by Howard Waitzkin
Daily Lobo guest columnist
Mark Erasmus' letter published in the Daily Lobo on Wednesday contains errors and distortions that misrepresent health care in Cuba.
I have visited Cuba four times in the last 30 years for in-depth study of the Cuban public health system and primary care services. Although some problems arise in any system, the Cuban approach to health care has achieved remarkable accomplishments.
In contrast to Erasmus' complaint that the government limited his ability to observe health facilities, my colleagues and I were able to travel freely within Cuba and to make observations in local communities, hospitals, clinics, research institutes and the national sanitarium for AIDS patients. We experienced no restrictions on our ability to interact with Cubans. At several of these sites, we arrived spontaneously without prior
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We conducted interviews in Spanish with officials and community leaders. Although some people we interviewed criticized specific aspects of the Cuban system, most professionals and nonprofessionals praised their health system highly. Cuba's efforts in preventive care have greatly improved health indicators. For instance, the incidence of infectious diseases preventable by vaccines is lower than in any other nation at Cuba's level of economic development. Immunization rates are between 99 and 100 percent, as opposed to 75 to 85 percent in states such as New Mexico.
Cuba's public health and primary care services have received recognition from the World Health Organization, the Pan American Health Organization and even the World Bank. These efforts have led to greater success in controlling epidemics such as dengue fever, to which Erasmas refers, than in other Latin America countries and even the U.S.
Cuba has eradicated infectious diseases such as malaria, controlled the AIDS epidemic at one of the lowest prevalence rates in the world and has achieved a lower infant mortality rate than the U.S. by assuring adequate nutrition and monitoring for diseases such as infantile diarrhea. Even critics of the Cuban political system have acknowledged its accomplishments in the public health field.
Although Erasmus claims, "Cuba lacks any specialized medicine," Cuba also has achieved notable successes in high-technology specialties, in addition to advances in primary care. Cuba's specialized accomplishments remain little known in the U.S. because of the economic and information boycott imposed by our government.
For instance, transplantation surgery has emerged as a major emphasis of Cuban medicine. Since the late 1980s, Cuban physicians have performed virtually all types of contemporary transplantation surgery at a national referral center - Hermanos Ameijeiras Hospital in Havana. This hospital routinely provides heart, lung, kidney, pancreas, liver, cornea and bone marrow transplants.
Cuba's transplantation and other surgical programs accept patients not only from Cuba but also from many other countries of Latin America, Africa and Asia. Visiting leaders from other countries have received treatment in Cuba, and Cuban leaders such as Fidel Castro have received all of their specialized medical and surgical care within Cuba.
Cuba has excelled in other high-technology fields, partly because of a national policy that encourages biotechnology. At the Dalmer Laboratories and the Carlos J. Finlay Institute in Havana, scientists have developed medications and vaccines through advanced biotechnological methods. Pharmaceutical products comprise Cuba's third-largest export, behind sugar and nickel.
One of these products, policosanol, is an oral medication derived from sugarcane that lowers cholesterol. Cuban research publications evaluating the effectiveness and side effects of policosanol have reached few U.S. readers. Many European and Latin American countries have approved the use of policosanol. Because of the trade embargo against Cuba, however, the U.S. Food and Drug Administration has not evaluated policosanol for potential approval.
I share Erasmus' concern about the deterioration of medicine in the United States due to the expansion of managed care organizations. These organizations, which reduce doctors' ability to make decisions freely with their patients, are for-profit corporations which operate under the capitalist model.
All other high-income capitalist countries, including France, the United Kingdom and Canada - which Michael Moore highlights in his film "Sicko" - provide universal access to services at a much lower cost than the U.S. system. Erasmus and others who oppose a similar national health program in the U.S. might open their eyes to the suffering in our country that such a program could prevent.
Howard Waitzkin is a distinguished professor in the departments of sociology, family and community medicine, and internal medicine.
