain
If you are poor in Britain, you will live five to seven years less than if you are rich. Access to health care is now being rationed and its quality undermined as hospitals seek to meet government targets which promote privatisation.
In 2004 and 2005, there were two outbreaks of Clostridium difficile at Stoke Mandeville Hospital resulting in the deaths of 30 people. A 2006 Healthcare Commission investigation found that the deaths were avoidable and that senior managers were concentrating on controlling finances and meeting waiting time targets. The Commission reported a similar story at Maidstone and Tunbridge Wells NHS Trust where at least 90 patients died as a result of the infection between 2004 and 2006.
Nothing changed. On 17 March this year, the Commission reported that over a three-year period there had been between 400 and 1,200 more deaths than should be expected at Mid-Staffordshire NHS Foundation Trust. The trust had become obsessed with meeting targets and saving money at the expense of patient care. Three days later, yet another Commission report decided that managerial incompetence and under-staffing had undermined patient care at Birmingham Children’s Hospital.
Privatisation of the NHS is leading to deteriorating health care for the poor, for the working class, and for those who are of no consequence to capitalism – the elderly. Week after week sees further examples of discrimination in the health care of elderly people, such as inadequate treatment of Alzheimer’s and of fractures arising from falls. Yet in November 2008 the government announced the postponement of promised legislation against age discrimination in health and social services. Cuts in health care spending that will inevitably accompany the deepening crisis will result in an even worse service.
Socialism’s human priorities
The contrast with Cuba is stark. Cuba has established a system where health care is inseparable from politics, education and society. The approach is encapsulated in the Cuban medical graduate’s oath:
‘We pledge to serve the revolution unconditionally wherever we are needed, with the premise that true medicine is not that which cures but that which prevents, whether in an isolated community on our island or in any sister country in the world, where we will always be the standard bearers of solidarity and internationalism.’
Che Guevara’s vision of medical solidarity as a revolutionary weapon has been put into practice through the priority given to health in Cuba. Its achievements in critical health indicators such as infant mortality, life expectancy, HIV infection and low birth weight infants are the best in Latin America and as good as or better than those for the richest countries. Cuba’s infant mortality is an astounding 4.7 per 1,000 live births; it has fallen dramatically since the Revolution in 1959 when it was 60 per 1,000.
Cuba’s planned economy allowed the country to continue its health care developments throughout the Special Period when its economy was devastated with the collapse of the Soviet Union and the tightening of the US blockade. Between 1990 and 2003, the number of doctors increased by 76%, dentists by 46% and nurses by 16%. Family doctor coverage expanded from 47% in 1990 to 99.2% in 2003. Over the same period the number of maternity homes rose by 86%, elderly day care centres by 107% and homes for the disabled by 47%. In 2007, Cuba had 6.5 doctors per 1,000 people. The figures for Western Europe are 3.1 per 1,000, and for the US, 2.4 per 1,000.
International co-operation in health
Cuba sees its international health programmes politically as tools to promote international solidarity and to spread the influence of socialism through example. Cuba’s capacity at home is the basis for its international work. By November 2008, Cuba had more than 70,000 doctors, allowing it to send 17,697 abroad to serve in 75 countries, along with 20,847 other Cuban health professionals.
Cuba has medical brigades in 27 countries, including Guatemala, Haiti, Belize, Honduras, Botswana, Ghana, Mali, Gambia, Namibia, and Timor Leste. Its programmes use Cuban doctors who are then replaced over a ten-year period by students from the host country who have been trained by Cuba. All such students are on full scholarships which include tuition, board, food and a living allowance. Cuban doctors abroad work under local direction but the Ministry of Health in Cuba encourages them to work in rural areas, prioritising areas where primary care is absent and focusing on preventative health care. Where necessary, a literacy programme runs alongside the health programme.
Cuba’s co-operation programme with Bolivia is the largest after Venezuela with more than 1,000 Cuban doctors; 5,000 Bolivian medical students are training in Cuba. There are also over 100 Cuban doctors in each of Guatemala, Haiti, Honduras, Timor Leste, Ghana, Namibia, Gambia, Belize, and Mali. In areas served by Cuban medical teams between 1999 and 2003, infant mortality rates showed significant falls: from 45 to 16.8 per thousand live births in Guatemala, 121 to 61 in Gambia, and 59.4 to 33 in Haiti. Between 2003 and 2008, the Cuban medical brigade in Timor Leste is estimated to have saved over 11,400 lives and contributed to a significant fall in infant mortality.
