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Cuba Health

Harassment of Cuban doctor and journalist Eduardo Herrera Duran.

HRF to Cuba: Stop Harassing Dissident Doctor

Human Rights Foundation (HRF) strongly condemns the continued harassment of Cuban doctor and journalist Eduardo Herrera Duran. In March, Herrera — a surgeon at the Calixto García University Hospital in Havana and a deputy editor for the Hablemos Press independent news agency — was barred from leaving the country to attend a human rights conference in the Czech Republic. Herrera was unable to board his plane after state agents stopped him at the airport and claimed that he needed further authorization to travel.

Dr Eduardo Herrera Duran ( Hablemos Press)
 “In 2012, Cuba began to allow some dissidents to travel abroad, but this new rule seldom applies to medical doctors who disagree with the government. Journalists, dissidents, and activists like Herrera often find themselves helpless when the authorities, targeting them for their work, prevent them from leaving the country,” said HRF president Thor Halvorssen. “Doctor Herrera is clearly being targeted for his role in condemning the farce of Cuba’s ‘significant achievements’ in areas like health care,” said Halvorssen.
In December, the Cuban government reinstated a travel permit requirement for health professionals. In violation of their fundamental right to freedom of movement, medical specialists are now required to obtain permission from health ministry officials in order to leave the country. Herrera requested the travel permit two months in advance of his departure and was never informed that the officials had arbitrarily rejected his request.  In a phone call yesterday, Herrera informed HRF that he has once again filed a travel permit request to attend HRF’s Oslo Freedom Forum in May.

HRF is a nonpartisan nonprofit organization that promotes and protects human rights globally, with a focus on closed societies.


Source: Note received by email.

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Medicine capitalist in Cuba.

There are double standards discriminatory and exploitative Cuban doctors and patients both for foreign patients.

By Dr. Eduardo Enrique Herrera Duran.*

For many in the world, in Cuba, medical care is free. But actually it is not so, and especially for tourists. People who visited the island and ill, have seen are required a hefty payment in foreign currency by the health services required.

Some foreigners complained that they have to pay for any services of this type that will deliver to them at a much higher price than in some of their countries, and with less quality. In addition, sometimes they are examined by several specialists unnecessarily, charged each query in order to increase the final amount.

As medical specialists, sometimes forwards us cases to assess as surgeons who had simply not are sent to our service. In my opinion, this happened for the effort to add an unnecessary specialist consultation and thus charged more.

An example of this occurred on February 14 of Calixto Garcia University Hospital at emergency room. A German patient who suffered several diarrhea ended envoy to be valued by the emergency surgery and therapy, most without this case required it, which was discussed by the medical team.

Hospitals such as the Cira García, Camilo Cienfuegos and the CIREN (Neurological Restoration Center), are those who receive largest number of foreigners. Others only have some rooms which cater to this type of patient, as it is the case of the Hospitals Pando Ferrer, Hnos Amejeiras and CITED (Ibero-American Centre for the Elderly), in the Calixto Garcia University Hospital.

Ambulances available in the Hospital “Cira Garcia". Author’s photo

Hospitals and rooms primarily responsible for the care of foreigners have better comfort. The equipment is superior and the staff working in them are familiar with provide a service that is not customary in health centers where are served our neighbors.
When tourists arrive to seek medical attention, are required to pay either cash or insurance cards. However, despite such outlay, the doctors who are in charge of care for them not benefiting from this gain. They receive the same salary as all other specialists (approximately the equivalent in pesos to about 60 to 70 dollars a month).

Thus, is the most profitable business for the Cuban State, forming a large number of professionals in the sector without investing much in it. The teachers who teach them usually win approximately 80 dollars a month.

Formed as low-cost physicians are sent to many countries for the so-called "medical collaborations". As a result, and unlike the worker who produces them, the Cuban State receives juicy profits.

This machine make money also joined the physicians from other countries who are studying on the island. Input, and only by registration for the specialty, pay 18 thousand dollars annually. This figure would represent a fortune to any Cuban, even being a teacher of the most qualified. Working in Cuba, could not meet this amount in a lifetime.

Cuba is a paradox for scholars of classical Marxism. For those who still believe in the myth of free medicine, "Socialist" model was transformed into a country where the capitalist health care method, applies more however wages which sustain it remain insufficiently low.

* Dr. Eduardo Herrera Duran is a physician specialist in Surgery. He lives in the city of Havana, Cuba and works at the University Hospital "Calixto García". He collaborates with the independent Cuban Press Agency, Hablemos Press, on health issues. Some of his articles appear in the Blog of Cuban Medicine.  (Microsoft translator)


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Thermometers returned to some pharmacies in Havana, Cuba.

Thermometers again available in Cuba, but only on the ration book.

Thermometers are again available in some pharmacies in Havana,
 but to purchase one you have to submit your ration book. (14ymedio)

After disappearing for months, this January thermometers have returned to some pharmacies in Havana, although they can only be purchased through the ration book.
In 2015 about 60 medications - included in the “basic health core”- where unavailable in Cuban hospitals and pharmacies, mainly those used in the treatment of cancer. Also missing were over-the-counter products such as adhesive tape, elastic bandages and Band-Aids.

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Cuban surgeons rented to Chile.

The Cuban regimen sells qualified health workforce and denied the right to do the same on their own.

By Dr. Eduardo Herrera. *

In the emergency at Department of surgery at the University Hospital "Calixto García", last December 18, informed medical specialists the chance to go to work in Chile for 3 months. The salary offer is thousand dollars a month, according to rinse off the head of the service, informed by the director of the Hospital.

This happens only a few weeks have restricted travel of physicians by announcement. According to the official note, it was a measure that was taken by necessity, since they caused a deficit in attention to the population. However, the official argument does not seem very relevant, especially if they are still devoting thousands of doctors to work in other countries, sent by the same nurture which prohibits such a decision when it is private.

With this measure, the national Government leaves clear how slavery way medical staff has. It offers Governments taking a figure much higher than that paid to the same doctors, even less to those who see a natural counterpart of the country that sent them.

So both Governments with the benefit that produce well-qualified professionals are preferred.

