Reflections by Comrade Fidel




Around 35,000 Cuban health specialists provide free or paid-for services in the world.  Furthermore, some young doctors from countries such as Haiti and others among the poorest of the Third World are working in their homelands thanks to the assistance provided by Cuba.  In Latin America, our main contribution has been the ophthalmologic surgeries that will help to preserve the eyesight of millions of people.  Besides, we are assisting in the training of tens of thousands of young medical students from other nations, both in and outside Cuba.

Nevertheless, this is not anything that is ruining our people, who were able to survive thanks to the internationalism that the USSR pursued with Cuba, which helps us to pay our own debt to humankind.

After carefully meditating and analyzing in detail the history of the last few decades, I have come to the conclusion, without the least bit of chauvinism, that Cuba has the best medical care in the whole world, and it is important that we are aware of that, since it is the starting point for what I wish to state.

The basis of the aforementioned success lies in the network of polyclinics and family doctors’ offices set up throughout the country, which replaced the disastrous and precarious capitalist system of medical care that was based on the private practice of medicine, although the tough reality of the times imposed the creation of a number of mutualist health care centers. To the youngest ones amongst us, I should clarify that these were cooperative institutions where those services were offered for a monthly fee.  Under that modality, all the members of my family benefited from some of those services at a hospital located in the far-away capital of the former province of Oriente.  However, I cannot remember one single sugarcane or sugar mill worker entitled to be a member of that institution, for they lacked the necessary resources and never used to travel to that city. Wherever the principles of capitalism prevail, society moves backward.  That is why we must be extremely careful every time we see that socialism is forced to resort to capitalist mechanisms. There are those who get intoxicated and alienated while dreaming about the effects of the drug of individual egoism as if it were the only incentive capable of mobilizing people.

The great need for medical specialists generated a bourgeois elitist spirit in that sector.  Cuba put an end to it, once and for all, after the Revolution, all along these years, graduated growing numbers of doctors who refused the private practice of medicine and later on became specialists through study and systematic practice, which resulted in a huge mass of well trained professionals.  

Under capitalism, the limited number of specialists whose work had to do with health and life became gods. We have no other alternative but to cultivate in these people, as well as in the high-level educators and other professionals who require great doses of knowledge, a profound revolutionary spirit.  Experience has shown that is possible, especially in a profession that has so much to do with life and death. 

Our network of polyclinics provides coverage to all cities and rural areas throughout Cuba; it was created as a result of a process aimed at developing health centers adapted to the most varied situations in our country and among its inhabitants.

In a city such as Havana, the largest in the country that stands as an example of the complexities of urban life –which, on the other hand, are different from those in Santiago de Cuba, Holguín, Camagüey, Villa Clara or Pinar del Río, just as much as they differ amongst themselves –each polyclinic looks after approximately 22 000 people. 

After the triumph of the Revolution on January 1st, 1959, the citizens of the capital used to inundate the emergency rooms of the hospitals which were generally many blocks away from their homes, seeking the assistance that the Revolution was providing there, free of charge, with the then-available equipment.  They did not go to the recently created polyclinics where, quite often, the least efficient doctors were assigned to. Later on they learned to receive such assistance at the polyclinics which were gradually better equipped and staffed with doctors of an increasing quality and professionalism.  Finally, they opted for the best variant: first they went to the family doctor’s office, where they would be looked after by a young doctor who was trained after a six-year programme of theoretical and practical courses skillfully designed by eminent professors. Afterwards they continued studying until they became specialists in General Comprehensive Medicine. The polyclinic, with its laboratories and equipment, used to be their support system.

One day, when I visited one such centre to check on its professionalism, I asked them, without previous notice, to examine my vital signs.  That was one of the best and fastest tests I had ever seen in my life.

Not even for a single second has the Revolution waned in its efforts to repair, adapt or build new polyclinics and family doctors’ offices, while thousands of students enrolled in and graduated from more than 20 medical schools.  It’s been a long and fascinating experience.

