Category Archives: Humanitarianism

A  Model for Healthcare Reform from a Surprising Place

The issue of healthcare reform is one that is consistently identified by opinion polls as being among the most important to Americans. The United States continues to be the only fully industrialized nation that lacks a public healthcare system, a feature of modern “democracy” that is taken for granted in most developed countries. Most American proponents of healthcare reform typically cite the models utilized by Canada, Western Europe, or Australia as the most appropriate guides for the implementation of universal healthcare in the United States. However, Don Fitz, a Green Party activist, provides a comprehensive overview of a model for reform that originates from what many would consider to be a surprising place. Cuba is widely regarded by Americans as an impoverished “Third World” nation. Yet, Fitz’s Cuban Health Care: The Ongoing Revolution describes how Cuba’s approach to healthcare during the six decades since the 1959 revolution has produced rather extraordinary results.

The overview of Cuban healthcare begins with an examination of the challenges that Cuba faced immediately following the revolution. Previously, healthcare in Cuba had been almost entirely private. After the revolution, Cuba lost approximately half of its physicians with most of these becoming émigrés to the United States in search of a more lucrative place to practice medicine. Only about three thousand Cuban physicians remained and those who stayed did so out of a commitment to their profession. The methods of funding healthcare before the revolution typically relied on either fee-for-service relationships between physicians and patients or “mutuals” that functioned as a kind of private insurance system operating on a semi-cooperative basis. The very limited healthcare that was available to the poor was mostly provided by the state.

An innovative reform that was implemented following the revolution involved the creation of “polyclinics” organized on the basis of a structural framework described as “centralization/decentralization.” Under this model, small teams of healthcare professionals were assigned to serve individual communities, with each healthcare team having a collection of families under their care, usually numbering in the range of 120 to 150 family groupings, with the families including 600 to 800 persons. Clinicians would often visit patients at home. The polyclinics functioned within a centralized meta-level framework that was based on a single system of healthcare provision. The individual teams providing healthcare to particular communities were the decentralized component of the system. It was not the provision of health care that indicate decentralization but rather the ability to decide how to do it locally.

Over time, Cuban healthcare practices experienced a series of innovations. The initial community-based polyclinics eventually evolved into a system of family doctors that were able to provide personalized care in a way that included the cultivation of physician-patient and physician-community relationships. The achievements of Cuba in the area of healthcare are particularly astounding when it is considered that Cuba is an island nation with approximately the same population size as New York City. Clearly, the Cubans have been highly capable of successfully managing their own affairs in spite of the hardships the country has faced in the post-revolutionary era. The obstacles faced by Cuba have largely been due to the hostility of the United States and the Americans’ persistent attempts to undermine the achievements of the Cuban revolution.

An important aspect of Cuban healthcare has been the role of Cuba’s military doctors in providing health services to insurgent movements in Africa, a process that began when Cuba began offering support to anti-colonial resistance forces on the African continent in the 1960s. Cuban physicians involved in Africa often traveled clandestinely in order to avoid detection by Western intelligence services or those of colonial and neo-colonial governments on the continent. African resistance leaders often preferred that Cuba send black doctors so that the Cuban physicians would more easily blend in with the local population. The role of Cuban doctors in establishing healthcare services in impoverished African nations such as Angola, which was involved in an intense anti-imperialist struggle in the 1970s and 1980s, attests to the quality of the Cuban healthcare system and its exportability to other nations. Cuba faced a predictable crisis after the fall of the Soviet Union, which occurred during a time when the AIDS crisis was also presenting challenges to Cuba’s healthcare system.  Cuba responded to the economic crisis of the post-Cold War era through the implementation of changes reminiscent of those adopted by Lenin during the period of the New Economic Policy.

Aside from the interesting overview of the history of post-revolutionary Cuban healthcare provided by Fitz, the discussion of medical education in Cuba is also quite fascinating. Fitz’s examination of Cuban medical training is based in part on his daughter’s experience as a student at the ELAM, or Latin American School of Medicine. ELAM was established by the Cubans and provides opportunity for students from around the world to study medicine on the condition that ELAM graduates serve as healthcare workers in an underserved part of the world upon the completion of their studies. Such a concept could theoretically be transplanted to the US where the medical education of students could be publicly funded in return for medical service in underserved communities.

