Speech given by Dr. Fidel Castro Ruz, President of the Republic of Cuba, at the ceremony commemorating the 40th anniversary of the Victoria de Girón Institute of Basic Medical Sciences, on October 17, 2002.
Professors, researchers and students;
That ceremony took place on a day like today, October 17, but 40 years ago, five days before the outbreak of the 1962 crisis that has been so thoroughly discussed and analyzed in recent days. A nuclear holocaust was on the verge of taking place.
Exactly one and a half years had passed since the mercenary invasion by the Bay of Pigs in Playa Girón, and 10 months since the culmination of the feat of the Literacy Campaign. More than 2000 doctors and most of the medical school professors had left the country. It was necessary to make up for those losses and to quickly train the doctors needed for the ambitious revolutionary public health program. Part of that effort was the founding of an important Basic Sciences Institute, to speed up the process of training and graduating doctors with the revolutionary quality and knowledge required. In a matter of weeks, this Institute was established in a large facility that had once been the headquarters of one of the most important institutions of the haute bourgeoisie, many of whom were already living with their families in the United States.
In honor of the heroic victory of our combatants at Playa Girón, that was the name given to this new institute.
Given the special circumstances of that moment, and the transcendental importance of the Victoria de Girón Institute of Basic Medical Sciences in the subsequent evolution of Cuban medicine, I felt it would be fitting to recall some of the ideas I put forward on that day, using the same words that I used then. They will comprise a large part of my speech today, given their continued relevance.
At one point, I happened to begin talking about the nursing sector:
"We believed," I said, "that the medical students would be present here at this meeting of the medical family. We have seen that the girls from the nursing schools are present here as well. And this pleases us very much, because I do not understand how the nurses were forgotten during the discussions of all of the problems concerning medical care and doctors. During the discussion of student associations, the nursing schools were forgotten. Nurses constitute an important, fundamental part of all the work in the medical sector, and the Revolution has a great interest in training revolutionary nurses. Just look at their enthusiasm!
"Health care is one of the most sensitive areas through which our enemies tried to hurt our people. It is very logical that we Cubans aspire to lowering infant mortality; to extending the average life expectancy of every citizen; to combating diseases, and combating death. There is no aspiration more legitimate than this one, or more sacred, one could say.
"Unscrupulous individuals tried to hurt our people this way. They tried to deprive our country of the resources needed to fight for life, to fight against disease, to save thousands, tens of thousands, hundreds of thousands of lives, especially the lives of children. How? By taking away our doctors.
"When they attacked us through Playa Girón, their intention was to take control of a piece of our territory, and from there they would begin to launch bombings every day and every night, subjecting our country to a war of attrition that would have cost us hundreds of thousands of lives. But even so, one of the most heinous actions undertaken against our country by imperialism was the policy of bribing doctors and attempting to bring about an exodus of doctors to the United States, thus depriving our country of the qualified technical personnel needed to care for our sick. And they did in fact manage to take away a certain number of doctors.
"They knew that they were causing harm, not to us, but to the people. It was painful for us to see the harm they were so cruelly inflicting with this policy. We know the anxiety and obsession felt by the poor sectors with regard to doctors; we know how grateful the peasants are for the rural medical services provided to them, the medicines sent to them, the hospitals that have been built for them.
"One of the areas where the influence of the Revolution has been most strongly felt has been the field of health care. In our country, there were only 9000 beds in public hospitals.
"Everyone knows how the sick were treated in hospitals back then, how they often had to sleep on the floor, how poor and even shocking the conditions were in many hospitals.
"Everyone knows that no doctors ever went to the countryside here; that the rural population was virtually abandoned; that in order to see a doctor, a peasant had to begin by selling a pig, half a dozen chickens, anything that could be sold.
"When our people had no medical care, they did not bother to take our doctors to the United States, it did not matter to them. When our country initiated an extraordinary medical care program, rising funding for public health care from 21 million to 103 million pesos, that was when they decided to try to deprive our people of doctors.
"Of course, the doctors they took away were neither little lambs nor saints, obviously."
"Medical students had to make enormous efforts to graduate, especially those from other parts of the country, and then they could not find work anywhere. Doctors were concentrated in the capital. A recently graduated doctor would be considered very lucky to be given a minor post at city hall, in a hospital, and a salary of 100 or 120 pesos, anything at all.
