|Book Review - Revolutionary Doctors: How Venezuela and Cuba Are Changing the World’s Conception of Health Care|
“Often we need to change our concepts, not only the general concepts, the social or philosophical ones, but also sometimes our medical concepts.” - Ernesto Che Guevara.
Modelled on Che Guevara's principles and keeping in line with the Cuban revolution, Steve Browuer's assessment of Cuba's health care system in his book Revolutionary Doctors: How Venezuela and Cuba Are Changing the World's Conception of Health Care (Monthly Review Press, July, 2011) stands as a testimony to anyone claiming that socialism cannot function. Cuban doctors have regaled people in Latin America and around the world with medical opportunities which, in capitalist ideology and implementation, remain remote. While Cubans are provided free health care provided by medics who are dedicated to science and society, the United States has created a scheme based on profits, which marginalizes a major segment of the population who cannot afford costly treatment.
Che Guevara, himself a doctor, always reiterated the responsibility of helping the oppressed. Having observed the effects of poverty and social class during his travels in Latin America, his revolutionary consciousness stemmed from the concept of restoring dignity to the poor who were oppressed and neglected by dictatorships. Reaffirming Che’s philosophy, at the ELAM (Escuela Latinoamericana de Medicina) medical school in Cuba, an inscription of Fidel Castro’s words greets the students. “This will be a battle of solidarity against selfishness.” Striving against the reluctance of the minority who view a career medicine as an opportunity to achieve higher social status, ELAM’s philosophy is “transforming the doctor’s privilege into a doctor’s responsibility.”
Immediately after the triumph of the revolution, the health care system in Cuba underwent major changes. Despite a shortage of doctors, many of them having left to practice in the US and thereby retain prestige and social status, Cuba invested heavily in social welfare. Health care services were nationalized, medicine prices were reduced and treatment fees were gradually eliminated. By the end of 1960, Cuban doctors were employed in a system that provided free health care to all Cubans.
Aspiring doctors in Cuba were able to study medicine for free. In return for free education, doctors were required to relinquish the notion of medicine as an elitist career and work in close contact with the people, travel to rural areas, conduct home visits, and research in rural communities. In 1970, the Ministry of Health pointed out the mistake of valuing specialization over primary health care, given that many medical problems could have been solved by paying special attention to the environment. The study of primary health care and environmental problems proved successful when in Venezuela, it was discovered that apart from the effects of damp weather during rainy seasons, the wood fires which women lighted in their houses were causing lung congestion. The problem was lack of proper ventilation in houses. In 1984, a program of comprehensive general medicine was formulated, enabling medical students to study different areas of medicine in a continuous sequence, rather than separate subjects. The new curriculum was discussed with medics from Canada, Venezuela, Australia and the Philippines, with the director of ELAM stating that comprehensive general medicine allowed students to progress in scientific training whilst at the same time providing the opportunity for students to 'understand the patient as a whole'.
Cuba has become a key player in responding to humanitarian aid around the world. Medical help was provided for countries ravaged by natural disasters such as Haiti, where Cuban doctors performed 6449 surgeries and stayed on long after the seven weeks of humanitarian aid offered to the Haitians by the US were over. In the aftermath of Hurricane Katrina in the US, Cuban doctors were forbidden by then- President Bush to assist in humanitarian aid. While Bush dismissed the Cuban offer as ‘propaganda’ by Fidel Castro, the brigade of doctors proved otherwise as they were dispatched to Pakistan, where an earthquake had left thousands of people in dire need of medical and humanitarian assistance. Indeed, the disposition and ethics of Cuban doctors is a source of pride to Fidel Castro who, in his column Reflections of Fidel, contrasted Cuba’s contribution to that of the US. “We are sending doctors, not soldiers!”
Combining medical care, research and ethics, Cuban doctors continue to export the revolutionary struggle on an international level. Cuba provided medical and humanitarian aid to countries whose politics were hostile to the Cuban revolution, such as the Nicaragua under the Somoza dictatorship. South Africa was aided by Cuban doctors in developing health care programs for combating HIV. Tanzania now boasts a medical school set up by Cuban doctors. And in Venezuela, the successful Barrio Adentro mission, as well as the free health care system has been modelled after the Cuban project, with doctors assisting and training Venezuelan medics in revolutionizing health care as a model of social responsibility.