Fitz provides an interesting profile of 13 students attending ELAM and their activities, including the participation of ELAM students in disaster relief activities such as the Haitian earthquake of 2010. During the first two decades of the 21st century, Cuban healthcare has continued to face a range of challenges. For example, dengue fever and mosquito-borne illnesses are common to Cuba’s tropical environment. Fitz describes the efforts of Mariela Castro, daughter of Fidel’s brother Raul to challenge discrimination against women, gender, and sexual minorities in Cuba. He likewise describes his own participation in Cuba’s March Against Homophobia in 2012. Post-revolutionary Cuba has a regrettable history of discrimination and repression directed toward sexual preference which the nation has fortunately made bold efforts to overcome in more recent years. Cuba has continued to provide much needed assistance to African nations in response to challenges such as the Ebola crisis in West Africa in 2014.

Clearly, Cuba’s achievements in the development of its healthcare system in the decades since the revolution have been remarkable. Fitz’s discussion of these achievements is not only thorough but well-documented from appropriately cited source material. The analysis of Cuban healthcare that Fitz provides is based on a synthesis of both scholarly research drawing from the relevant literature, including both English language and Spanish language sources, and the experiential research of Fitz and members of his family. If nothing else, Cuban Health Care: The Ongoing Revolution is an excellent representation of mixed method scholarship which includes painstaking documentation of the claims being made concerning the accomplishments of Cuban healthcare. Perhaps the most compelling aspect of the book is the statistical data that Fitz provides for the purpose of supporting his claims.

Astonishingly, Cuba has in recent decades managed to outperform the United States in a range of critical areas pertaining to general public health. As of the early 2000s, 45% of Cuban physicians were family doctors living in the same neighborhoods as their patients. The typical patient wait time at a clinic was 15 minutes. In the year 2000, Cuba’s infant mortality rate was 6.3 per 100,000 births compared with 7.1 for the United States. By the year 2017, infant mortality in Cuba had dropped to 4.1 per 100,000 births as opposed to 5.7 for the United States. Cuba has made comparable progress regarding life expectancy. In 1960, shortly after the revolution, Cuba’s average life expectancy was 64.2 years compared to 69. 8 years in the United States. By 2016, Cuba had slightly passed the United States with an average life expectancy of 79 years compared to 78.5 years for the United States.

A reasonable standard with which a society’s healthcare system can be evaluated is the combination of infant mortality rates and life expectancy that is experienced. One of the great achievements of modern civilization is the dramatic increase in life expectancy. During the height of its empire, ancient Rome’s life expectancy was only 48 years. In many historic societies, life expectancy was only in the range of 30 years. Low life expectancy rates were partially rooted in high rates of infant mortality and deaths from childhood diseases. In many families, a third to a half of the children would not survive until adulthood. Indeed, it was during the era of rising living standards at the dawn of modernity that the status of children began to increase dramatically with practices such as infanticide, child slavery, and child labor experiencing a significant decline.

Within the context of American political discourse, American healthcare is often touted as being “the best in the world” as opposed to supposedly backward nations of the Global South or “socialist” countries supposedly hampered by the ills of bureaucratization and inefficiency. However, Don Fitz describes how Cuba has been able to provide higher quality healthcare to its citizens than the United States in spite of the fact that Cuba spends only 4 to 5 percent per individual on healthcare compared to the United States. Indeed, some of the voluminous facts that Fitz provides would be comical if they were not so tragic. For example, an average hospital stay in Cuba costs $5.49 per day as opposed to $1,944 in the United States. It has been widely documented that medical bankruptcy is the leading cause of bankruptcy in the US. Fitz manages to marshal a vast range of evidence in support of his thesis that US healthcare is largely an elaborate corporate-perpetrated scam that frequently pales in comparison to Cuban healthcare, which often produces superior results at a tiny fraction of the costs.

The post A  Model for Healthcare Reform from a Surprising Place first appeared on Dissident Voice.

