Introduction
Just prior to the July 26th Movement or Revolution in 1959 by forces under Fidel Castro. Since 1965, the country has been governed by the Communist Party of Cuba. Culturally, the country is part of Latin America. The country has several cultural influences, namely, the ancient aboriginal culture of the indigenous Taino and Ciboney, Spanish influences as the country was colonized by Spain, the inflows of African American slaves and a close relationship with the Soviets during the Cold War era (Skidmore and Smith, 2005). At present, the country is one of the few remaining socialist nations in the world, following the ideology of Jose Marti, Engels and Marx. Its constitution describes its Communist Party as the main foundation of the state and society (Constitution.Org, n.d.). The ideology of the socialists in this country is that the industrialized nations of the world have benefited from their relationships with developing nations in Latin America and Africa. The nature of this relationship is that it is exploitative; that the developed nations, through their exploitation of these less developed countries, have benefited and have reaped such benefits already. This short paper will look at a certain policy implemented by the leadership of Cuba and how it has affected a certain sector of society. In particular, this paper will examine the healthcare system of the country and how it has affected the poor people of the nation.
Life in Cuba Prior to the July 26th Movement
It is said that the elite class in Cuba prior to the revolution led a charmed life. They were landowners in a feudal system wherein the poor people did not own the land, but worked on it for their whole lives while earning almost nothing. The rich therefore profited from the labor of the poor peasant class. It is said that there were no democratic institutions that provided services to the poor. The rich were used to an “American lifestyle”, having been able to possess the material items of the day – they had the latest model vehicles, and also were able to taste hot dogs, steak and all the other American niceties. Most of the population, however, belonged to the poor. They were called “guajiros”, and they lived in small one-room huts with earthen floors and thatched roofs called “bohios”. They did not have power, and used only kerosene lamps for illumination. Almost half of the peasants and the rural poor did not receive any education. As they were ill-fed, many of them fell victim to a host of diseases such as tuberculosis, anemia, parasitic illnesses and the like.
Thus one objective of the revolution was to eliminate the material and psychological dependence of the country on the United States. It also hoped to avoid the pitfalls of swift industrialization. Also, the removal of any inequalities between the city and the countryside through the promotion of programs and services equally around the country was another main objective. One offshoot of this objective was the provision of access to health services to all regardless of where they resided or their socioeconomic status in life (Chomsky, 2015).
Cuban Healthcare System
In 1960, the country established the Rural Medical System (RMS). The government started things rolling by registering 750 doctors and medical students and required them to work for a fixed period of time. They were also required to serve the rural population, to include the mountainous regions of the country. The main objective of the RMS was to offer and provide disease prevention and to revive the provision of health services to those who need these services the most. By the 1970s, there were already many polyclinics around the island, and these polyclinic services soon evolved into family doctor and nurse programs (WHO, 2008). The main premises of the healthcare program are: first, that healthcare is a right that must be available to all and must be free; that healthcare is the responsibility of the government and the state; that both curative and preventive health services should be integrated into the program, and that the public must be a strong participant in the development and the functioning of the healthcare system (Keck and Reed, 2012). Student physicians are afforded free tuition so that many were (and are to this day) attracted to study medicine.
In the 1980s, the program evolved into a Family Physician and Nurse program. This program aimed to provide both individuals and families in neighborhoods and communities with a team of health practitioners that would be able to deliver medical care and promote disease prevention techniques. The emphasis of the program is on health maintenance and disease prevention. For a community of 600-800 families, a medical team is assigned and takes residence in the area. In the clinic, consultations are done in the mornings, and the team goes around to make house calls for most of the afternoons. The role of the nurse is one that is very strong, as the nurse in the teams live in the communities almost permanently, while the physicians are rotated for certain periods of time (Keck and Reed, 2012). The family doctor and nurse teams are then under a bigger polyclinic where patients may avail of other medical services, largely for free.
Aside from this program, the country also established research programs consistent with the needs of the populace. The country also invested in technology, but reserved the new equipment for patients that needed them the most. As for the medical and nursing curriculum in tertiary studies, tuition was made free for those willing to become doctors and nurses. This ensures a steady stream of students becoming doctors and nurses.
Pros of the Cuban Healthcare System and Effects on the Poor
For a developing nation, the achievements of this system are hard to beat. The health indicators of the population are near excellent, considering that the country is considered to be a developing country. There is 98% full immunization up to two years of age, with children being inoculated against 13 different illnesses. There is a 95% level of prenatal care for pregnant women, and infant mortality is at less than 5 out of 1000 births (Keck and Reed, 2012). As of 2014, the infant mortality rate is down to 4.2 per 1000 births (Lamrani, 2014). Life expectancy is at 78 years, and therefore on the average, Cubans live 30 years longer than the Haitians, their next-door neighbors.
