Cuban healthcare system is world class? Not so much.

[eomer]

Yoani Sanchez of the blog Generación Y describes her visit to a Cuban hospital:

Hospitals - did you bring everything?

by: Yoani Sanchez

A bucket in one hand, the pillow under my arm and the fan resting on my hip. I enter the door of the oncology hospital and my backpack hides my face from the security guard. It doesn't matter, since he is accustomed to patients' families having to bring everything, so my baroque structure of blades, bucket, and sheets doesn't phase him. He doesn't know it yet, but in my bag hanging off to one side I've brought some bread and omelet so that he will let me stay after visiting hours.

I arrive at the hospital room and Monica holds her mother's hand, whose face has become more emaciated. She has cancer of the esophagus and there is little that can be done although she does not know it. I've never understand the refusal of doctors to inform one - directly - when little time is left until the end; but I respect the decision of the family, although I will not join in the lie that she will soon be well.

The hospital room has a dim light and the air smells of pain. I begin to unpack what I brought. I take out the little bag of detergent and the cleanser with which I will clean the bathroom, whose aroma overwhelms everything. With the bucket we will be able to bath the woman and flush the toilet, as the water valve is not working. For the great cleaning I have brought a pair of yellow gloves, afraid of the germs that I might catch at the hospital. Monica urges me to continue unpacking and I take out the cantina of food and some puree made especially for the sick woman. The pillow has been a godsend and the set of clean sheets covers the mattress which is stained with repeated excretions.

The most well received item is the fan which I connect with two worn cables that stick out from the wall. I continue digging and I get to the bag with the medical materials. I have obtained some adequate needles for the IV as the one in her arm is very thick and produces a lot of pain. I also bought some gauze and cotton on the black market. The most difficult - which took days and incredible dealing - is some suture thread for tomorrow's surgery. I also brought a box of disposable syringes as she had a fit when she saw the nurse with one made of glass.

For distraction I brought a radio and a nearby patient has brought a television. My friend and her mother can then watch the soap opera, while I look for the doctor and give him a gift sent from the patient's husband. At bedtime a cockroach crosses the wall near the bed and I remember that I also brought some insecticide spray. In the backpack I still have a few medicines and a little gift for the lab girl. The money in my pocket is because ambulances are for very critical cases and when she is discharged - evicted - home, we will have to take a taxi.

In front of our bed is a little old lady who eats the watery soup that the hospital personnel has given her. Next to her bed there is no bag brought by her family and she does not have a pillow to rest her head. I put the fan in a way that she too can get some fresh air and I speak to her of the arrival of another hurricane. Without thinking I knock on the wood of the door, I don't really know if to expel the fear of sickness or the horror of the conditions at the hospital. A woman goes by shouting who sells bread with ham for the visitors and I lock myself in the bathroom, which smells like jasmine after my cleaning.

Original blog in Spanish:

Hospitales ¿lo llevas todo?

Escrito por: Yoani Sanchez en General

Un cubo en una mano, la almohada bajo la axila y el ventilador apoyado en el hueso de la cadera. Entro por la puerta del hospital oncológico y la mochila que me sobresale sobre el hombro no deja ver mi rostro al custodio. Poco le importa, pues el hombre está acostumbrado a que las familias de los pacientes deben llevarlo todo, así que mi barroca estructura de aspas, cubo y fundas, no lo inmuta. Él no lo sabe todavía, pero en una bolsa que me cuelga de algún lado le he traído un pan con tortilla, para que me deje quedarme fuera del horario de visita.

Llego a la sala y Mónica sostiene la mano de su madre, cuyo rostro está cada vez más demacrado. Tiene cáncer en el esófago y ya hay poco que hacer, aunque la señora aún no lo sabe. Nunca he entendido esa negativa de los médicos a informarle a uno –directamente– cuán poco tiempo queda para el final; pero respeto la decisión de la familia, aunque no me sumo a la mentira de que pronto estará bien.

La sala tiene una luz tenue y en el aire se huele el dolor. Comienzo a desempaquetar lo que he traído. Saco la bolsita de detergente y el aromatizante con los que limpiaré el baño, cuyo “aroma” lo inunda todo. Con el cubo podremos bañar a la señora y descargar la taza, pues la válvula de agua no le funciona. Para el gran fregado traje un par de guantes amarillos, temerosa de los gérmenes que puede pescar en aquel hospital. Mónica me conmina a seguir desempacando y extraigo la cantina de la comida y un purecito especial para la enferma. La almohada ha venido de maravilla y el juego de sábanas limpias logra tapar el colchón, manchado con sucesivos efluvios.