What Can We Learn from Cuba? Medicare-for-All Is a Beginning, Not the End Point

As a coup de grâce to the Bernie Sanders campaign Joe Biden declared that he would veto Medicare-for-All.  This could drive a dedicated health care advocate to relentlessly pursue Med-4-All as a final goal.  However, it is not the final goal. It should be the first step in a complete transformation of medicine which includes combining community medicine with natural medicine and health-care-for-the-world.

Contrasting Cuban changes in medicine during the last 60 years with the US non-system of medical care gives a clear picture of why changes must be all-encompassing.  The concept of Medicare-for-All is deeply intertwined with attacks on Cuba’s global medical “missions” and the opposite responses to Covid-19 in the two countries.

Going Forward or Going Backward?

Immediately after the 1959 revolution Cubans began the task of spreading medical care to those without it.  This included a flurry of building medical clinics and sending doctors to poor parts of cities and to rural areas, both of which were predominantly black.

As the revolution spread medicine from cities to the country, it realized the need to expand medical care across the world.  This included both sending medical staff overseas and bringing others to Cuba for treatment.  Cuba spent 30 years redesigning its health care system, which resulted in the most comprehensive community-based medicine in the world.

Throughout the expansion of health care, both inside the country and internationally, Cuban doctors used “allopathic” medicine (based largely on drugging and cutting, which is the focus of US medical schools).  But they simultaneously incorporated traditional healing and preventive medicine as well as respecting practices of other cultures.

Today, the most critical parts of the Cuban health care system include (1) everyone receives health care as a human right, (2) all parts are fully integrated into a single whole which can quickly respond to crises, (3) everyone in the country has input into the system so that it enjoys their collective experiences and (4) health care is global.

In contrast, the call for Medicare-for-All by the left in Democratic Party is a demand for Allopathy-for-US-Citizens.  It would extend corporate-driven health care, but with no fundamental change towards holistic and community medicine.  Though a necessary beginning, it is a conservative demand which does not recognize that a failure to go forward will inevitably result in market forces pushing health care backward.

There is already a right-wing effort to destroy Medicare and Medicaid in any form and leave people to only receive medical treatment they can pay for.  It is part of the same movement to destroy the US Post Office and eliminate Social Security.  It is funded by the same sources trying to get rid of public education except for a few schools that will prepare the poor to go to prison or be unemployed.  These are neoliberals who believe that Black-Lives-Do-Not-Really-Matter.  They hate all the gains won during the last century-and-a-half and want to overturn any form of environmental protection, any workers’ rights, the eight-hour work day, child labor laws, and civil rights, including voting rights.

Destroying Health Care Advances of the Cuban Revolution

What does the Cuban health care have to do with Medicare-for-All in the US?  Cuba has a lower infant mortality rate and longer life expectancy than the US while spending less than 10% per person annually on health care.  It has provided medical education to so many from other countries that in 1999 it opened the Latin American School of Medicine to bring students from impoverished countries to study and become doctors.  By 2020 it had trained over 30,000 doctors.  It had also trained huge numbers of other health professionals from beyond its shores.

Even before Cuba brought in students, it sent its own professionals on “missions” to help those in other countries.  Over the past six decades more than 400,000 Cuban medical professionals have worked in 164 countries and improved the lives of hundreds of millions of people.

The US response to this incredible international medical revolution documents that it is not satisfied to stop medical care from improving but has an irresistable urge to reverse gains across the globe.  The US government glommed onto complaints from physicians in multipe countries who whined because Cuban doctors would go to jungles and other dangerous areas where the rich urban doctors refused to venture.  Of course, the US had its own reasons to despise Cuban medical assistance.

Cuba has long done humanitarian work in education as well as medicine which puts its northerm behemoth to shame.  Its actions expose that health care can be done vastly cheaper with better outcomes than corportate medicine, which traumatizes financiers of the sickness industry.

Republicans and Democrats are firmly united with corporate media in hiding Cuban medical accomplishments from the US population.  They defnitely do not want other poor countries to replicate Cuba’s system.  Horrifed at the prospect that Cuban health care would shine as an example, the US went to work to undermine and destroy Cuban medical internationalism in any way it could.

