Cuba: More for less

Victor Vasiuk, a Ukrainian child who was a victim of the April 1986 nuclear accident in Chernobyl, at Tarara Hospital, east of Havana, in April 2006 with his grandmother. In March 1990, Cuba started treating persons affected by the massive radiation leak from the Chernobyl nuclear plant, offering them psychical and physical recovery therapies.

THE near-universal health care system put in place by socialist Cuba ranks among the best in the world. In this developing nation health care is free for all and the quality and efficiency of the service is commendable. Cuba’s economy took a massive beating with the collapse of the Soviet Union. The island nation continues to suffer because of the United States’ embargo on it. But its health care system can be a model for all developing nations.

Last month, the World Health Organisation (WHO) announced that Cuba would send a medical team of 165 people to Sierra Leone to assist in the fight against the Ebola virus. “This is the largest offer of a foreign medical team from a single country during this outbreak,” said Dr Margaret Chan, Director-General of the WHO, in a release.

This is not the first time Cuba has stepped in to aid a country in difficulty. When Hurricane Katrina hit New Orleans in 2005, Cuba offered medical supplies and staff. The George W. Bush administration declined the offer. It was unfortunate, for thousands could have benefited from Cuba’s humanitarian support.

False pride or ideological barriers, however, did not stand in the way of the Pakistan government when it accepted Cuba’s offer of help after an earthquake struck the subcontinent ( Frontline , December 2005). While the Indian government did not even acknowledge the Cuban gesture, Pakistan’s President Pervez Musharraf welcomed it and was quoted as having said that “one of the most heart-warming letters of support” following the earthquake was from Cuban President Fidel Castro. He expressed his “deep gratitude” in a telephone conversation with Castro. Cuba sent more than a thousand medical personnel, who worked tirelessly in the tough conditions of the rugged mountains and also bore the entire administrative and logistical expense.

A country with a population of 11.2 million, Cuba has an impressive record of medical aid in the international arena. From helping out in Guatemala, Algeria, Haiti and Chile to treating more than 18,000 Ukrainian children affected by the Chernobyl disaster, Cuba has always extended a hand of cooperation. A rapid response team of thousands of doctors and nurses was constituted under the Henry Reeve International Team of Medical Specialists in Disasters and Epidemics. At any given point in time, there are more than 30,000 members of this team working in about 70 countries. Not only does Cuba provide medical aid, it also invites students from other countries to train as doctors almost free of charge. Medical schools with Cuban cooperation have been established in several countries of Africa, including Ethiopia, Uganda, Ghana, Gambia and Equatorial Guinea, and Yemen and East Timor. Cuba’s expertise in disaster preparedness has been recognised by the United Nations Development Programme (UNDP). The Association of Caribbean States selected Havana, the Cuban capital, as the headquarters of the Cross Cultural Network for Disaster Risk Reduction to facilitate regional cooperation in disaster management.

Yet the international media continue to ignore these valuable contributions. When countries send money and equipment, Cuba sends medical professionals to treat the sick and the injured. Fidel Castro was quoted as saying, “You cannot sort out anything with a few million; what is needed are medical personnel to save lives and treat the sick, but they cannot send anyone because they don't have them, nor could they even assemble them. This is where you can appreciate what a genuine revolution is, the values that it inculcates, the enormous wealth of human capital that we have created.”

In Cuba, the health care system rests on the idea of prevention. Every community or neighbourhood has a doctor who resides in the same area. The nurses and doctors not only treat patients but also monitor the health of the entire population within their jurisdiction. To give an example, in urban areas, for every 1,000 patients there is one physician who is responsible for delivering primary care. When required, the general physician refers patients to the district speciality centre equipped to deal with the problem. Patients are categorised, according to health risks, from 1 to 4, with the ones with chronic ailments in category 3 or 4. It is not uncommon for doctors to visit patients at home and the onus for ensuring good health is on the doctors. In case of a maternal or infant mortality, the state can call upon the doctor responsible to explain. The average life expectancy in Cuba is 77.5 years and its infant mortality rate is one of the lowest in the world. On the contrary, in India medical aid is provided to patients who seek help. This makes health care costly and out of the reach of a great many people.

The state-run health care system in Cuba has shown how the state, too, stands to benefit from these measures: Cuba spends less per person annually and gets more done. It also makes good business sense: the country earns oil subsidies from Venezuela in lieu of medical aid.

Divya Trivedi