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on:
Editorial:
Planning for Cuba's transition
The Lancet - Vol. 368, Number 9535, 12 August
2006, Pages 554
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Cuba's
health needs
Rob
Miller, August 16 2006 |
|
Planning
for Cuba's transition?
Pedro A. Lopez-Saura, August 16
2006 |
|
Please,
don't. Thank you.
Sergio Jorge Pastrana, August 22
2006 |
|
Cuba
possible crisis
Leonardo Cançado Monteiro Savassi,
August 22 2006 |
|
Colonialism
is hard to unlearn
Luis Justo, August 22
2006 |
|
Health:
Icon of the Cuban Revolution
Pedro Ordúñez, MD, August 22
2006 |
|
A
“new” Cuban transition?
Alfredo Espinosa-Brito, August 22
2006 |
|
The
Lancet on Cuba - When Ignorance is not
Bliss
Richard Cooper,
August 22 2006 |
|
Planning
for Cuba's Transition - to another Iraq?
John Waller, August 22
2006 |
|
Complex
issues surround Cuba's health in transicion
Antonio María de Gordon, August 22
2006 |
Cuba's health
needs
August 16 2006
Rob Miller, Director,
UK.
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|
Cuba has managed to
achieve much in terms of the health provision of its
citizens: all the internationally recognised indices
show a system that, despite enormous difficulties, has
managed to provide a health service that matches those
of many 'Western' countries and is certainly envied by
many across the region.
The idea that the $80
million dollars set aside for the 'Commission for
Assistance to a Free Cuba' could somehow be used to
actually help Cubans is absurd. The entire premise of
the 'Commission' is one of interference and regime
change in a sovereign and 'stable' country. The money
has been set aside to undermine the Government of Cuba
and in doing will actually be used to negatively affect
health provision on the island.
If the United States is
really interested in the health concerns of Cuban
citizens it should end the illegal blockade of the
island steer clear of interfering in yet another
independent nation.
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| Competing Interests:
None |
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| References:
none |
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Planning for Cuba's
transition?
August 16 2006
Pedro A. Lopez-Saura, Researcher, Center for
Biological Research, Havana, Cuba.
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|
Dear Sir:
It is
surprising that such a rigorous and serious journal,
publishes such an editorial, based, indeed, on an
absolute ignorance of what is happening or can happen in
Cuba. Cuba's healthcare system already made a very large
transition in 1959 to the best indexes among the so
called "third world" countries, even in some cases
better than some of the so called "first world" (please
look at WHO reports), particularly as compared to the
United States. In fact, if the Lancet pretends to show
and study how healthcare can be improved in developing
countries, it should look at Cuba's case as an example
(which has been never taken into account). No one in
Cuba wishes to go back. At the same time the Lancet
should not ignore the effort that Cuba does to improve
healthcare in other developing countries. For example,
in your reports about the recent earthquake in Pakistan,
there has been no mention to the more than 2000 Cuban
doctors and nurses that worked in the very intensively
damaged zones for more than 6 months. This has been
highly acknowledged by the Pakistani people and
government. At present there are more than 30000 Cuban
doctors throughout Latin America, Africa and Asia,
working in the mountains and rural zones, giving care to
people that otherwise are not reached by their
countries' mostly private healthcare systems. The main
medical journal in the world should pay attention to the
so called "Operación Milagro" (Miracle Operation) in
which more than 200 000 blind patients from Cuba,
Venezuela, and other Latin American and Caribbean
countries have recovered vision. Our closest neighbor
should dedicate the 80 million USD you mentioned to
improve the health of more than 40 million people they
have without health coverage. On the contrary this sum
will be used in Cuba to promote uneasiness and
terrorism. I suggest the Lancet to review its editorials
with the same rigour it does with the articles sent
there.
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| Competing Interests: A
Cuban doctor |
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| References: World Health
Organisation. WORLD HEALTH STATISTICS 2006 |
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Please, don't. Thank
you.
