The restoration of capitalism in Cuba, held between the years 70-90, among other aberrations, is showing how the great achievements of the 1959 revolution that overthrew the bourgeois government, broke the bonds of dependence on imperialism, expropriated the bourgeoisie and placed the Cuban people for better living conditions, were adulterated until they turned into their opposite.
The More Physicians program, from Dilma Rousseff’s government PT – Workers’ Party) in Brazil, exposed to the world the absurd and demeaning reality existing in Cuba. Cuban physicians have become a source of income for their government, which practices semi-slave labor by exporting men and women, treated like goods in a dirty deal with other governments that support Fidel and turn this business into a way to send currency, as well as exposing their own bad health situation.
Prevention better than cure
After the 1959 revolution, there was a shortage of medical professionals, who fled Cuba for not supporting the Revolution. Half of Cuban physicians, a privileged sector of the population, fled the country; leaving only 3000 physicians and just 14 Medicine teachers. Besides leaving the population underserved, this crisis has put the island on the verge of running out of medical education.
In its first stage, the Revolution would meet this shortage by popularizing educational and professional training programs. It ought to be able to secure housing, food and clothing for all the people who were impoverished and full of illnesses since the Batista dictatorship didn’t guarantee the minimum living conditions for the workers and the poor. Therefore, in addition to proper nutrition, it was necessary to ensure medical care and free education for all. It was the fulfillment of this program within a planned economy that allowed Cuba to give an unimaginable leap forward in its economy and quality of life.
The Cuban working class, especially the workers of the sugar mills and the miners, strove very hard to carry out these measures. This gesture made Che Guevara, one of the leaders of the 1959 Revolution, who had just taken office in the Ministry of Economy in Cuba, to pay special attention to these sectors. Che was a physician himself and suffered from asthma, the same disease that had been claiming the lives of workers in the mines, due to their poor working conditions, where prevailed especially lung diseases produced by silicon and other substances. To solve the problem, Che has created and implemented a community health system, opening the doors of schools for all those who wanted to be medical student and expanding the public hospitals network, well equipped and in which the population had free assistance of good quality. At the same time, by the expropriation and nationalization of the pharmaceutical companies, it was possible to develop medical research, including from medicinal plants, which led Cuba to become one of the world’s most advanced countries in the field of pharmacology, in the discovery of vaccines and other drugs unprecedented in the world of science.
According to Che, the preventive medicine program has to “provide public health services for the greatest possible number of persons, institute a program of preventive medicine, and orient the public to the performance of hygienic practices.” It’s better known as Family and Community Practice, a medical specialty characterized by comprehensive health care which takes into account the inclusion of the patient in the family and community. The doctor of family and community is, par excellence, a doctor of primary health care, who should have a bond with their patients even before they get sick, and when they feel something he should be the first physician to be appointed. Thus, the physicians are in a unique position to make what they call health promotion, disease prevention, early diagnosis and treatment of diseases that are part of their clinical ability. In this specialty there is no dichotomy between prevention and cure. A home visit is standard practice, but queries are performed preferably in the medical office, unless the patient is in bed. Another important feature is the knowledge of the community where the patient dwells, which ranges from infrastructure to customs and cultural values.
The doctor of family and community sees people of all ages and both sexes, in a continuing and comprehensive manner, and work in an interdisciplinary team. According to the literature, these professionals resolves 80 to 90 % of the problems that require health care. This specialty rescues the doctor-patient relationship hampered by fragmentation due to the ultra-specialization of medicine. This type of medicine was introduced in Russia after the October Revolution and served as a model for other revolutions, such as in Cuba and China. It is cheaper than traditional medicine because it prevents the onset of disease and, beeing a continued service, prevents worsening of the patient, avoiding surgery and sophisticated tests.
This program served as an incentive for thousands of Cubans to graduate in medicine and provide a good health care to their people. The Cuban government also took part in humanitarian aid, for example, sending Cuban doctors to save 600,000 Africans from blindness or after the Haiti earthquake, when they rushed to rescue the wounded, saving hundreds of victims with their skill and dexterity.
