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    Cuba Has Lowest Infant Mortality in the Americas!
    Cuba’s Free Universal Healthcare System: How do they do it?

    By Tamara Hansen

    On January 24, 2013 the New England Journal of Medicine published an article entitled, “A Different Model — Medical Care in Cuba”. As visitors from the United States to Cuba the authors of the article, Dr. Edward Campion and Dr. Stephen Morrissey explain in the introductory paragraph, “The whole system seems turned upside down. It is tightly organized, and the first priority is prevention. Although Cuba has limited economic resources, its health care system has solved some problems that ours has not yet managed to address.” So the question we need to ask is how do they do it?

    In this article Fire This Time will explore Cuba’s revolutionary healthcare system and the gains made in family planning, life expectancy, infant mortality and for transgendered people. We agree with the New England Medical Journal article that Cuba’s healthcare system has solved some problems that the healthcare systems in Canada and the United States have not. We agree that it is partly due to Cuba’s focus on prevention, but want to go deeper. We believe Cuba is an example and leader in healthcare world-wide because they are putting people before profit in their healthcare system. They are also making these developments under very difficult conditions, especially those imposed on Cuba by the United States’ 50 year blockade, which has severely limited the amount of items Cuba can import or trade with other countries from high-tech medical equipment to pharmaceutical drugs to Band-Aids and Aspirin.

    To start with, Cuban doctors are trained to put families and family health first. Dr. Edward Campion and Dr. Stephen Morrissey write, “Cuba's medical faculties, of which there are now 22, remain steadily focused on primary care, with family medicine required as the first residency for all physicians, even though Cuba now has more than twice as many physicians per capita as the United States.” This is important as this means doctors cannot just go after the highest paying careers, they first have to learn how to treat patients directly. Working with people directly from all different backgrounds and many different ailments teaches doctors to not only treat the patient, but also to focus on the health of their whole community.

    A Different Model

    The article , “A Different Model — Medical Care in Cuba” explains, “care delivery is organized at the local level, and the patients and their caregivers generally live in the same community.” In Canada most people avoid going to the doctor whenever possible, because in the doctor’s office you have a limited amount of time, the doctor always seems rushed and usually the advice you get is just to deal with an immediate problem, they don’t know you well enough or have enough time to give advice on long term health concerns. In Cuba many people will have the same doctor from childhood, a doctor who knows their neighbours, their family and their friends, because they live in the same neighbourhood. Most family doctors know who’s parent has diabetes and might be at risk, who might be dealing with depression or alcoholism, who is elderly and in need of extra attention. The idea with preventative medicine is that it cannot just be a national media campaign or a top down approach, the community must take responsibility for the health of community members.

    Family Planning in Cuba

    Cuba is known for many things from its cigars, to rum, to baseball, to 1950s classic cars and of course its socialist revolution. However Cuba is also known worldwide for its spicy and exciting dance and music. Sometimes when you see a 2 or 3 year old dancing in Cuba you think they must just dance their way out of their mother’s womb and into the world!

    Part of this culture means that many teenagers and young adults have an active sex life. This is treated as a norm in Cuba, not something to be awkward or ashamed of. However, it does come with some health concerns. This is where having a community-based medical practice helps. Dr. Edward Campion and Dr. Stephen Morrissey explain, “House calls and discussions with family members are common tactics for addressing problems with compliance or follow-up and even for failure to protect against unwanted pregnancy.” Can you imagine, in the United States or Canada, your doctor doing a follow-up visit to your home to make sure you are following through with their advice? Or to sit in your living room to have a difficult conversation about how to protect against unwanted pregnancy? The idea seems so foreign you might event think, ‘that sounds awful and unpleasant, I wouldn’t like that,’ but if you really think about how important you and your family’s health is and how much you could learn from a professionally trained doctor, wouldn’t it be worth it?

    In July 2012, Venezuelan news agency Telesur reported that in 2010 Cuba reported 13,900 births by women between the ages of 15 and 19, an increase of 10% from previous years. This increase in teen pregnancy is worrying to Cuban experts because many methods of contraception, including the pill and condoms, are already free for Cubans of all ages. The Telesur report explained how Cuba will be increasing its education campaign, but that the education must start in the family and be reinforced by health institutions and at school. It also spoke to community leaders who explained that in Cuba teen pregnancy is considered the responsibility of everyone – basically meaning it is a social problem, not the problem of the young woman or young man and their families. This is very different than in Canada as it is uncommon for us to hear about teen pregnancy as an issue that must be discussed and solved by the community. Free birth control is also not readily accessible to most teens across Canada, especially those living outside of urban centers. Another important point about Cuba’s healthcare with relation to pregnancy which is discussed in the New England Journal of Medicine about is that in Cuba, ”abortion is legal but is seen as a failure of prevention.” Abortion in Cuba has been free and legal since 1965 and is an achievement of Cuban women in their struggle for equality.