University Hospital "Calixto Garcia" La Habana,Cuba
The Cuban Government gets scandalous profits and the recipient Government indirect advantages in economic, or direct political. In the first case, due to the low wage that perceived labor for rent, pocketing nurture 75% of what you earn. And in the second case, because the cheap coming out to the recipient country improvements in the health service which would offer its citizens.
Different rulers are using this business with huge gains of the Cuban State to succeed in his political campaigns. And they do so without repairing what is subjected to these Cuban professionals in their own country of origin, receiving wages that do not pass 70 dollars a month. It is a figure that would not reach them to lead a life as any industry professional in another nation, even poorer.

Therefore, what the Cuban authorities are trying to prevent is the output of many physicians with personal contracts, by those who perceive much more fair wages. And probably achieve their objectives thanks to coercion imposed to its analogues.

Case, it is the reason that is, is abruptly reduced supply of free private contracting of Cuban specialists had been proposing in countries such as Angola, Ecuador, Trinidad and Tobago, Chile and some more.

Prices for the legalization of titles and notes by the Cuban Ministry of Foreign Affairs (MINREX), as well as the passport and the passages are very high in relation to the salaries that are paid in our country. However, many still try to sell what little they possess in the family to make going out to work to another nation, in search of a decent remuneration.

A lot of doctors in Cuba are ready to be hired in countries where the human work we do is recognized and therefore will pay us fees that really meet our needs. The democratic countries  where reigns the justice independent of the State, should not make deals with modern slavers as the Cuban State. And medical schools or other organizations as the World Labor Organization (ILO online) should prevent to continue with the exploitation of their doctors.

*Dr. Eduardo Herrera Duran is a physician specialist in Surgery. He lives in the city of Havana, Cuba and works at the University Hospital "Calixto García". He collaborates with the Cuban Agency of independent press, Hablemos Press, on health issues. Some of his articles appear in the Blog of Cuban Medicine. (Microsoft translator)


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A researcher for the National Institute for Oncology and Radiobiology is pressured and prevented from fully carrying out his work. He’s threats from State Security and Director.

By Waldo Fernandez Cuenca.

Oscar Antonio Casanella Saint-Blancard, bio-chemist, researcher for the National Institute for Oncology and Radiobiology, speaks of how he is pressured and prevented from fully carrying out his work because of his friendship with dissidents.

It all started because of a party for his best friend, Ciro Diaz, at the end of 2013. Ciro Diaz, besides being a graduate in Mathematics from the University of Havana, has just one remarkable characteristic: He is a dissident and member of the band Porno for Ricardo. Soon came the threats from State Security to make him a prisoner if he engaged in the activity.

Then came the accusations at work of his being “mercenary” and “annexationist*.” But at no time was this young man, a bio-chemist by profession, intimidated, and he resisted the wishes of his oppressors. Oscar Antonio Casanella Saint-Blancard has kept his ties of friendship with Ciro and other opposition figures.

Oscar Antonio Casanella Saint-Blancard,
bio-chemist, researcher for the
National Institute for Oncology and Radiobiology
Casanella made his case known to the independent project Estado de Sats and was also arrested during the wave of repression unleashed by the performance by activist and artist Tania Bruguera at the end of last year. Since that time his harassment by State Security has continued, principally at his place of employment: The National Institute for Oncology and Radio-biology (INOR) where he serves as a researcher.
We talked about his current work situation and the plight of the Cuban health system. In spite of the difficulties he has lived through, Oscar has never lost his smile, and he maintains the same composure as always, which has led to his repressors to try to corner him.

What situation are you in right now?

Right now I am subjected to psychological warfare in the workplace. Not just me, but also my co-workers, and it hurts me more for them than for myself because I have already overcome my fear, but my colleagues have not.

What does the psychological warfare consist of?

The doctor and deputy director of research for INOR, Lorenzo Anasagasti Angulo, has been pressuring and coercing my co-workers, above all the laboratory managers, to not let me into the various labs of the Center. He explains that there is a labor rule that says that access to these places is restricted, and that is true, but it only applies in my case, because the other researchers enter and exit the various labs without any restriction, while my access is impeded. I think I am treated very differently and discriminated against.

That is not the only thing that has happened to you…

Before this, in June of this year, I prepared a course on Bio-computing for students at the University of Havana and researchers from the INOR, and after my immediate boss had approved it, even though teaching personnel had reserved a hall for me to teach the classes, when this was all coordinated with the Biology Faculty so that students of that school could receive this training, this gentleman, Lorenzo Anasagasti Angulo, did not give me the authorization to teach the class.

But it did not stop there, he also coerced many employees of the Oncology Institute to not attend the course, and he has told them on more than one occasion not to talk to me. All these actions were not enough for him, and he told me: “Oscar, get this into your head; I am going to make sure that you have no future in this institution and I am going to make everything as difficult for you as I can.”

This gentleman, together with a member of the Communist Party from the Pedro Fernandez Cabezas Institute, has threatened to expel me from the Center just because of my ties with opposition figures. Also, Anasagasti has pressured my colleagues to deliver the copy of the lawsuit and letter that I sent to Raul Castro where I reveal the articles and laws so violated by the State Security officers, agents of the PNR and members of the PCC and where I demand the President of the country leave me in peace.

National Institute for Oncology and Radio-biology (INOR)
La Habana,Cuba
The deputy director asked my colleagues to destroy all this documentation and said that it was “enemy propaganda.” So, to demand adherence to Cubans laws is, according to Doctor Anasagasti, “enemy propaganda.”
As if that were not enough, just a month ago Lorenzo Anasagasti appeared with two State Security officers at the home of Doctor Carlos Vazquez, head of the Board of the Oncological Tumor Devices, in order to sound him out and tell him in a threatening tone: “We’re checking up on you.”

Lorenzo Anasagasti is a collaborator with the repressors, which makes him another repressor who occupies a job at the Institute of Health which has nothing to do with these issues. This is a person in service to the Cuban political police and for him that function is more important than the professional development and education of the INOR. This gentleman has demonstrated that he prefers no thesis be carried out if I participate in the statistical analysis of an academic project in the Institute.

I also am a Molecular Biology teacher for a module that is taught to doctors, who are specializing in Oncology, and I have to interact with a person who coordinates that course, but Anasagasti has demanded that person prohibit me from accessing his laboratory and pressured him to not even talk to me. In this way the interaction between researchers and workers, so necessary to offering high quality training for the country’s future oncologists, is made more difficult. The development and quality of teaching are sacrificed for the sake of repression.

Some foreign mission doctors are familiar with the dispossession of their fees by the Cuban government, and they justify it on the grounds that the country invests that money primarily in oncology resources. What is your opinion of this matter? Do you believe that is really so?

