Days ago, in one of those aberrations that are published with sickening frequency in the Cuban newspapers (whose titles are not worth mentioning), there was a reference to the mutual medical clinics which, before 1959, provided medical services to members who paid a monthly installment for that right. In this convoluted text, a variant of the health service cooperative was presented as a privilege of pre-Revolution medicine that only benefited those with moderately high resources and to which the lower classes did not have access.
I was really surprised at such a tall story. I don’t know how things would have been in a remote hamlet like Birán–a place where the poorest peasants were paid poverty wages by their employers, thanks to which they lived comfortably and could study the rich peasants, sons of those employers–but I can assure you that here in the capital my whole family, my grandparents, parents and siblings, even my aunts, uncles and cousins, were all “associated” with a mutual medical clinic, and none of us was the child of landowners, nor even small merchants or property owners, but rather—as in my own case—the granddaughter of a humble street coffee vendor whose clients were, for the most part, the workers from Sarra Drugstore (at Teniente Rey and Compostela Streets in Old Havana), and daughter of a skilled worker and a housewife. We all went to the Medical Action Clinic, located at Coco and Rabí, Santos Suárez, where my siblings and I were born, by Caesarean as it happened, without this requiring an increase in the monthly cost (about two pesos per month) that was paid by each associate member. The regular medical check ups we had there were included in the monthly fee, and they always had all the equipment and materials for each exam and we were cared for by excellent professionals. At the mutual clinic my mother was operated on for her tonsils as well, and for acute appendicitis when she was a little girl, and my oldest brother was treated for bronchial asthma. We were a simple working class family in which the adults worked and made it their business to guarantee medical care for their children.
In truth, there were many poor Cubans who did not have that option, especially in rural areas. Now, in contrast, everyone has the ability to be seen by a doctor but they do not always have access to the corresponding technologies needed for an accurate and effective diagnosis or to the medication required for the treatment of their disease.
Unfortunately, many young people are unaware that there was free medical care in Cuba even from the colonial era. In fact, hospitals as well known as the Calixto García, Emergencias o Maternidad de Línea, to cite examples, provided free, quality care during the Republican period, not to mention the First Aid Posts, closer to the neighborhoods, which also provided free care to the poorest. These young people, and certain forgetful adults (which always exist), could be fooled by the misrepresentations of the press, although, inevitably, the day could also come when they might verify for themselves the irony of Revolutionary medicine.
The mutual clinics were swept away by the Revolution around the middle of the 60s and replaced by polyclinics that initially, like all things in this system, offered efficient care and covered any medical service that was required, from primary to emergency care, until that tragic day the idea of the family medicine clinics arose, a true epitaph for an already moribund health care system. Because, today as we all know, the once splendid health system, proud showcase of the regime, is in a calamitous state.
I will not mention, so as not to state the obvious, the deterioration and unsanitary conditions in hospitals, polyclinics and neighborhood clinics. I want to be fair and acknowledge that in Cuba there are still many doctors and other health professionals whose talent and good treatment of patients is unquestionable, but it is also time to end the myth of “free care.” And I affirm that it is not free care or free medicine because from the first moment that we are seen as patients there begins a harrowing, long and costly “Via Cruces.” Part of the specialized medical staff is dedicated to “completing mission” (a euphemism that means Cuban specialists are sent to serve our “brothers” in other countries), which means every clinic waiting room is packed with people waiting for the inadequate number of doctors available to the natives of the Island. Then, many times, there are no materials for the needed medical tests, no material for X-rays, or the equipment for ultrasounds, electrocardiograms or MRIs is damaged and that leaves two options: reaching an understanding by means of a little gift that “resolves” the problem in the only hospital that has working equipment, or you must wait patiently (the one truth in this system is patience) for your turn for an electrocardiogram or an ultrasound two or three months later, if you don’t have a heart attack before then.
Add to this the lack of medicines for sale in national currency that are, however, available in CUCs,* so those of the healing arts, once a specific diagnosis is reached (sometimes almost by crystal ball), suggest in a low and compassionate voice to the patient or family: Go see if you can buy it in the CUC pharmacies, or find it in the donations sent to churches, or whether a relative or friend will send it to you “from outside.” And this is no fable. Last year, months before the death of my father, we needed to buy pentoxifylline, the medication prescribed by the neurologist, which was available only in the pharmacies of the privileged at a cost of 18.80 CUCs (just over 450 pesos*) for a meager 20 pills. He had to take three pills a day; you can calculate the price of treatment. This doesn’t take into account the progress of the illness, the eventual need for a wheelchair, feeding tube, catheter, wound care, syringes, cotton swabs, alcohol, and other medicines. All these resources, unavailable at the health centers, appeared thanks to the infinite indulgence of family and friends who could help, and not thanks to the health system. Nor will I mention the issue of prescribed food. After more than 47 years working as a laborer, the Revolutionary medical system didn’t have the capacity to even guarantee the possibility of dignified, and moderately free, death. Today in Cuba every family that has a serious illness must vigorously convert itself into a small health care system with whatever resources it can manage by itself.
My family’s experience is not unique but just a sample of what goes on. I know that on Saturday, September 27, 2008, in the intensive therapy ward of the pediatric hospital, there were none of the plastic syringes used to insert liquid nutrition into feeding tubes, which are sold in CUCs at 2.85 a unit (around 70 pesos). Two weeks later I witnessed the freak occurrence that the Institute of Gastroenterology in this city only had one wheelchair for the transfer of patients; that the “specialized” ambulance that transported a family member of mine to this center had no stretcher nor paramedics, so they had to tie him to a chair in the back of the vehicle as if he were a sack of food; that access to an adjustable bed or other accessories that humanize patient care are chimeras… Others could contribute to this list of miseries with their personal experiences and in each case the details would be endless and the official response only one: The blockade. Yes, there is a blockade; a systematic and selective blockade that only hits those at the bottom, because the elderly gentlemen of the island’s Brahmin caste, despite the fact that we know some of them are very ill, have never been seen as patients in the dirty waiting rooms or other parts of our run-down hospitals, although now they fantasize otherwise.
Translator’s note:
Cuba has a dual monetary system with Cuban Convertible Pesos (CUCs), the money used by tourists but also required for many purchases inside Cuba, and Cuban pesos, called “moneda nacional” (national money), the currency in which wages are paid. The CUC is roughly pegged to the U.S. dollar (before exchange fees). CUCs are worth about 24 Cuban pesos. The average monthly wage is around 500 Cuban pesos a month, or roughly 15 euros or 20 dollars Canadian or U.S.
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