For Cubans, a bitter pill (2)

(Castro's health care system is paid for through onerous taxation and cannot provide even basic drugs

(Even as Cuba is abandoned by long-time allies for its human rights violations, Canada continues to display affection for Fidel Castro's one-man state. In the second of a three-part series, Isabel Vincent explores the myth of of the Caribbean nation's health care system.)

by Isabel Vincent


MORON, Cuba - In this historic town of 70,000 people in central Cuba, a small bottle of tetracycline costs US$5 and a tube of cortisone cream will set you back as much as US$25.

But neither are available at the local pharmacy, which is neat and spotless, but stocks almost nothing. Even the most common pharmaceutical items, such as Aspirin and rubbing alcohol, are conspicuously absent. In their place there is a neat display of green boxes of herbal diet teas from Spain.

One of the myths Canadians harbour about Cuba is that its people may be poor and living under a repressive government, but they have access to quality health and education facilities. It's a portrait encouraged by the government, but the reality is sharply different.

Antibiotics, one of the most valuable commodities on the cash-strapped Communist island, are in extremely short supply and available only on the black market. Aspirin can be purchased only at government-run dollar stores, which carry common medications at a huge markup in U.S. dollars.

This puts them out of reach of most Cubans, who are paid little and in pesos. Their average wage is 300 pesos per month, about $12.

"My parents are really old and suffer from heart problems, and they need to take an Aspirin a day, but even I have difficulty finding it," says Estela (not her real name), one of the pharmacists who works at a small shop off the main square, where school-children in maroon and beige uniforms sit on park benches sharing snacks.

Still, the residents of Moron are luckier than most Cubans because many of them work in the nearby resorts, where they often receive foreign medications as tips.

"We know how difficult life is here, so when we come for a vacation, we always bring a few bottles of antibiotics and Tylenol," says Laura, a housewife from Oakville, Ont., who was recently vacationing at a large resort in nearby Cayo Coco.

A 72-year-old pensioner from Toronto who did not want to be identified also said she had arrived for her recent vacation well- stocked with tubes of antibiotic cream, Aspirin, decongestants and bandages.

"My doctor in Toronto told me that there is nothing available in Cuba, so I came prepared just in case I needed any of these things for myself," she said.

"But I am leaving most of what I brought for the maids and the bartender."

For years, supporters of the Communist regime of Fidel Castro have praised the island's universal health care system as a model for the developing world. Indeed, Cuba has the world's highest concentration of physicians and health care is free.

"If you need the most complicated operation, you can get it at a Cuban hospital," Estela said. "But medicines are the problem."

After the Soviet Union stopped sending Cuba US$5-billion in annual funding to prop up its economy, the health care system, like most social services, fell on difficult times.

In common with other buildings on the Communist island, hospitals are falling apart, surgeons lack basic supplies and must re-use latex gloves. Patients must buy their own sutures on the black market and provide bedsheets and food for extended hospital stays.

The situation is so bad that a Canadian pro-Castro group urges tourists in a recent issue of its monthly newsletter to take "a suitcase full of medical supplies to drop off at a local clinic or hospital with a letter about humanitarian aid."

Like many supporters of the Castro regime, the Canadian-Cuban Friendship Association blames the island's crumbling health care situation on the 42-year-old trade embargo imposed by the United States.

"Cuba's uniquely resourceful health care system ... has continued working well for decades despite the U.S. embargo," notes the association on its Web site.

But the embargo is only part of the problem, Cuba analysts say. Over the past decade ordinary Cubans have lost out as the government reoriented the public health system to earn desperately needed hard currency. Today, the Cuban government has set up several tourist-only hospitals to cater to the growing number of foreigners arriving on health tourism packages.

Every year, thousands of visitors, most of them from other Latin American countries and some parts of Europe, arrive in Havana to obtain treatment at cut-rate prices. A kidney transplant in Cuba costs about half the price of one in the United States, which can be as high as US$45,000. Tourists also come for cut-rate prices on plastic surgery and even dental work.

Argentine soccer star Diego Maradona raves about Cuban health care, and has been repeatedly treated for his drug addiction at a Cuban drug and alcohol addiction centre.

"It's the best health care system in the world," he recently told an Argentine reporter.

Indeed, tourist hospitals in Cuba are well-stocked with the latest equipment and imported medicines, said a Cuban pediatrician, who did not want to be identified.

Cuban doctors also specialize in treating Parkinson's disease and retinatis pigmentosa, a hereditary disease that causes night blindness and can eventually result in complete loss of sight.

"Tourists have everything they need," said the pediatrician, who spoke on the condition he would not be identified in any way. "But for Cubans, it's different. Unless you work with tourists or have a relative in Miami sending you money, you will not be able to get what you need if you are sick in Cuba. As a doctor, I find it disgusting."

In 1993, when Havana began the tourism packages, officials sought to convert Cuba's prestigious International Centre for Neurological Restoration, which over the years had gained an international reputation for treating trauma and Parkinson's Disease, into a tourists-only hospital.

But the hospital's founder, the internationally respected neurosurgeon Hilda Molina, refused to comply with the government decision.

"There is a fundamental discrepancy," she said at the time. "I am not a politician. I am a doctor. Cubans should be treated the same as foreigners. Cubans have less rights in their own country than foreigners who visit here."

Dr. Molina also said government officials encouraged her to transplant brain tissue from still-warm fetuses into wealthy foreign victims of Parkinson's disease, a practice she found unethical because many of the Cuban women who had undergone state-financed abortions were not told their fetuses had been dissected for transplants.

Dr. Molina, who was branded a counterrevolutionary and ban-ned from practising medicine in Cuba, stands by those same principles today. Now 60, she has refused to cave in to government pressure and survives in Havana on remittances from her family abroad.

For the past decade she has been trying to obtain a permit to leave the island and go to Argentina to visit her son, also a neurosurgeon. The government has repeatedly refused her requests, calling her brain "a national asset."

These days, officials in the Castro government say they rely on money earned from joint-venture operations on the island with foreign companies to finance the universal public health system.

Cuban workers contracted for joint venture operations are paid indirectly. The Cuban government receives about US$450 per worker per month from the foreign company. While the worker typically makes 5% of this total amount -- in pesos-- the government directs most of the foreign currency earned in this scheme to pay for its social services, including health care for ordinary Cubans.

"The Cuban government says indirect employment helps protect the social welfare system," say Matias Travieso-Diaz and Charles Trumbull in a recent study on foreign investment in Cuba published in George Washington University's International Law Review. "Employment agencies provide a constant source of hard currency for the Cuban government."

According to the report, about 30,000 Cubans work in joint- venture operations in manufacturing, tourism, banking and mineral exploration. The government earns US$15-million per month from their work.

"The Cuban government argues that the money that the government keeps away from the worker is reinvested for the good of the entire population," the study says, adding world labour regulatory bodies such as the International Labour Organization have condemned the practice, in which the Cuban government essentially pockets 95% of a worker's wages.

"There is absolutely nothing free about Cuban health care and other social services," says Ismael Sambra, president of the Cuban-Canadian Foundation. "Social services are financed from the sweat of the poor Cuban workers."

Some ILO officials suggest the state could finance social welfare by further opening the economy to foreign investment and collecting taxes on the income of companies involving foreign investors.

But for most Cubans, the question of who is financing health care is rather academic.

"We have nothing," said Jasmin, a nurse who lives in Moron.

"I haven't seen Aspirin in a Cuban store here for more than a year. If you have any pills in your purse, I'll take them. Even if they have passed their expiry date."