    To be a new born baby in Cuba today

    To be born in Cuba today is to be born with rights. According the Cuba’s Ministry of Foreign relations (MINREX), “The state regulates the rights of children and adolescents through the Constitution of the Republic and various codes, laws and decree-laws, including the Child and Youth Code, the Family Code, the Civil Code and the Penal Code. The rights of Cuban children and adolescents are also protected through a system of social policies, programs and projects in the areas of health care, education, social security, the environment, and others. Cuba was one of the first countries to ratify the Convention on the Rights of the Child.” This is important as we cannot see healthcare simply as a solution for what ails us. If babies are healthy, but raised to be uneducated and uncultured then society cannot advance.

    A few accomplishments that a Cuban baby born today could look forward to are summarized in the article from the New England Journal of Medicine: “This highly structured, prevention-oriented [healthcare] system has produced positive results. Vaccination rates in Cuba are among the highest in the world. The life expectancy of 78 years from birth is virtually identical to that in the United States. The infant mortality rate in Cuba has fallen from more than 80 per 1000 live births in the 1950s to less than 5 per 1000.” In fact, once you are born in Cuba you have the highest chance of surviving past the first year of your life than in any other country of the Americas as Cuba has a lower infant mortality rate than even Canada and the United States. According to UNICEF, in 2010 Canada’s infant mortality was 5 per 1,000 and The US was 7 per 1,000. The low infant mortality rate in Cuba, 4.6 per 1,000, did not just happen, it is an important success built by the leadership of the Cuban government, which has created an accessible, universal and free healthcare system for all people.

    To be Queer in Cuba today

    Cuba has national campaigns for sexual health which include discussions not only about heterosexual sex, but also homosexual relationships. These are organized by the Cuban Center for Sex Education (CENESEX). Dr. Edward Campion and Dr. Stephen Morrissey write, “A recent national program to promote acceptance of men who have sex with men was designed in part to reduce rates of sexually transmitted disease and improve acceptance of and adherence to treatment.” Throughout Cuba the struggle against homophobia is breaking down barriers led by the director of CENESEX, Mariela Castro, who also happens to be the daughter of Raul Castro (Cuba’s president) and the niece of Fidel Castro (leader of the Cuban revolution). CENESEX has offices across the country which organize regular events for the queer community and its supporters. Clubs and discotheques across the country now have “gay” nights. While the difficulty of growing up gay, lesbian, transgendered or bisexual is clear, in Cuba or any country in the world, In roads are being steadily being made across the country from the Cuban government sponsored film, “Strawberry & Chocolate” released in 1993 to the recent hit song by Buena Fe “Ser de Sol” which is about a love affair between two women.

    While CENESEX is involved in many projects to improve social acceptance of queer people in Cuba, the healthcare system is also responding, from the education campaigns mentioned above, to the decision in 2008 to resume offering sex-change surgeries.

    In October 2012 Fox News Latino published an article explaining, “The number of Cuban transsexuals who have had sex-change surgery has risen to 20, according to figures released by Mariela Castro, director of the National Center for Sex Education, or Cenesex.” This was accompanied by two widely published news stories about two transgender people in Cuba, Juani Santos, who was born a woman, but has lived as a man since childhood. Juani completed his surgery at the age of 61 in 2011. CNN reported on Juani’s story and the fact that the Cuban government is offering sex-change surgeries for free, writing, “Although his parents were fairly understanding from the time he was young, his older brother used to burn Juani's clothes when he dressed like a boy. "But he was clever," Fernando Santos said. "As soon as I left the house, he would just wear my clothes." The brothers now live together, with Fernando taking care of most domestic duties while Juani works at the factory and tinkers with his motorcycle at home.” The second story which was reported in November 2012 was the election of Adela Hernandez, which the Associated Press called “the first known transgender person to hold public office in the country, winning election as a delegate to the municipal government of Caibarien in the central province of Villa Clara.” This is a great advancement, not only for trans-gender people in Cuba, but also for the international bourgeois media which generally does not like to admit that Cuba has elections! While these are social gains they are being supported by Cuba’s free and universal healthcare system and the sex-positive and inclusive message being brought to society by some great leaders, including Mariela Castro and those working with her at CENESEX.

    Why Canada’s healthcare system is sick?

