Cuba: Health Care

Health Care International

Havana, Cuba: I recently read an extended mash note of a book by Tracey Kidder called Mountain to Mountain about Dr. Paul Farmer, a unique public health doctor with a practice in the central plains of Haiti, Peru, and Boston, who with others founded something called Partners in Health – Socios en Salud ( Besides the fact that Farmer clearly emerged as very special and dedicated doctor, increasingly having impact on a global scale, it was also interesting, since I’m still in Havana to remember his views on the Cuban health care system.

Dr. Farmer thought Cuban represented a model, especially for the underdeveloped part of the world, for how a very poor country could build an excellent universal health care system. He found the doctors extremely well trained and committed. A doctor is not the specialized and well paid modern priest that we know from the American culture, but a modestly paid professional like a teacher or mechanic with great value in the society, but very much a part of it. Cuban in fact almost produces a surplus of doctors, and they do not produce a surplus of much else other than perhaps sugar, so they are generous in loaning doctors to neighboring countries to assist in improving the health systems there as well.

I thought of all of this as I heard a woman from the Vancouver park system at breakfast talking about an accident at the zoo yesterday. She and another half-dozen Canadians from British Columbia were in Havana as part of a work exchange with Cuba. Their union, the giant public employees in Canada, CUPE had helped sponsor an essay contest that had given them this opportunity. She was a Recreation II in the beautiful Vancouver park system and an artist on the side. In Havana she was working at the Zoo. Somehow she had stumbled on a root and cut her foot, so she was experiencing the health system first hand.

There was a nurse almost immediately on the scene – most workplaces have health professionals assigned. There was a lot of gauze and few band aids. She also reported that she had never had so much mercurochrome applied to her body in her life. The system was extremely attentive though perhaps more crude that she might have experienced in the Canadian health system. The nurse from the hotel came into the dining area to check on her a little after seven in the morning. This was obviously a “no big deal” kind of situation, but it offered a small look at something much, much bigger.

The report from the Sugar Law Center and Debra Evenson ( detailed vaccines given routinely to the Cuban people that according to the web site of the U.S. Center for Disease Control ( do not exist for some diseases common around the world. Visitors report being on the street when the Cubans are spraying block to block to prevent the dreaded dengue fever.

There is some pride and purpose to the feeling about health as well; if one can believe the constant times officials and workers told us the story independently. Tipped employees with access to hard currency, like the taxi drivers we visited yesterday, pool their tips so that they are shared by tipped and non-tipped workers equally. In many cases they also separate a healthy percentage of the tips and turn them over to the health system to deal with problems that trump normal resources, specifically for cancer research. The taxi drivers reported to us yesterday that they had given $35000 (U.S) to try to prevent cancer in 2003.

Having organized tipped employees for years, it is remarkable enough just trying to imagine all tips being pooled!

Many in our meeting proudly reported their donation at the end of the meeting and then walked into the compound yard and lit up cigarettes, which once again indicated, ironically, the dedication to a common purpose regardless of individual decision.