Lo mejor recibido es el ventilador, que conecto a dos cables pelados que asoman desde la pared. Sigo desembalando y llego a la jabita con los materiales médicos. He conseguido unas agujas adecuadas para el suero, pues la que tiene en el brazo es muy gruesa y le produce dolor. También compré algo de gasa y algodón en el mercado negro. Lo más difícil –que me ha costado días e increíbles canjes– es el hilo de sutura para la cirugía que le harán mañana. Le traje además una caja de jeringuillas desechables, pues puso el grito en el cielo cuando vio a la enfermera con una de cristal.

Para la distracción, he cargado con una radio y a una paciente cercana le han traído un televisor. Mi amiga y su mamá podrán ver entonces la novela, mientras yo busco al médico y le entrego un regalo enviado por el esposo de la enferma. Al llegar la hora de dormir, una cucaracha atraviesa la pared cercana a la cama y me acuerdo que también traje un spray contra insectos. En la mochila todavía me quedan algunas medicinas y un regalito para la muchacha del laboratorio. El dinero lo tengo en el bolsillo, pues las ambulancias son para casos muy críticos y cuando la envíen –desahuciada– a casa, tendremos que tomar un Panataxi.

Frente a nuestra cama hay una viejita que se come la sopa aguada que le ha dado el personal del hospital. Alrededor de su cama no hay ningún bolso traído por la familia y no tiene almohada para apoyar la cabeza. Pongo el ventilador de una forma que ella también reciba el fresco y le hablo sobre la llegada de otro huracán. Sin que se dé cuenta toco la madera del marco de la puerta, no sé muy bien si para expulsar el miedo a la enfermedad o el espanto ante las condiciones del hospital. Una mujer pasa gritando que vende panes con jamón para los acompañantes y yo me encierro en el baño, que huele a jazmines después de mi limpieza.

http://74.125.47.132/search?q=cache:stbhY7fNiLEJ:desdecuba.com/generaciony/%3Fp%3D528+generacion+y+hospital&cd=1&hl=en&ct=clnk&gl=us

[Xipe Totec]

1. Just like our pay-for-stay prisons. Interesting. n/t

[cobalt1999]

2. Well, they are free.

I've been to Cuba a couple of times. Depressing poverty, dirty streets, lots of children looking for handouts. It's not a utopia by any means, BUT I have to give them props on not bankrupting their own citizens for health care.

[eomer]

5. Not bankrupting them?

You yourself describe them as bankrupted. Or else I don't know the meaning of the word.

[cobalt1999]

6. I meant they don't bankrupt the patients.

How many people in the U.S. are saddled with massive medical bills?

The Cubans hospitals and medical care doesn't have the frills of the U.S., but how many people here would trade comforts & bills for basic & free?

[eomer]

12. Yes, agreed, now that I understand you.

Being free and accessible to all is a required feature of a world class system. Required but not sufficient.

[naaman fletcher]

3. let me guess:

1. Your source is biased.
2. You ought not to talk about things you don't know about. You ought to find out what is is REALLY like in Cuba before you say anything.
3. Some people in the US don't get good healthcare, either.

Did I miss any? Ping the defenders of the worker's paradise!!

[eomer]

7. Bad guesses.

This is a blog written by a Cuban young woman who grew up and lives in Cuba. The words are hers -- all I've done is the translation but I provided her original in Spanish if you prefer to get it straight from her.

I agree completely with you that some people in the US, many I would say, don't get good healthcare. For the record, I am in favor of a single-payer, universal system for the US.

[Codeine]

28. I think he was trying to anticipate

the fallacious nonsense the Apologist Brigade will bring on.

[eomer]

30. Oh, my bad. He did a pretty good imitation. (eom)

[angstlessk]

4. USA embargo helps make their hospitals not fully stocked...hell I CAN AFFORD A FAN AND A HYPERDERMIC

NEEDLE.I cannot afford the hosptial and doctor bills...sorry...health care vs stocked hospitals not even the same thing..our hospitals have every thing they need EXCEPT AFFORDABLE HEALTH CARE!

