Speech given by Fidel Castro, President of the Republic of Cuba, at the ceremony to inaugurate the works of the extraordinary health program already underway, which is being implemented in Cuba. April 7, 2003, Astral Theater.
Mr. Alpha Oumar Konaré, former president of the Republic of Mali;
Mr. Lassana Traoré, Minister of Foreign Affairs and International Cooperation of the Republic of Mali;
Mr. Peter Piot, Assistant Secretary General of the United Nations and Executive Director of UNAIDS;
Mr. Daniel López Acuña, Program Director at PAHO;
Ms. Gina Tambini, Manager of the PAHO’s Family and Community Division;
Mr. Patricio Yépez, PAHO representative in Cuba;
It is a great honor to have you all with us here this evening.
A far-reaching revolution in health services will be taking place in our country. Some steps have already been taken. The first was a special effort in the areas of pharmaceutical services given the need to cope with shortages, inefficiencies and irregularities in the distribution of medicines. We have been working on this for over a year now and introduced significant changes in the manufacturing structure.
Less than four months ago, on December 15, the "Mario Escalona" Polyclinic in East Havana was reopened with 12 new services, after extensive renovation.
Today, in this excellent primary care facility located in the municipality of Cerro, and bearing the name of "Abel Santamaría", --a polyclinic that was in ruins, the victim of time, of the ‘special period’ and of subjective factors-- we are inaugurating its complete renovation and expansion rather than just repairs to the building. This, along with the previously mentioned Mario Escalona polyclinic and nine others restored in the last four months brings to eleven the number of primary care facilities in the capital of the republic that have been extensively renovated in line with the new prevailing concepts.
Work is already underway on the repair and expansion of sixteen other polyclinics in Havana and thirty-six in the rest of the country.
Over the last eight months, the number of electrocardiogram services has been increased to 271 in the same number of polyclinics all across the country and before this year ends it will rise to 444. In other words, this service will be available in every polyclinic in Cuba.
Today, 31 ultrasound services are being inaugurated in polyclinics in Havana and 26 in other provinces. These have high-resolution equipment that will make it possible to make examinations in these primary care units of kidneys, liver, gall bladder, and spleen. It will also make it possible to do gynecological-obstetrical diagnoses of the fetus.
In addition to this, 29 hospitals in the capital, in eleven provinces and on the Isle of Youth will receive special high resolution ultrasound equipment which, in addition to the aforementioned examinations, will allow for more specific diagnoses of gynecological and obstetric illnesses and of problems in the soft parts of the human body such as breasts, thyroid, prostate and others, depending on the field in which each of these hospitals specializes.
Taking the capital as an example of the situation, it can be said that, previously, a patient sometimes had to travel up to 20 kilometers to receive this service, the average distance traveled being very high. Today, with a distance of between 300 meters and 6 kilometers, the average is reduced to 600 meters and it will continue to decrease.
There is absolutely no doubt, however, that the most significant thing we are inaugurating today is the medical upgrading courses. These courses cover 373 different subjects. They began seven days ago, on April 1 with 23,733 doctors from various specialties and 10,718 nurses and ancillary personnel registered, for a total registration of 34,451. These courses are being taught in the polyclinics by professors from the Medical Schools and specialists from our hospitals and polyclinics, none of whom have in any way neglected their professional work in those centers.
A group of specialists who have great experience and much national and international prestige deserve a special mention; they are the ones who designed the program for the courses. Daily attendance by those registered is almost one hundred percent. This is truly unprecedented in medical history. They want to expand their knowledge and by doing so can even, en masse, gain academic degrees such as a Master’s or even a PhD in sciences.
This will be the bedrock of the revolution that we are proposing to carry out in the health field. It is possible only because of the huge human capital created by the Cuban Revolution in more than four decades. The need to implement this revolution stems not only from the quest for excellent services but also from the fact that, after 44 years with infant mortality reduced to less that seven for every thousand live births in the first year of life and life expectancy increased by more than 14 years; when a large number of diseases have been eradicated and vaccination against thirteen diseases has been spread to all of the population and other preventive measures have been implemented, the causes of death in our country are now very different from those that existed when the Revolution triumphed and they demand new and distinct care and services.
First among these causes of death are heart and brain diseases, those that come about because of malignant growths and others that are usually related to advanced age and accidents.
But it is not only a question of trying to postpone death. There are diseases, like Alzheimer’s and others closely related to advanced age, which require treatment and special care. A basic aim of our health program is to improve a person’s quality of life at every age.
It is a true fact that our hospitals dedicate a significant part of their staff and facilities to provide primary care. It was an old habit. The polyclinics were created by the Revolution especially for primary care, which they have shared with the hospitals. But the time has come, for the reasons given, when primary care must be taken on mostly by polyclinics while hospitals are basically used to attending to more complicated health problems that require special treatment and the use of the appropriate resources, facilities and medical techniques.