August 22 2006
Sergio Jorge Pastrana,
Foreign
Secretary, Academia de Ciencias de Cuba, Havana,
CUBA.
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|
It is indeed surprising
that The Lancet should have dedicated an editorial to
discuss the need for aid in the public health sector in
case of a Cuban political transition. I wonder whether
the editorialist has visited Cuba, or if he/she is aware
of the resilience of a primary health care system that
during the worst years of the crisis during the nineties
managed to maintain the good health indicators already
achieved, and which, by the way, are even now much
better than those in several states and cities of the
USA, the richest country in the World. Needless to say,
aid at that time was negligible, and Cubans managed not
only to keep the good indicators, but to continue
improving on them.
Instead of thinking
what to do to help in a "Cuban Transition Period", The
Lancet could urge right now the Bush administration to
lift the measures of the embargo that prevent Cuba to
acquire direly needed medical equipment, supplies and
medicines that could help save lives and that are
perversely prohibited, even to third parties, to be sold
to Cuba.
It is indeed something of a
paradox that this page of The Lancet is shared by
another editorial discussing what to do about trachoma
so as to decrease the incidence of that already curable
disease in the poor World. I wonder whether the
editorialist knows of the best effort ever to lower the
incidence of blindness in poor countries: the Operación
Milagro that is being carried out by Cuban doctors, and
that in a couple of years has already surgically treated
hundreds of thousands to restore their sight, and by the
way, free of charge.
I do not know why
The Lancet should echo the call of the Bush government
in the case of Cuba. Instead of siding with those who
are pouring millions on efforts to intervene in the
internal affairs of a sovereign country, The Lancet
could recommend the US government, and the international
community, that the money they are wasting on campaigns
towards foreign intervention in Cuba be used to cure the
diseased in poor countries, or even within the USA,
where there are 40 millions inhabitants that do not have
adequate access to health care.
We
Cubans are rather suspicious of the good intentions of
our powerful neighbors to help us cope with difficulties
in transition. We are still convalescent of the US
intervention in Cuba at the end of the XIX Century when
US troops came to help us gain independence and we ended
with such a bad case of meddling in our affairs that we
still have the sore of Guantanamo Base to remind us of
their good intentions.
Cuba will manage
for itself in spite of all those intent on deciding what
to do here. Let us Cubans cope with our problems
ourselves, and decide whether we need any assistance,
and what, when, and from whom, to ask for
it.
Sergio Jorge Pastrana
Academia
de Ciencias de Cuba.
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|
| Competing Interests: Tha
Cuban Academy is an independent body specialized as
adviser in Science matters. |
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| References: For updated
information in English on Cuba's Health Indicators and
international cooperation in health care you can go to
www.medicc org |
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Cuba
possible crisis
August 22 2006
Leonardo Cançado Monteiro Savassi,
Family
Physician and Pediatrician, Belo Horizonte, MG,
Brasil.
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| I hope that US "help" to
cuban citizens does not change the Cuban health system
into the American health System. Cubans do not deserve
this. |
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| Competing Interests: I
work in primary care |
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| References:
none |
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Colonialism is hard to
unlearn
August 22 2006
Luis Justo, Professor of Bioethics,
Universidad Nacional del Comahue -
Argentina.
|
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| It is hard to understand
how a medical journal such as The Lancet could harbour
such a high-browed Editorial as Planning for Cuba's
transition. There’s no possibility of developing a
sanitary system such as the Cuban without the deep
belief and compromise of its people in this
revolutionary goal. The attribution of this achievement
to a single person seems provincial and short-sighted.
The real strength of the Cuban revolution will be seen
after Castro's death, as the predicted humanitarian
catastrophe will not exist. Perhaps the USA and its
imperial minions should dedicate funds to their excluded
people at home. There are many Imperial citizens lacking
the health standard Cubans are currently used to, so
please, don’t be so colonially patronising! |
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| Competing Interests:
None |
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| References: No
references. |
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Health: Icon of the Cuban
Revolution
August 22 2006
Pedro Ordúñez, MD, Director, Hospital
UNiversitario Gustavo Aldereguía. Cienfuegos,
Cuba.