    In Canada very little emphasis is being placed on preventing sickness or injury. Yes there are national media campaigns against smoking, or drinking and driving, but the healthcare system is not set up to really discuss key-issues with people about how to improve their health. Healthy organize food can be very expensive or take longer to prepare. Many sceptics agree that pharmaceutical companies make more money when we are sick and so these multi-billions dollar corporations have a big interest in keeping the level of health low, and prevention of illness is the last thing on their minds.

    Also the statistics about Canada’s health are unreliable and cover up some disturbing facts. For example, it was mentioned earlier that while Cuba has an infant mortality rate of 4.6 per 1,000 born, Canada sits at 5 per 1,000. However, In the report "Infant mortality among First Nations versus non-First Nations in British Columbia" published by the International Journal of Epidemiology, research indicated that between 1981 and 2000 Infant mortality among First Nations families in British Columbia, Canada was twice as high as infant mortality in non-First Nations families.

    In the Health Canada study from 2001/2002, "A Statistical Profile on the Health of First Nations in Canada" the authors write, "Infant mortality rate is the single most comprehensive indicator of the level of health development in a society and is recognized internationally in its inclusion in the Millennium Development Goals." While this may be true the authors also write that "current Canadian data systems fail to capture a significant number of First Nations infant deaths, resulting in incomplete data on this important indicator -- it is therefore not possible to report infant mortality for First Nations populations in Canada." How is it that research shows that First Nations women are losing double the amount of infants in their first years of life in British Columbia, and yet the government has not made investigating it a priority? How is it that Canada, a so called "first-world" country, has a section of the population with such poor healthcare standards? As the article says, "Infant mortality rate is the single most comprehensive indicator of the level of health development in a society," doesn't that mean that this should be cause for concern? protest? change? Unfortunately the fact that infant mortality is a “comprehensive indicator” means that health statistics about all other aspects of First Nations peoples' health will also be lower than the Canadian average, from life span to maternal mortality to mental health concerns and suicide.

    The culture of medicine world-wide and in Canada is also such that doctors are not taking their personal health seriously. In an article published by MedScape News in June 2011, Kate Johnson writes, "Sleep deprivation in physicians and nurses working extended-hour hospital shifts is compromising patient safety and increasing the risk for car crashes in both Canada and the United States, according to 2 studies presented here at SLEEP 2011: Associated Professional Sleep Societies 25th Annual Meeting." According to Canadian Medical Association data, 64% per cent of Canadian doctors feel their workload is too heavy, while 48% have had an increase in their workload in the past year. Many doctors and nurses are working in Canadian hospitals are working 12 hour shifts or longer, would you like to be the patient receiving care at the end of one of those shifts?

    Cuba’s healthcare system – Where Humanity comes first!

    We began this article with a question, how does Cuba have a free universal healthcare system with a focus on prevention. The reason we need to ask this question is because every time we discuss making healthcare more efficient and affordable in Canada or the United States the response is always the same, there is no money. Yet Cuba is funding a very efficient healthcare system and offering the service free of charge and Cuba is a developing or “third-world” country, so how can they afford it? The simplest answer is that the Cuban government is a revolutionary socialist government and people of Cuba and its communist government together have made healthcare a priority or societal obligation. When will people living in Canada and the US demand the same of their governments? For us working and poor people living in Canada and around the world there is only one way: Follow revolutionary Cuba!

    What people are saying about their healthcare system in the US and Canada

    Here are some jokes that sadly reflect some of the reality of the American and Canadian healthcare systems today, these humorous comments can remind us of the necessity of changing the way we view healthcare and why the advances Cuba has made are important example for us:

    (1) "President Obama says that Congress is very close to getting a new health care plan, but due to compromises, it 'won't include everything that everybody wants.' For instance, it covers everything except trips to the doctor or the hospital." –Conan O'Brien, Comedian

    (2) "If conservatives get to call universal healthcare 'socialized medicine,' I get to call private, for-profit healthcare 'soulless, vampire bastards making money off human pain.'" --Bill Maher, Comedian

    (3) "Of course, a lot of right wingers are very upset about this because they believe this health care bill will cost a lot of money. You know what I think? Just pretend it's another unnecessary war. You'll feel better about it already." --Jay Leno, Comedian

    (4) “Two patients limp into two different Canadian medical clinics with the same complaint. Both have trouble walking and appear to require a hip replacement. The first patient is examined within the hour, is x-rayed the same day and has a time booked for surgery the following week. The second sees his family doctor after waiting a week for an appointment, then waits eighteen weeks to see a specialist, then gets an x-ray, which isn't reviewed for another month and finally has his surgery scheduled for a year from then.
    Question: Why the different treatment for the two patients?
    Answer:The first is a Golden Retriever; the second is a Senior Citizen." - Unknown

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