In August 2006 the George W. Bush administration began the “Cuban Medical Professional Parole” program to encourage Cuban medical staff on international missions to desert and move to the US, with no questions asked. Only 2-3% did so; but their departure left those poor countries with less care.

This is in line with any corporate goals to destroy local health care and replace it with profit-based health care across the globe.  Driven by the same market factors that compel extraction, transportation and food production industries to go international, the US sickness industry likely feels the urge to create and control a global market of “health care providers.”  One of its main obstacles will be community health systems, which actually work much better for poor people.

As the knowledge of the success of Cuba’s medical information spread, its detractors flew into a frenzy and clutched onto wild hallucinations.  As accurately explained by Vijay Prashad, they fantasized that Cuba was engaging in “human trafficking” by forcing its doctors to work internationally.  The accusation is blatantly absurd since Cuban doctors always have the choice of whether to broaden their medical knowledge by going abroad and treating diseases that have been eradicated in Cuba or to stay at home.

It is true that its doctors have incredibly low wages (as do all working people in Cuba) due to the destructive effects of the US embargo.  In one of the great ironies of propaganda machines, the US seeks to criminalize Cuba in the eyes of the world by screeching that medical wages are low while itself being the cause of meager pay.

Results of this attacking Cuba during Covid-19 have been murderous.  After Lenín Moreno became president of Ecuador in 2017 he abruptly veered from what he promised and ordered Cuban doctors to leave.  At the same time Venezuela and Cuba had a total of 27 Covid-19 deaths, Ecuador’s largest city, Guayaquil, had an estimated death toll of 7,600.  Similarly, when the neoliberal Jair Bolsonaro took power in Brazil in 2019, he threw out Cuban doctors.  This left the country with rising infant mortality and so unprepared for Covid that even inviting them back was unable to undo the damage.  Following the 2019 anti-democratic coup in Bolivia, the ultra right-wing Jeanine Áñez had herself anointed as president and expelled Cuban doctors, which devastated that country’s health care system.  Although Bolivia is a physically isolated country with a population of only 8.7 million it had 2200 deaths by June 2020.

Who Coped with Covid-19?

The fact that Cuba had gone far, far beyond Medicare-for-All is what allowed it to have such spectacular control over Covid.  Its politicians unified behind the ministry of health which developed a national strategy.  That strategy was in effect before the island’s first victim had succumbed to the disease.  Social distancing, masks and contact tracing were universally accepted.  According to Susana Hurlich, medical students went door-to-door collecting data, distributing homeopathic medication (PrevengHo-Vir), and, most important, finding out what problems people needed help with.

Neighborhood doctors collected data to send to polyclinics and helped make certain that residents’ medical and other needs were met.  Clinic staff met needs that neighborhood doctors could not provide and sent patients they could not care for to hospitals.  Hospital doctors slept at hospitals for 14 day shifts before being quarantined for another 14 days so they would not infect their families or communities.

On July 18, deaths from Covid-19 numbered 140,300 in the US and 87 in Cuba.   Though its population is only 30 times that of Cuba, the US had 1,612 times as many deaths.

As US politicians conspired with corporations to see how much profit could be made from the pandemic, Cuban health care went international.  When northern Italy became the epicenter of Covid-19 cases, one of its hardest hit cities was Crema. On March 26, 2020 Cuba sent 52 doctors and nurses. A smaller and poorer Caribbean nation was one of the few aiding a major European power.

On March 12, 2020 nearly 50 crew members and passengers on the British cruise ship Braemar either had Covid-19 or were showing symptoms as the ship approached the Bahamas, a British Commonwealth nation. During the next five days, the US, the Bahamas, and several other Caribbean countries turned it away.  On March 18, Cuba became the only country to allow the Braemar’s over 1000 crew members and passengers to dock.

The incidents of Crema and the Braemar were hardly without precedent.  They resulted from 60 years of medical internationalism by Cuba.  Just as Cuba’s actions during Covid-19 reflected its development, so the horrible expansion of the disease in the US, Brazil and India showed the lack of concern under reactionary rule.