It is true that cancer treatments are expensive anywhere in the world and that, for being an underdeveloped country, the country’s situation is not one of the worst. But really the duties that the doctors, researchers, nurses and service personnel perform does not correspond at all with the wages that they earn and the conditions under which they work.

Currently the volume of patients seen in Cuba by a single doctor is abusive. It is a situation that affects the doctor as well as the cancer patient, who has to wait long hours to be seen, and now the quality of the attention and treatment is not the same. This is mainly due to a stampede, a very big exodus of professionals to the outside, and this causes a work overload for those who remain, although those from the INOR who emigrate the most are the recent graduates, not doctors, who barely stay two years between their graduation and their exit abroad.

I worked some years ago on research about brain tumors and, of the specialists who carried out the research with me, all left the country. There was one point when INOR had no neurosurgeons or neurologists. Another interesting element is that when I started to work at the Institute in 2004, there was free internet access for all researchers, and the situation, 11 years later, is very different. In my department I do not have access to the internet, and I work in Bio-computing. They have restricted access to the internet only for department and laboratory heads, but there is less access than there was 11 years ago.

In spite of the promises that the Government has made to doctors about economic improvements like better wages, the chance to buy a car, a laptop, etc., several of the doctors at my workplace are very pessimistic, because they listened to the words of Chancellor Bruno Rodriguez Parrilla at the press conference about the embargo on September 16, which confirmed that Cuba was not going to change its internal politics. “Maybe I improve my life, but my relatives who are not doctors are going to continue with the same deprivations,” one of them told me. That’s why they have decided to abandon the country at the first opportunity that is presented.

*Translator’s note: An “annexationist” is someone who advocates Cuba becoming a part of the United States.

Translated by Mary Lou Keel


Source: Diario de Cuba and Translating Cuba

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Insufficient compensation, the high cost of living, and increased demand have also influenced the health care sector in Cuba.

By Dr. Eduardo Herrera Duran.*

News media inside and outside of Cuba highlight the functioning of the Island’s health care system. They consider it exemplary, and even compare with developed countries.

Many of my medical colleagues and I have been discussing the condition of medical care in recent years. The majority of us agree that it has been deteriorating for more than 20 years. Contrary to what the Cuban state communicates.

The lack of professional, technical and service personnel in the public health centers – something that militates against good care – is evident. At the wards that receive a great number of patients, often one can find only one nurse – even in intensive care units, where the ratio should be one nurse per patient. In general, each nurse is tending to two or three very gravely ill patients at a time.

Nor can we find nurse assistants, nor cleaning staff; in the best of cases, these are not sufficient to the task. All of which causes the hygiene in the various departments to not be what it should be in a center for treating the sick.

The number of physicians has been gradually diminishing because of their recruitment for the so-called “missions,” which generate juicy revenues for the government. All of which increases the number of patients for each doctor to see, which adversely impacts the quality of care.

To all this, let us add the shortages of necessary medications, supplies and equipment that we do not have on hand when we are treating patients. This affects not only the patients and their families, but also the public health personnel who find themselves unable to provide good service.

Insufficient compensation, the high cost of living, and increased demand in the country have also influenced the health care sector, which is among the most essential for maintaining the well-being of our citizens.

Unquestionably, these factors have influenced the sector’s deterioration. Officials from the Public Health Ministry, during their scheduled visits to the health care centers, see only what they want to see, and do not reflect the reality of what is occurring in their reports to the citizenry. They say that although there are fewer health care centers, medical care has increased in quality.

Referring to what the Public Health Minister said in the most recent meeting of the National Assembly of the People’s Power, one of the physicians, with whom I conversed, Dr. Dayte, said (with humor despite the adversity we face), “Possibly, when they refer to medical attention, there is some misunderstanding, and it is really medical tension that has increased.”

*Dr. Edward E. Herrera Duran. He is a physician, specialist in surgery, living in Cuba and works at the University General “Calixto Garcia” in Havana, Cuba. He writes articles about health to Hablemos Press Agency.


Source: Hablemos Press and Translating Cuba. Translated by: Alicia Barraqué Ellison

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Medical solidarity pays well.

By Augusto Cesar San Martin.*  

For the Cuban government, medical solidarity is a windfall. Monopolize its sale, a priority

For The government, medical solidarity is a windfall. To increase profits, monopolize the sale of health services is a priority of the Ministry of Public Health (Public Health Ministry).

Prevent earnings from escaping toward those who produce, it is the first purpose of the authorities. During the last year the Ministry of Public Health paved the way to bring slavery to immigration doctors opening on the island.

Special status for doctors

Working on issues of pressing irons, the government issued Decree Law No. 302 on migration states:

¨ ... With regard to the final departure from the country, the worker must apply to remove the head of the entity, and report their intention to travel abroad definitive way.

The violation of the decree, supported by the labor code, involves professional disqualification. Also provides for the suspension of benefits as health workers, Infomed, Internet, media houses as basic access to literature and other registration stamp within a period of 30 days.
A source at the Department of Immigration and Aliens (DIE) who asked not to be named for fear of job reprisals, told CubaNet.

The decree contradicts the new immigration regulations ... For us the category of final departure there since 2012.

No money, no solidarity

Another visible step to grab the medical solidarity income amounting to 8.7 million per year is the creation of a monopoly to sell medical services.

On July 1 the Distributor of Medical Services (SMC) created with Cuban capital in 2009, absorbed legally SERVIMED, who sold limited health services.

The purpose of joining a company of 25 years of creation to the SMC is to expand the marketing of seven service lines. Pharmaceutical, optical, welfare and quality of life, health borders, attention to foreign patients, academic events and technology.

The creation of the new consortium was supported by the Ministry of Foreign Affairs (Foreign Ministry). The ambassadors of the 66 countries where there are about 50,000 Cuban doctors, discussed and with foreign government des stimulation individual contracts of Cuban doctors.

Describes a report submitted by an official Cubanet MINSAP, which increased medical Angola stopped, waiting for concrete by the Angolan party discourage hiring private individual clinical measures and institutions.

It added. Reviewing individual contracts and negotiate with the partner commitments not to individual contracts and that their procurement is through the SMC.

Promote agreements with private clinics through the SMC as a way to counter the individual contracts, or what best means to monopolize the business.

The report MINSAP direction, directs, review individual agreements and the SMC to negotiate with the other party and not allow individual contracts in public or private institutions. At least those provide high profits demanded by the government.

