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Public Health System In Cuba

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The public health system in Cuba has become one of the most praised systems of our time. Even though their health system is very successful, the island has endured some hardships, but continues to stay healthy. Cuba is, to this day, under the U.S. embargo, adapting to their limited resources (medicine and equipment), continuing to educate thousands of students, and saving the lives of millions while trying to piece together what is left of their economy.

Before Fidel Castro came to power in 1959, sixty-four percent of Cuba's doctors worked in Havana where the majority of the wealthy people lived. When he ordered that the doctors be redistributed throughout Cuba, over half of the 6,000 doctors left the country. For the past four decades, Cuba has been isolated by the U.S. embargo and tied to communist and poor third world nations. This isolation has intensified some of the problems that the country was already having after losing eighty percent of foreign trade in 1989. The U.S. embargo prohibits foreign subsidiaries of U.S. companies to trade with Cuba and bans merchant ships that stop at Cuban ports from the U.S. market for six months after they leave Cuba...The embargo extends to trade in food, medicines, and medical supplies (Almost all, ninety percent, of Cuban trading was done with subsidiaries of the United States. The Cuban government was forced to reduce all trade almost completely after the termination of trade relations between the former Soviet Union and Eastern European countries. The U.S. tightened the embargo in 1992 leaving Cuba with a shortage of food and medical supplies. Consequently, Cuba was forced to establish a top notch medical program for third world conditions. With this in mind, Cuba has managed to implement highly innovative national and public health policies despite limited material resources.

Although the Cuban government boasts about their accomplishments in other countries and free education, they have been having some rough times within their own country. In Havana, September 8th of 2000, two year old Rachel Franco Morales had an allergic reaction to her asthma medicine, Intal. She has been taking Intal for sometime now and the bottle says it expires September 1999. The Public Health Minister told someone to change the expiration date on the box to September 2000. This is an example of how scarce the medication in Cuba is. The government exercises strict control over medication, everything is under prescription, and people can only receive a small dosage. Quite often individuals who work in pharmacies steal the medication to sell. The people who buy the medication from the pharmacy employees sell it to people who need it at very high prices. Doctors are unable to prescribe medicine for their patients. The doctors tell patients the name of the medicine and the dosage. In the end the patients are left to track down these medicines on their own.

As stated above the medication is very scarce, but so is the hospital equipment. Many hospitals don't have x-ray films, bandages, needles, scissors, sterile material, analgesics, and shots for asthma. Medicine is kept for hospital admissions only. Patients are complaining about poor service from hospital staff and bad food. Even dentistry offices are lacking the materials to safely treat patients. They often don't have water, electricity, sterile equipment, working materials, working equipment, anesthetics, or assistants. Dentists usually ask patients to bring their own anesthetics for extractions. Cuban government made an agreement with South Africa to send Cuban doctors to work there for two years in a better neo-internationalist trend. The doctors were only asked to be good at medicine and to be fluent English speakers. Many doctors learn English and go abroad due to the conditions in Cuba. Many of them have to bike to work, they don't have enough clothes, no food, no money, and if they have cars, they don't have any gas. "Castro boasts that Public Health is free, and it really should be free because it practically doesn't exist", says Mario Torres in his article on Cuba's Public Health and Education. Exile leaders say Cuba's medical reputation is being exaggerated. They point to one example of Cuban doctors attempting to flee assignments in Africa who were often forced to work in dangerous conditions. Even if they don't have as many resources as the United States they have done an amazing job at saving millions of lives and continue to do so.

The Cuban government established the Latin American Medical School or ELAM. The medical school was established in response to the dual hurricanes that struck Central America and the Caribbean in 1998. Low income students received full scholarships in exchange for a pledge to practice in undeserved communities upon graduation. The school has expanded to enroll 10,500 students from Latin America, the Caribbean, North America (65 U.S. students), and Africa. The number of foreign medical students in Cuba is nearly 12,000 from eighty-three countries. Cuba also has plans to join with Venezuela to open another medical school to train at least 100,000 students over the next ten years. The focus of the Cuban government is to dramatically increase accessibility to health services by undeserved populations and strengthen health systems in poor countries. Students who go to school in Cuba will learn something that they can't learn in the U.S. according to Dr. Anthony Kirkpatrick, professor at the University of South Florida's College of Medicine. They are able to study the health system in the classroom and by completing field based work. Practicing medicine in third world nations allows the students to work with different types of diseases and disorders. Students who only practice medicine in the U.S. don't always have the opportunity to work with people who have diseases that are prevalent in third world countries. Cuba has allowed students to broaden their horizons and gain some real knowledge and a true understanding of what it means to be a doctor. On the other hand, Joe Garcia, executive director of Cuban American National Foundation says that "Cuban doctors working worldwide are slaves under Castro's government. They're not dedicated, they're ordered to do so."

If the conditions in Cuba are so bad then how is it that they were able to eliminate many diseases such as measles, mumps, polio, diphtheria, and tuberculosis? The life expectancy is seventy-five years old, only one year less than that of the United States. Cuba has one of the best infant mortality rates in Latin America. They have reduced the spread of AIDS in Cuba as well as many other Caribbean countries through their tough vaccination campaigns (CubaNet 2001). Cuba has revived a collapsed health system in Haiti,



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