Capitalism has exterminated hundreds of millions, if not billions, of people in order to consolidate growth and power.  Whether enslaving Africans, or slaughtering native Americans to steal land, or experimenting with nuclear bombs during WWII, or destroying health systems that would prevent mass death during a pandemic, these are merely “costs of doing business” to capitalism.  Driving native peoples off of land is not unique to US in the past, but continues today throughout Latin America, Africa, Asia and the Pacific Islands.

Trump has terribly bungled coping with Covid-19, but the approach of Democrats is not essentially different.  Neither corporate party has any intention of providing Cuban-type care within the US. And they certainly do not even imagine putting protection of the world’s poor from Covid above profit potentials for US corporations.  They never had any intention of telling US public that 72 countries had requested Cuba’s Interferon Alpha 2B for treating Covid-19.  They wanted people to believe that only an American or European country could discover treatment.

Is Thinking Beyond Medicare-for-All Part of the Real World?

Is the idea of a radical health care transformation even worth talking about as right-wingers seem to be on the move across much of the world?  Let’s remember our past.  During the time the reactionary Richard Nixon was president (1969-1974), despite an overwhelming pro-war victory, the following were accomplished under his reign: declaration of an end to the Vietnam War, start of the Food Stamp program, decriminalization of abortion, recognition of China, creation of Environmental Protection Agency, passage of Freedom of Information Act, formal dismantling of FBI’s COINTEL program, creation of Earned Income Tax Credits, formal ban on biological weapons, and passage of the Clean Water Act.

We have never won as many gains since then, even when there was a Democratic House, Senate and president.  The essential difference between then and now was the existence of mass movements.  Perhaps it is the time for today’s movements to ask if a fair and just payment of reparations by the US and western Europe for the pain and suffering they have caused throughout the world should include providing medical care for those billions of people who Cuba cannot afford to help.  Health care is not genuine health care if it fails to be health-care-for-the-world.

Cuba: From the Moncada to the Front Lines of the Pandemic

Santiago de Cuba. Photo: Bill Hackwell

Today Cuba celebrates the 67th anniversary of the assault on the Moncada and Carlos Manuel de Céspedes barracks that mark the beginning of the Cuban Revolution. From this beginning, Cuba’s altruistic view of making the world safer and healthier began.

It has developed into a society that gives everything it has without expecting credit. There are hundreds of examples of this; for instance, what took place in 1986, after the nuclear catastrophe of Chernobyl, when blockaded Cuba took in over 20,000 young cancer victims and their family members from 1989 to 2011 providing medical care, schooling, clothing, food, accommodation, playgrounds – all free of charge.

Another story worth remembering is one of forgiveness in 2007 when Mario Terán, the Bolivian sergeant who murdered Che Guevara on October 9, 1967, was operated on for free by Cuban doctors who restored his vision in a hospital donated by the Cuban government to Bolivia and inaugurated by President Evo Morales in the city of Santa Cruz de la Sierra.

And now Cuba is on the world stage in the midst of this dangerous global Pandemic and Cuba is continuing to save lives, while the US government and its media, instead of being constructive in the battle, have intensified the campaign to discredit Cuba’s collaboration. The misinformation is not surprising from a country whose president’s main vocation is preaching an endless stream of lies.

Even Trump’s faithful followers must be starting to see that there is a contradiction in how the richest country in the world has not been able to put any brake on the virus, is accumulating the highest number of infections and deaths, with no end in sight, while attacking Cuba, a nation that not only has been able to control the pandemic but has extended their full solidarity to other nations.

Why the Trump administration puts priority on discrediting Cuba’s international missions abroad that save lives instead of focusing on the social and human cost in the US is mindboggling and criminal. Trump, his anti-Cuba friends in Florida, and the mainstream media are mixing up a concoction of ignorance with malicious intention, never mentioning that Cuba has flattened the curve of the virus and has had only one death in three weeks.

All the empty words we hear about the Cuban Medical Brigades going to other countries being forced labor is not only without proof but fails to explain why there are many more medical professionals who volunteer to go than openings. Furthermore, the White House, the State Department, and the media fail to mention one word about the 60-year-old US blockade and its impact against the island that causes unnecessary suffering for the Cuban people. As we have become accustomed, the Trump Administration likes to throw things at the wall to see what sticks.