In cases of technical and contracted health professionals, the report makes clear that even abroad, are under the terms of the Cuban Labor Code.
Legalization of hegemony

The exploitation of health workers is described in the bad and restrictive living conditions of physicians in the countries where they are serving missions. Also in the appropriation by the Cuban government for more than 70% of the salary paid by the beneficiary government, every doctor.

To cite one example, the Cuban government gets 3000 to 4000 dollars per month you pay the Cuban doctors Brazil.

Within the island, the best picture of the depreciation of the health sector is the wage, high in the past year to $ 64 monthly. What becomes a privilege fulfill mission to Brazil in bad and restrictive conditions, at a salary of $ 400 and 600 deposited in Cuba to encourage the return.

But the return of health workers who slavery escalates. With a better view of their service, the Cuban doctors do not return with the same ideas. As the government realized, he implements what he does best, suppress ideas.

By order of the Ministry of Public Health, is withheld passport to reviewers when they return to the island, either on holiday or for the purpose of their mission.

The measure has the aim of avoiding individual contracts and violation of Decree-Law No 302, on permits to leave the country.

Despite the intimidations, the Ministry of Public Health recorded 109 Comprehensive General Medicine specialists left the hospital without respecting the decree. The number of rebels doctors down to 48 in non-specialized physicians, 29 pediatricians, 28 internal medicine, 18 anesthetists, 15 and 14 gynecological surgeons.

In this sense, the Calixto Garcia Hospital is among the most disobedient with a total of 35 doctors who left the facility without notice or requested temporary permit, and did not return.

They continue in Havana, the Enrique Cabrera hospital with 29, Manuel Fajardo 17, William Soler and Juan Manuel Marquez 14 13.

After the entry into force of the decree, until now, they were disqualified 211 health professionals. Promote disqualification records it is part of the policy of the Ministry of Public Health, according to the cited official report which blames its implementation to the provincial directors, human resources, rectors and deans.

Without the right to strike, not even express, health professionals reported double revenue to the government, money and an image of solidarity usurped Cuban doctors.
* Augusto Cesar San Martin. He was born on April 20, 1967 in Havana. It was captured by the Interior Ministry and studied Criminal Sciences Institute at the Hermanos Martinez, where he graduated. By discrepancies with the military, called permanent downward of the agency, a request that was denied for a year. At that time he established contact with the peaceful opposition and was jailed in 1994. He declared a prisoner of conscience in 1996, and his release from prison collaborated with the Cuba Press agency from 1997 to 1999. In 2006 he founded the Center for Information Jose Lezama Lima.

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Slavery, Exploitation and Conformity

Dr. Eduardo Enrique Herrera.*

It is said that in times of slavery slaves were mistreated and were not free. But the gentlemen slave owners were responsible for feeding and clothing them, providing them healthcare—even for teaching them to read and write, and caring for their small children and pregnant women. The gentlemen slave owners who did this were better regarded by society.

It is also said that the abolition of slavery was a business decision because the time came when the masters could no longer finance all the costs associated with holding slaves. They decided to free them, then employ and pay them, turning the slaves into salaried workers. This way, although the pay was meager, these exploiters were technically complying with abolition, even though they continued being exploiters.

On a daily basis, I converse with many Cubans who, when we speak of the country’s situation, agree with me that it is very dire. The majority complain that salaries are inadequate, even for providing decent nutrition. Working conditions and the state of their dwellings are deplorable. The lack of products and other items essential to life in this modern era is ever more notable, in addition to the lack of freedom.

But most of them say, “Why should I do anything if nothing gets resolved? I can’t change things by myself. The best option is to try to leave the country.” Others, more committed to the government, argue that “there are many problems, but we will get better, always, with the historic momentum of the Revolution leading the way” — without acknowledging that the revolutionary government has been in power for more than 55 years, and we have almost frozen in time.

All of these pessimistic and submissive behaviors make me think of the history of slavery, when the majority of those in bondage shrank from confronting the slave owners out of fear of punishment and death. They would try to escape, they flattered their masters so as to obtain benefits, and even when they were freed, many preferred to remain in servitude.

Although some came out and fought against slavery, the majority adapted to the slaveholding method of exploitation. Today in Cuba, many have adapted to the regime by trying to subsist however they can, but without claiming the rights that appertain to them. It makes me think that when one lives so long in the condition of slavery, it is difficult to recognize, and demand, the freedom that belongs to us from birth.


* Medical specialist in Surgery. Working in the Surgery department of the Hospital "Calixto Garcia “, he collaborates with articles on health and medicine in the independent press agency Hablemos Press. He resides in Havana, Cuba

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¿Why hoarding in Cuban Public Health System?

By Dr. Eduardo Herrera.*Most state workers in Cuba have the need, in a personal capacity, getting the tools, material and to determine the places where they work. Public health has not escaped this phenomenon.Doctors, nurses and many health technicians... Continue reading

We ask for help and solidarity to Olivia, a Cuban girl who suffers from optic nerve hypoplasia, schizencephaly and bilateral hippocampal atrophy.

Olivia is a Cuban girl three years old who suffers from multiple neurological problems; parents seek contact with other families with similar situations in the world and with experts from other countries who can contribute their opinions on treatment alternatives. This is the information below:

Olivia case: difficult but possible.

By: Osmel Almaguer.

Cuban doctors find no cure for a girl who suffers from optic nerve hypoplasia (ONH). He has refused to parents the possibility to consult other specialists outside the country.

Olivia de la Caridad, Cruz just three years old suffer, as a result of their disease, a neurological disorder that has reduced their hours of sleep less than four, preventing her from also vision. The disease is complicated by other illnesses as the unilateral schizencephaly on the right side, the atrophy bilateral hippocampal, among others.
The parents of Olivia, a Cuban girl stricken with optic nerve hypoplasia, recently reported its case through independent media, the refusal of solution by the Cuban doctors, who claim an effective treatment for this condition, is not known.

Photo: Olivia with her father 

"Doctors have recommended us a visual therapy, which consists of making work with it as if it were to be blind all life", says Erlinda Noris.
"[Specialists] people have shown more interest, but they do not have the knowledge necessary to treat such diseases, [...]" they have shown where have been able to reach, "says the father.

Erlinda Noris and Juan Cruz , who have accepted the conditions of the little girl from birth, have been proposed contact with other parents and doctors abroad who have faced similar situations and receive the help they as possible.

