Cuban Anonymous Commentary for the CMAJ

Cuban Anonymous Commentary for the CMAJ

The Silenced Socialist Apartheid and Confinement of Physicians in Cuba.

While the term ‘apartheid’ has been always related with extreme racial segregation of black people in South Africa by the white people, two letters of 20 years ago discussed a borderline type of ‘medical apartheid’ of immigrants in Canada to obtain medical jobs, according to their nationality, obviously from developing countries and universities.[1-2]

These two letters have encouraged us to make some comments on a totally inverse and broader type of apartheid and confinement suffered in Cuba for a half century by 99% of its population, but more by its physicians, by a tyrannical elite of socialist revolutionaries.

To understand this is necessary to go back. In 1762, Havana City was a more opulent city than Montreal, Boston and New York (Toronto did not exist yet), due to the benefits of the rich Ibero-American fleet’s scales at its harbor. Thus, in the 1950s, Havana had a sixth of the Cuba’s population, exceeded this proportion only by London and Vienna.[3]

Cuba since the 1700s followed the French before the U.S. medicine, founding a medical school in 1728, an academy of science in 1861, and eradicating epidemics of cholera in 1871, yellow fever in 1908, and smallpox in 1923, years before than its U.S. neighbor.

In the 1950s, Cuba had excess of physicians by U.S. standards with lowest infant mortality and infections morbidity reduction and highest life expectancy increase by world standards. (table) [3-11] Russian-Cuban misinformation spread the falsehood that democratic and flourishing Cuba had in that times neither medicine nor public health, because it had a plethora of doctors in Havana and other cities, and a shortage in the countryside.[12]

They accused Cuba of a common situation worldwide then. In the West, these differences progressively disappeared with prosperity in the daily living and working conditions in the countryside in relation to the advancing cities. Cuba in 1959, much more modern than Russia and China, was forced by the revolution to a leveling setback to the miserable urban and rural populations and infrastructure of the 1800s. It prepared since then massively doctors (table) and forcing them at the expense of their indigence, to work in the poorest rural areas as made in the past the Russian feldshers and Chinese barefoot doctors, and even, their university doctors, but with a difference, also in foreign rural missions.

In Cuba until 1958, as in every advanced country there were more physicians than state jobs. But all Cuban physicians, independently of their political affiliation could have any type of private practice; work in any other professions or businesses; because of Cuba’s political democracy and free market economy. From 1959 thousands of physicians emigrated until an iron door was closed in 1962. In 2008, every doctor has a job, but only pays the double or triple of the extreme poverty social ‘security’ of non-workers (table).

Cuba occupied for 50 years by Russian and Chinese military, suffered an inverse and extreme medical apartheid compared with Canada, intensified with a confinement of its active and retired doctors, favoring foreign and Cuban doctors unconditional politically. If doctors dissent of the socialist re(in)volution, they could be in a penitentiary, without any medical work, or even in a subtle kind of medical work in domiciliary prison.

Since then, the foreign doctors working in Cuba from Latin America and the Soviet Bloc, used to earn in U.S. dollars part of their wages and live in the best housing (robbed to outcast Cubans). They used to buy in special shops (without rationing cards), including cars and modern stuff, and enjoyed special leisure facilities (robbed to the owners). Latin Americans (not the socialists) traveled overseas freely for scientific trainings, exchanges, fellowships, Sabbath years, or simply leisure to any country. These natural things in Cuba until 1958 and The Americas until now, were forbidden in Cuba for more than 99% of the Cuban doctors, earning wages estimated now from 15 to 25 U.S. dollars monthly.

For 50-years our scientific education and updating have been worsened due to unnecessary massive preparation, and ban since 1959 of our copious open exchanges with the U.S., Canada and Western European professionals, who assisted us to forge from 1762 to 1958 an advanced completely integrated living, working and healthcare system

During this half century dark night, there have been three main ways that few doctors have had to live a little better; have traveled with a ‘parole’ abroad (letting the family in Cuba as hostage) and brought some modern stuff, and have been authorized (or not) to nominally own a Russian car and some housing (robbed as well). They are as follows:

1. Being a political opportunist and accepting being public health party or state officer at the national or province health level; participating unconditionally in the massive political repression and misinformation of doctors and patients, directed by the unique party, manipulating the history of Cuba, most of all in relation to the U.S. and the West, and the Cuban statistics and achievements in the medical, health, education and science sectors.

2. Participating since 1959 in secret missions overseas of military sedition and rebellion and/or since 1964 in ‘Trojan Horse’ ideological conspiracy and subversion against native governments and doctors as strike breakers; against North America, Europe, Japan, democracy and market economy; and in favor of Russia, China, other enemies of the West, and socialist despotism in Latin American, African, Islamic and Asian countries. Most civil two-year missions abroad have been made earning 120 U.S. dollars yearly.

3. By top family or crony relations, political militancy or reliability, having scientific trainings, expert consultation, and exchanges in North America, Europe, Japan, and by United Nations’ organizations, through all the grants controlled by the unique party, most of all, for executives of institutes and top hospitals, and including political propaganda, misinformation, and ‘Trojan Horse’ ideological subversion in these countries too.

The socialist discrimination and exploitation by nationality and ideology of physicians have distorted the medical ethical values and functioning of the Cuban clinical, health, university and research sectors, creating since 1959, an accented preference in the doctors to work in a dessert, jungle, icy mountain or slum abroad, caring, teaching or advising foreign people, instead of working in our primary care polyclinics and family medicine practices with our poorest 99% of Cuban population, in our poorest countryside and even dis-urbanized cities converted in huge slums by this Stalinist and Maoist style revolution.

