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Cuban Medicine

Write a Book.


By: Eloy A Gonzalez.

Buena parte de mi vida está vinculada con los libros. Much of my life is linked with the books. Los reconocí un día del año 1962 en aquella amplia biblioteca de una casona confiscada a sus dueños. I recognized one day in 1962 in this large library of a house confiscated from its owners. La sensación que experimenté aquel verano aun lo recuerdo con delectación.The feeling I experienced that summer still remember with pleasure.

The idea of writing has always accompanied me. Completing a book is another issue that has occupied me last year. This after a brief contact with death, living the hazardous conditions and have a good number of articles I have written in recent years.
Es que desde hace cinco años  comencé a escribir artículos sobre temas de Salud, Medicina y Educación Médica en Cuba, muy a tono con mi profesión, esa que me había acompañado  durante casi 30 años y que retomé brevemente hace apenas tres años.Is that five years ago I started writing articles on topics of Health, Medicine and Medical Education in Cuba, quite in keeping with my profession, that had accompanied me for almost 30 years and may return briefly just three years ago. Hace algún tiempo escribí un artículo titulado: “Buen Aniversario” (puede consultarse en Internet) que bien explica los sucesos y motivaciones que me han llevado a escribir tantos artículos de opinión sobre temas muy variados. Some time ago I wrote an article entitled "Good Anniversary" (available on the Internet) that clearly explains the events and motivations that have led me to write opinion articles on many varied topics. Hace seis meses, y siguiendo a un silencio demasiado prolongado, les brindé mi artículo: “Regreso a escribir”. Six months ago, following a silence too long, I toasted my article: "Back to writing." Vale la pena repetir lo que fue una especie de declaración de intenciones sobre lo que sería mi hacer a partir de finales de año 2009:It is worth repeating what was a sort of mission statement about what should be done from my end of year 2009:

En este punto de inflexión, y como nada tengo. At this turning point, as I have nothing. Me muestro compasivo y amable tanto como puedo ser iracundo e irreverente, siempre que lo crea conveniente. I remain compassionate and kind, much as I can be angry, irreverent, whenever it sees fit. No tengo lealtades a quienes responder, ni alineaciones que me fuercen a pensar.I have no loyalties to those who respond, or alignments that force me to think. No tengo esperanzas inmediatas, ni pasiones que me inhiban. I have no immediate hopes, and passions that inhibit me. Disfruto del sosiego de los días estériles y me sumerjo en las noches agradables del insomnio y los sueños. I enjoy the serenity of the barren days and I bathe in the pleasant nights of insomnia and dreams. No cuento con la vida, así me resulta más fácil llevarla sin sobresaltos. I do not have a living, so I take it easier smoothly.

Fue precisamente en ese tiempo de silencio que concebí la idea de seleccionar aquellos artículos sobre temas de Salud y Medicina que tanto me habían ocupado; algunos aparecieron, con algunas modificaciones, en estas páginas. Agrupar los artículos, revisarlos y adecuarlos a una edición por demanda parecía una tarea fácil pero no fue así. It was precisely in that quiet time that I conceived the idea of selecting those articles on topics of Health and Medicine had me so busy; some appeared, with some modifications, in these pages. Grouping articles, review and editing to suit demand seemed an easy task but it did not. Terminada la selección y revisado los textos, estaba listo lo que sería el libro: “La Habana bien vale unos Títulos”. After the selection and revised text, which would be ready the book: "La Habana bien vale unos titulos”.  La edición fue completada por un buen trabajo del diseñador, Salvador Andrade, quien con la portada y contraportada salvó una edición que muestra algunos problemas en los créditos y la tipografía. The edition was supplemented by a good job of the designer, who with the front and back covers saved an issue that shows some problems in the credits and typography.

Faltó en el libro un artículo esencial. Lacking in the book an essential item. Se trata de la nota introductoria y Las Bases y Estatutos del Colegio Medico Independiente de Cuba.This is the introductory note and Bases and Statutes of the Independent Medical College of Cuba. Texto que preparé íntegramente en Cuba en el año de 1997. Prepared text entirely in Cuba in 1997. Ese texto, fundamental para este libro, no lo tenía para incluirlo;  espero que algún día pueda recuperarlo. That text, central to this book was not to include it, I hope that someday it back.

Ayer recibí el libro, las expectativas de tener en la mano un libro al que le dediqué tanto tiempo y energías me produjo una alegría que disfrute en soledad.Yesterday I received the book, expected to have on hand a book to which I devoted much time and energy was a joy that I enjoy in solitude. El libro no es nada pretencioso, tiene el valor de que es mi libro; las ideas y opiniones que están en sus páginas muestran mi quehacer creativo libre de presiones, contradicciones y temores. The book is unpretentious, has a value that is my book, the ideas and opinions that are in their pages show my creative activity free of pressures, contradictions and fears.

Este mi libro , el que ahora tengo cerca mientras escribo estas notas, es un sueño que me he regalado. This, mybook, I now have about as I write these notes, is a dream that I've given.No será el único sueño, porque a pesar del drama que representa una vida acabada, es posible hacerse de un sueño y los sueños no tienen cualidades. It will not be the only dream, because despite the drama that represents a life finished, you may be a dream and dreams do not have qualities.