Luis C
Silva, PhD, Yanelis La Rosa, MD, Frank C Alvarez, MD,
MsC, Salvador Tamayo, MD<br/> Alfredo Espinosa,
MD, PhD<br/> |
|
Cuba is a middle-low
income country with more than 70 000 doctors serving a
population of 11 million healthy, well educated
citizens. As health professionals we take pride in
Cuba’s accomplishments. The course of our history has
not been entirely in our own hands, however. The US, our
closest neighbour only 90 miles to the north, has been
an implacable enemy responsible for an unprecedented
economic, financial and commercial blockade over the
last 47 years. The recent Lancet editorial - Planning
for Cuba’s Transition - (1) misreads this history and
puts forward a wholly unbalanced and misleading
perspective on the nature of Cuban society. This
“charitable” piece, which is in reality hostile to our
community and scarcely compatible with your respected
journal’s usual good sense, could be confusing to
external actors and dangerous to us, Cubans living on
the island.
President Fidel Castro is recovering
from his medical condition and almost everybody here is
celebrating his 80th birthday. Meanwhile, Cuban society
is demonstrating once again it’s well tested resilience
to live through hard times. The opportunity to fully
enjoy our natural health endowment has been the iconic
achievement of the Cuban Revolution and Castro’s
devotion. This has been accomplished without the
technologic resources that can be found in
industrialized countries. If these accomplishments could
be reproduced across other poor and middle income
countries the health of the world’s population would be
transformed. (2-4)
Although the trajectory of
social development in Cuba over the last 50 years is
both complex and controversial the public health
experience should be subjected to judgment on the basis
of the usual rules of science. Rather than prophesying
that violence will break out and that internal divisions
will put Cuba on the road to becoming a failed state,
The Lancet, using it’s prestige and influence, should
launch an initiative to evaluate the significance of the
Cuban experience. On every measure this strategy has
been more successful than the “neo-liberal” policies in
place elsewhere in the developing world. This result
apparently remains incomprehensible to both North
Americans and Europeans alike. (5)
By choosing
to ignore the evidence, The Lancet offers a prediction
similar to those of the Blair-Bush administration on
Iraq. Cuba consistently astonishes more careful observes
with its cultural, sport and health achievements. For
example, infant mortality is well below the US, AIDS
rates are the lowest in the Americas, and universal,
cost-efficient care is delivered without charge to all
citizens. We are also a provider of doctors and teachers
to the poorest communities of world, free medical care
to 300 000 foreign patients that have recovered their
vision, and thousands of university fellowships to Latin
American and Caribbean students. Is this evidence of a
“failed state”?
Cuba does not need a “US
Presidential Commission for Assistance”. What Cuba does
need now is action to prevent further aggression, as has
been initiated by Harold Pinter and others Nobel
laureates (6). This declaration, now supported by
thousands of intellectuals and progressive people
worldwide, is in stark contrast to the call by The
Lancet for a “humanitarian” US intervention. We ask your
readers instead to join us in our campaign to insure
that the sovereignty of Cuba be respected.
(6)
|
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| Competing Interests:
None |
|
References: 1. The
Lancet. Planning for Cuba’s transition. The Lancet 2006;
368:554.
2. Silva LC, Urra P. Learning from low
income countries: what are the lessons? Br Med J
2004;329:1185
3. Franco M, Cooper R, Ordúñez P.
Making sure public health policies work. Science 2006;
311: 1098.
4. Lazo M, Franco M, Cooper R, Orduñez P.
Better health statistic: the Cuban experience. The
Lancet 2006; 367:985-986
5. Cooper R, Kenelly J,
Ordúñez P. Health in Cuba. Int J of Epi 2006 (in
press)
6. www.porcuba.org. Accessed August 13, 2006
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A
“new” Cuban transition?