[Traveling_Home]

8. They trade with virtually every ....

every other country - Canada, European, South American.
Quality Medical supplies are not an exclusivly American item. Does a US company even make syringes?

There has to be a better reason.

[EFerrari]

10. Doesn't have to be a US company if the product contains US parts.

Helms Burton Act. Yes, this is the reason.

And that's one way to tell that this young lady is a professional right wing blogger. Because she doesn't introduce that simple fact. She needn't blame the US but suppressing this information is less than honest.

[Traveling_Home]

13. Syringes???? - Just Not True nt

[EFerrari]

15. I don't pretend to know all the ins and outs of the Helms act. n/t

[eomer]

9. US law was changed in 2000 during Clinton admin. Medical items are not embargoed.

I agree with your point about access and affordability. Those are definitely required features in a world class healthcare system. But the Cuban system is far from world class on other grounds. My belief is that there are other systems in other countries that can be held up as a model of world class healthcare. The Cuban system isn't it. And the US system isn't either.

[EFerrari]

11. Is that true? Then how is this incident explained?

Published on Wednesday, July 4, 2001 in the Portland (ME) Press Herald
Medical Supplies for Cuba Seized at Maine Border
by Allan Drury

The U.S. Treasury Department said Tuesday it will not release 40 packages of medical equipment and supplies seized at the Canadian border Monday.

Maine activists had hoped to ship the seized items to Cuba, along with supplies that made it across the border during a scuffle with federal agents.

Dean Boyd, a spokesman for the U.S. Customs Service in Washington, said the Brunswick-based Let Cuba Live Committee of Maine – which was confronted at the border in Coburn Gore – did not have a license to ship items to Cuba.

The items, including two anesthesiology machines, were held at the border overnight Monday after agents and police stopped a caravan of committee members. The Office of Foreign Assets Control, a branch of the Treasury Department, made the decision to retain the items on Tuesday, Boyd said.

http://www.commondreams.org/headlines.shtml?/headlines01/0704-03.htm

[eomer]

14. Explained by the fact there are regulations that must be followed.

A license is required, but is (I believe) almost always granted when applied for.

If you don't apply for the license (perhaps because you disagree that you ought to have to get one) then your shipment may be stopped.

But if you do comply with the regulations then medical items can be imported and are imported into Cuba from the US.

I don't know for a fact that there isn't monkey business perpetrated by some US agency, so if you have some evidence of that I probably wouldn't argue it. But the case you cited, at least according to your cite, appears to be a case where they simply didn't bother to get the license.

I'm most strongly in favor of accuracy and clarity, so I'm glad that you posted this. The statement that medical supplies are prohibited by the embargo is most definitely not true. The more nuanced question of how hard or easy it is to import medical supplies is a topic I'd like to know more about.

[EFerrari]

16. I would like to know more, too. And would rather know

than buy in to anything.

[eomer]

19. Fair enough.

My wife was born in Cuba and had quite a few relatives there up until a few years ago. We have heard descriptions similar to the one in the blog directly from relatives who lived through the same thing.

I don't buy in to the claim that Cuba's system is world class. There are aspects that are world class and that we should incorporate in our system if we ever can, but there are other aspects that are decidedly substandard.

[sufrommich]

18. It says right in the article that the group did not follow

procedure for taking medical supplies across the border.When the customs people tried to help them get the license, the group refused:

"Officials at the border sent a license application to the U.S. Office of Foreign Assets Control in Washington, D.C., for the committee. But the committee did not want a license and doesn't think it should be required, Cote said."

Not everybody who writes negative articles about life in Cuba is a right winger, anymore than anyone in the US is automatically suspect when we point out negatives in our own country. I like to believe they are at least as three dimensional as we are.

[EFerrari]

21. Go look at her blog before you lecture me. Thanks!

:)

[mmonk]

17. No, not world class due to shortages (because of embargo).

They are two spots below us in 39 despite their situation.

[EFerrari]

20. eomer, check this out re medical supplies. I think I figured it out.

The embargo doesn't apply to medical products distributed by NGO. So, in a country with socialized medicine, wouldn't that present a problem?

Check behind me, to make sure:

"Effect of the Embargo

The United States Government has always exempted from the embargo medicine and humanitarian supplies to the Cuban people, as long as such aid is distributed by independent non-governmental organizations (NGO) such as the Catholic Church and international organizations such as Pastors for Peace."

http://www.lanuevacuba.com/archivo2009/Abr/humberto-corzo-12.htm

[Warpy]

22. Exactly, a friend went there with a church group delivering

medical supplies a few years ago. Their system is largely supplied by charity and we all know what that means: not much gets through, certainly not what is needed.