"When a doctor in the class society we lived in, the exploitative society we lived in, became an experienced professional and achieved fame, the people could no longer count on this doctor, except for exceptional cases, because there are always exceptions, naturally. These doctors became the doctors of the rich. It would be very difficult for a humble man or woman of the people to receive their services.
"Many of those doctors were the doctors of the owners of the sugar mills, the millionaires, and when the millionaires left, they missed them, and decided to leave as well.
"In spite of the fact that many of the doctors who were seduced into going to the United States ended up washing dishes, operating elevators and doing similar kinds of work; in spite of this, there can be no doubt that the attitude of the doctors who left was a highly immoral attitude. This is a crime against the people, against the sick, against the unfortunate, against those who suffer.
"Who can help us to solve our problems? First of all, we must solve our problems with good doctors. Because it is only fair to say that while there have been corrupt, disreputable and money-hungry doctors, there have also been many, very many good, conscientious and humane doctors, who view their profession the way they should.
"Some took the Hippocratic oath, and others took the hypocritical oath. Those who took the genuine oath and viewed their mission as a sacred one did not leave the country, and never will. These are the ones who must help us solve our problem.
"Those who remained pure in the midst of a society of corruption and selfishness can serve as seeds and as teachers.
"What is the significance of those who have left? Speaking in medical terms, it is quite similar to what happens when you squeeze a tumor.
"The imperialists are trying to use those who have left for propaganda purposes. This is like making propaganda with pus, because those who have left are the pus of Cuban society, squeezed out of that society by the Revolution.
"The petit bourgeois, weak-kneed, hesitant spirit of the first moments is nowhere to be seen today.
"What do we have to do? We should go ahead and solve our problems now and forever.
"When it comes to our people, and our sentiments as revolutionaries, what makes up for the repugnance and disgust caused by the traitors and deserters? This is what makes up for all that: this new mass, this contingent that is beginning its studies, the largely purified mass of today’s university students.
"I can assure you that today our country has a medical school with a formidable mass of good students and revolutionary students.
"What do we have, as of now? Several hundreds of excellent comrades who will graduate year after year and will then go on to reinforce the contingent of revolutionary doctors, while providing the country with a new mentality, a new conception of the work of a doctor; a work that, as in the case of teachers as well, the people should hold in the highest esteem. Of course, bad doctors conspire against the good image that the people should have of doctors.
"That mass will entail a further contribution year after year and a more steadfast, pure, conscientious attitude among the doctors at work.
"That contingent will forge a spirit that will combat the spirit of selfishness, or the remnants of the spirit of selfishness and laziness, which can corrupt students – yes, even students!
"Our people can rest assured that all of the young people studying in the medical school are studying full time, and we are going to train doctors in massive numbers, much better doctors. And we believe that this is the Revolution’s duty to the people.
"Now then, did this provide a definitive solution to the problem? No! There is, for example, a particular circumstance, which is the following: the doctors all piled up in Havana. That society concentrated doctors in Havana, and then they did not want to leave. For Miami, yes; for the Sierra Maestra mountains, no! And many of them preferred to take the route of leaving the country, instead of taking the route of going out and serving their people.
"Our problems could still not be solved with the measures I have mentioned. Where is the true and definitive solution to the problem, where? With a view to the future, the only, true, definitive solution is the massive training of doctors. Today the Revolution has the forces and the resources and the organization and the people – the people, which are the most important of all! – to begin a program for the training of doctors in the numbers that is needed. And not only a lot of doctors, but above all, good doctors. And not only good as doctors, but also good as men and women, as patriots and as revolutionaries!
"And who says the Revolution will not be able to do this? We are already showing ourselves to be able! And the best proof of that is this ceremony tonight.
"Of course, in order to enter university, you need at least to be senior high school graduates. What was done? It was decided that senior high school graduates in both the sciences and the arts would be accepted as medical students, after a short course that will begin tomorrow.
"Because of this," I continued to explain to those young people on that night 40 years ago, "some 800 students are now entering this Institute of Basic Sciences, and another 240 are beginning their studies at the (recently created) University of Oriente. That makes a total of over 1000. Over 1000 beginning their studies! And that is just this year.
"But at the same time, at this institute, there are also 1300 senior high school students beginning a 15-month course. When they are combined with those who will graduate from senior high school, this means that next year, even allowing for those who drop out of their studies, there will be 1250 students entering school here, or beginning university, in other words, right here.
