Living Inside Cuba’s Health
Services:
The Reality of Castro’s’ Power and Influence Inside and
Outside of the Island.
Antonio M. Gordon, Jr.,
M.D., Ph.D.
Cuba's health
services have come under attention recently.(1,2)
Since 1963, Fidel Castro has been exporting health care
personnel including physicians to countries in Africa, Latin
America, and Asia. It is estimated that approximately 5
percent of the Cuban physicians working for Castro's MINSAP
(Cuban Public Health Service) are involved in service
abroad.(3) The so-called "doctor
diplomacy" may have begun in the manner of an assistance
program for guerrilla movements, but it soon turned into big
business for Havana. In this article, we analyze briefly the
current events that led to two physicians serving in
Castro's "doctor diplomacy" in Africa to desert in a
maneuver that turned dangerous for them and for innocent
bystanders.(4) Furthermore, we analyze the
recent offer from Fidel Castro to train low-income Americans
in medical sciences in order to remedy the health statistics
of the United States in the context of the "doctor
diplomacy" --- one of Castro's ways to influence public
opinion abroad.
The Breadth and Scope of
"Doctor Diplomacy"
The story of two Cuban physicians who were serving in
Castro's elite "doctor diplomacy" service in Zimbabwe became
front page material when they dangerously escaped from being
kidnapped and returned to Cuba under the "long arms of the
revolution."(2) The doctors who managed to
escape, Drs. Leonel Cordova and Mirta Peña, were two of the
thousands of physicians and health care personnel who are
currently stationed in carefully crafted, thoroughly
supervised and managed units in many countries of the
so-called Third World. The income to Castro's purse from
this "doctor diplomacy" in Zimbabwe alone is estimated at
$1.2 million (U.S.) per month.(4) A very
small fraction of this goes to pay the physicians themselves
and their families in the island.
Contrasting with the saga of the doctors serving in
Zimbabwe, two weeks ago, Castro offered free medical
instruction to recruit and register Americans to join his
"doctor diplomacy."(5) Castro's offer was
made to "low income Americans" who were invited to study
medicine in Cuba for free and then return to the United
States to provide treatment for the poor and underserved in
what may turn into the latest twist of the "doctor
diplomacy" schemes. These events seem to be temporally
intertwined making it possible to look at them
chronologically. Let us retrace them together from the
various press releases that have appeared later. On May 26,
the first signs of defection of Drs. Cordova and Peña were
noted in Havana. During the weekend of June 3-4, Castro
offered free medical training for low income Americans to a
congressional delegation of African-American lawmakers that
were touring Cuba. At that time, the communist leader was
already attempting to divert the defection by kidnapping the
Cuban doctors, ordering them to return to Havana via Paris.4
Later, when the logistics in Zimbabwe and South Africa
became known through a note written by the defecting doctors
and the press coverage, perhaps Castro attempted to divert
negative public opinion on his "doctor diplomacy" by
offering free medical training to Americans.
Castro made the free training offer without consulting the
proper authorities in his own MINSAP. He just commented to
the press on this "offer that could not be refused" after
Democrat Rep. Bennie Thompson told him that his Mississippi
Delta congressional district has an infant mortality rate
much higher than that of Cuba. According to the Associated
Press, Castro stated: "It would be hard for your government
to oppose such a program. It would be a trial for them.
Morally, how could they refuse?"(5)
We feel compelled to reject the offer made by Fidel Castro.
His is an offer of malicious distraction, and a
propagandistic attempt to improve on the perception of the
health standards and achievement claims of his Revolution.(6)
Castro has used these claims to justify all aspects of his
41 year rule by a single party and a single individual ---
himself.