The healthcare system has also enabled Cuba to deliver healthcare to other nations around the globe. Cuban doctors are also sent on missions around the world. It is estimated that around 30,000 Cuban medical staff are working all over the world, helping the world’s poor. One program is Operation Miracle, a vision restoration program co-launched by Fidel Castro and Hugo Chavez in 2004. In a decade, over 3.5 million people have had their cataracts removed or eye illnesses cured or controlled all over Latin America (Lamrani, 2014). In 2015, Cuba was the first nation to win validation from the World Health Organization to achieve the elimination of mother-to-child transmission of HIV and syphilis. Successful Cuban missions working in Africa to help combat the Ebola virus also returned to their home country.
Medical research in the country has also recently enabled the country to produce its own pharmaceuticals. Just recently, the country has produced the new Cimavax drug, which is said to be able to suppress the growth of tumors in the lungs (Hopkins, 2015). The doctor to population ratio is at a very impressive 1: 170 (Keck and Reed, 2012).
Cons of the Cuban Healthcare System and Its Effects on the Poor
As with all endeavors, the system could still be improved. The decade-long embargo of the United States and some of its allies on Cuba has of course its negative effects on the delivery of healthcare, especially for the poor. While there is access, there is still plenty to be desired when it comes to technology and equipment. Even if Cuba is a stone’s throw away from the United States, Cuban doctors cannot go to the United States to train in modern methods and to be appraised of the latest in medical knowledge. The sparsity of the use of the Internet (also partly due to the embargo) has deprived the medical community of vital information that could help them further their work and their research. These modern techniques and information could of course be disseminated to the communities in the country, especially to the communities in the rural and mountainous areas. This is perhaps the only disadvantage faced by the poor and the marginalized in the country. While the healthcare workers are present in their midst, the lack of modern medical facilities can also impede the delivery of the needed healthcare services in their area.
While the healthcare system is wonderful, its focus on prevention may also cause the government to neglect the need to enhance its curative services. This is then related to the con of the US embargo becoming a hindrance to Cuba’s being able to secure more modern facilities for its healthcare system. Without more modern equipment and technologies, the curative aspect of the system will not grow.
Conclusion
The framework of the Cuban healthcare system is such that there are levels of care that follow a hierarchy, and that these levels are also linked to the country’s administrative departments and agencies. The system also grows from the “grassroots” level such that all citizens are literally included in it. The focus on disease prevention and health promotion has enabled the system to produce a population that has lifetime expectancy that rivals those of developed nations. What is also outstanding about the system is that healthcare is also woven into the educational system of the nation, and so there are classes for everyone on sanitation, the prevention of drug and alcohol abuse. Prevention is also included in maternity care, and the would-be mothers are provided with free meals and vitamin supplements so that birth weights are increased and infant mortality is decreased. The success of the program lies in its foundations and ideology – that healthcare is the responsibility of the state, must be provided to all, and that it should not be a “for-profit” endeavor. Equality has become a reality with respect to healthcare in Cuba. The health indicators of the country, the ability to manufacture pharmaceuticals, and the generosity of the country in sharing its medical services to the need y individuals of the world are all testament to the success of the system.
The socialist ideology upon which the healthcare policy of the nation has ensured that healthcare will not discriminate between the rich and the poor, the urban and the rural, and the mestizo and the colored individual. Everyone has access to healthcare and medical services, but only as far as the available medicines, equipment and training will provide. The embargo (which has been partly lifted already) must be totally eliminated so that the delivered health services will be at par with what one can find in the hospitals in the United States, with all the modern equipment that will help enhance the delivery of these services. Thus the focus would be on both preventive and curative aspects of healthcare. Once this happens, the marginalized and the poor will be able to enjoy quality services, without sacrificing the emphasis on prevention and community medicine that the system has excelled in so far.
References
Chomsky, A. 2015. A History of the Cuban Revolution. Malden, MA: Wiley.
Constitution.Org. (n.d.). The Constitution of the Republic of Cuba, 1976 (as amended to 2002). Retrieved from: http://www.constitutionnet.org/files/Cuba%20Constitution.pdf
Keck, W. and Reed, G. 2012. The Curious Case of Cuba. American Journal of Public Health, 102(8), e13-e22.
Lamrani, S. 2014. Cuba’s Health Care System: A Model for the World. Retrieved from: http://www.huffingtonpost.com/salim-lamrani/cubas-health-care-system-_b_5649968.html
Skidmore, T. and Smith, P. 2005. Modern Latin America. NY: Oxford University Press.
World Health Organization. 2008. Cuba’s Primary Health Care Revolution: 30 Years On. Retrieved from: http://www.who.int/bulletin/volumes/86/5/08-030508/en/
