The shortage of life-saving drugs makes the island's achievements all the more impressive
Tuesday September 18, 2007
Rory Carroll does an excellent job in describing Cuba's prioritising of health provision (First world results on a third world budget, September 12). He sums it up well as a "unique blend of third-world conditions with a progressive ethos and first-world results". Yet he fails to mention the 46-year-old United States blockade of the island, against which Cuba's achievements in health must be put into context and are even more impressive for doing so.
It is a direct consequence of this blockade that hospitals lack vitamins, "pharmacies lack basics such as aspirin", and people are forced to take more exercise because "cars and public transport are scarce". Such shortages drive down Cuba's impressive health indicators, "causing patients including children unnecessary pain and in some cases to die needlessly", according to an Association for World Health report.
During her recent tour of the UK, Dr Aleida Guevara, daughter of Che, and a practising paediatrician in Cuba, used every opportunity to collect supplies of life-saving cancer drugs, which the blockade prevented her from importing, and which resulted in the deaths of youngsters in her care.
"Health and education are the revolution's pillars of legitimacy so the government has to make them work," says a senior western diplomat in Carroll's piece. But I would add Cuba's commitment to internationalism as a further pillar of the revolution, and for which Cubans have been prepared to sacrifice their own limited resources.
A much-used Cuban phrase is "we share what we have and not just our leftovers", and never is this more true than in the 32,000 Cuban doctors volunteering in 72 developing countries to help deliver healthcare.
I took one such doctor on a tour of the UK earlier this year. Dr Carlos Dupuy was leader of the 2,465-strong Cuban emergency medical team which treated 1.7 million people affected by the Pakistan earthquake in 2005. He is now heading up the Cuban emergency effort in Peru following the recent quake there.
This reduction of doctors on the ground does cause Cubans to moan, and many have done so to me, often loudly, rather than "muffle complaints lest they be jailed as political dissidents", as Carroll asserts. But Cuba is committed to training doctors and nurses from the developing world, in marked contrast to the western nations who actively recruit from poor countries for their own health services. I have witnessed first-hand the succession of UK practitioners who have travelled to Havana to find out how a seemingly failed system has been able to develop into the envy of many in Latin America and beyond. Yet valuable lessons are too often ignored, swamped by the dead end of blockade policies.
Cuba is no utopia, and the problems are many. Yet we must recognise the obstacles they face. Western governments who are serious about delivering on the millennium development goals in health could do well to learn from a country that has become adept at delivering healthcare at home and increasingly internationally.
Rob Miller is director of the Cuba Solidarity Campaign firstname.lastname@example.org