Disaster response contingents
The first Cuban disaster relief medical team went to earthquake-devastated Chile in 1960; relief was provided to another 16 countries over the next 20 years. Cuba offered help to the US following Hurricane Katrina in August 2005, an offer the Bush administration ignored. Cuba’s largest disaster relief programme has been in Pakistan and followed the earthquake that killed 75,000 people and left hundreds of thousands injured and homeless in October 2005. The first Cubans arrived within six days of the earthquake, entering areas where previously there had only been one doctor for a population of 25,000 people. Overall, 2,500 Cuban health workers went to Pakistan. They set up 32 field hospitals within five months of the disaster, treated over one million people, performed over 10,000 operations, and carried out almost half a million rehabilitation treatments. They outstayed all other international agencies. 1,000 scholarships were offered to poor Pakistani students to study medicine in Cuba and a number of Pakistanis with limb loss were flown to Cuba for rehabilitation.
Battle of Ideas
The Battle of Ideas, initiated in 2000, represents a revalidation of socialist principles. As Abel Prieto, Cuban Minister for Culture, said in 2004:
‘What should be globalised, are not bombs or hatred, but peace, solidarity, health, education for all, culture etc. That is why, when our physicians go to help in other countries, although their mission is to work for medical attention, they are also bearers of our values and our ideas of solidarity. This is the essence of the Battle of Ideas.’
The expansion of international health work and the role of the Latin American School of Medicine (ELAM) were part of this. At the inauguration of ELAM in 1999, Fidel Castro said ‘This institution is an attempt at a modest contribution by Cuba to the unity and integration of the peoples of Latin America.’ Since 2005, 1,500 students from over 40 countries have graduated every year. Everything is free to the students for six years; in return they agree to return to work in marginalised areas in their own countries. There are also about 100 US medical students in Cuba on Pastors for Peace scholarships.
Cuba–Venezuela
Cuba’s medical programmes contribute to the revolutionary process in Venezuela. In 2003, a strike by the Venezuelan Medical Federation threatened the breakdown of medical services. Venezuela sought help, and within months hundreds of Cuban doctors arrived and the Caracas pilot programme Barrio Adentro (‘Within the Neighbourhood’) was extended across Venezuela. By mid-2004, 10,000 Cuban doctors were working nationwide. When Chavez became president in 1999, only 4,000 of 35,000 Venezuelan doctors were family doctors, and most were concentrated in the cities. Since then, the number has increased from one primary care doctor per 17,300 people to one per 3,400 and infant mortality has fallen from 21.4 per 1,000 live births to 13.9.
When Cuba began a literacy programme in Venezuela, the number of people who could not begin to learn to write because of eyesight difficulties led the two countries to set up Operation Miracle. There were an estimated six million people with reversible blindness in Latin America and the Caribbean, most too poor to pay for surgery. Since July 2004, over 1,300,000 people from 32 countries have had corrective operations in Cuba and in the 59 eye hospitals Cuba has donated under the programme.
Revolutionary training
Cuba is conscious of the need to continue to train doctors, nurses and allied health workers, as well as ensuring that they are equipped to deal with their national and international challenges. In 2004 Cuba started a new type of medical training – the University Polyclinic Medical Training Programme; Venezuela followed in 2005. Cuba’s revolutionary vision for this programme was to create a ‘medical university without walls’. The bulk of the teaching occurs in clinical situations with small group teaching covering traditional subjects. This encourages poor students from rural communities to train as doctors locally. Over 12,000 Cuban students are enrolled alongside the 17,000 Cubans taking the traditional medical course. The course lasts six years and exposes students to the human aspect of health care and the needs of local communities. In Venezuela, 20,000 students are enrolled, with 5,000 entering the fourth year in early 2009.
Venezuela is also starting a branch of the Latin American School of Medicine and has enrolled 800 students from abroad. Cuba and Venezuela are now training more doctors than the whole of the US. The doctors who graduate have no personal debt, come from the communities they will serve, are politically conscious, understand humanity and the ravages of imperialism, and are the ideological opposite to the doctors formed under capitalism. They, along with the nurses and health workers trained in the same context, are an international revolutionary army with humanitarian weapons. Socialist planning has created this.
As the crisis deepens, the contrast between this and the contempt capitalism has for the health of the mass of the people even in the richest countries will become more apparent. For the mass of the working class, proper health care is possible only under socialism.
FRFI 208 April / May 2009
