What Cubans have and Americans need-cradle to grave free healthcare

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•..getting doctors, nurses, and medicine to every sick Cuban demands social organization that is quite beyond the U.S. 'medicine for "Cubans are protected not only from the health of the yet-to-be born,.

While citizens of the world's richest country agonize over the problem of healthcare, the Cuban people are enjoying one of the most comprehensive systems of lifetime health maintenance in the world.

Cubans are protected, not only from the cradle to the grave, but also through those critical prenatal months which determine the health of the yet-to-be-born. The infant mortality rate is 10 per 1000 births; only slightly over the American national rate of 9.1. But the U.S. rate is misleading. In New York City, for example, 26 Black babies out of 1000 die in infancy. The healthy Cuban baby can expect to live longer than the American: 76 years compared to 75.2 in the U.S.

The comparison is all the more striking when we note that per capita income in the United States is around $15,000. In Cuba it is $800. Yet the poorest Cuban has access to the pharmaceuticals and technology that, in the United States, only wealthy Americans can afford.

Before the revolution in 1959, life expectancy in Cuba was only 58 years. Then, there were no more than 6000 doctors for 6.5 million Cubans. Seventy percent of the doctors practiced in Havana. Half of the poor never saw a doctor. There were no polio shots or other immunization procedures for those who could not pay. Malnutrition and infectious diseases were epidemic. When the Cuban revolutionaries came to power, half the doctors fled the island.

Health care is a right The first concern of the Castro leadership was the health of the people. The priority of healthcare was clearly codified in the new Constitution. It states: (1) Health care is a human right rather than a product for economic profit. Therefore, all Cubans have equal access to health services, and all services are free; (2) healthcare delivery is the responsibility of the state; (3) prevention and curative services are integrated with national and social development; and (4) the population participates in developthe grave, a total of 15,000 people, to 11 Asian and Latin American countries and 26 countries in Africa. The Cubans have built their own pharmaceutical industry, which supplies 80 percent of their basic needs, and eams hard currency by selling a surplus of some drugs overseas.

Of course, getting doctors, nurses, and medicine to every sick Cuban demands social organization that is quite beyond the U.S. "medicine for profit" system. All Cuban medical resources are controlled by the Ministry of Public Health and directed to the areas of greatest need.

The first task in the 1960s was wiping out the infectious diseases that ravage most tropical countries. Malaria, infantile tetanus, rabies, polio, and diptheria were eradicated by 1980. The incidence of malnutrition among Cuban children is now 0.1 percent. Among American children the rate is 5 percent!

To tight endemic diseases the Ministry of Health relied on hospitals and a series of large polyclinics. Each clinic was expected to care for as many as 25,000 patients. The result was long waits and complaints by citizens that doctors gave them very little attention.

While there was a shortage of doctors these problems were hard to overcome. By 1980, however, the doctor shortage had passea, and the diseases brea by centures of poverty were brought under control. It was now time to concentrate on the key to good healthprevention rather than cure.

Neighborhood clinics

determine profit' system."

A visitor from the United States described a typical clinic: "The clinic consists of a few exam rooms, a simple laboratory. ... The small office abounds with patient education material on pre-natal care, government benefits to new parents, immunization and nutrition posters, birth control, and detailed information on AIDS awareness and prevention.

"The nurse...proudly showed us her wellkept filing system which includes, not only a medical record of every patient, but information on their physical living conditions and problems in the home that might affect the patient's health.

"They also keep a file projecting several years ahead to determine their patients' needs on a regular basis... Because of this detailed system throughout the country, immunization rates are nearly 100 percent, and most preventable contagious diseases have been eliminated entirely. There were no cases of measles in Cuba in 1990, while there were 25,000 in the U.S."

All of the medical information about patients is not obtained by the three-person team alone. Residents of a neighborhood collectively participate in their own healthcare. At open meetings in the community, citizens meet with the medical staff to discuss local health problems: a chemical smell in the air, lack of fruit in the stores, or alcoholism.

At the national level, mass organizations—including the Federation of Cuban Women and the Committees for the Defense of the Revolution-send delegates to conferences to advise on the goals and priorities of the Ministry of Public Health.

The mini-clinics are not designed to be substitutes for hospitals or the care of medical specialists. Two hundred and fifty hospitals are available in provincial centers, together with ambulance service to get there. Much of the time, however, Cubans need nothing more than the preventative care that the local clinic provides.

Birth control information and devices are available, and abortions are performed upon request. Treatment of AIDS patients has been the subject of some controversy. There is no AIDS epidemic in Cuba, and the authorities are determined to prevent one. They insist that the few AIDS patients be hospitalized and treated in isolation from all other patients.

Although the best possible care is given to victims of AIDS, some observers believe such a quarantine is unnecessary, and is a burden on the patient and his or her family.

Paradoxically, some healthcare specialists who have visited Cuba question whether young Cubans are being given excessive medical attention. They point to a rural kindergarten where 200 healthy youngsters under five years old were given weekly examinations by a pediatrician. Even wealthy American parents would feel this is unnecessary for their children.

This is partly due, these critics assert, to the fact that doctors tend to dominate the healthcare system.

Nurses also suffer from doctor domination of the health care system. The wide gap between nurse and doctor makes patients feel they are getting a lesser level of care if they don't see the doctor even for a simple injection.

Medication, according to these U.S. observers, is inclined to be over-prescribed. But these are "faults" that the people of most Third World countries wish they could have in their healthcare systems!

End the U.S. embargo!

As the U.S. embargo against Cuba tightens its noose and help from the former Soviet Union disappears, over-medication is the least problem. On the contrary, shortages of drugs and the inability to buy needed medical equipment are already threatening to degrade the excellent quality of Cuban health care.

The embargo has cut off Cuba's traditional source of pharmaceuticals. The only medical supplies received from the United States in 30 years were some shiploads sent in 1962 in exchange for the counter-revolutionaries taken prisoner during the aborted Bay of Pigs invasion in 1961.

When the U.S.-supported Chamorro government took power in Nicaragua in March 1990, the peoples' healthcare network there was all but destroyed. Cubans know that will be the fate of their healthcare system if U.S. aggression against them succeeds.

The battleground against that aggression is in the United States. Americans must demand an end to the undeclared war against Cuba and the conquests of its revolution— a revolution that provides free, quality healthcare for every Cuban citizen.

Shipments of needed medicines can reach Cuba-and must be sent. For information on how you can help, contact: Global Exchange, 2141 Mission St., #202, San Francisco, CA 94110, (415) 255-7296.

The Cuban experience in public health is not only a tremendous gain for the Cuban people. It proves to the world that universal healthcare is a practical goal when the medical profiteers are pushed aside.