Don Fitz has written a fascinating account (Cuban Health Care: The Ongoing Revolution) of the development of the Cuban health care system. Placing developments in their historical context—and emphasizing Cuban internationalism throughout—Fitz has illuminated how the Cubans have developed a health care system that is the envy of many countries around the world; and one from which many people (especially Americans) might want to learn.
To convey his findings, Fitz details the processes by which the Cuban health care system has developed, seeking to address established problems with new radical solutions. But this is more than just a detached, “neutral” look at the subject—it is developed around his experiences in Cuba, supporting his daughter, Rebecca Fitz, throughout her six-year medical training at the Latin American School of Medicine, ELAM (ELAM are its Spanish initials), which is located in Santa Fe, Playa, about a 90 minute bus ride outside of Havana.
Just the very existence of ELAM signifies the role of internationalism in the Cuban medical system. In addition to developing a health care system that provides Cubans with a life expectancy the same as for those of us in the US, with a lower infant mortality rate, and at a cost about 4 percent of what the US pays annually, Cuban medical missions currently are taking place around the world: “The Associated Press reported that when COVID-19 went world-wide, Cuba had 37,000 medical workers in 67 countries” (p. 251). But he also shows how Cubans have brought over 20,000 people from around the world since 1999 to Cuba to be trained in providing quality health care for their respective countries, and this training—even for Americans—is provided for free! And he provides accounts of 13 medical students from around the world in ELAM to give their perspectives and experiences from that training.
However, this is not a celebratory book; Fitz examines certain areas that have brought new challenges to the Cuban health care system. He writes extensively about how their early medical work benefitted from their experiences, especially in support of Cuban military missions in Africa. (Cuba played a major role in driving the apartheid South African military out of neighboring countries.) From their work in Venezuela, Fitz argues they went from seeing health care ameliorative to transformative. He shows how they have confronted homophobia in their country as well as in others. And he notes how they conquered dengue fever through community mobilization.
The heart of the Cuban medical system is preventative care, and starting in the mid-1980s, they started having doctors and nurses live in the communities in which they work. This developed a trust between medical personnel and the respective community, and so when they seek community participation in combatting a medical emergency, such as dengue fever, they get extensive support. Fitz explains:
The integration of neighborhood doctors’ offices with area clinics and the existence of national hospital system means that the country responds well to emergencies. Cuba can evacuate entire cities during hurricanes, largely because consoltorio staff know everyone in the neighborhood and know who to call for help getting disabled residents out of harm’s way. At the same time that New York City (which has roughly the same population as Cuba) had 43,000 cases of AIDS, Cuba had only two hundred AIDS patients. Recent emergencies, such as the outbreak of dengue fever, have been followed by national mobilizations. Perhaps the most amazing aspect of Cuban medicine is that, despite being a poor country, Cuba has sent over 124,000 health care professionals to provide care in 154 countries. In addition to providing preventative medicine, Cuba sends response teams world wide following disasters (such as earthquakes, hurricanes, and a nuclear meltdown) [Chernobyl] … (p. 204).
It is this central concern for the well-being of its own people, and a dedication to address the health problems of people around the world, that comes through Don Fitz’ book. For those who want to denigrate the Cuban Revolution, this will possibly sound “pollyannish”—it’s laser-like focus on the health care system means it does not examine the entire Cuban Revolution, although it understands that the Cuban health care system is much more than just about medicine—but for those who want to learn about a country that has persevered despite a continuous hostility from its outsized nearby neighbor, whose outcomes have been amazing despite severe shortages, whose medical personnel have made life better for people around the world, this is an excellent place to start.
I highly recommend this book.