This program implemented by Che Guevara in the heat of Revolution and to which thousands of bourgeois doctors have turned their backs has put Cuba on a higher level than all the capitalist powers together. Cuba used to have the best health indicators in the world, higher than the imperialist countries, like the United States and throughout Europe. This led the World Health Organization to consider the Cuban system a model to be followed by all countries of the world.
Planned economy has enabled this achievement
What allowed Cuba to solve the problem of public health, that in capitalist countries seems an insoluble problem, was the planned economy, which began to be implemented after the Revolution of 1959. This planning is based on three economic pillars. Firstly, most of the means of production were nationalized, ie, became state owned properties. Secondly, the quantity and quality of what was produced was not determined by market forces, but by a central economic plan, to which all companies were subordinated. Thirdly, all foreign trade, whatever the country bought and sold was monopolized by the state. (Hernández, Martin, O Veredicto da História, Sunderman, p. 185)
In the field of health it meant giving priority to the most urgent needs of the population: the incentive for free medical schools, so that there was no obstacle for the youngs who wanted to be a physician. It meant the nationalization of pharmaceutical laboratories for the mass production of medicines, delivered free of charge to the needy. And priority to Preventive and Community Medicine, as stated above, with a plan involving sanitation, to prevent epidemics and prevent the emergence of disease or its aggravation. Also, it involved another very important thing: the physicians living within their communities; which allowed them to know their patients, their way of life and thus be able to better manage their health. With these simple steps, the medical care in Cuba has become an example to the world.
Restoration of capitalism could not destroy everything
The Cuban government, after the restoration of capitalism, destroyed practically all the gains achieved the revolution that had taken the Island out of the swamp where the Batista government sank Cuba and out of the dependence on imperialism. But the preventive and community medicine was such a great achievement that the dictatorship of Fidel Casto failed to totally destroy after the capitalist restoration. But it’s so battered, with doctors turned into semi-slave labor, and leaving the Cuban people, who is on the brink of starving, without that quality public health it enjoyed in the early days of the Revolution.
The restoration of capitalism manifested itself in the toppling of the three economic pillars quoted above. In the late 1970s concessions to capitalism began to be made, but it was in the 90s that a qualitative leap was given. In a short period the government ended the state monopoly of foreign trade and the economy ceased to be centrally planned. The economic anarchy that characterizes the capitalist system, where the market is the dealer where every business and every industry defends its own interests, concerned only with increasing their profits and not the welfare of the population, pushed Cuba back again to the pre-revolution period. Today, those who wanders the streets of Havana, the beautiful Cuban capital, is surprised by the appearance of the houses, ramshackle streets covered with trash, the stench of urine and feces everywhere, beggars begging on every corner, dirty children loose in the streets, abandoned to their own fate, young men and women prostituting themselves in bars and squares, rotten government warehouses, the police everywhere, watching, students panicked and much, much propaganda of “socialism” everywhere. There’s a brutal contrats between this situation and the towering hotels for the rich, rich neighborhoods full of squeaky cleaned mansions, without a scrap of paper thrown into the street.
Admittedly, in such a situation, it is almost impossible to maintain the health of the poor people.
Prejudice and low wages
Then, Cuba began to sell the professional services, especially physicians’, to other countries. Venezuela, Brazil and 50 other Latin American, African and Middle Eastern countries import the Cuban physicians, which is the primary source of foreign income of the Island. This year, the export shall render to the country US$ 8.2 billion. Overall, professionals exported to other countries receive monthly salaries ranging from 200 to 1000 dollars. Much of this money is sent directly to the Cuban government, which is held until the doctors return to the country. Thus, they are hostage of the Cuban government, which requires them to return to Cuba when their contracts expire.