The basic idea is to make primary care services more accessible to the public. The risks of a cardiac arrest or a brain accident need immediate, urgent attention. Even the family doctors who do not have the equipment polyclinics must know, in fact, they do, what must be done in the event of heart failure and other similar situations.
For example, I cite the case of a city like Havana: of the 82 polyclinics here, there will be no less than 30, in the different municipalities, providing emergency services for vascular accidents and other similar cases with specialized ambulances and the proper staff to provide first aid services. But, all the polyclinics will be prepared to give emergency care and will request an ambulance from the closest possible station to take the patient to the nearest hospital if required.
All of the polyclinics will offer rehabilitation services to treat physical disorders, bone and muscle diseases, temporary or prolonged disabilities; for psychomotor development stimulation of children who need it, for persons who have suffered a heart attack and for others who sustain neurological disorders for a variety of reasons. There was only one polyclinic providing these services for all of Havana, in Plaza municipality. The number has now increased to twelve with the polyclinics we are opening today. And to give support to these tasks, 1137 youths from Havana are being intensively trained in the "Salvador Allende" polytechnic school.
All polyclinic laboratories will quickly and safely perform most of the tests that are needed for the most common health problems in the Cuban population.
All will have x-rays equipment.
All of Havana polyclinics will provide optometry services as will a number of them targeted in the rest of the country according to objective needs.
A suitable number of polyclinics, depending on the population they look after, in the country’s cities and provinces will offer endoscopic services for an early diagnosis of gastritis, ulcers and digestive tract disorders, which cause discomfort and illness.
An equally suitable number will have laboratories to diagnose allergic diseases and manufacture the vaccines used in treating these diseases.
There will be a certain number of polyclinics for attending to orthopedic diseases caused by minor trauma that may require, for example, immobilization with a cast, something that today is performed only in hospitals.
There will be a certain number for attending to cases requiring minor surgery.
A certain number offering ophthalmology services.
A given number that will perform bile drainage procedures.
Something of great importance will be the creation, which has already begun, of Infomed, an intranet service which will communicate all health centers, hospitals, polyclinics, senior citizens homes, pharmacies, etc., through a compact network of computers which will allow all doctors, nurses and technicians to communicate, consult and exchange scientific knowledge and will allow them access to all medical data bases and information using thousands of computers and computer equipment.
We have not forgotten about repairing the family doctors homes/consulting rooms. Starting with Havana, where the family medicine program began 19 years ago, almost 200 have already been completely repaired and 45 are completed every month.
New dentistry services will be created and those already in existence will be provided with the necessary means to increase the efficiency and quality of dental services and of dental prosthesis manufacturing. A given number of dental clinics and polyclinics will provide 24-hour emergency service.
The number of opticians in the capital and in the rest of the country will increase and, something very important: almost half of those in the capital will be relocated since almost all of them are concentrated in the north center part of the city, a long way away from the outlying districts. It is hoped that the time it takes to get a pair of glasses will be considerable reduced.
In the immediate future, 19 new services for treating patients with renal insufficiency that require hemodialysis will be started up, as will 17 plants for treating the water required by the artificial kidneys, bearing in mind the diversity of water sources throughout the country.
The appropriate restoration and improvement in existing services will be carried out and conditions created that will reduce to a minimum the infections that often affect those renal treatments. And something even more important, that is, special prevention work will be done so that a large number of people can avoid falling ill with chronic renal insufficiency arising from certain health situations which, when not properly treated, can lead to this disease. This will enable us to save more lives every year.
Progress is being made in establishing four large cardiovascular surgery centers for adults. These are to be located in Santiago de Cuba, Villa Clara and Havana. Progress is also being made in setting up diagnostic centers in the country’s 14 provinces and the Isle of Youth, which will make it possible to detect in time those persons with certain problems which lead inexorably to life threatening situations. In this way the lives of thousands of people will be saved every year.
Each one of the numerous services I have mentioned are located with a map in hand taking into account not only the need but also something as crucial as the need to reduce to a minimum the distance that hundreds of thousand of people requiring those services must travel every month.
Hospital facilities will be improved and restored. There, as in the case of the polyclinics, priorities will be set according to which hospitals are in the most critical situation.
Far more important that the number of centers and services is the excellence of the services they should offer. That is the purpose of this colossal plan, already underway, and of the courses for medical upgrading. It is encouraging to see the enthusiasm showed by our health professionals, who have performed such glorious feats.
And not everything has been said. Ours centers, which research and produce new medicines, will give a special support to this program. Our firm unity and the nature of our social, economic and political system will make it possible to reach the goal we have set ourselves.
We shall certainly be the first in the world in the health field, and its noble and human benefits will be within reach of all of our compatriots in health centers of excellence where they will not pay a penny.
This is the socialism that we are willing to defend to our last drop of blood from the threats of a world fascist tyranny!
Long live the Revolution!
Patria o Muerte!