Susan E. Mason, David L. Strug, Joan Beder, eds.
Community Health Care in Cuba (Chicago: Lyceum Books, 2010).
For anyone who wants to learn the ABCs of the Cuban health system, this is the book. The six sections divide into: a history and an overview of the current healthcare system; treatment of specific diseases such as breast cancer, HIV/AIDS, etc.; social services featuring chapters on dementia and on the elderly; mental health; three short chapters covering the Jewish community, Chinese-Cubans, and Afro-Cuban women; and a very brief look at Cuba’s international health care programs. The writing is concise, not overly technical, and nearly always to the point. The nineteen authors split between Cubans and non-Cubans, and almost every article is based upon fieldwork and many include interview material with participants – both health workers and recipients of services. The resulting anecdotal passages give the study a further human dimension.
Several things strike the reader immediately. First is the system’s integrated nature. The contributors clearly show the various levels of planning, concern, and care as well as interactions between MINSAP (Ministry for Health) and even the smallest rural communities. Care includes not only family doctors who make house calls regularly, but active intervention on numerous levels by any number of national and local organizations such as the Federation of Cuban Women or the Committees for the Defense of the Revolution. Beyond this, neighbors look after neighbors and families are shown how best to care for members in need. There is plenty of interchange between generations too in the care of the elderly or care of youngsters. Second, the system does its best to look at the big picture, the total environment, when examining those in need of medical attention. In addition, all kinds of therapies come into play, traditional and non-traditional medicine, or music therapy which is the focus of one chapter. Preventive rather than curative medicine is another large theme. A solid educational network trains personnel in both general and specialized health practices. Third, that this is all done at no cost to the patient and on an equal basis to all boggles the mind of those used to the system here in the United States where most physicians make six figures minimally and all too often receive goodies from drug companies as well. Cuba, with limited resources has invented a health system whose results in many areas such as longevity rival those of developed societies.
So has Cuba achieved the perfect health system? No, but the system has served and serves as a model for poorer nations. The book correctly notes problems at all levels of care. While many of these are due to or exacerbated by the US embargo against Cuba (which prevents or severely limits the shipment of medicines and updated equipment), an inadequate infrastructure and systemic inefficiencies also lower health standards. The Special Period (ca. 1992–2006) brought particular strains in that incidence of sickness increased due to insufficient diets and more acute shortages of medicines. Still, the articles make it clear that the system is back on track. One myth that is dispelled by several authors is the purported use of “political diagnosis,” whereby dissidents supposedly would be declared mentally incompetent and locked up.
The Cuban Revolution if nothing else has always been internationalist. A dimension in the health field that is only briefly touched upon, but which has huge implications, is Cuba’s international efforts. These range from sending doctors to countries with almost non-existing health systems, to founding hospitals and training centers overseas in Africa and Asia, to the creation of the Latin American School of Medicine in Cuba which trains doctors from all over the continent including a significant contingent from the United States (another center trains people from just the Caribbean), to the sending of medical teams to wealthier countries such as Venezuela where the services are compensated, helping Cuba’s economy and rewarding the individuals involved, and just plain emergency aid such as the efforts after hurricanes devastated Central America in 1998. Almost no US news sources noted that in addition to several hundred medical personnel already in Haiti at the time of the recent earthquake, Cuba quickly sent an additional contingent of doctors to help out. In fact, those already there set up a medical facility outside the main hospital in Port-au-Prince which had collapsed and remained inoperative (see Wall Street Journal, January 23–24, 2010, A8).
It seems strange to say that a book which reminds us constantly of the health problems that exist in all societies is joyous. But these pages exude a remarkable love for humanity and a spirit of love (a recommended therapeutic in Cuba for young adults by the way) and community. The authors, who all teach at the Yeshiva School for Social Work, should be congratulated for having brought together such a significant work.
2010 Hobart A. Spalding
Socialism and Democracy