August 22 2006
Alfredo Espinosa-Brito,
Professor of
Internal Medicine, Hospital Dr. Gustavo Aldereguía Lima,
Cienfuegos, Cuba.
Pedro O. Ordúñez-García<br/>
Luis G. del Sol-Padrón |
|
A pessimist forecast was
done in the editorial “Planning for Cuba’s transition”
(Lancet 2006; 368:553). “Cuba will experience a period
of rapid and uncomfortable change”. According to it, one
can imagine Cuba’s future (“post-Castro”) similar to
other recent wellknown cases of “western democratic
transitions”… with their dangerous consequences for
citizens, who will “require immediate humanitarian
assistance” and “as the closest neighbour, the USA must
be ready to help meet immediate humanitarian needs”.
But, what about these claims? “Denying food and
medicine to Cuba’s civilian population in an effort to
effect political change represents a sad and shameful
episode in the history of the USA”? (1). "The US embargo
since 1960 has caused a significant rise in
suffering—and even deaths—in Cuba”. “Such an embargo
appears to violate the most basic international charters
and conventions governing human rights, including the
articles of the Geneva Convention governing the
treatment of civilians during wartime." (2) "The Cuban
instance make it abundantly clear that economic
sanctions are a war against public health. As
physicians, we have a moral imperative to call for the
end of sanctions." (3)
In the last decades, Cuba
has been represented an alternative example where modest
infrastructure investments combined with a
well-developed public health strategy have generated
health status measures comparable to those of
industrialized countries. (4) Given current political
alignments, however, the major public health advances in
Cuba, and the underlying strategy that has guided its
health gains, have been systematically ignored.
Since 1963, more than 100 000 Cuban health
professionals were helping to provide health care
throughout Latin America, Africa and southestern Asia.
Also they having gone to a lot of countries devastated
by natural disasters for many years, as a proactive
approach to helping them (5) Recently, there were more
than 2 000 in Pakinstan after the last eathquake.
Nowadays, more than 25 000 Cuban doctors are working in
70 underdeveloped countries all over the world.
More than 4000 medical doctors studied freely in
Cuba since 1966, mainly from the Third World countries.
The Latin American School of Medicine provides free
training to individuals from poor areas of these
nations. Thousands of students have to agree to return
to their own region within their own country and provide
health care for their local population after
qualification. (5)
What is the meaning of:
“Injustices and inequalities, although already present,
will become more obvious and could lead to social unrest
…it is essential to national stability that a
functioning health system is maintained”. “For health,
the consequences are potentially dire. Is it possible to
build a “new Cuba” with social unrest because the
restoration of capitalism and neoliberalism and to
maintain a well functioning socialist health system in a
poor country simultaneously? How to do it? Should we go
back? Look to example of Soviet Union. But Cuba is
another “case study”. Please, let us build our own
future, according to our history, principles and vision
of the immense majority of Cubans.
Alfredo D.
Espinosa-Brito, MD, PhD
Pedro O. Ordúñez-García,
MD
Luis G. Del Sol-Padrón, MD
Hospital Dr.
Gustavo Aldereguía Lima,
Cienfuegos,
Cuba
|
|
| Competing Interests:
Cuban doctors |
|
References: 1.
Kirkpatrick AF. Cuban President Fidel Castro’s
health-care system. Lancet 2000;355:1191-2
2.
Delamothe T. Embargoes that endanger health. BMJ 1997;
315: 1393-4
3. Eisenberg L. The sleep of reason
produces monsters: human costs of economic sanctions. N
Engl J Med 1997;336:1248-50
4. Spiegel J, Yassi A.
Lessons from the margins of globalization: appreciating
the Cuban health paradox J Public Health Policy
2002;25(1):85-110
5. Choonara I. Cuban doctors.
Lancet 2004;364:579
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The
Lancet on Cuba - When Ignorance is not
Bliss
August 22 2006
Richard Cooper, Prof and Chair, Loyola
Medical School, Chicago, IL, USA.