According to its own research via the Internet, is known that in countries such as China and the United States it has been implemented a treatment from stem cells, which some patients have partially recovered vision.

Before the efforts of both parents in different Cuban medical facilities, the answers have always been negative: We propose to Ministry of Public Health the possibility that the child receives treatment set that was part of the medical process. “Let us not access doctors from other countries. Simply do not let us contact doctors of the International Red Cross, the Spanish Red Cross or ONCE organization.

"We have gone to the Ministry of Health , the Ministry of Education, ANSI , UNICEF , WHO , Caritas Cuba  and Caritas Havana , but not serve us because we are a special case . We also come to church authorities and have refused us because our case could give a bad image of the country” Cruz said.

Hypoplasia, according to Wikipedia, is the name given to the arrested or incomplete development of an organ or part of it. It refers to a number of cells, inadequate or below normal.

Cuban doctors are unaware of - hypoplasia - disease for which consultation with foreign specialists can increase the recovery of Olivia. Countries as China and the EE.UU implement treatments with stem cells.

While efforts are slowed by the Cuban health authorities, the health of Olivia will continue to deteriorate daily.


Please send information to: cubanmedicine@yahoo.com

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The story behind Cuba’s deal to send doctors to Brazil.

By Daniel A. Medina @dmedin11 July 16, 2014
Last summer, long before before Brazil was demolished 7-1 by Germany in the World Cup, the country faced a crisis of another sort. Millions of citizens marched in cities across the country to demand wholesale reforms to the country’s crippled public health care system, which faced huge shortages of doctors and a failing infrastructure.
That’s when the tiny island nation of Cuba stepped in to this neglected area of the world’s seventh-largest economy.
Under Brazil’s Mais Médicos (“More Doctors”) program, which pays foreign physicians to work in undeserved areas of the country, Cuba sent 4,500 doctors to rural areas in the Amazon and to the undeserved slums known as favelas in its booming cities. The move angered Brazil’s doctors’ unions, who protested outside hospitals, and the Brazilian Medical Association filed a lawsuit in the country’s Supreme Court questioning its existence. Protestors denounced the program as only a temporary solution to a systemic problem, saying the changes should come internally, not by importing doctors.
Brazil currently has 1.9 physicians per thousand people, according to the World Bank, one of the lowest doctor-to-patient ratios in the world. In the country of roughly 200 million, the disparity is so pronounced that some remote areas have virtually no doctors to serve patients. Cuba, on the other hand, has 6.7 physicians per thousand people, the highest number of doctors in proportion to population in the world, and some of the lowest annual costs for medical care.
Cuba-has-many-doctors-and-cheap-care-Physicians-Cost-of-Care_chartbuilder
Financial rewards for both countries
Despite the lack of popular support, the Mais Médicos program was a win-win for both countries. Cuba received $270 million dollars a year from the Brazilian government, hard currency that Havana desperately needs to ease inflation. The deal further enhanced the prestige of Cuba’s long-heralded international medical program, which exports doctors every year to developing countries. And as well as easing its medical crunch, Brazil increased its already privileged access to one of the world’s last untapped markets. Cuban president Raúl Castro has in recent years implemented gradual reforms to the state-controlled economy, and Brazil has positioned itself as a major player in the country’s redevelopment.
Bazilian exports to Cuba have quadrupled over the past decade to $450 million a year, mostly in agriculture, as the country has become a top food supplier to Havana. But Brazil’s most lucrative project in Cuba is a $900-million two-phase modernization of the Port of Mariel by the construction behemoth Odebrecht. Cuba’s only deep-water port is located 30 miles north of Havana, and it is there that Cuba will establish a special economic zone that will be open to non-state owned companies. When that happens, Brazilian companies appear to be first in line.
The project has depended on important financing from the Brazilian government at advantageous terms,” said president Castro at a ribbon-cutting ceremony this past January to open the port’s first phase. “And it has not only been a great help in building the container terminal, but also in other public works such as highways, networks, rail lines and dredging the bay.”
Brazilian president Dilma Rousseff and Cuba’s Raúl Castro were all smiles at the port renovation’s ribbon-cutting.REUTERS/Miraflores Palace Handout
An increase in doctors means political rewards for Rousseff
Brazilian president Dilma Rousseff this year faces reelection in what looks likely tobe the fight of her life. Corruption, government mismanagement of the economy, and soaring inflation are just some of the problems saddling her administration. Brazilians are also still angry about how much the government spent to host the FIFA World Cup, estimated at $11.3 billion dollars in public spending alone—the most expensive in tournament history. With her eroding popularity, Rousseff’s best hope is to reach the poorest Brazilians that have long been the backbone of her Workers Party.
By sending these long-neglected citizens doctors and essential medical care through the Mais Médicos program, she may well reap the benefits at the ballot box. Rousseff has pointed to the program as evidence that she responded to last summer’s nationwide protests. And although it has faced some problems, most Brazilians appreciate its results.
Will the program last?
A March nationwide poll showed national approval of the program at 67%. Support is highest in the country’s poor northeast, at 72%, where the most doctors are concentrated. In fact, the program has been so popular there that other states are copying it. In the state of Sao Paolo, the leading opposition PSDB (Partido da Democracia Social Brasileira) party has sent doctors into the state’s interior to reach its poorest residents.
President Rousseff remains unpopular amongst the country’s middle class. That won’t matter, however, if she can win the hearts and minds of the poorest Brazilians, who still make up a majority of the electorate.
Dilma, as she is affectionately known amongst her supporters, can only hope that these voters will come out in droves and give her the victory that the Seleção couldn’t give the nation on the football pitch. Cuba will be watching, too.
   Fuente: QUARTZ
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When Nature Calls: Cuba’s Public Health Infrastructure Exposed.

Sherri L. Porcelain*

A disaster will not spontaneously trigger an outbreak of disease, unless, of course, a highly infectious disease such as Ebola is the reason for the emergency event. Countries are vulnerable to both newly emerging and remerging communicable diseases when collapsing infrastructure and continuing neglect threatens the health of residents and tourists visiting the country.