A few days ago, Kenneth Roth, the executive director of Human Rights Watch, an organization with a long history of parroting the official line of the US,  jumped on the bandwagon with a tweet, “Cuban doctors deployed abroad offer valuable service but at the expense of their freedoms”. At least Mr. Roth admitted that Cuban doctors offered valuable services but Roth offered no proof about what he meant. He continues, “They can be disciplined for being friends w/ people who hold hostile or contrary views to the Cuban revolution and face prosecution if they “abandon” their jobs. This is the Executive Director of an international so-called human rights organization talking with no examples.

Cuba, with a little more than 11 million people, has more than 95,000 doctors, 9 for every 1,000 inhabitants, and more than 85,000 nurses that are part of the 492,000 Cuban health professionals according to the latest Statistical Yearbook at the beginning of 2019.

According to the Pan American Health Organization (PAHO), the first brigade of Cuba health professionals to provide services abroad was in Algeria in 1963. Since then, more than 400,000 professionals have served in 164 countries in Latin America and the Caribbean, Africa, the Middle East, Asia, and even Portugal.

These services, popularly known as “medical missions,” include sending health professionals to countries that officially request them from the Cuban government. And those who go do so voluntarily because they are part of a society that puts human lives at the center. They leave their families behind for a just cause but they also know that the Cuban government will take care of them.

Cuba is so respected around the world that recently eight Cuban Scientists were chosen as Advisors for the World Struggle against COVID-19 as part of an Inter-Academy Panel (IAP). In 2000, the IAP founded the Inter-Academy Council (IAC) and the Inter-Academy Medical Panel (IAMP).  Currently, membership includes 140 national and regional Academies of Science, including all branches of science, engineering, and medicine from around the world.

Despite the slander, Cuba continues to extend its solidarity with great pride. Currently, there are three thousand members of the Henry Reeve medical brigades (designed to fight pandemics and natural disasters) who are on the front lines of the pandemic in 37 countries with 43 brigades.

But the attacks never quit.  On May 8, 2020, the U.S. Agency for International Development (USAID) added another $2 million to undermine the work of the brigades and a month later, head Cuba hater Marco Rubio joined other Republican Senators and presented a bill to “punish” countries that sign agreements with the Cuban government to receive this support. Rubio’s credibility has been suspect ever since he was caught in his own lies by claiming his parents ‘came to America following Fidel Castro’s takeover’ of Cuba when, in fact, they came to the US in 1956, three years before the revolution during the repression of the US-backed Bautista regime.

One would think that government officials in Florida like Rubio would be focused on containing COVID-19 in their state that has become an epicenter of infection rates and deaths instead of being fixated on tarnishing the success that Cuba is having in beating back the pandemic.

Some of the medical personnel are now returning to Cuba from their missions and have been telling their experiences in their own words to the people through video conferencing, welcomed by President Miguel Diaz Canel.

Dr. Edelsy Delgado, an Intensive Care specialist from the Gustavo Aldereguía Hospital in Cienfuegos, kept a journal during the three months he spent in Andorra. He said upon his return “Believe me, we represented Cuba at the highest level.”

Leidisbet Lopez Cantero, a nurse from Camaguey, was the flag-bearer who couldn’t hold back her tears when she got off the airplane that brought her to Havana and saw her mother and son speaking of her in the welcoming video.

Dr Michael Cabrera Laza, head of the group of five distinguished consultants in Nicaragua, was deeply moved as he spoke of traveling through all 17 regions of Nicaragua, and finding in absolutely all of them the marks left by some Cuban doctor or teacher or the presence of some community leader trained in Cuba. “And in every action that we carried out, Fidel was there.”

Nurses Francisco Gonzalez Prada of Sancti Spiritus, Liliana Martinez of Holguin, and Aldo Moreira of Camaguey, who were all part of the Antigua and Barbuda brigade testified about their own feelings when they saw the positive changes in how their patients felt when they found out they were being cared for by Cubans. “I didn’t make a mistake; I am right where I should be.”

Cuba is right where it should be without hesitation.