According to the Castro government, in pre-revolutionary Cuba only the monied class could afford good medical care; it also has claimed that there were only 6,250 physicians in all of Cuba on the eve of the Revolution. True many people (especially in rural areas) went without medical services. According to the United Nations Statistical Yearbook, however, in 1958 Cuba had an advanced medical system that ranked third in Latin America (behind only Uruguay and Argentina), with 128 physicians and dentists per 100,000 people—the same as the Netherlands, and ahead of the United Kingdom, with 122 per 100,000 people. And Cuba’s infant mortality rate of 32 per 1,000 live births in 1957 was the lowest in Latin America and the 13th lowest in the world (today it is 28th lowest).
From the beginning, health care has assumed an inordinately prominent place in revolutionary government policies (about 12 percent of its budget). Today, 20 medical schools churn out thousands of doctors each year. In 1978, Castro predicted that Cuba would become the bulwark of third world medicine, put a doctor on every block, become a world medical power, and surpass the United States in certain health indices. In all four, he has been vindicated. Moreover, Cuban doctors are inspired by a genuine concern for the Hippocratic oath, without concern for money.
Cuba’s life expectancy of 78.3 years is behind only Chile, Costa Rica, Puerto Rico in Latin America and exceeds that of the United States (78.2); it also has one of the highest rates of centenarians per capita in the world. In 2009 Cuba’s infant mortality rate of 5.4 per 1,000 births also better that of the United States (6.3) and was almost as good as the United Kingdom’s (4.8).
The Revolution’s accomplishment is due to its emphasis on preventative medicine and community-based doctors. A near 100 percent immunization rate has ensured the total eradication of several preventable contagious diseases. For example, Cuba has the highest rate of immunization against measles in the world, says UNICEF, which uses the measles immunization rate as the most reliable barometer of a country’s commitment to bringing basic medical advances to its people.
Castro set out to train doctors en masse. According to the World Health Organization, Cuba has a doctor for every 170 residents, ahead of the United States with 1:188. (Dental care lags behind, however, with one dentist for about every 1,280 inhabitants.) The idea is for every Cuban to have his or her own doctor trained in comprehensive general medicine close by, living and working in the neighborhood, combining the duties of a family doctor and public health advocate. Every community has a casa del médico (family doctor’s home), with a clinic. Every town also has a hospital, plus a maternity home and a day-care center for the elderly, and mobile laboratories travel the country. All medical services are free.
Cuba also commands the kind of technology that most poor countries can only dream about: ultrasound for obstetricians, CAT scans for radiologists, stacks of high-tech monitors in the suites for intensive care. Cuba has performed heart transplants since 1985, heart-lung transplants since 1987, coronary bypasses, pacemaker implantations, microsurgery, and a host of other advanced surgical procedures. Even sex-change operations are provided free of charge. The Pan-American Health Organization stated that the Hospital Hermanos Almeijeiras “conducts research and uses technology at the international cutting edge in the 38 specialties in which services are rendered.” Science magazine rated the Ibero-Latin American Center for Nervous System Transplants and Regeneration as the world’s best for the treatment of Parkinson’s disease. And Cuban doctors “have turned mass production eye operations into a fine art,” says the BBC’s Michael Voss.
Cuba has also made notable leaps in advancing the field of molecular immunology. It even manufactures interferons for AIDS treatment; a meningitis vaccine first “discovered” at the Finlay Institute; even a cure for the skin disease vitiligo.
Local pharmacies are meagerly stocked; Cuban pharmaceuticals are exported to obtain foreign funds, and although pharmacies for foreigners are fully stocked, the Cuban government opts not to import pharmaceuticals for Cubans. Resources have also been shifted from primary care toward turning Cuba’s medical system into a profit-making enterprise catering to foreigners, notably in the surgical and advanced medicines fields. (Dr. Hilda Molina, founder of Havana’s International Center for Neurological Restoration, claims that “foreigners are assigned the highest priority, followed by government functionaries and their families, followed by athletes with good records of performance, then dancers, and lastly, ordinary Cuban patients.”)
Cubans also complain that the plethora of Cuban medical staff serving abroad has sapped local clinics and hospitals. In 2008, Raúl Castro announced an overhaul of the health system, reducing the number of clinics by half. Outside Havana, conditions in hospitals and clinics are often of third world standard; everywhere, medical equipment is broken. In 2009, a visit to a hospital outside Santa Clara revealed men and women sharing wards with open toilets that lacked doors.
In 2000, the U.S. rescinded restrictions preventing medicines and medical equipment manufactured in the United States or under U.S. patent from being exported to Cuba. In 2001, Cuba began purchasing millions of dollars of U.S. medical products. (Nonetheless, Fidel has consistently refused to accept Uncle Sam’s occasional offers of medical relief; in December 1999, he turned away 55,000 pounds of desperately needed U.S. medical supplies meant for pediatric hospitals.)