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Cuba Surgeons Write to Raul Castro About Disastrous Health Care System

Cuba Surgeons Write to About Disastrous Care System

Translating Cuba

Open letter from the General Surgery Department of the "Calixto Garcia"

Hospital to the First Secretary of the Cuban Communist Party and

of the Councils of State and Ministers, General Raul

Castro Ruz

To be good is the only way to be happy.

To be cultured is the only way to be free.

But, given human nature, one needs to be prosperous to be good.

José Martí

The "Calixto Garcia" hospital in Havana takes as its mission to provide

specialized preventative-curative medical care and rehabilitation

without interruption to the population through high-quality medical care

and high professional standards [1]. With its 100-year history it has

been a permanent of surgeons in the country, and an important

element in our country's struggle for independence; many of our

professors were clandestine combatants [2] and brilliant doctors on

international medical missions of great importance.

Surgeons at the hospital, respecting the Hippocratic Oath [3], have

historically been characterized as being critical and self-critical, but

especially combative in the face of difficulties, bad decisions taken,

and the multiple errors that affect our nation, and that little by

little are endangering the future, taking health as a pillar of the

transformations arising in the Revolutionary period, and our duty to

provide a professional and dignified medical care, in accord with the

scientific advances of the 21st century.

After countless reports to the head of the service, hospital management,

discussions within the core of the Cuban Communist Party, and our long

standing inability to participate in discussion at other levels with the

leaders of the ministry, where medical personnel present their

uncensored opinions [8] and ways to solve the major problems currently

plaguing the health sector, which include everything from training to

direct care, a group of surgeons felt it their elementary duty [8, 9,

10] and agreed to send this letter to the head of the service, for the

sole purpose of informing him of the extremely serious elements in

healthcare delivery to the Cuban people, which apparently at this time

when it is happening in public health in general, and in our hospital in

particular, the lack of immediate plans to resolve them are unknown by

the top political leadership of the country, contrasting inversely with

the official discourse of our media.

Medical care, and especially surgery in our center is a great disaster,

characterized by:

A hospital with a destroyed physical structure, due to its age and

innumerable poor quality and short-term repairs.

A lack of important resources for the care of patients, because of

inadequate distribution, insufficient management, or excess work because

of the reduction of this activity in other hospitals for similar reasons.

Human mental deterioration accompanied by the loss of the minimum

attention to the person, who spends long days of free labor for a

significant number of hours, and in a country where the "free perks"

have been ended, and where working conditions are below those of any

poor place in the world.

In our hospital the surgical services have been declining and the number

of operating rooms has been reduced from about 30 for all specialties to

no more than 10 at present, which although greatly destroyed still

provide this vital service to the people. The irregularities in these

operating rooms, their constantly broken air conditioning, lack of

water, lack of adequate equipment in some of them, means that cancer

patients cannot be operated on in time in our institution, others with

benign conditions, susceptible to immediate treatment when diagnosed,

develop complications because of delays in the resolution of their problems.

And as if that weren't enough, the urgent conditions also present great

difficulties. These, which constitute an important number of cases, are

referred from some other place in the city, many times transferred

poorly, which puts the lives of these patients in danger and even kills

them when theoretically this could have been avoided. Despite the fact

this this is the only surgical priority this hospital serves a good part

of the time, they must sometimes wait more than 24 hours between their

arrival and their emergency surgery, mainly because of the lack of

available operating rooms and of sufficient and adequate personnel, but

also because of the physical exhaustion of the doctors who raise these

issues and raise them again and discuss these problems at every possible

level and/or a good part of the time put the responsibility on the

orderlies, cleaners, and in addition put the full responsibility for

sick patients on their families, the sick patients themselves, and society.

The deficiencies in the health care system are so serious, in our

opinion, that we are forced by these issues and others of resources that

continue in a temporary or permanent way, to provide care to our people

that is not professionally ethical or dignified, as is our sacred duty.

Moreover, the repairs undertaken at our hospital, that have been

underway for more than 10 years, have done little to change the

unviability of a horizontal hospital in current times; the majority of

the repairs are putting make-up on old buildings, performed with

terrible quality and, of course, lasting a short time, which increases

the frequency of new repairs.

Rooms that have waited 10 years for repairs, today crumble four months

after they open, with the first downpour; leaks, collapses of the false

ceilings, and a number of important areas declared inhabitable, are a

daily fact of life in our work and our patients' stays.

The suspension of operations because of the weather, water, insufficient

rooms, or whatever cause, is no longer unforeseen but rather is

commonplace. As the operating rooms are no longer available to solve the

problems of the patients, now it is us, the surgeons, who must

prioritize one or another patient in an an unfortunate and exhausting

search for surgical opportunities for a Cuban whom we only know, sadly,

because of his illness.

