Havana, Cuba, 11/12/1992AIDS Patients Isolated For Therapy

(HAVANA, CUBA Nov. 12, 1992)

by Bob Van Leer

Our plane has just taken off from Jose’ Marti’ Airport for the 750 kilometer hour and 50 minute flight to Santiago de Cuba.

Our plane is an Ilyushin 62, a Russian-built jet with four engines. We flew on one of these planes from Leningrad to Warsaw three years ago on LOT, The Polish airline. This plane is better fitted inside than the Polish plane.

To catch this flight we were called at 4:30 a.m. Yesterday we started the morning touring a day-care center and a huge hospital.

PROUD OF MEDICAL CARE

Cuba is justifiably proud of its medical care system. The orientation of the system is better than in the U.S.

The focus is on prevention of illness rather than treating it after it begins.

This is a third world country but the average life expectancy is similar to the U.S. Fidel Castro delights in pointing out that infant mortality in Cuba is lower than in Washington, D.C.

A major difference is the way physicians are deployed. Family physicians are typically recent graduates who are assigned a neighborhood or rural area to serve.

The physician has a clinic with living quarters upstairs. The physician is responsible for the health of about 150 families.

The doctor has a duty to see that patients have regular checkups, provide treatment, or refer them to hospitals.

If someone doesn’t show up for a checkup the physician has to track that person down. If a vaccination program is needed it is the responsibility of the physician to see that 100% of those needing it do get it.

We were taken to the Hermanos Amejeiras 950 bed teaching hospital. Xenobia Gonzales, public affairs spokesman, gave us a briefing.

He said the emphasis is on prevention, this is cheaper than treatment. But some people will get sick and hospitals are provided.

There are three levels: municipal, provincial and advanced. The two lowest levels handle 99% of treatment. This hospital takes care of a municipal level plus referrals of part of the 1%.

Hermanos Amejeiiras is a major medical center doing everything up to heart and lung transplants.

There are three of these centers in Cuba. This also a teaching hospital for Cuba and for residents from Central and South America.

All care of patients from examinations through transplants is done without cost to the patients.

It is not free, of course. Gonzales said health care takes 8% of the Cuban budget.

Pay scales are very low compared to the U.S. Gonzales said physicians are paid 400-650 pesos per month, a high wage for Cuba, “But not enough for breakfast in New York”.

However, he pointed out that housing costs 10% of income, health care is free, sporting events are free and there are many other compensating factors.

He said nurses are grouped into three categories with university graduates getting 280-340 pesos per month and some nurses are paid more than some physicians.

He said 98% of deliveries in Cuba are in hospitals “and the rest in taxis”.

MORE ON AIDS CARE

He told us more on how Cuba treats AIDS and patients. Cuba is trying to isolate the disease. Anyone returning from foreign countries, including the U.S., can’t donate blood for three years.

Testing for AIDS is mandatory for anyone from 25-50 years of age. Gonzales said there are only about 700 diagnosed cases of AIDS or HIV positive patients in Cuba.

These are isolated in sanitariums initially. Patients are individually analyzed by a team.

The effort now is to try to get HIV positive individuals back to work areas. But some are too risky to be let out of the sanitarium.

He said very few want to go back to their old jobs. Some prefer to go to new jobs and some prefer to stay in the sanitarium.

The first AIDS case was known in 1985. He said tourists are the most likely source of AIDS infection.

He said none of the AIDS cases have been prostitutes. He called prostitution a minor problem confined to Havana hotels and tourist spots.

There are a lot of prostitutes around our hotel. It is only necessary to step outside our hotel to the street to be propositioned.

After the briefing we were taken on a tour of a geriatric floor. This is an excellent hospital, well-equipped, well-staffed and well-maintained. It is another one of the contradictions, world-class hospitals and hotels with leaky plumbing.

The day care center we visited was for infants from three months to seven years of age. It is open from 6 a.m. to 7 p.m. and the cost ranges from none to 60 pesos per month.

LICENSE PLATES

License plates are color coded here. Maroon is for tourists and foreigners.

Yellow is for private cars. White is for government ministers and deputy ministers.

Red and blue are for government enterprises. Those with blue plates have the privilege of taking the vehicles home.

Black plates are for diplomats.

We left the group for lunch. We aren’t restricted, we can go anywhere by ourselves.

We wanted to eat in a local restaurant instead of a hotel but the lines were so long we gave up and retreated to a tourist sanctuary, Hotel Nacional, for lunch.

Our next meeting was with Carlos Alcuqaray, assistant to the foreign minister and deputy director of the North American desk.

I started by asking him if Cuba was still training revolutionaries for other countries. He ducked. He said he didn’t think so but, “If we were, do you think we would tell you?”

He said one of the principals of Cuban foreign policy is internationalism. Cuba felt duty bound to help other revolutionaries.

He said revolution can’t be exported. There has to be a revolutionary movement to start with.

Differences in thinking were illustrated by Carlos saying that the West sees human rights as political. But he said we see it as social rights, such as a baby has a right to be born healthy.

He said the U.S. is pressuring other nations to isolate Cuba. With the realignment, U.S. policy hurts more.

In the last three years Cuba’s buying power went from $8 billion to $2 billion. The Eastern Bloc collapse hurt more than the U.S. embargo.

The Cubans make a point of imperfections in the U.S. system. He said only 43% of the voters voted for Clinton and just over half of the eligible voters voted at all, so Clinton is the choice of only 23% of the people. “I wouldn’t consider that a very democratic system”.

He said before 1959 when Castro took over, the U.S. ambassador was the “number one and number two man in Cuba”. Apparently the Cuban president was third.

He pleaded for no-interference from the U.S. saying, “Let us be us – let us have our own system”.

In any accommodation of the U.S. and Cuba, the Cuban exiles in south Florida are going to be a problem.

Alcugaray said, “Most of us feel these people have gone over to the other side and cooperated with the enemy”.

The new electoral law pointedly requires a two years residency to vote and five years to be a candidate. He said he thinks the government has gone exactly where the people want us to go.

Two principals are: maintaining sovereignty and maintaining Cuba’s social justice system.

He complained about Radio and TV Marti, stations that broadcast from the Florida Keys.

He said, “Why do you feel you have the right to transmit radio and television to Cuba?”

CUBAN MISSILE CRISIS

On the Cuban missile crisis of 30 years ago, he said Cuba felt the U.S. would invade Cuba. The Russians proposed to install nuclear missiles to protect Cuba.

“We felt if the Russians were willing to risk nuclear war, it was our moral duty to accept”.

He said it was a step to defend all socialist countries, not just Cuba.

In the evening we had a meeting with Rafael Sed Perez, president of the National Institute of Tourism. Sed was another speaker who needs coaching in handling public meetings.

He completely lost the audience. He said Cuba now has 500,000 tourists per year. For comparison, I’d estimate Gold Beach hosts that many tourists in five years.

Cuba is planning on doubling tourism in three years.

Canadian tourists, he said, are number one. One of our party pointed out that museums and other tourist places have no signs in English and this was not the way to attract English-speaking tourists.

He blamed lack of maintenance in hotels on the U.S. embargo. The embargo is a handy scapegoat for everything wrong in Cuba.