Joan Kennelly, Division of
Community Health Sciences, University of Illinois School
of Public Health, Chicago, IL |
|
Dear Sir or
Madam,
We were dismayed by your editorial on Cuba
(1). Embedded within the convoluted argument are basic
errors in judgment. First, it misperceives and
misrepresents the situation inside Cuba. Second, and
even more surprising given international events of the
last 5 years, it attributes to the US administration a
desire and capacity to improve the lot of poor
countries, let alone Cuba.
The editorial is
premised on political assumptions about the character of
Cuban society which are subject to challenge; this
venue, however, is not the place to pursue that debate.
Although aspects of Cuban society deserve re-evaluation,
in the last 15 years Cuba has been extraordinarily
flexible in its response to changing political and
economic conditions (2). While desire for change
undoubtedly exists, the social forces required to
generate violence and chaos in Cuba do not. Your specter
of a popular uprising reflects an understanding of life
in “faraway places” on a par with that of the Bush-Blair
administrations. Their initiatives in the Middle East as
well as Latin America demonstrate that limited knowledge
of local conditions is a poor basis for policy. The same
can be said of your call for “humanitarian assistance”
to Cuba. “Collapse” is not in the offing; even those in
Miami are admitting that such a scenario was “wishful
thinking” (3). The Cuban economy reportedly grew over
11% last year, power outages have been minimized and
wages doubled. The achievements in health continue to
outpace any other non-industrialized country, and some
rich countries, including the US (Table).
Your
belief in imminent collapse justifies the conjecture
that social services would cease to function, requiring
“massive influx of aid” including “food, water and
shelter”. This perspective strikes us as bizarre and
sounds like an open pretext for US intervention. In the
face of 3 recent major hurricanes, only 16 Cubans died
and millions were successfully evacuated, fed and
housed. On the contrary, upwards of 2,000 US citizens
lost their lives in Katrina and a year later tens of
thousands remain displaced and in serious need. These
examples could be multiplied – in terms of response to
everything from AIDS to dengue fever. The point is that
no society with an infrastructure as decrepit as the one
you describe could function with the resilience and
effectiveness of Cuba. In 1990 loss of a dependent trade
relation with the USSR led to a 35% drop in the Cuban
GDP. Nevertheless, Cuba has survived and in the
meanwhile achieved an infant mortality rate of 5.8 /
1000, compared with 7.0 in the US (4,5). In contrast,
over the same period, US “assistance” to Russia has cost
millions of people their health and livelihoods.
Your doomsday perspective is one-sided and lacks
an empirical basis. We would hope your readers will have
more of an interest in an evidence-based evaluation of
Cuba’s unique place in the contemporary world.
|
|
| Competing Interests:
Health professional<br/ <br/ This correspondence
was also submitted for publication but we have chosen
this option instead. |
|
References:
1.
Editorial. Planning for Cuba’s transition. Lancet
2006;368:554.
2. Gott R. Cuba. A New History.
Yale University Press, New Haven, Connecticut,
2005
3. Cuba stays calm with Castro on the
sidelines. International Herald Tribune, August 14,
2006.
3.
http://unstats.un.org/unsd/snaama/SelectionCountry.asp
(Accessed August 15, 2006)
4. Ministry of Public
Health, Annual Statistical Report on Health. Havana,
Cuba (Ministerio de Salud Publica. Anuario Estadistico
de Salud. Republica de Cuba. La Habana, Cuba);
http://www.infomed.sld.cu/servicios/estadisticas/
(Accessed August 15, 2006)
Richard
Cooper, Department of Preventive Medicine, Loyola
Medical School, Chicago, IL.