The only thing we need to add to this depressing picture is the working

conditions of the doctors and the personnel in general, starting with

wages that are not enough to support a family, degrading working

conditions; including lack of a place to rest during long days of

surgery or work, the several miles walked between rooms, in the dust,

the sun, and many times the rain; the terrible quality and quantify of

; the lack of a decent place to take care of one's physiological

needs; and no showers to cool off in the intense heat or to clean up

before contaminating a surgery, almost force us, when they become

permanent, to change our mentality.

The fatigue leads to well studied complications [4, 5, 6, 7]; if on top

of that we add the ridiculous figure of 2-1/2 gallons of gas a month for

those fortunate enough to have cars, not even enough to go to and from

work for the first week of the month, among many other mistreatments; it

all completes the picture of deteriorations that definitely have a

bearing on the medical care that is offered to the people.

Today it is impossible to ask doctors, even with a car, to come to the

hospital in the middle of the night to check on their surgical patients,

or to come on Sunday, as was common among surgeons historically; and

what's more it's impossible to ask them to perform a new operation on a

patient with complications at 10 PM and you don't have to be very

intelligent to know what happens with a case when a patient has been

repeatedly operated on five times by different surgeons.

We believe that this situation generates unquestionably disastrous

complications in patients, where studies show that after six hours of

work of a surgeon's complications multiply [4, 5, 6, 7]; and of course,

that's talking about working with appropriate comfort. Also in many

cases, death, which we cause when we have a terminal patient with almost

no hope; it is not ethically dignified because we can't do for him what

he deserves or should have, at the time it should be done: we have

multiple examples from all the surgeons who work in this hospital, and

the great number of the population who observe and criticize, that what

is said in the media has no connection to our country and our hospitals.

We think that our government has a commitment in all this, because it

exists to meet the needs of the people, to solve the problems of the

people, of the workers, simply because they are responsible for

maintaining the hospitals, for properly training the workers in a high

quality and fair educational system, for developing an ethical

consistent with the work they will be doing, or anyone thinks why do

doctors, engineers, builders undertake the missions they do in their

work: they do it because their work makes things better, for their

family and the society they live in, but unfortunately that is only

achieved in our country by leaving it, leaving the country that gave us

birth [10], which is ours by right, and nobody, absolutely nobody, has

the right to take away our identity under any circumstances, and for

which we must give even our lives for our nation to remain independent.

The misfortunes narrated here do not come alone, they come about slowly

when the is maintained for years in the living standards of

the people with their ability and dedications, the socialist law well

known by everyone: "to everyone according to his work." When the

leaders, with their laws, decrees, special circulars, and their

decisions and provisions, are compromising the future, how long will we

thank the centenary generation for having fulfilled their duty and

obligation of liberating Cuba, while our generation wants to fulfill its

duty to develop and give our families, our children, our Cuban brothers,

the life they deserve, while the destructive tracks of corruption run

riot with a singular debauchery on every side of society where we turn

our gaze?

As José Martí said: "given human nature, one needs to be prosperous to

be good." The government is responsible for all this, not only for

knowing it, but also for fixing it. So, and before it's too late,

leading to events like those at the Mazorra hospital [where 40+ patients

starved and froze to death], we decided in this group of doctors,

sacrificing, hard-working, dedicated, ethical, and above all badly

treated, to report to you and to those responsible all of our concerns,

in our modest opinion serious ones, from this place so undervalued on

the social scale, which is the heroic and historical general surgery

service of the oldest hospital in our beloved country.




[3] Juramento Hipocrático.

[4] Editorial. Revista Canadian Medical Association Journal

[5] Journal of the American Medical Association



[8] "Now whomever wants to speak will speak, good or bad, but whoever

wants to will speak. Not as happened here, when only those who spoke

evil spoke, there will be ." Speech by . Parque

Cespedes, Santiago de Cuba, on January 1, 1959.

[9] "… How can we say 'this is our homeland' if the homeland does not

have anything? 'My homeland', but my homeland does not give me anything,

my homeland does not sustain me, in my homeland I'm starving. That's not

a homeland! Will the homeland be for a few, but not a homeland for the

people. Homeland does not mean only a place where one can shout, talk

and walk without being killed; homeland is a place where you can live,

homeland is a place where you can work and earn an honest living, and

also earn what is fair pay for your work. Homeland is where the citizen

is not exploited, because if they exploit the citizen, if you take away

what belongs to him, if you steal what he has, that is not homeland."

Speech by Fidel Castro Ruz, at the Town Square of Camagüey, the January

4, 1959.

[10] "… it is precisely the tragedy of our people not to have a

homeland. And the best evidence, the best evidence that we have no

homeland is that tens of thousands of children of this land are leaving

Cuba for another country to live, but they have no homeland. And not

everyone who wants to leave goes, only those who can. And that's true

and you know it." Speech by Fidel Castro Ruz, at the Town Square of

Camagüey, the January 4, 1959.

Taken from, 22 September 2012

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