Cuba’s current challenges with cholera, dengue, and its viral relative, chikungunya, are good examples. Cholera and dengue continue to spread throughout the island, while the Cuban government claims that all the reported cases of chikungunya have been imported to the island from Haiti and the Dominican Republic. According to the Pan American Health Organization’s (PAHO) Update on Chikungunya Fever in the Americas (August 8, 2014), Cuba has officially reported 11 imported cases with no suspect or confirmed locally acquired cases since the start of the outbreak in the Americas. (1)

Chikungunya, a viral disease transmitted by an infected mosquito, has reached this hemisphere for the first time in history in December 2013 when it arrived on the Caribbean island of Saint Martin and spread throughout the region. Recent data shows local transmission of chikungunya has been identified in 29 countries and territories in the Caribbean, Central, South and North America, including the United States with a cumulative total of 508,122 suspected and 5,271 laboratory-confirmed cases, as of August 1, 2014. (2) Cuba rebuffs what independent journalists, rumors, and local health professionals describe on the island.

Here we go again.

Most likely Cuba’s failure to report chikungunya is intentional and not due to poor data gathering capabilities. Cuba has an advanced epidemiologic surveillance system with highly skilled scientists and dedicated health professionals. However, the government’s failure to release timely outbreak data threatens health security today.

A brief discussion on the relationship of climate change, failing infrastructure, and the frequency and intensity of natural disasters is considered below to identify both the challenges and realities with such diseases as cholera, dengue, and chikungunya in Cuba.

Climate Change

Scientists project that climate change will impact both the frequency and intensity of extreme weather patterns. The Caribbean region, and islands like Cuba, could expect rise in sea levels, and this combined with more intense weather events will make flooding more common.

Cuba’s coastal regions will be impacted the most, however, Cuba could experience protracted seasons of both droughts and flooding, and reliable potable water could become scarce.

According to José Rubiera, top Cuban Meteorologist, the “seawater temperature is rising and the conditions in the upper atmosphere are favorable to rapid intensification. These cases are now somewhat more frequent; it means something is changing.”(3)

The vibrio cholera bacteria has been known to survive in brackish waters and estuarine environments, attaches to zooplankton and moves along the ocean currents as it is carried into new areas,(4) continuing the threat to Cuba and Hispaniola.

This danger is especially problematic in countries where fragile water, sanitation, sewage, and housing systems are further threaten by climate change and rising water temperatures where the multiplication of the cholera bacteria has been documented.(5)

Infrastructure

Even though Cuba’s official reporting on their health status indicators match developed world measures, I suggest that the earlier investment in the Cuban public health infrastructure is eroding quickly and without greater attention, the likelihood of infectious diseases spreading spatially and temporarily will continue.

As reported in New England Journal of Medicine article earlier this year, the reality is that, “Any visitor can see that Cuba remains far from a developed country in basic infrastructure such as roads, housing, plumbing, and sanitation.” (6)

According to Relief Web, PAHO warned Cuba a week before Hurricane Sandy (October 2012) struck that further damage to the sanitation system could be problematic in the areas previously affected by cholera and other illnesses related to water use and handling of food.

It is no surprise that “Drinking water is contaminated in most Cuban cities,” and neighborhoods have ongoing problems with sewage in the streets. (7)

Let’s not overlook the poor hygienic conditions in hospitals and clinics. Cuban independent journalists along with dissident physicians have described water and vector borne disease outbreaks associated with the government’s failure to meet basic sanitation standards. (8)

Current water treatment facilities seem to lack the chemicals, equipment, and appropriate filter units, along with the inconsistent availability of chlorine for safe water. (9)

Furthermore, a failure to maintain continuous water pressure will hinder the amount of water and contributes to the contamination of the water supply. (10)

Lastly, a valuable engineering report on Cuba’s infrastructure reminds us “more than 50% of the water pumped through the distribution system is lost due to leaks in deteriorated piping.” (11)

Natural disasters

Based upon what we know about climate change and infrastructure demands in Cuba, the vulnerability and hazard reduction strategies associated with natural disasters are especially important with high winds, surging seas, and flooding. Hurricane season begins June 1 through November with October and November recognized as the most active times for cyclones to strike in Cuba.

Fifteen hurricanes and two major storms have struck Cuba since the new millennium. The greatest risk for landslides is located in the eastern provinces where earthquakes also have a higher likelihood of threats.

While Cuba has a well-developed emergency evacuation and response plan, they show a poor performance in disaster reconstruction, recovery, and mitigation. (12) This is evident as the battering of their public health infrastructure continues to decline.

According to researchers the most “troublesome is the lack of meaningful official programs to attempt to minimize or mitigate the damage that is caused by the severe vulnerability of the built environment to the hazard agents of hurricanes and earthquakes,” (13)

Hurricanes Michelle (November 2001), Isadore (September 2002) followed by Lily (late September 2002) presented national challenges.

However, it was Hurricanes such as Charley (August 2004) which became the most destructive to strike Cuba’s western Havana region since 1914 followed by Ivan (September 2004), the first Category 5 hurricane to hit Cuba in 80 years. This battered Pinar del Rio, Cuba’s most western region, which has been more regularly impacted by hurricanes.

The 2005 hurricane season was very active with Dennis (July), Rita (September), and then Wilma (October) reporting the worst death toll in Cuba in more than 40 years.

After some quiet hurricane seasons, Gustav (August 2008) a Category 4, and weeks after tropic storm Fay hit, became the strongest storm in 60 years with an estimated $5 billion to damage to medical facilities, schools, infrastructure, crops and livelihood. (14)

Hurricane Ike (September 2008) reported hundreds of water wells in rural areas damaged, dams overflowing, and more than 1 million without potable water.

U.S. engineers report that the “water supply system is unstable because pumps are in need of repair and because of frequent interruptions in the electrical supply needed to run the pumps,” (15) which is especially challenging during hurricane seasons.

Hurricane Sandy (October 2012) hit the eastern region leaving devastation in Santiago de Cuba and Holguin while threatening highly populated communities and destroying critical public health infrastructure.

In 2013, Ricardo Mena, a United Nations official responsible for disaster risk reduction in the Americas announced that “Cuba has enormous amount of deteriorated buildings that can't withstand natural disasters." (16)

While Cuba has a well-developed disaster response system, the foundation to protect its people continues to crumble and expose the fragility of the water, sanitation, sewerage, housing and road systems. Rising sea levels, flooding, warming temperature, and the number and frequency of emergency events are expected to create both water-borne and vector-borne diseases threats in the 21st century. So if we want to blame Cuba’s recent problems on climate change, natural disasters, or other reasons it doesn’t matter. What matters is protecting the health of the country’s residents and visitors. This must begin by reminding the international community that Cuba's silence on disease outbreaks (17) -along with their deteriorating infrastructure- could wreak havoc when nature calls.

