Sunday 18 March 2018

Castro's clinics: how good is the health service in Cuba?

Fidel the Big Friendly Giant cast a spell over President Higgins, says Maurice Gueret, as he checks the pulse of Cuba

The late Cuban leader Fidel Castro Photo: ADALBERTO ROQUE/AFP/Getty Images
The late Cuban leader Fidel Castro Photo: ADALBERTO ROQUE/AFP/Getty Images
Dr Maurice Gueret

There has been plenty of criticism of President Michael D Higgins for the fulsome praise showered on Fidel Castro when his favourite revolutionary shuffled off parade. His tribute to the Cuban dictator was three times longer than the one he proffered on the passing of Irish writer William Trevor. Nobody minds too much that he called his hero "a giant among global leaders". They all have the appearance of giants from where Michael D stands. What is at issue is whether his statement on behalf of a nation might have been more measured and nuanced.

The President's schoolboy essay on the great sadness he felt on Castro's death is there for all to see on He praises 'El Comandante' for surviving 600 attempts on his life. He extols Castro as a champion of freedom, of literacy and a health system admired around the world. In Michael D's world, Fidel Castro was his Big Friendly Giant. Perhaps Joe Stalin is his Willy Wonka. There was even talk of President Higgins planning a state visit to Cuba. He might capture both sides of history by visiting the million-strong Cuban exiles who live just 200 miles from Havana in the state of Florida. They don't dance for nothing.

So how good is the health service in Cuba? Well, left-leaning doctors tell us it's the best in the world. Right-leaning ones would run a mile. Doctors shouldn't really lean too far either side, in case patients think they are drunk. The jewels in the island's health crown are good maternity care, excellent vaccine uptake and an infant mortality rate that puts America's three-trillion-dollar health system to shame. Life expectancy is 79, six years longer than neighbouring Jamaica and 16 years longer than nearby Haiti. They train a large population of doctors in Cuba, and average pay is about €65 a month, which compares well with €40 for nurses and €25 as an average working wage. I think it's fair to say that care in the community is excellent. That's where most of the limited investment has gone, as it gives better value for money. The longstanding trade embargo left Cuba short of essential medicines, treatment for rarer diseases and new equipment for hospitals. Recent reports speak of dilapidated conditions and hygiene concerns at many state hospitals. As with other state-run systems, tricks for jumping queues develop. Irish people are trained to use TDs. But in Cuba, it's little gifts for nurses, tips for doctors and under-the-table payments for administrators that get undivided attention.

By all accounts, Fidel Castro led a modest daily existence without feeling any revolutionary desire to inhabit a big house. He had nine children that we know of, and they, in turn, had a handful of mothers between them. Only two were wives of Castro. It is said that the only three people he ever trusted were his brother Raul, his doctor Rene Vallejo, and a lady guerilla and long-time soulmate from the 1956 revolutionary landings called Celia Sanchez. Celia was herself the daughter of the head of the Cuban Medical Association, a wealthy GP with three farms and a social conscience. The criminality and cruelty of the Batista regime revolted both the doctor and his daughter.

Historians have speculated about whether Celia Sanchez and Castro were lovers. Their friendship was lifelong. When Celia first developed symptoms of lung cancer in the late 1970s, Castro and the doctors initially conspired to keep the diagnosis from her. She was told her respiratory symptoms were caused by a nasty mould found at her house, but letters from Celia to friends just before her death in 1980 show that she knew of her fatal illness. Castro commemorated Celia by building a 630-bed hospital in her home city of Manzanillo that bears her name.

A new staff member is about to appear at GP surgeries across the UK. A barrister reporting on the NHS has decreed that all family doctor clinics must now have a 'Freedom To Speak Up Guardian', whose job will be to create perfect conditions for staff members to voice concerns. I now know why there are so few single-handed doctors practising solo in today's Britain. When you invest so many dull and meaningless chores in one person, there is nobody around to ring bells or blow whistles.

It's quite a few years since I wrote here about human cryopreservation, the practice of deep freezing your body post-mortem, instead of burying, cremating or donating it in the usual way. The case of the young British teenager with cancer who was flown to the United States after her death was particularly tragic. There are plenty of clinics about that offer cryopreservation of sperm, eggs and embryos, which might better serve those who want to leave a future bit of themselves. But the painful truth is that restoration of life after years in a deep freeze is no more likely to happen than a chicken is to walk from the freezer to an oven.

There was a famous case in France where a court intervened to have a doctor and his wife defrosted, and cremated for the public good. Dr Martinot was an octogenarian cryonics enthusiast from the Loire Valley who refused to let death part him from his wife. She was first into cold storage, and he would sell viewing tickets to the public to help pay the high electric bills. But the real trouble started when he took a bad stroke and joined her in the freezer. The authorities took their son to court, alleging violation of old burial laws, and during the long legal case, the freezer broke down in a heatwave. Dr and Mrs Martinot were defrosted and cremated. The movie has yet to be made.

Dr Maurice Gueret is editor of the Irish Medical Directory

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