Our conclusion is based on facts that can be described and
analyzed. The first consideration in assessing the offer by
Fidel Castro for free medical training is that medicine is
in reality a social science that uses the methods of the
natural sciences to attain four goals: to promote health, to
restore health, to prevent disease, and to rehabilitate the
patient.(7) The practice of medicine is
therefore carried out in a social order that cannot be
improvised, invented or assumed to be totally controlled or
controllable --- unless, of course, one practices medicine
in a totalitarian society. While it is no secret that
Castro's Cuba is a totalitarian society ruled by a
tyrannical leader for the past 41 years, the people of the
United States and of Mississippi in particular must not be
intimidated into accepting an "offer that could not be
refused." Castro's offer can and must be refused on further
grounds. While Castro pointed out that Cuba has an infant
mortality rate of 7.3 deaths per 1000 live births,* he did
not disclose that the mortality of children in Cuba in the
age group from 1 to 4 years is 11.8. This latter figure is
34 percent higher than the equivalent health statistic for
the United States, despite the fact that Cuba has the most
comprehensively organized health service in the Americas.
These official data from the Pan American Health
Organization (8) and our analysis suggest
that Castro has organized the MINSAP services with one goal
in mind: to lower the infant mortality rate without
effective consideration to other important health
parameters.
The importance of infant mortality is that it correlates
with the overall health, education, nutrition, standard of
living and well-being of the population. In Cuba's case,
this is not true. Cuban health services are organized and
structured so that the resources, support, and services are
directed to reach the facilities that must maintain a lower
infant mortality (death from the time of birth to 12.0
months). Therefore, in Castro's Cuba, life support may be
artificially instituted and continued on an individual
infant or a community to achieve a numerical goal in the
infant mortality of a particular health sector or region.
This is done without consideration to other health services
that are rationed, denied, simply ignored, or blamed on the
CIA, obscure reasons or the improperly called American
embargo. While these excuses are made part of the
propaganda, fundamental health issues such as the provision
of the elements for public hygiene are not prioritized.
Instead, priorities are given to the desired goals of the
MINSAP, a lower infant mortality with bonuses and favors for
those physicians and units that reach their goals.
Therefore, infant mortality data in Cuba since the 1970s
reflect the organization of the health services and the
compliance of the health care personnel in terms of the
promulgated and designated goals promulgated by the
totalitarian State. Infant mortality in Cuba cannot be a
measure of the well-being and the standard of living of the
population under these circumstances.
The issues on infant mortality must be developed further.
The following brief analysis will demonstrate the lack of
seriousness in Castro's infant mortality propaganda.
Consider, for example, a health parameter linked to infant
mortality, maternal mortality. The maternal mortality of
Cuba in the last three years has been 26 to 33 deaths per
100,000 live births. This health statistic is not low
despite the fact that Cuba has the lowest birth rate in
Latin America (12.5 births per 1000 population). Cuba's
maternal mortality figure is in fact 4 to 5 times greater
than the equivalent parameter for the United States (8.4).
Furthermore, Castro's comments to the African-American
lawmakers alluded to the health status of Mississippi, a
State with an infant mortality of 10.2 but a maternal
mortality of 9.3.(9) It is well recognized
that mortality statistics do not depend solely on medical
care. Issues such as nutrition, education and communication
are considered important in achieving truly significant
health statistics. Therefore, unless Castro is planning to
take over the economy, the schools, the agriculture, and the
communications of Mississippi, how can he offer to lower
this important health statistic through his "doctor
diplomacy?"
Physicians who take their undergraduate training in a
foreign country outside the regulations of the American
Association of Medical Colleges are required to apply to the
Educational Commission for Foreign Medical Graduates (ECFMG).
This is a regulation that applies to all individuals,
foreign born or nationals, who have completed a course
equivalent to that of an American medical school. The ECFMG
has supervised and controlled the influx of foreign medical
graduates (FMG) since its inception in the late 1950s. At
this point in time, FMG's sit for the same exams offered to
American medical students and graduates but the passing
scores are not identical for each of these groups. The
passing score of FMG's is set, among several considerations,
on the number of physicians that may be desired in the U.S.
for immigration purposes. Where will the graduates of this
new posture of Castro's "doctor diplomacy" fit in any of
these regulatory measures? It is true that Cuban FMG's have
in general passed the required examinations in about 25
percent of the cases in their first attempt.(10)
But even if the graduates from Castro's "doctor diplomacy"
do go through the arduous passages reserved for FMG's, how
are the imprints of communist social indoctrination going to
fit into the training programs offered in the U.S.? Or how
are the working habits, values, and merits for promotion
free of political alignment or ideology going to adapt to
American institutions? Some have argued that medicine under
Castro in Cuba has been inappropriately contaminated with
militarism, politics, specific guidelines and schemes for
the management and treatment of all commonly seen illnesses,
and directives on what can and cannot be written into a
death certificate.
