World class doctors for the rich – how Cuba’s flagship healthcare system deteriorated

In 1959, Cuba had more doctors per capita than the NHS.

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In October 1960, Marxist historian Eric Hobsbawm gave readers of the New Statesman his glowing appraisal of the early stages of the Cuban Revolution. Nearly two years on from the rebels’ triumph, Hobsbawm understood that the central tenet of Fidel Castro’s 26 July Movement was that to be “free and prosperous, Cuba must be free of imperialism, poverty and ignorance.”

But, as we enter the final five months of the premiership of Fidel’s brother, Raúl, the demise of Cuba’s healthcare suggests that the revolution has not successfully achieved this trio of aims.

In January 1959, in the first weeks of his new government, Fidel Castro told the Cuban magazine Bohemia that he would “decline any relations with dictatorial states…first of all the Soviet Union.” Yet within three years, he had declared conclusively, “I am a Marxist-Leninist and I will be until the last day of my life.” Within four, he was harbouring Soviet missiles on his island.

The rationale for Castro’s volte-face was more geopolitical than ideological. Mutual mistrust between Cuba and the United States pushed Castro in the direction of the USSR. The result was a cash-for-Caribbean-outpost arrangement. This contract enabled the Cuban government, bankrolled by the Soviet Union, to bring in many of the landmark social policies the island has been so lauded for, principally, world-class healthcare.

Until the fall of its Cold War financier, Castro’s revolution was able to live up to many of its ideals. But Castro had made a Faustian pact. When tanks were putting down the democratic ambitions of the Prague Spring, Castro refused to condemn the brutality. For all his nationalist and underdog rhetoric, he was a client of the world’s second most powerful state.

The deal was the bedrock of Cuban prosperity and the catalyst for the democratisation of is health service. However, when the USSR dissolved, so too, did the stream of finance to Cuba. The country entered the era of economic crisis known euphemistically as the “Special Period”. Its fabled medical provision slowly became a two-tiered system and little more than a cash cow.

“For the health tourist, everything. For us, what is left”

When Castro’s rebels toppled the dictator, Fulgencio Batista, Cuba had more doctors per capita than the NHS in Britain, and life expectancy was just behind the United States. The revolution consolidated these advantages and expanded them thanks to funding from the USSR. 

Since the 1990s, though, healthcare has deteriorated. Thousands of Cuban doctors work abroad in Latin America, on state-arranged missions to allies such as Venezuela and Brazil, earning their government approximately $2.5bn each year. At home, world-class facilities for the political elite and health tourists contrast startlingly with the mediocrity and scarcity of medicines for the average citizen.

Miguel, a forty-something musician and percussion teacher in the second city, Santiago, had to wait so long to have a dental operation that he was forced have the work done on the black market.

“Often, there is no water in our hospitals and very often, there are no prescriptions,” he said. “And when the government doesn’t have the prescriptions you need, the only advice we are given is to go to the pharmacies that sell the medicine in the foreigner’s currency, the convertible peso. There, your prescription can cost more than your monthly state wage. For the health tourist, everything. For us, what is left.”

Mauricio, a world-weary bus driver from the central Cuban city of Camagüey, tells a similar story of scarcity and squalor at the hands of the health service.

“I was in hospital for a week and couldn’t have a shower any day I was there. And when my sister was taken in, the cleaner for the ward refused to do anything – the family members of the ill had to sweep the floor.”

Revolutionary Cuba, once commendably free of many forms of poverty, is now struggling to provide basic medical resources. 

Castro, however, did succeed in achieving one of the key aims identified by Hobsbawm. The well-educated Cuban people are not ignorant of the failures of his regime, nor of the tactics they must now employ to secure access to a service that was once the pride of a nation.

“I had a pain in my chest, so I went to the doctor,” says Tyson Gutiérrez (not his real name), a state-worker in Camagüey. “He got his stethoscope out, said indifferently that he couldn’t see that anything was wrong, and that I should go. It was only when I slipped him some money, under the table, that he suddenly he woke up, tried the stethoscope again and, miraculously, his instrument began to work.”

“An excess of Cubatopianism”

Hobsbawm’s 1960  article, while full of acclaim for the revolution, included a prescient note of caution, predicting that “the difficulties which will increasingly arise are likely to be overlooked in an excess of Cubatopianism”. In this he showed foresight. Cubatopianism continues to this day, as defenders of the regime cite the defiance of a superpower and the government's social policies in education, equality and healthcare.

Yet such rhetoric obscures the fact that even in its heyday, Cuba was neither prosperous of itself nor truly free of imperialism. Now that it must stand on its own two feet, Cuba has found that its knees are giving way. Poverty is rearing its ugly head once again.

In March next year, when Raúl retires, for the first time in six decades, Cuba will not be ruled by a Castro. Especially given the parlous finances of the country’s post-Soviet guarantor, Venezuela, Cuba stands at a crossroads. Will Castro’s successor be able to tackle its serious social and economic challenges? How long the island’s political status quo can persist will depend on it.