Urban Renaissance Institute

National Post
January 27, 2003

Re: Lawrence Solomon’s article, “Bad Cuban medicine,” published in the Jan. 18, 2003, issue of the National Post

Lawrence Solomon’s columns are a gross misrepresentation of facts with a very creative spin. Cuba is a developing country, undergoing severe economic constrains. It is not a country with rich natural resources and it has suffered for the past 44 years a relentless economic war carried out by the world’s most powerful nation.

It is no surprise for most observers that the standard of living of Cubans is below typical expectation in North America, and that the country faces uncommon challenges in its development objectives. Cuba is perhaps the only developing country that receives absolutely no financial loans from the World Bank or the IMF, that receives no preferential financing from any bilateral source whatsoever and that is forcefully exempted from accessing the most lucrative and dynamic market for the export of its goods and services.

Without pretending to answer every misrepresentation in the column, historical facts must be recalled. The Economic Commission for Latin America, UNESCO and the World Bank recorded in the 1950s their assessment of Cuba, and it was far from the heavenly picture that the article tries to portray. Cuba was a playground for foreign interests, with a backward economy and a corrupt and extremely unequal society, where crime, prostitution, gambling, drugs and racism coloured the landscape. Today that is certainly not the case.

The core message of the article seems to be in the last sentence, calling for the government to do “much, much less.” Such a call reflects more an ideological impulse than an informed understanding of Cuba and the region in which we live in. However, it does not explain the motivation behind the untruthful depiction of a country striving to do better for its people.

In Mr. Solomon’s Jan. 18 column, “Bad Cuban Medicine,” Mr. Hiroshi Nakajima, director-general of the World Health Organization, said in May, 1998, that “Cuba’s national health system, with its emphasis on primary health care managed by a “health team” is widely considered to be exemplary. Few developing countries have adopted such a comprehensive range of health policies, geared to priority needs and the capacity of health workers to meet them, on behalf of all Cuban people, particularly the most vulnerable and impoverished.”

The following figures can give an idea of how wrong Mr. Solomon’s characterization is. The Panamerican Health Organization, the United Nations Economic Commission for Latin America and the Caribbean and the CIA World Fact Book 2002 have all published their assessments of health care conditions in Cuba and other countries of the world. Among the findings:

•   Child mortality/per thousand live births:
Cuba, 6.5; United States, 6.7; Mexico, 24.9; Argentina, 16.6; Brasil, 31. 8.
•   Life expectancy:
Cuba, 76.6 years; Russia, 67.3; Nicaragua, 68; Colombia, 70.7.
•   Medical doctors/10,000 inhabitants:
Cuba, 59; United States, 27. 9; Chile, 13; Colombia, 1.5.
•   Hospital beds/1,000 inhabitants:
Cuba, 6.3; United States, 4; El Salvador, 1.6; Guatemala, 1.
•   Proportion of under-five registered deaths due to intestinal infectious diseases:
Cuba, 2%; United States, 1%; Mexico, 6%.
•   Proportion of under-one population vaccinated against poliomyelitis:
Cuba, 100%; United States, 91%; Mexico, 89%.
Vladimir Mirabal, press attaché, Cuban embassy, Ottawa.

Like Lawrence Solomon, I too have been stopped in the street by people begging for money for medicine and have also experienced desperate fathers asking for help in getting their asthmatic child’s puffer refilled. I also recently talked to a “health tourist” from the United States taking advantage of hospital services.

These incidents all happened not in Cuba, but in Ottawa, a city where government officials and military get excellent treatment and the government confiscates any foreign currency we earn.

Cuban panhandlers seem to be as enterprising as ours. If their leaders are indeed as fit as Mr. Solomon has been led to believe, then at least they are ahead of our sorry looking lot.

Keith Richardson, Ottawa.

While Mr. Solomon raised some important questions, I found his article on the whole to be not only unbalanced but unfair.

His description of Cuba’s pre-1959 health system is untrue, and would more accurately describe the situation of the health system during the years of the Revolution.

There is no denying the shortages that the Cuban health system has suffered in recent years, but these have not altered the country’s priorities in terms of social spending. In fact, the percentage of GDP spent on the health sector has increased in recent years despite the country’s severe economic crisis.

Curiously absent from Mr. Solomon’s article is reference to the fact that the U.S. economic blockade of the island greatly hinders Cuba’s access to medicine.

Dr. Alexander Gray, Centre for Peace and Development Studies, University of Limerick, Limerick, Ireland.