           According to the current approach, polyclinics must always be ready to offer 10 basic services: diagnosis, emergency care, dental care, comprehensive rehabilitation, maternal and child health, nursing, clinical and surgical care, assistance to the elderly, mental health, hygiene and epidemiology.  The system was designed to provide services in 32 specialties, including those that must be looked after at any time, day or night, ranging from an agonizing toothache to a heart attack.  Polyclinics should have emergency rooms, thus placing emergency care closer to family households.

 When I wrote Vices and Virtues, I pointed out that every attempt by those workers to appropriate goods passing by their hands, as some do, was something unworthy of those workers’ behavior, whatever their social status, skills, education or knowledge; whether they harvest potatoes, milk cows, cook in a restaurant, work in a factory or a school, a library or a museum, whether a manual or an intellectual worker, anywhere they were. Nobody wishes to establish slave or semi-slave labor in our world. We all believe that citizens are born to live a prouder life.

He who steals forgets that all persons wants tranquility and respect for themselves and  their relatives, a variety of quality foods, decent housing, power without cut-offs, running water, roads without potholes, comfortable and safe transportation, good hospitals, well-equipped polyclinics, first-class schools, shops and groceries that work properly, movie theatres, radio, television, the Internet and many other nice things that can only be the result of methodical, efficient and well organized work by highly productive workers.

The production of consumer goods and services requires modern equipment in construction, agriculture, transportation, high voltage electric power, chemical or flammable products; working conditions that encompass risks in terms of heights, depths and many other unavoidable variants.  The tiniest negligence causes mutilation and death, and so we are forced to always observe measures to prevent them or minimize them as much as possible, even though, unfortunately, we have been unable to avoid the occurrence of a painful number of such cases every year. Added to this there are the occupational diseases and the suffering and damages they cause. Those goods and services everybody longs for will not come out of mere chance.  Heavy investments, state-of-the-art technologies, costly raw materials, abundant energy, and, especially, human labor are indispensable if we do not want to remain stuck in prehistory.    

Just recently I requested data from the Ministry of Labor and Social Security about the number of workers involved in health and education programmes in the country; figures accounted to almost 20 % of the active labor force involved in economic production and services.

The data I received, which I carefully analyzed, justify the steps we have taken to increase the retirement age.  In the bill this is associated with real improvements in household income and, in my opinion, it is also related to the pressing need to avoid excess of money in circulation and the duty we have to swiftly recover from the ravages of the hurricanes in a way that nobody feels they have been abandoned to their own fate.

The question I pose is whether or not human beings are able to rationally organize the society they are obliged to live in. 

The efforts being made by musicians with their instruments are probably just as powerful as those of the welders at the Antillana de Acero steel industry. Sometimes there are no differences between the first and the latter in terms of their mental and physical efforts, although there might be some differences in their way of thinking, because the first are well-known and constantly applauded, and the latter are not.  However, the first can make use of their influence to combat the old vices of past societies, as many others do, not only musicians, but also prestigious writers and painters who have been trained by the Revolution. 

There are professionals specialized in economic sciences, labor organization, psychology and other branches, who are aware of these realities, dealing with subjects associated to them in some way or another. We read or hear about interesting concepts seeking answers which will no doubt end up pointing in the same direction as long as the national and international debate opens up.  

The Nobel Laureates in Economics are amazed by the never before seen crisis of developed capitalism, which at this moment requires an additional 700 billion dollars that will have to be paid by the children of American families. Apparently, the experts of imperialism just can’t hit the nail on the head, while the heads of state, prime ministers and high-ranking officials who attend the United Nations General Assembly are straining their brains trying to find solutions.  It is curious to see that many of the United States’ allies at NATO no longer speak in their own national language, but in English – visibly broken English- the Esperanto of our era. .

I think that there is no alternative but to re-evaluate everything, looking for more productivity and less waste of human resources in all vital sectors, including health and education –as well as in all others in the productive economy and the services –without strictly abiding by the figures that were issued years ago, trying to enhance –rather than allowing a decrease of- the quality of everything that is being done in our country, without neglecting our internationalist duty, the fruits of which have started to be clearly noticed.  Those are many more than one could imagine and considerably less than we need.  We have to contribute the rest without any hesitation whatsoever.



Fidel Castro Ruz

September 24, 2008

8:37 p.m.