"Also at the same time, this year at least 2500 junior high school students will begin a special two-year senior high school program that will allow them to enter medical school immediately after graduation.
"And after that? After that there will be a whole river of medical students: 1000 this year, who will begin studying in 1963; 1250 who will begin in 1964; 2500 who will begin in 1965. Of course, because the Revolution has not been working in vain, the Revolution can do all of this, because it has enormous contingents of high school students from which to select in accordance with their preferences and their capacity. And that is because the Revolution has been carrying out a major educational work from the beginning. Keep in mind that there were only around 120,000 junior high school students when the Revolution took power, and today there are close to 250,000. These are figures, these are facts, and these are the fruit of the work of the Revolution. And now we have to have special courses, but as of 1965, there will not be room here or in any other building like this one for all those who will be able to study medicine. And that is the solution, the only and definitive solution!
"And not only that, but rather, we can still do something –although it may be more symbolic than anything else– to help other countries.
"We have the case of Algeria, for example. In Algeria, the majority of the doctors were French, and many of them left. With four million more inhabitants than we have, and a large number of diseases left there by colonialism, they have less than a third of the doctors that we have. They are facing a truly tragic situation in the field of health care. And that is why today, when we were talking to the students, we told them that 50 volunteer doctors are needed. And we are sure that these volunteers will be there. Just 50. We are sure that even more will offer to go, as an expression of our people’s spirit of solidarity with a friendly people that are worse off than we are.
"Today we can send 50; in another eight or ten years, who knows how many. And we will be able to offer our help to our sister nations, because with every year that passes, we will have more doctors, and with every year that passes, more students will enter medical school. Because the Revolution has the right to reap what it sows, and it has the right to gather the fruits that it has sown.
"And very soon, our country –we can declare this with pride– will have more doctors per capita than any other country in Latin America. Our universities will continue growing, and the students in our universities will number in the tens and tens of thousands, and our professors will be increasingly more experienced. The years are passing, and passing quickly, and the efforts of the Revolution can be seen.
"We say years, but years that will pass and that will allow us to witness this spectacle of 40,000 or 50,000 university students and young people graduating by the thousands and the tens of thousands, because the Revolution can do this, because the Revolution and only the Revolution is capable of such feats. And because a revolutionary people and only a revolutionary people can carry out such tasks.
Today is a day of heartfelt rejoicing, because the Revolution is not just about putting forward ideas, it is about carrying out ideas. The Revolution is not theory; it is action, above all. And whatever the Revolution has proposed to do, it has achieved. Whatever the Revolution has begun, it has carried on with. And this is the result of ideas turned into reality, of tasks undertaken and carried out. This is a reason to feel optimistic, a reason to believe more than ever in the dynamic of the Revolution and in the creative capacity of our people.
"We know what this signifies. We know that with this we can defend ourselves from the lowest blows dealt by our enemy in the most sensitive area for our people. We know that this signifies hundreds of thousands of children who will be saved for the homeland. It signifies health for our people. It signifies raising the average life expectancy of every citizen of our country, the creation of the conditions needed not only to combat diseases, but also to prevent them. Because in the future, we will have increasingly more doctors, and increasingly fewer sick people.
"The facts are right there: in the last six months, there has not been a single case of polio in our country. In the last six months, not a single mother, not a single family, has had to endure the indescribable pain of seeing a child left crippled. Hundreds of children have already been saved, hundreds of happy lives have been saved, and the happiness and joy of hundreds of families have been saved.
"Once again the Revolution is launching an attack against diseases, and is preparing to save thousands of lives from tetanus, diphtheria and whooping cough, diseases that kill thousands of children every year, and can be caught by any child in any family. And how is this being done? By preventing these diseases through vaccination. And in this way we will continue to combat disease after disease, and will go on decreasing the number of epidemics, the number of deaths, the number of victims. In this way we will work at fulfilling this worthy goal: to move from therapeutic medicine to preventive medicine.
"The future of our people will no doubt be brilliant, the health of our people will no doubt be brilliant. On the one hand, we are combating diseases, decreasing the numbers of their victims, fighting them until we make them disappear. And at the same time, contingents of enthusiastic youth, who are the hope of the homeland, forgers of the health of our people, savers of lives, are entering an institution like this one."
