HAVANA — In Cuba, public health care is free and universal. Nobody doubts that.

When we look at indicators such as child mortality (4.2 for every 1,000 born, a figure lower than in a country like the United States) or life expectancy (79, 4 years older than in almost all of Latin America and many European countries), when we learn that Cuba was the first country in the world to eliminate the transmission of HIV from mother to child, or that in 1985 Cuba developed the first and only vaccine against hepatitis B, diabetic foot, vitiligo and psoriasis, and developed a vaccine against lung cancer, then we realize what a true medical and scientific power this Third-World country has become.

The success of medicine in Cuba is due to the formation and preventive focus of the Cuban health-care system. The work of promoting good health and community assistance is the most important, even in the formation of future medical students and functions not only as a strategy of prevention but also as a source of sustainability. At least, those are the objectives.

Cuba is also the country that has sent the most doctors to countries with health-care needs. More than 50,000 of its doctors are providing their service to 66 countries in Latin America, Africa and Asia. Yet — although this enhances our supportive and internationalist value — part of the population sees it as a reason why the public health-care system in Cuba has been deteriorating.

I refer to a patient who needs follow-up but must change physician because the doctor who has been looking after him must leave for Sierra Leone because of a work contract of the kind that the doctor himself needs to feed and care for his family. In Cuba, even though a health professional’s minimum wage (40 to 80 dollars a month) is twice the average wage, the economy trumps Hypocrates by far.

The fewer doctors in Cuba, the more patients each medic tends to. Therein emerges the dark side of Cubans, a side that takes advantage of the most sensitive opportunities to make a profit. “I can arrange for a earlier date of surgery. Give me 30 dollars and you can start on the pre-op tests,” says some intermediary who almost never is a doctor but profits from the patient’s need.

People don’t like to go to an Emergency Room because they fear dealing with a third-year medical student who attends — by himself and without supervision — someone who arrives at dawn with a pain that an experienced doctor could diagnose more accurately than a youth who has not yet perused one third of the books he needs to read before graduation.

In Cuba, the practice of medical students is part of their formation. For that reason, a Cuban student spends more in the Operating Room than any graduate in any other country. That gives him (or her) more experience, better diagnostic skills. But, while waiting for the future, the patient goes home without an adequate treatment, because to err is human and the doctor was on call with only a brief foreign experience. Then come the complications.

People like to have their own doctors, who always have doctor-friends in all specialties, and for that reason the patients always bring gifts or food. When the patients bring gifts to thank the doctor, well, that’s okay. It’s ethical to treat alike a patient who brings a ham and another who brings a couple of bars of soap. But we know that, in many cases, the first patient to be attended is the one that brings a larger “gift.” Or that the doctor will better remember a patient with a heavier bag.

Doctors are human, and a larger gift inevitably generates more sympathy.

Cuban medics who travel abroad on international missions constitute not only a show of solidarity and devotion but also are one of the main sources of revenue to the nation.

International service brought to the Cuban Treasury more than $8.2 billion in 2014, an amount much greater than international tourism. Then, how is it possible that we must pay 25 Cuban pesos (the equivalent of 1 convertible peso or 1 dollar or what I earn in two days’ work) for a few milligrams of some potion that the clinic doesn’t have but the dentist does?

How is it possible that the lines at the pharmacy on Thursday (the day the medicines arrive) extend around the corner and always leave someone dissatisfied? And that the rest of the week you don’t find Dipyrone, unless you’re willing to pay — under the table — $1 for two boxes of three blisters each, whose regular price is 1 Cuban peso, tops?

Penicillin is in short supply (oh, Fleming!) but you can buy it at 15 Cuban pesos an ampoule, or 13 Cuban pesos each for 10 ampoules. Thirty-six ampoules of crystalline penicillin will cost you $16, and that bottle of B-vitamin pills that would cost you 27 Cuban pesos (if available) can cost you $5, four times the retail price.

I’m not going to talk about the no-cost organ transplants, or the chemotherapy or hemodialysis that save thousands of Cubans, because everybody knows that. But while we’re looking at the big picture, there will be more heart failures in a population whose deaths are related to organs that can’t withstand certain pressures.

Let’s love our wine because it comes from an exceptional variety, but let’s not leave it so long in the wrong cask. It’s sour enough.


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