©2010© 2010

Nota: El libro, “La Habana bien vale unos Títulos”, fue publicado en España, mediante el sistema de edición por demanda en la Editorial Bubok.Note: The book, "La Habana bien vale unos titulos”, was published in Spain by the editing system by demands. It was recently published again. It is available on Amazon.  Puede adquirirse  en Internet empleando un buscador con el título ó el nombre del autor. It can be purchased on the Internet using a search engine with the title or author name.


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Cuba’s doctors are emigrating and quitting for lack of incentives.

By Katarina Hall.*

Cuba boasts that it has one of the world’s best healthcare systems and that it provides some of the best doctors out there. But this hasn’t stopped the island’s doctors from leaving the country in droves and abandoning their careers for better livelihoods in other fields. What gives?

The main reason that Cuba’s doctors are emigrating and quitting is simple: a lack of incentives. They work very demanding jobs for low wages and are subject to a whole set of regulations created especially for them—they are not allowed to leave the country without special permits and they have to attend to anyone who seeks their help, on penalty of jail time.

After the Revolution of 1959, the Cuban Communist Party banned private enterprise and established centrally-determined prices and salaries for nearly everything on the island. They also took over the country’s healthcare system, making all doctors state employees.

Doctors’ salaries of about $40-50 a month are actually $10-20 dollars per month more than the average Cuban’s. But the long hours and stressful conditions make up for it. Anyway, with Cuba’s rising prices, $40-$50 a month isn’t enough for a comfortable life. That’s why most doctors have picked up a second job or left medicine altogether, usually for a job in the growing private sector or in the black market. Being a doctor is prestigious, but paying the bills is more important. In Havana you can meet countless taxi drivers, cooks, and street vendors who were once doctors.


Take for example Clara, the caretaker of my neighbor’s elderly mother. A cheery woman in her late 50s, Clara told me that she had been a dentist for many years but that the bad pay had led her to quit and take up her current job. Clara provides for her mother, who has been diagnosed with senile dementia. Her dentist’s salary couldn’t put food on the table for one, let alone for two. While taking care of another elderly person is not the best-paying job out there, it provides Clara with the money and the flexible schedule she needs to take care of her own mother.

For a doctor to take up another profession is normal, she told me. “There are a lot of doctors who have ended up baking and selling cakes. And they bake because there is nothing better to do. You can sell a cake for 10 or 15 pesos. So if you make two cakes per day, you make some money and you don’t have to deal with a nine-to-five job where you are pressured and where you can’t earn a living.”

The flexibility of Cuba’s growing private sector has allowed many to quit their jobs with the Cuban state and move to jobs that pay in Cuban Convertible Pesos (CUC)—the convertible currency that’s worth about one US dollar. Unfortunately, only a limited number of private sector jobs are permitted: driving a taxi, renting out a house, running a restaurant and hairdressing, for example.

One person who has benefitted from such a move is Rosy, one of my neighbors. Rosy was a doctor for 24 years, but now she rents her apartment to tourists. Rosy explained to me that she had quit mainly because her wages, which were paid in Cuban Pesos (CUP), were just too low. “You get paid six CUP for each shift you take. Six CUP. Do you know how much six CUP is? Twenty-five cents of an American dollar. That is just enough for your day’s lunch.” By renting her apartment, Rosy makes an average of $20-$30 a night.

Rosy finally decided to quit her job after being sent on a year-long medical mission in Angola. Cuba is known for sending doctors to developing countries to do social work, usually to other socialist-friendly countries such as Venezuela, Bolivia, Ecuador, and Nicaragua. “In just one year in Angola, I made more than I had in 24 years,” she said. What disappointed her most was that she didn’t even get paid all the money she earned: “In the whole year there, I made up to a quarter of a million dollars. I know that because I had to register every procedure I did because I got paid depending on what I did and how many times I did it. But I didn’t receive the amount of money corresponding to my work. I only received ten percent of every procedure. From that quarter of a million, I only got $450 a month.” Seeing how much she could make in a year and how much of her money the Communist Party of Cuba kept, she decided to quit.

Rosy also told me that Cuban doctors are expected to be Good Samaritans—or else. “If a neighbor tells you to please check their sick kid you can’t charge them anything. It has to be free. And if you don’t check them, then they are able to turn you in to the authorities and say that you denied them your attention and service.”

Manuel, the taxi driver I’ve mentioned in previous posts, told me that his daughter was a doctor. He was sad that someone as smart and dedicated as his daughter would never have a decent life. “With her doctor’s title and $40 she can’t feed herself. I have to give her food and clothing, because if not, she can’t live. And she’s a doctor! Doctors can’t live here. Where would they live? What can they buy with that amount of money? What are they going to eat? They can’t survive.”


 *Katarina Hall is a Research Associate for Victims of Communism Memorial Foundation. She is a graduate of Universidad Francisco Marroquin in Guatemala, where she studied economic history.


Source: Dissident

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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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