Here I will end my review of the essential points and the program I addressed that night.
Forty years later, there is almost nothing left to add to these ideas, drawn up four decades ago, completely fulfilled, and amply surpassed in many cases.
Here are a few examples:
In 1981, a brutal and unexpected epidemic of hemorrhagic dengue, caused by the previously unknown virus type 2, spread throughout the entire country, affecting 344,203 citizens and taking the lives of 158, including 101 children with an average age of four. This epidemic constituted a difficult and severe test for the Cuban health care system. At that time, the number of doctors was 16,210, four times less than today, yet already four times greater than the number of doctors in the country in 1962.
With considerable expenditures and a superhuman effort, the epidemic was beaten, the number of vectors reduced to insignificant figures, and the virus eradicated from the entire national territory. This event, like yet another challenge, multiplied the Revolution’s efforts in the health care sector. This was when the decision was made to create over 15 new medical schools, in addition to the already existing ones, in order to have a minimum of one per province; the new political-administrative division meant that the number of provinces had risen to 14. In the capital and Santiago de Cuba, the total combined number of medical schools was over six. New advanced techniques were introduced, new services were created, new hospitals were built, and many of the already existing hospitals were expanded. Special emphasis was placed on scientific research centers, a number of which were related to health care.
This was how the country gradually transformed itself into a genuine medical power. Dozens of measures were applied; truly revolutionary ideas emerged, including the introduction of the family doctor in cities, rural communities and mountain communities throughout the country, leading to a health care system without precedent and unique in the world.
Then came the collapse of the Soviet Union and the socialist countries of Europe. We fully and abruptly entered the special period. The people succeeded in the astonishing feat of surviving, but these circumstances caused considerable damage to the advance of the health care programs in full development. Proof of the momentum already achieved in the health care sector is the fact that during the special period, over 30,000 doctors have graduated, which is almost as many doctors as there were at the beginning of this period.
Objective and subjective factors contributed to creating and aggravating difficulties in health care services. Despite the heroic efforts of a great number of our scientists, doctors, technicians and other workers in the sector, erratic decisions, bureaucratic regulations, and absurd work schemes caused considerable damage, which was supposedly due solely to the critical shortage of material resources and difficulties brought on by the new situation, combined with the U.S. government’s deliberate and opportunistic intensification of the blockade and the economic war.
Of all the programs, the one that bore the brunt of the stupidities committed was the family doctor program, undoubtedly the most promising of all. Old prejudices and misunderstandings on the part of a number of specialists and authorities in the sector, combined with measures that reflected arrogance, mediocrity and incorrect management methods, could have wiped out some of the best things achieved by Cuban medicine, the sources of its glory.
The attention paid and measures adopted by our Party’s leadership, in the face of the difficulties and problems emerging in the midst of the confusion created by the material shortages, served to prevent even greater damage from taking place.
In the midst of the battle of ideas we were waging, it became evident that we needed to deal with situations created by incorrect management styles and methods and even, in certain cases, commercialization vices that are unacceptable in the health care services created by the Revolution.
These realities called for changes in the leadership of the sector, and new conceptions and ideas, in line with the grandiose advances achieved and the experience accumulated since those glorious and difficult days when this historic Institute was founded, 40 years ago.
In the new stage now beginning, the enormous wealth of human resources that has been created and the traditional spirit of sacrifice and heroism demonstrated by our professionals, technicians and workers in the health care sector; the extraordinary services they provide in Cuba and abroad; the new resources and steps made in the production and distribution of medications; the immediate and crushing offensive that wiped out the latest outbreak of dengue in just 70 days, at the beginning of this year; the solid defense in the face of the dangers of increasing contact with travelers from places where the disease is endemic, and of the threats of new and old diseases that are latent; all of these things demonstrate and will continue to demonstrate the immense power achieved by our people, their health care workers, and our medical science sector.
The effort to achieve excellence in our health care services will be tenacious and profound. The scope and breadth of the new ideas and health care projects for the safety and well-being of our people have never even been dreamt of in our own country or anywhere else. The health care programs already initiated, although they are more complex and will require more time and resources than the educational services already on their way to the greatest heights, will not be detained for even an instant. Working quietly and suppressing any tendencies towards strident promises and excess publicity, nothing will prevent our victory, just as nothing has prevented it up until today.
Long live socialism!
Patria o muerte!