Help for Venezuela strains Cuban health care
By Indira A.R. Lakshmanan The Boston Globe
FRIDAY, AUGUST 26, 2005
HAVANA Free universal health care has long been the crowning achievement
of this socialist state, but the system is now under fire from Cubans who
complain that quality and access are suffering as they lose tens of thousands
of medical workers to Venezuela in exchange for cheap oil, which this
impoverished country desperately needs.
The close friendship between the Cuban leader, Fidel Castro, and the
Venezuelan president, Hugo Chávez, has netted Venezuela a loan of 20,000 Cuban
health workers - including 14,000 doctors, according to the Venezuelan
government - who work in poor barrios and rural outposts for stipends seven
times higher on average than their salaries at home. Castro has vowed to send
Chávez as many as 10,000 additional medical workers by year's end.
In return for farming out more than one-fifth of its doctors to the
petroleum-rich state, Cuba is permitted to import 90,000 barrels of oil a day
from Venezuela under preferential terms. The arrangement gives Cuba's
struggling economy, crippled by the US embargo in place since 1963, the biggest
boost since the country lost Soviet subsidies in the early 1990s.
The Cuban doctors program is wildly popular among Venezuela's poor. But
Cubans have begun to object that the exodus of their health care workers is
taking a toll on medical care for Cubans. Most people interviewed would speak
only on condition that they not be identified or asked that just their first
names be used, for fear of reprisals.
A 45-year-old nurse in Camaguey Province said she has worked without a
doctor in her primary-care clinic for more than two years since the physician
was transferred to another clinic to replace a doctor sent to Venezuela.
"My patients complain every day. They want me to act as a doctor, but I
can't," she said. "The level of attention isn't the same as before."
"It's not fair," she added, "to take from us to give to our neighbors.
People are now saying, 'I've got to get a ticket to Venezuela to get health
care!"'
Cuban doctors and nurses have long worked overseas in humanitarian
missions, and their small country has made significant contributions to serving
disaster victims worldwide.
With one of the best doctor-patient ratios in the world, Cuba could
afford to loan more than 52,000 medical workers over the last four decades to
95 needy countries, including Algeria, Equatorial Guinea and Haiti, according
to official figures. But over the last two and a half years, as Castro and
Chávez's cooperation has blossomed, the Cuban assistance program has
substantially increased the number of medical workers overseas, with the
overwhelming majority in Venezuela.
Aware of early grumblings about the exodus, Castro acknowledged in a 2003
speech that "it could very possibly be true that in the midst of so much
movement there is no doctor in a certain place for a short time. These
situations must be immediately resolved."
But rather than being speedily rectified, the situation has gotten worse,
ordinary Cubans complain, with the flight of family doctors who handle primary
care, a shortage of specialists, and a longer wait for eye surgery, physical
therapy and dentistry.
The Ministry of Public Health and the Cuban press center did not respond
to requests for interviews and data.
According to the World Health Organization, Cuba, with 66,567 doctors,
boasts a ratio of 1 doctor per 170 citizens, compared with 1 doctor per 188
residents in the United States. The emphasis on preventive, personalized care
has yielded life expectancy rates almost identical to those in the United
States, and infant mortality rates even lower than its northern neighbor's, WHO
data show.
Advocates of the Cuban system point out that Cubans are entitled to free
health care and medicine, while more than 44 million American residents have no
health insurance.
The system has suffered setbacks, however, since the cutoff of Soviet aid
some 15 years ago, with hospitals and clinics in need of renovation and
equipment, pharmaceutical costs soaring, and patients saying they must bring
bedclothes, food and fans to hospitals. But complaints about a lack of medical
personnel are new, dating to the cooperation with Venezuela that some observers
disparagingly call the "oil-for-doctors program."
Castro recently raised medical workers' salaries so that a doctor with
two specialties earns the equivalent of $23 a month, according to Granma, the
Communist Party newspaper. The pay, which doesn't stretch to buy shampoo and
other essentials, is one reason health workers are attracted by the extra $186
monthly stipend on average they earn in Venezuela.
Josefina Jiminez, 61, a Havana teacher whose son was recently
hospitalized, complained that "there are too many students doing the job of
doctors, because so many physicians are in Venezuela."
María, a Havana dentist, said her clinic now had 6 instead of 16
dentists. Danilo, 29, a Havana hospital nurse, said his overnight rounds had
increased to 9 from 6 times a month because of colleagues going to Venezuela.
In a July 26 speech, Castro talked up improvements to health care,
including renovations at hospitals and nearly a third of 444 health centers,
known as polyclinics. Castro said nearly all polyclinics now have
electrocardiographs and ultrasound. "I dream that one day Americans will come
to Cuba to receive treatment," he said.
But when he boasted that "100,000 Venezuelan brothers and sisters" will
fly to Cuba for eye treatment this year, a number of Cubans perceived
favoritism toward outsiders.
"It's all the Venezuelans who need cataracts surgery first, and then the
Cubans if there's any time left," said Georgina, 60, a retired Havana clerk.
Carlos, 37, an engineer with a chronic ear problem, resents waiting 20
days for an appointment because his specialist is in Venezuela: "Now when I
need hearing tests, I see technicians who haven't even graduated yet."
Medical workers dismissed the criticisms as the gripes of a spoiled
population unaccustomed to waiting.
"Before, there was a family doctor for every block or two of this city.
Now you may have to walk six blocks - so what?" asked Migdalia, a nurse at a
Havana polyclinic. "It's still free and the quality is the same."
"Cubans can even get plastic surgery," she said.
But ordinary Cubans, accustomed to waiting interminably for nearly
everything - from transport to rations to salary increases - retort that
medical care was the one thing they never had to wait for.
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