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THE GOAL THAT CAN’T BE RENOUNCEDReflections by Comrade FidelAround 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.
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