Notes

(1) PAHO Epidemiology Week Report on Chikungunya to Date (Week 32), August 8, 2014.

(2) Center for Disease Control and Prevention (CDC), Chikungunya in the Americas http://www.cdc.gov/chikungunya/geo/americas.html, accessed August 8, 2014.

(3) Patricia Grogg. Hurricanes Getting Stronger in the Caribbean, InterPress Service, Interview with José Rubiera July 10, 2013, http://www.ipsnews.net/2013/07/qa-hurricanes-are-getting-stronger-in-the-caribbean/

(4) RR Colwell Global Climate Change and Infectious Disease The Cholera Paradigm (1996) Science, 274 2025-2031.

(5) Joan L Aron & Johnathan Patz Ecosystem Change and Public Health: A Global Perspective (2001).

(6) Edward D Campion, and Stephen Morrissey, A Different Model-Medical Care in Cuba New England Journal of Medicine Perspective, January 24, 2014.

(7) Katherine Hirschfeld, Book Review, Linda Whiteford and Laurence Branch’s Primary Health Care in Cuba: The Other Revolution (Rowman and Littlefield, 2008), in Soc (2009) 46:293–296 Published online: 27 March 2009 p. 294.

(8) Katherine Hirshfeld (2009).

(9) Eds. Manuel Cereijo and Helena Solo-Gabriele, Infrastructure Assessment for a Transition in Cuba (March11, 2011), Endowment for Cuban American Studies p. 11.

(10) Ibid.

(11) Cerijo and SoloGabriel (2011), p.12.

(12) B. E. Aguirre and Joseph E Trainor, Emergency Management in Cuba: Disasters Experienced, Lessons Learned, and Recommendations for the Future, in ed. David A. McEntire Comparative Emergency Management: Understanding Disaster Policies, Organizations, and Initiatives from Around the World, http://training.fema.gov/EMIWeb/edu/CompEmMgmtBookProject.

(13) Aguirre and Trainor, p.5.

(14) Canadian Red Cross, Cuba Hurricanes 2008, accessed August 7, 2014

(15) Helena M. Solo-Gabriele and Armando I. Perez Water and Waste Sector: Environmental Literature, Institutional and Economic Issues and Future Work, 378-389, in Infrastructure Assessment for a Transition in Cuba (2008) http://ctp.iccas.miami.edu/InfrastructureAssessment.asp p. 387.

(16) Jean Friedman-Rudovsky. Hurricane Tips From Cuba, New York Times, 30 July 2013: D.6

(17) Luis Rosas Suarez, El silencio epidemiológico y la ética de la salud pública cubana, Revista Cuban de Salud Pública 39(3) (2013), 524-539 and Sherri L. Porcelain Cuba’s Silence is Dangerous to Your Health, ICCAS Focus in Cuba Issue 197, August 5, 2013 http://ctp.iccas.miami.edu/FOCUS_Web/Issue197.htm.

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*Sherri L. Porcelain teaches global public health in world affairs at the University of Miami Departments of International Studies and Public Health Sciences and Senior Research Associate, Institute for Cuban and Cuban-American Studies.

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The CTP can be contacted at P.O. Box 248174, Coral Gables, Florida 33124-3010, Tel: 305-284-CUBA (2822), Fax: 305-284-4875, and by email at ctp.iccas@miami.edu. The CTP Website is accessible at http://ctp.iccas.miami.edu.


Nota del Editor: Articulo recibido por correo electrónico desde la fuente. 

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Cuba’s Silence is Dangerous to Your Health

Sherri L. Porcelain*

After a century hiatus, cholera, malaria and dengue have returned to Cuba. This is no surprise since Cuba’s deteriorated water, sewage, sanitation and housing systems all create the ideal environment for rapid disease spread. Dengue, a mosquito borne viral disease, and cholera, a bacterial infection contracted by drinking water or eating food contaminated with a strain of cholera, present threats to both the local population and tourists visiting the island.

Luis Suarez Rosas, a physician with Cuba’s National School of Medicine, accurately captures the paradox of Cuban health care today in using the term epidemiologic silence to describe Cuba’s official position on disease outbreak information. Cuba is a unique case study because of its long history of highly trained infectious disease specialists as seen in the yellow fever response in the early 1900s, and the prominence of the Pedro Kouri Tropical Medicine Institute founded in 1937. Yet, today, the policy to call dengue euphemistically as a febrile illness or cholera as a gastrointestinal illness represents an unethical national public health policy affecting individuals beyond their national borders. This choice to withhold information derails global public health goals to inform and protect travelers; it also encourages rumors and creates confusion. Suarez Rosas, using dengue as a recent example, explains how this artificial epidemiologic silence does not help patients, nor does it address the risk or the perception of the severity of the disease. Additionally, it does not respond to the culprit, the aedes aegypti mosquito, which also carries the yellow fever virus.
While both the Center for Disease Control and Prevention (CDC) and the Pan American Health Organization (PAHO) provide health alerts and identify health problems, their information often relies upon the official reporting of information. However, the Program for Monitoring Emerging Diseases (ProMED), operating under the International Society for Infectious Disease, is an internet-based information system created in 1994 with the purpose of sharing emerging and re-emerging infectious disease information. ProMED mail welcomes all sources of information, including independent journalists who have reported outbreaks long before the Cuban government forced to make an official statement. ProMED continues to share information about the re-emergence of cholera in Cuba’s Manzanillo (Granma) Province in 2012 that spread through eastern provinces, and reached the western capital of Havana.

In June 2013, an independent journalist from Hablemos Press reported approximately 30 cases of malaria in Cuba. The Cuban government claimed these cases are imported by tourists or from returning residents that traveled to an endemic area. Imported cases of malaria are not new; however, the history of Cuba’s denials of other re-emerging diseases compels one to question the veracity of the government’s official report.
Malaria expert John Beier, Professor of Public Health Sciences at the University of Miami Miller School of Medicine, states that Cuba is receptive to malaria since the mosquito has not been eliminated. It is also important to acknowledge that local pocket of transmissions can exist through imported cases from other areas in the region, such as Hispaniola where malaria is known to exist. During rainy season, and when vector population increases, the risk of transmission increases as well. Still no official government report exists.

Sharing good epidemiologic evidence in a timely fashion is a reasonable expectation for global public health cooperation to be maintained. Promoting global health security begins with greater transparency on potential health threats. These are not state secrets as proposed during the 1980s and 1990s denial of Cuba’s dengue re-emergence, along with the incarceration of health professionals who released such data.