Joan Kennelly,
Division of Community Health Sciences, University of
Illinois School of Public Health, Chicago,
IL
Table
Indicators of Cuba’s
Accomplishments in Public Health
First country to
eliminate polio – 1962
First country to eliminate
measles – 1996
Lowest AIDS rate in the
Americas
Most effective dengue control program in the
Americas
Comprehensive health care; 1
physician/120-160 families
Highest rates of treatment
and control of hypertension in the world
Reduction in
cardiovascular mortality rate by 45%
Crude infant
mortality rate of 5.8/1,000
Development and
implementation of a “comprehensive health plan for the
Americas”
Free medical education for students from
Africa and Latin America
Support of 34,000 health
professionals in 52 poor countries
Creation of a
national biomedical internet grid
(INFOMED)
Indigenous bio-technology sector; producing
the first human polysaccharide vaccine
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Planning for Cuba's
Transition - to another Iraq?
August 22 2006
John Waller, freelance health
researcher, Sheffield, England.
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|
The Lancet has a history
of publishing sensible review articles about Cuban
health care - read for instance any of the contributions
by US public health care physician Richard Garfield over
the years. Sadly your editorial comment - Planning for
Cuba's Transition - Health - in The Lancet 2006; 368:554
seems to have descended into insanity.
For
brevity lets just take part of one
paragaraph.
"As Cuba's closest neighbour, the USA
must be ready to help meet immediate humanitarian needs,
if the worst-case scenario arises. If suggestions made
last month, by the US Presidential Commission for
Assistance to a Free Cuba, are heeded, resources of
US$80 million could be set aside for the
task."
Has the Lancet forgotten all the evidence
(documented in its own pages) of the damage to Cuban
health caused by US economic sanctions? Does it not know
that the US organisation who has sent most humanitarian
medical aid to Cuba (possibly about $30 million over 15
years) - Pastors for Peace - has been regularly harassed
by the US government and, as of the quoted Commission
report, is now threatened with possible criminal
charges.
Has it not read the report and its much
longer predecessor in 2004 where it is made quite clear
that the US aim for the Cuban health care system is
total privatisation. Yes some of that $80 million
destined to support regime change in Cuba might be spent
on legal fees for US lawyers to assist the privatisation
process. But lets get some scale here - last year Cuba
earned about $8 Billion through foreign trade. Roughly
$800 million of that came from remittances from Cuban
Americans to their families - people throughout the US
who, whatever their opinion of the Cuban government,
genuinely care about their loved ones and are restricted
from visiting them and financially supporting them by
the Bush administration.
For 47 years the Cuban
health service and wider social system has done a pretty
remarkable job in raising the country's health
indicators up to a par with the US itself, despite the
US blockade. Left alone it can reasonably be expected to
continue to do so - with or without Fidel Castro. The
real uncertainty comes from what is being planned in the
White House and the Pentagon - the openly admitted
'secret annex' to the Commission report. The May 2004
Commission report talked about a major programme for
caring for Cuba's orphans. Curious since Cuba doesn't
have that many - but doubtless a bit of Donald
Rumsfeld's "shock and awe" would soon change
that.
The real question for humanitarians in
Britain is - are we going to support the Cuban people in
building their own future, or are we going to be once
again global cheer leaders for a George W Bush
'humanitarian' invasion?
Iraq had reasonably
good health indicators once.
|
|
| Competing Interests:
None |
|
References: Role of the
USA in shortage of food and medicine in
Cuba
Kirkpatrick AF
The Lancet - Vol. 348, Issue
9040, 30 November 1996, Pages 1489-1491
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Complex issues surround
Cuba's health in transicion
August 22 2006
Antonio María de Gordon,
Director,
Finlay Institute, Miami, USA.
None |
|
I read with interest you
editorial comments and do agree that it is simplistic to
loos at Cuba's health and 47 years of revolution in such
a "status quo" manner. You and your readers interested
in this topic should be directed to these articles
published elsewhere.
a)
http://www.finlay-online.com/finlayinstitute/cubasalud.htm,
b)
http://www.finlay-online.com/finlayinstitute/healthintransition.htm,
and
c)
http://www.finlay-online.com/finlayinstitute/healthandhealth.htm |
|
| Competing Interests:
None |
|
| References:
www.finlay-online.org |
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| Back
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