If they could buy medical supplies on the open market from the US, there would likely be far fewer shortages.

Still, as bare bones as their system is, it's a model for what could and should happen throughout the third world, with everyone having access to basic care, if not the latest technology.

[EFerrari]

23. I'd appreciate having some "bare bones" care up here

so I don't have to die from something preventable. The last time I had health care was while working at Cal. They had a great system there, great preventive focus, the whole deal.

[eomer]

27. Absolutely. "Please help me or I will die."

There was an OP recently about a freshman rep who was shocked by the number of constituents writing letters saying "Please help me or I will die".

That a country as wealthy as ours treats its most vulnerable the way we do is an atrocity.

[eomer]

26. They can buy medical supplies from the US.

See my other posts explaining that the embargo was changed under Clinton in 2000 so that medical supplies are no longer prohibited by the embargo. There is a requirement to get a license, but it is a mere formality.

[eomer]

24. That NGO restriction and some similar constraints are what was eliminated in 2000 under Clinton.

Here are the relevant sections of the October 2000 legislation:

SEC. 902. DEFINITIONS.

In this title:

-snip-

(7) UNILATERAL MEDICAL SANCTION- The term `unilateral medical sanction' means any prohibition, restriction, or condition on exports of, or the provision of assistance consisting of, medicine or a medical device with respect to a foreign country or foreign entity that is imposed by the United States for reasons of foreign policy or national security, except in a case in which the United States imposes the measure pursuant to--

(A) a multilateral regime and the other member countries of that regime have agreed to impose substantially equivalent measures; or

(B) a mandatory decision of the United Nations Security Council.

-snip-

SEC. 903. RESTRICTION.

(a) NEW SANCTIONS- Except as provided in sections 904 and 905 and notwithstanding any other provision of law, the President may not impose a unilateral agricultural sanction or unilateral medical sanction against a foreign country or foreign entity, unless--

(1) not later than 60 days before the sanction is proposed to be imposed, the President submits a report to Congress that--

(A) describes the activity proposed to be prohibited, restricted, or conditioned; and

(B) describes the actions by the foreign country or foreign entity that justify the sanction; and

(2) there is enacted into law a joint resolution stating the approval of Congress for the report submitted under paragraph (1).

(b) EXISTING SANCTIONS- The President shall terminate any unilateral agricultural sanction or unilateral medical sanction that is in effect as of the date of enactment of this Act.

http://www.fas.usda.gov/itp/cuba/title_ix.html

US law no longer allows any requirement for NGOs to distribute medical supplies, any requirement for verification that the supplies go to Cuban citizens rather than foreign customers, or any of the other restrictions that were in place before 2000. Now all that is required is application for a license by some entity not engaged in terrorism (and I don't believe there are any cases of this terrorist entity restriction being invoked since 2000).

[EFerrari]

25. The real question, though, is can the Cuban government get a license?

[eomer]

29. It is the exporter who is required to get a license.

1) IN GENERAL- Notwithstanding any other provision of this title (other than section 904), the export of agricultural commodities, medicine, or medical devices to Cuba or to the government of a country that has been determined by the Secretary of State to have repeatedly provided support for acts of international terrorism under section 620A of the Foreign Assistance Act of 1961 (22 U.S.C. 2371), section 6(j)(1) of the Export Administration Act of 1979 (50 U.S.C. app. 2405(j)(1)), or section 40(d) of the Arms Export Control Act (22 U.S.C. 2780(d)), or to any other entity in such a country, shall only be made pursuant to one-year licenses issued by the United States Government for contracts entered into during the one-year period of the license and shipped within the 12-month period beginning on the date of the signing of the contract, except that the requirements of such one-year licenses shall be no more restrictive than license exceptions administered by the Department of Commerce or general licenses administered by the Department of the Treasury, except that procedures shall be in place to deny licenses for exports to any entity within such country promoting international terrorism.

http://www.fas.usda.gov/itp/cuba/title_ix.html

[EFerrari]

31. Thanks. But does that answer the problem? I don't know.

[eomer]

32. Nice talking with you. Have a nice evening. n/t