For a half century the Cuban tyrants have blocked the exit permission of active doctors for scientific interests or leisure in the western countries, specially in the U.S., excepting for political propaganda, military and subversion missions. Castro personally authorizes every trip to the U.S. But the tragedy continues after retirement. The leisure visas that can apply freely the retired doctors to have some scientific exchange, friendly or family visit, paid from abroad are being denied, because they are considered possible emigrants by most consulates. In complicity with the tyrant, some consulates request mountains of papers and/or cash, and in some cannot be seen a consul. Some Cubans who were born before 1959 in a prosper family and nation, are being segregated worse than if they were poorest illiterate Haitian immigrants, who has a higher status than most of our doctors now.

Physicians need not this official extreme abuse, but the protection by the Cuban state of ‘all’ their individual freedoms, the transition to our previous political democracy, mixed state and private property, and prosper free market economy again; reestablishing Cuban and foreign private organizations and firms independent of socialist political affiliation, reconciling and reunifying all the Cubans of the U.S. and exile by all the world countries overcoming all ideological gaps. The few cosmetic openings made in 2008 by the Castros, as ever, have not brought any benefit for the 99% of the Cuban people.

We, the Cuban people and doctors anywhere, need to throw away once and for all, from our homeland the Russian and Chinese invaders with all type of secret military bases in Cuba (and through Cuba in Latin America), totally alien Eurasian imperial powers to the culture of freedom that had progressed in The Americas since the liberation from Spain.

The world must know that the Cuba re-liberation was blocked in the 1990s and 2000s by the revenge of socialist Spanish governments and other resentful countries to the U.S., supporting the Castro’s puppets, collaborating in the coercive subjection of the Cuban people. Taking advantage of this, Cuba has diffused through heavy indoctrination in Latin America, its repressive system, with its retrograde animal living and health system.

References:

1. Rossmann C. Medical apartheid in Canada. CMAJ. 1988 Mar 15;138(6):492.

2. Bose B. Medical apartheid in Canada. CMAJ. 1988 Jun 1;138(11):995-6.

3. Thomas H. Cuba or the Pursuit of Freedom. New York, Updated Edition Da Capo Press, 1998.

4. McGuire JW, Frankel LM. Dimensions and determinants of mortality decline in pre-revolutionary Cuba. Harvard Working Paper Series, vol 14, no 6. Cambridge, MA: Center for Population and Development Studies, 2004. Available in:

http://www.globalhealth.harvard.edu/hcpds/wpweb/McGuire_wp1406.pdf

5. Anon. Cuba's delayed transition needs. Lancet 2006 368(9544):1323. (Oct 14) http://www.thelancet.com/journals/lancet/article/PIIS0140673606695445/fulltext

6. Cuban Health Statistics Bureau. Annual Health Statistics Reports 1973-2007. Havana City: Ministry of Public Health, 1974-2008. Last 13 years available in: http://www.sld.cu/servicios/estadisticas/

7. Maddison A. Contours of the World Economy 1-2030 AD. Essays in Macro-Economic History. Oxford University Press, 2007.

8. UNICEF. The State of the World’s Children 2008. New York, NY: UNICEF Database; 2008. Available in:

http://www.unicef.org/publications/files/The_State_of_the_Worlds_Children_2008.pdf

9. UNDP. Human Development Index report, 2007/2008. Available in:

http://hdr.undp.org/en/media/hdr_20072008_en_complete.pdf

10.UNESCO. Progress of literacy in various countries; World illiteracy at mid-century. Monographs on fundamental education VI, XI. Paris: UNESCO Publ; 1953, 1957. Available in: http://unesdoc.unesco.org/images/0000/000029/002930eo.pdf

11. US-National Bureau of Economic Research. Occupational wages around the world; International labor organization, 2007. Available in: http://www.nber.org/oww/ ; http://laborsta.ilo.org

12. Torras J. [The economical factors in the medical crisis]. Rev Cub Economia y Desarrollo 1972;13:6‑34.

Table

Cuba: Democratic market-economy 1800, 1900, 1958 vs. socialism 1959, 2008.

Index / Year	1800	1900	1957	2007
Gross mortality rate (x 1000 inhabitants)	39	32	6.5	8
Infant mortality <1 yr. (x 1000 live births)**	300	200	32	5.3
Life expectancy at birth (years)	28	32	64	78
Gross birth rate (x 1000 inhabitants)	47	32	27	10
Total fertility rate	7	5	3.7	1.4
Total number of physicians (physicians working out of Cuba)	200	1250	6000	72400* (36000)
Adult literacy (>14 yr.) percent (functional illiterates)	5	46	80	99* (9)
Urban population percent (urban infrastructure deteriorated)	15	30	54	75* (67)
GDP per-person [1990-GKUS$] (GDP calculated by World Bank norms)	700	1700	2406	3400* (2700)
General physician monthly mean wage (US$) (including doctor private work)	100	200	400	25 (0)
Total population (million) (emigrants, some drown/eaten by sharks)	0.4	1.6	6.4	11.3* (1.5)
Human development index country rank (including repressed UN liberties/rights)	50	30	25	51 (>100)
Access to best living, working, education & health care of elder/adult population percent	1	10	25	1

*Indexes adjustments by world standards & specific situations.

**Infant mortality rate in 1957 was the 14th world lowest rate; in 2007, it worsened up to the 28th-37th world lowest rate shared with nine countries.

Author’ adjustment and estimation of data were made from multiple sources for circa 1800, 1900 & 1957, when exact data for all the population groups were not available.

Main Sources: [3-11]