Cuba’s policy to withhold information on infectious disease threats for the purpose of protecting their health image, or their tourism industry is unacceptable in an era where rapid and frequent transport across borders occurs. International travelers and concerned citizens everywhere must realize that mosquitoes and microbes do not require their own passport stamp for entry into the United States, and the intrepid stowaways may arrive with their presence undetected.

Based upon what we know and don’t know-

We need to:
1.      Promote greater awareness about mosquito avoidance and cholera, dengue and malaria prevention for travelers to Cuba. While other countries may have higher reported cases, their risk is documented through transparency in their reporting. On June 27, 2013 the U.S. Interests Section in Havana, Cuba posted an alert message for U.S. citizens regarding road safety and traffic related deaths and injuries. This is an important health and safety message, so why not extend this to other public health issues such as dengue, malaria, and cholera?

2.      Become more proactive and use Rapid Diagnostic Kits (RDK) for early identification of diseases such as dengue and malaria. This could be especially important to Travel Medicine Clinics where licensed and trained health professionals have the ability to do accurate testing and patient histories. Dr. Kunjana Mavunda, Medical Director and Tropical Disease Specialist at International Travel Clinic in South Miami, Florida supports this approach. “I’ve been looking at these rapid diagnostic kits as part of the patient care and it is important that you get a good history of the patient and identify potential exposure risks.” She indicated that Cuba’s neglected infrastructure makes it ripe for potential disease spread.

3.      Generate a wider dialogue concerning Cuba’s epidemiologic silence. Notwithstanding the issues surrounding dengue, malaria and cholera, a bird flu spread remains a possibility. The 2003 Severe Acute Respiratory Syndrome (SARS) coronavirus scare originated in South China and today the Middle East Respiratory Syndrome (MERS), another coronavirus, lurks nearby. Will anyone hold Cuba accountable for failure to report early outbreaks? What about possible impact in South Florida?

Global health security depends upon the rigor of good science, the willingness of nations to uphold policies to protect both their citizens and visitors, and the timely reporting of potential health threats. A world that is forced to rely on rumors puts everyone at risk. Consequently, silence is dangerous to your health.

*Sherri Porcelain is Senior Lecturer in Global Public Health in World Affairs and a Senior Research Associate at the Institute for Cuban and Cuban-American Studies, University of Miami.
The CTP can be contacted at P.O. Box 248174, Coral Gables, Florida 33124-3010, Tel: 305-284-CUBA (2822), Fax: 305-284-4875, and by email at ctp.iccas@miami.edu. The CTP Website is accessible at http://ctp.iccas.miami.edu.

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Foods and Cancer in Cuba.

Foods VS Cancer
By Roberto Quiñones Haces.*


Guantanamo, Cuba, (PD) since the end of May this year the Cuban press has published articles eulogistic in favor of the Government due to the fact that Cuba, along with other 16 countries, advance fulfilled the objective of halving the number of people sub nourished.

Mr. José Graziano Da Silva, FAO's director-general, congratulated the Cuban Government and was received on 3 may by the President of the Council of State, general of army Raúl Castro Ruz. Ms. Entharin Cousin, Executive Director of the world food program of the United Nations, and Mr. Theodor Friedrich, the FAO representative in Cuba, were also laudatory words for the Government.

Is true that in Cuba there are no famines that persist in several countries of the world, but it also is that the power of the Cuban has been falling steadily as and that many families eat poorly - sometimes just a cup of coffee - and make a single daily meal. The so-called monthly basic basket - the products sold by the State at "subsidized"by the ration book - prices has been reduced to seven pounds of rice, a tiny amount of beans or peas that barely reaches for two meals, a little oil, a package of five pounds of sugar, coffee, a packet of iodized salt every three months and a box of matches. Withdraws children the allocation of milk at the age of seven, from that age and up to fourteen receive two packs of milk powder. In the butcher's shop sold ten eggs per person, called hash with soy - meat compound only God knows what it is, presence so repugnant that until my dog refuses to eat it - and a small ration of chicken once a month. This lean provision of food is what the State guarantees to every Cuban. Obviously, those who have been more than fifty years in power never have had to suffer these food rigors.
I have already explained this to relate it to another story that appeared on page 2 of the newspaper Granma on Saturday, June 8. In it, signed by José A. de la Osa, reporting that cancer is now the leading cause of death in Cuba, moving to diseases of the heart and cerebrovascular. The funny thing is that the people who served from source, Dr. Idalia Cardero Quevedo, specialist of the Department of Disease not transmissible of the Directorate of epidemiology of the Ministry of public health (MINSAP), recognizes that the inadequate power is one of the causes of cancer but deflected abound in this aspect of the problem. That's where I'm going to stop me. I reiterate, Cubans eat daily but the issue lies in the quality of what we are eating because our diet is not varied and unique animal protein which we can purchase - at least in this area of the country - and at a high price, is pork. The vegetables must be present at our tables on a daily basis but their prices prevent so. Not to mention beef, disappeared from the kitchen of the majority of the people since 1990. To talk about what meat Turkey, rabbit and fish and seafood, so rare now in our food. Nothing is said in the article about the impact that has had on the increase in deaths by cancer the intensive use of fertilizers and chemicals in agriculture and the preservative chemicals in canned foods.

Another ridge of the issue is the amount of food experiments that have been performed with our people as if we were guinea pigs. The list is long, but I remember that before the mince with soy were retail cereal unpalatable, grain never before consumed in our country, meat pasta, croquettes bland, cold cuts with a composition of flour that goes beyond of the seventy per cent, refreshments of unidentifiable flavors, etc.

The case is not satiate the hunger but make it so that foods that consume the population are varied and healthy, something that is still an unattainable goal for the vast majority of the Cuban people, whether by low production and low variety of offer or because commodity prices are still so high that it is not possible to access a healthy and balanced diet. In my opinion, it is this, more than smoking and alcoholism, the main cause of the increase of cancer in our country.
*Roberto Jesus Quiñones is an attorney and lives in Guantanamo. Cuba.

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Cuba: The riddle of the secret with cholera.

The riddle of the secret with cholera.By Jaime Leygonier.Havana, July 23. - The spread of the cholera epidemic in the country is kept in strict secrecy by the government and reported by the independent press whose reports which town of Cuba or Havana n... Continue reading