But beyond the physicians wages, the governments pay a much greater value to the Cuban government. In Brazil, for example, the government pays to Cuba worth US$ 4,700, from which just US$ 1,240 is forwarded to the physicians. That is, the Cuban government receives about US$ 3,400 for each “grant” paid by the Brazilian government to the physicians, while physicians from other countries included in the Brazilian program (called Mais Médicos – More Physicians) receive a full grant.
This practice of “exporting professionals” began in Cuba in 1963. Since then, about 132,000 Cuban doctors and paramedics have served missions abroad. The director of the Cuban Medical Services SA Distributor, Yilian Jiménez, said to the official newspaper Granma, “since, in 1963, when the first Cuban medical brigade internationalist mission left for Algeria, 131,933 health professionals have offered their collaboration to other nations.” Currently remain in such work over 50 thousand employees, of which about 25,000 are doctors.
Jimenez said that the export of medical services does not affect health coverage in the island, whose rate of physicians per capita “is comparable to first world countries.” But the Cuban people have been protesting against the export of doctors because the free public health got much worse. The Department of Health defends itself with numbers, saying that Cuba has 76,836 doctors, 14,964 dentists and 88,364 nurses for a population of 11.1 million inhabitants. But it forgets to say that Cuban physicians receive only about US$ 30 a month in Cuba.
Brazil: disease and anarchy
The president Dilma Rousseff (from PT – Workers’ Party) defends capitalism but did not hesitate to take advantage of Cuban doctors, a victory of the Cuban revolution to plug the holes that the capitalist economic anarchy leaves everywhere. In Brazil, the shortage of physicians is chronic and public health is a total disaster. Because medical schools are private and very expensive, because the pharmaceutical industry is monopolistic, because good hospitals are private. What prevails is private medicine and exorbitant health plans, whose only goal is profit.
There is not any kind of planning in such a vital area as public health. In public hospitals beds, doctors, nurses and even plasters are lacking! Patients are seen on the ground, in the street, in the corridors. The few employees get tired of protesting, but absolutely nothing is done. There is no equipment for tests such as mammography, for example, in a country where breast cancer is one of the most deadly women diseases. Meanwhile, the TV shows advertisements for fancy hospitals, with the most advanced technics in the medical world. But only for the rich.
The doctors working in private practice are an elite; the others kill themselves as slaves in appalling conditions and grueling work shifts. Amidst this chaos, Rousseff had the brilliant idea of creating the More Physicians program, a palliative program, the same as blocking the sun with a sieve.
A part of the Brazilian medical community repudiated the program, claiming that Cuban doctors would take up their jobs. Many Cuban doctors were greeted with boos and many manifestations of prejudice. But they are so exploited as our doctors – who are not part of the elite – are.
If the Brazilian government has enough money to pay US$ 3,400 to the Cuban government (not to the Cuban physicians) for each physician and there are 11400 of them, it means a total of 465 million dollars a year. This money should be employed in the formation of Brazilian physicians and improving public health.
What Brazil needs urgently is the nationalization of the private medicine and nursing schools; the end the entrance exams, which prevents students from public schools, the vast majority of students, from enrolling in these colleges. Free education, both in relation to fees as to the disposal of books and study materials. The immediate nationalization of the pharmaceutical industry for the mass production of medicines, distributed free of charge to the entire population. This may seem impossible, but it has been done in Brazil, in Fernando Henrique Cardoso’s administration, who broke patents and produced drugs against AIDS, which was a success and an example for the whole world. If a rightist government could do it, why not do the same in the case of drugs for cancer and other diseases that affect us? Another key measure is to end all private health plans, which are true mafias and a license to print money at the expense of the population’s (lack of) health, and turn the medical care into a public, free and good quality service. For this, the government should rely on the advice of programs that have worked, such as the Cuban.
But for this, the government must break with the big business and multinationals who control public health and make it a big deal. It’s a struggle of the entire working class, a necessary and urgent fight, so that nobody else has to give birth in a hospital corridor.