Finally, medical education is known to be easily adapted
to fit one or another system of indoctrination using
biological or social principles.(11)
Therefore, during the so-called free medical education
offered by Castro, one could easily expect that students
will be subjected to the systematic indoctrination that goes
on in Cuban medical education under Castro. Cuban medical
indoctrination has been applied to Cubans and Latin
Americans enrolled in medical schools in the island since
the early 1960s.(12)
The indoctrination begins with the premise that the
physician owes to society and the Castro regime their
medical education. It continues in terms that the physician
must become a communist and he or she must pledge to improve
his or her skills as a communist in parallel to his or her
skills as a physician. Finally, the graduate swears to be
like Che Guevara.(12) Although this last
goal of Castro's medical education may provide a new fashion
to European designers, the fact remains that violent
revolution, destruction, and death were all part and parcel
of the preachings and deeds of the communist martyr of
Cochabamba.
While Castro told the black lawmakers that he supports their
efforts to issue him credits despite the dismal status of
his bankrupt economy; the bearded, legendary communist
leader failed to discuss with the African-American lawmakers
the current issues dealing with physicians in the island.
Castro did not address anything regarding the situation of
Dr. Oscar Elias Biscet, prisoner of conscience. Castro never
mentioned his handling of the Colegio Médico Independiente
during the destruction of Concilio Cubano in 1996.(13)
Moreover, since 1999, Cuban physicians have not been able to
leave Cuba with proper documentation and permits according
to the MINSAP regulation Number 54.14 According to this
regulation, medical doctors and dentists must serve 3 to 5
years in designated areas in the island of Cuba before they
are considered for a permission to leave the island. In this
manner, Cuban physicians are blatantly discriminated and
made to suffer higher penalties than the rest of the
professionals.
Castro also failed to recall the stories of Dr. Desy Rivero(15)
and Omar del Pozo Marrero,(16) both
physicians who were unjustly jailed and later forcefully
exiled from Cuba for reasons that perhaps Castro alone would
have been able to explain to the press and the American
lawmakers. And, it goes without saying that Castro failed to
disclose to the lawmakers and the press those sensitive
negotiations that he was carrying out with Zimbabwe's
dictator-president, Robert Mugabe. The nature of those
negotiations on the defection and fate of the Cuban
physicians may have enlightened the lawmakers from their
financial, human rights, and political perspectives.
Conclusions and Summary
In summary, Castro's "doctor diplomacy" involves utilizing
Cuban physicians to serve in areas where the Cuban regime
has entered into contractual relationships with the
expressed intention of providing health care aid and
establishing or nourishing diplomatic relations with the
host community. The physicians serving in these units are
essentially under surveillance all the time and any change
in their plans not consistent with the orders given from
Havana invariably lead to the involvement of police or
paramilitary security forces. In the recent desertion of Dr.
Cordova and Dr. Peña from southern Africa, the news media
got involved in the saga about one week after its onset.
This led to massive media attention and the eventual
agreement between Castro and Mugabe to "let the doctors go."
The terms or consequences have not been disclosed.
Financially, "doctor diplomacy" is an outstanding source of
income for Castro's economy since his MINSAP pays doctors
and other personnel only a small fraction of the millions of
dollars that are received by Cuba. Regarding the alluded
health statistics for Mississippi, the offer of Castro to
train for free low-income Americans must be refused because
his "claims on health achievements" are based on propaganda
that are not indicative of health, well-being, or adequate
standards of living in Cuba. We must reject the fact that
these young American students will undergo an aggressive
brainwashing and indoctrinating process through which they
will become Castro's pawns. They will inevitably take to
Castro the much desired influx of dollars that he needs to
remain in power. Finally, the specific claim of Castro that
he can lower the infant mortality rate in Mississippi
implies a future control by Castro of health care, finances,
education, nutrition, and communications in that State.
Obviously, such claims must be denounced as delusional and
their malicious implications rejected.