The reluctance of Venezuela doctors to work and live in rural areas made it necessary for President Hugo Chavez to call in the expertise of Cuban doctors. The constitution drawn up by Chavez in 1999 granted all Venezuelans the right to accessible health care. Social missions were set up to monitor and ensure health care improvement in working class and poverty stricken areas. Cuban doctors made up for the lack of Venezuelan doctors willing to live in rural areas, reporting health problems that would have been common in countries with a very low GDP, such as Ethiopia and Angola.
The first phase of Barrio Adentro created over six thousand facilities throughout Venezuela which dealt with primary healthcare. The project was furthered to include diagnostic clinics and intensive care for people who were unable to be transferred to larger hospitals. Later the public hospital system was improved by technology updates, as well as improving communication with other health networks. Chavez’s government also ordered the construction of research laboratories and specialized hospitals offering advanced forms of treatment. By the end of August 2010, 83% of Venezuelans had benefited from Barrio Adentro – a far cry from the situation in the 1980’s where 17 million out of 24 million Venezuelans had no access to medical care.
Brouwer points out the benefits of health care as social responsibility. Apart from educating students and offering free courses to aspiring doctors, Cuba has also strived to educate and encourage Venezuelan people to assume responsibility for safeguarding the free health care system. Poor people were offered two meals a day prepared by volunteers, thus combating the effects of malnutrition. In order to avoid street crimes, Venezuelans volunteered as bodyguards for Cuban doctors. Committees of volunteers were set up, supplying Cuban doctors with food, housing and help in data collection, research and public health campaigns.
Financed by Venezuela, Cuban doctors in Bolivia treated over 300,000 Bolivians for eye surgery between 2006 and 2008. In an echo of history, it later became known that one of the patients treated for eye surgery was Mario Teran, the soldier singled out as Che Guevara’s executioner. Cuban doctors in Bolivia are perceived as emulating Che’s internationalist example.
Despite the obvious positive impact and social transformation which Cuban and Venezuelan health care had in Latin America, the US State Department and the CIA expressed concerns that Cuba and Venezuela were having a negative effect on Latin America. Counter-revolutionary efforts to thwart the socialist mission were staged, with a group of Cuban and Venezuelan exiles in Miami stating that doctors were exploited and coerced into servitude by the Cuban government. The only doctor to take part in this conspiracy was later found to be part of an anti-government group. President Bush also offered Cuban and Venezuelan doctors a safe and quick entry to the US, with the hope of disrupting the medical progress achieved in the continent. The US alternative was USAID, a program which promised financial aid in return for US approved “democratic” transition in Latin American socialist countries.
However, the sabotage program failed, highlighting instead capitalism’s failure to deliver what socialist revolutions are achieving in Latin America. Cuban doctors prided themselves on their role as teachers, imparting the necessity of education and community awareness to rural areas which would have otherwise been marginalized by unjust political systems. Within two years of adapting Cuba’s literacy program in Bolivia, UNESCO declared Bolivia free of illiteracy.
Almost every chapter in Revolutionary Doctors starts, befittingly, with a quote from Che Guevara. However, greater prominence might have been given to Fidel Castro's continuous exhortation, even after Che's death, that the West acknowledges and acts upon the injustices riddling Third World countries. In a speech to the United Nations General Assembly in 1979, Castro denounced the inequalities which triggered poverty and ill health:
"There is often talk of human rights, but it is also necessary to speak of the rights of humanity. Why should some people walk around barefoot so that others can travel in luxurious automobiles? Why should some live for 35 years so that others can live for 70? Why should some be miserably poor so that others can be overly rich? I speak in the name of the children in the world who do not have a piece of bread. I speak in the name of the sick who do not have medicine. I speak on behalf of those whose right to life and human dignity have been denied... Of what use, then, is civilization? What is the use of man's conscience? Of what use is the United Nations? [applause] Of what use is the world? It is not possible to speak of peace in the name of tens of millions of human beings who die yearly of hunger, of curable disease throughout the world."
By implementing education on a national level and ensuring its distribution to all echelons of society, Cuba and Venezuela have managed to create a system which embraces and values humanity, and revolutionized medical practice as an ethical and moral responsibility, thus restoring dignity to the people by creating a new social consciousness. The 'conscientious internationalist' embodied by Che Guevara has been transformed into a regenerating reality and, far from the distorted spectrum ranging from prestigious career to saviors, Cuba and Venezuela have managed to transform socialism from an ideology into a humanitarian practice.