Cuba's Revolution at 50: The Importance of Health Care Workers

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mr090101cvr_140January 1, 2009 marked the 50th anniversary of the Cuban Revolution. Monthly Review, the US’s independent socialist magazine, devoted its January 2009 issue to the topic of Why Cuba Still Matters.  Among the articles in this issue, one particularly caught our attention: Steve Brouwer’s The Cuban Revolutionary Doctor: The Ultimate Weapon of Solidarity.  Brouwer’s article provides a readable synopsis of the development of the Cuban medical system, first within Cuba and then increasingly overseas.

It is important to begin this story with 1958 Cuba where there was only 1 doctor for each 1,051 Cubans.  This statistic actually hid very large geographical disparities.  Most of Cuba’s doctors were concentrated in the towns and particularly Havana.  There were very few doctors in rural areas.  In the years immediately following the Revolution this situation only grew worse.  Many doctors emigrated, including much of Havana Medical School’s faculty.  By 1967 there was only 1 doctor for every 2,000 Cubans.  The health care system had, quite literally, to be rebuilt from scratch.

In a way this provided the Cubans with the opportunity to create an entirely different type of medical system, one established on principles of primary care and equal access to all.  By the mid-80’s the country had adopted a system of Comprehensive General Medicine (Family Medicine in US terms) based on doctor/nurse teams who served (and lived in) a neighborhood, typically of 800 people.  By 2007 there were 3 Cuban generalists per 1000 population as compared to 0.7 in the United States.  Many people attribute Cuba’s excellent health statistics to this commitment to primary care and equality of access.

However, developments on the island of Cuba are only half of this story.  Cuba had sent physicians on missions of medical solidarity since the early 1960’s.  This solidarity has accelerated notably in the past 10 years.  The 1998 Programa de Salud Integral (Comprehensive Health Program) sent brigades of Cuban doctors to Haiti, Guatemala and Honduras in the wake of Hurricanes George and Mitch.  These brigades led to semi-permanent Cuban health presences in these countries, particularly in the countryside.  Brouwer also examines the crucial role of Cuba in the Barrio Adentro program in Venezuela.

Sadly, the response of the Bush Administration has been the Cuban Medical Professional Parole Program,  an attempt to lure Cuban medical personnel to the US.  The existence of such a program is a backhanded compliment to the quality of Cuban medical personnel.  And a statement of the threat they posed to the Bush Administration.

The article closes with a discussion of Cuban medical training.  Brouwer highlights the Latin American Medical School (ELAM) as well as Cuban training in Venezuela and Yemen.   Brouwer notes that:

Cubans, with the help of Venezuela, are currently educating more doctors, about 70,000 in all, than all the medical schools in the United States, which typically have somewhere between 64,000 to 68,000 students enrolled in their programs. The U.S. students emerge from their four years of study burdened with an average of $140,000 of debt. So it’s not surprising that they have a desire to earn high salaries, either to pay that debt or simply enjoy the upper-middle-class lifestyle to which most first world physicians are accustomed. Consequently, very few U.S. medical school graduates go into residencies in family practice, the lowest paying specialty.

Interested readers are encouraged to consult the full text of the article which is available free online.

Further reading

One of the best English sources for current news about health and  medicine in Cuba is the MEDICC Review, publication of Medical Education Cooperation with Cuba.  Those who read Spanish may also want to visit the official Cuban Health Portal.

Our online journal, Social Medicine, has published articles on Barrio Adentro, the Latin American Medical School and the experience of a US student working in a Barrio Adentro clinic in rural Venezuela.

This Portal contains numerous postings about Cuba and the ELAM school.  Readers should note that Cuba still has several hundred  full scholarships for US students to attend the 6 year medical school in Havana.

posted by Matt Anderson, MD

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