Castro's offer of free medical training to serve the poor
and underserved can and must be refused. First and foremost,
it must be refused because there is no need to turn
Mississippi or any State or region of the United States into
another Cuba. Second, there is no need for hundreds of young
Americans to turn into Che Guevaras, who will then come into
the United States to preach and practice death, hate, and
oppression of individual and collective rights and
liberties. Furthermore, there is no need to adopt the
propaganda in "Castro's revolution health achievements"
without recognizing their hidden liabilities: widespread
alcoholism, sociopathic behavior, low birth weights, endemic
giardiasis, growing incidence of hepatitis E infection,
widespread venereal diseases, very high abortion rates, high
maternal mortality, double to triple the deaths from
unintentional injuries and accidents. Finally, there is no
need to guide the wholesome medical vocations of young
people in the United States from any race, creed,
nationality or income bracket to become physicians in Cuba.
Castro's is a society that will likely turn them into
revolutionaries looking for some "Mission Impossible" scheme
in order to establish an elusive, egalitarian, socialist
worker's paradise that has never existed. Instead, it has
forged chains on the people and a Hell on Earth wherever it
has been established.
Footnote
* This figure is highly open to question and does not agree
with U.S. government figures as published elsewhere. For
example, I suspect "live" is subject to Fidel Castro's
interpretation. See Tom Carter, "Cuba was 'advanced' before
Castro took over, report says." The Washington Times, March
29, 1998, p. 23. It cited an infant mortality figure of 12
per 1000 live births, according to Cuban government figures.
References
1. Cuba sells snake oil to visiting
congressmen. Miami Herald, June 6, 2000, p. 6B.
2. Gaither C, Marques-García S.
Castro maneuvers to bar doctors' defection to U.S. Miami
Herald, June 11, 2000.
3. Miranda OC. Recursos humanos en
salud de Cuba. Educ. Med. Salud. 1986;20(3):375-381.
4. Gaither C. Diserción en Zimbabwe
empaña la "diplomacia médica" de Castro. El Nuevo Herald,
June, 12, 2000.
5. Shepard P. Castro to offer medical
training. Associated Press, June 4, 2000.
6. Breo D. In socialist Cuba,
primary care now reaches rural areas. American Medical News,
July 25, 1977, pp. 11-13.
7. Martí-Ibañez F. To be a doctor.
Miami Medicine, November 1987, pp. 27-29.
8. Health situation in the Americas.
Pan American Health Organization. Basic Health Indicators
1999. PAHO/99.01, Washington, DC.
9. Personal communication with Dr.
Thompson, Head of the Mississippi Health Department
contacted by telephone.
10. Seywell RM, Studnick J, Bean JA,
Ludke R. A performance comparison: USMG-FMG house staff
physicians. Amer. Journal Public Health 1980;70(1):23-28.
11. Stetten D. The medical school
curriculum: the indoctrination of the medical student. Bull.
New York Acad. Med. 1973;49(4):285-288.
12. Gordon AM. Medicine in Cuba.
Lancet 1983, October 29; 2 (8357):1026.
13. Amnesty International. Cuba:
government crackdown on dissent. April 1996. AI Index: AMR
25/14/96.
14. El gobierno Cubano pone trabas
a los viajes de médicos y dentistas. El Nuevo Herald,
September 13, 1999.|
15. Cuba: doctors imprisoned.
Lancet 1998;351:439-440.
16. Gordon AM. Omar del Pozo
Marrero, physician prisoner of conscience. Lancet 1995.
August 19; 346 (8973):509.
The following physicians were interviewed and collaborated
for this paper were: Virgilio Beato-Núñez, M.D.; Enrique
Cantón, M.D.; Gladys Cárdenas, D.O.; José Carro, M.D.;
Alberto Fibla, M.D.; Sergio González-Arias, M.D.; Eduardo
Martínez, M.D.; Manuel Peñalver, M.D.; Juan C. Pérez-Espinosa,
D.O.; E. Ricardo Puig, M.D.; Joel Silverman, D.O. Finlay
Medical Society, P.O. Box 523096, Miami, FL 33152,
http://www.finlay-online.com.
Originally written for the Finlay Medical Society. Allowed
to be published in the Medical Sentinel 2000;5(5):163-166.