What Mr. Solomon should have reported is that the health of the Cuban population is not primarily determined by what its citizens can buy by way of care and medicine, but rather what is given free of charge to everyone in that society. Using every reasonable index of the key factors determining the real health of a nation – infant mortality rates, vaccination rates and life expectancy – Cuba clearly wins out over every other relatively poor country in the world.

Marvin Glass, Canadian Network on Cuba, Ottawa.

Lawrence Solomon
National Post
January 25, 2003

Over at the Museo de la Revolucion, Fidel Castro’s case against the dictator he overthrew 44 years ago is vividly on display.

Fulgencio Batista was evil incarnate, the museum earnestly instructs visitors in room after room of the once-magnificent building, formerly a presidential palace built in 1920 and decorated by Tiffany’s of New York. Under Batista and his predecessors, we learn through photos and text, Cuba became a playground for crass tourists who came for sex, drink and gambling, and who crowded the country’s pristine beaches to the detriment of ordinary folk. To drive home the immorality of pre-socialist times, the museum displays an original National Lottery of Cuba ticket from early in the century, a symbol of the country’s fall from grace.

We learn that Batista was an illegitimate leader, the election he won stolen by manipulating the press. Worse, Batista intimidated, even jailed or killed, political opponents.

But Batista also failed Cuba by failing to invest government funds wisely. One damning display berates Batista’s priorities with a list of budget line items that show government expenditures on frills such as roads, promenades and buildings. Batista’s sky-high spending on telecommunications – which the display dubs as military – comes in for criticism. Another display lambastes Batista for failing to diversify the economy. Another still, which provides a year-by-year report of sugar output, accuses Batista of neglecting this all-important industry. The numbers show a downward trend, interrupted with some up-ticks, in the 1950s, and then a giant leap forward, as Castro mobilized the country to produce more sugar in one of his regime’s grand economic plans.

The moral and economic rot under Batista led to humiliation and human tragedy, the museum tells us. “Many women who were denied jobs saw themselves forced to become prostitutes in order to survive,” said one display. Said another: “According to a census in 1953, there were 200,000 shacks and misery huts.” Said a third, also referring to the 1953 census: “40,939 people died due to lack of medical attendance and unsanitary living conditions.”

The history the museum imparts is part truth, part fiction and all hypocrisy. Batista was indeed an unsavory character. He did oversee a corrupt administration in Cuba. He did undermine the halting democracy that the United States helped create after liberating Cuba from oppressive Spanish occupation at the turn of the century.

But Cuba and its U.S.-style constitution was also an economic powerhouse with potent social institutions and impressive accomplishments. A 1958 United Nations report ranked Cuba’s vibrant free press eighth in the world, and first in Latin America. Despite its much smaller population, Cuba had 160 radio stations compared to the

U. K.’s 62 and France’s 50. It had 23 television stations compared to Mexico’s 12 and Venezuela’s 10. The tiny country supported 58 newspapers, fourth in Latin America behind populous Mexico, Brazil and Argentina.

Cuba once installed telephones at a rapid rate. No more. It once ranked first in Latin America, fifth in the world, in television sets per capita, and also ranked high in radios, automobiles, and many other consumer goods. No more. With the population increased and the housing stock degraded, more people suffer inadequate housing today than ever before, and sanitary conditions have become a scandal through much of the country.

The information-hungry populace in the Batista era was well-educated, as it remains. Student registration at primary schools in 1955 was 1,032 students per 10,000 inhabitants, higher than the figures for 1990 of 842. The registration rate for higher education was an impressive 38 per 10,000, about the same as it was 10 years later (34 per 10,000) and 15 years later (41 per 10,000). The country, in fact, had a long history of high literacy levels: At the turn of the 20th century, only 28% of those 10 and over couldn’t read or write, not that different from the current figure, 100 years later, of 16%.

But unlike today, Cuba’s economy under Batista was powerful, both domestically and in exports, and it was becoming increasingly diversified. Under Castro, its economy is in tatters, nowhere more so than in the sugar industry that Castro once promoted so heavily. Last summer, Castro announced a shut down of half of the country’s sugar mills. “We had to act or face ruin,” he explained. As he told NBC News just this week. “It cost us more to produce sugar than what we could sell it for.”

But if Batista bested Castro in virtually every broad socio-economic indicator, he paled in comparison when it came to controlling either the electoral process or the populace. Castro executed thousands of political opponents after he came to power, imprisoned tens of thousands and caused hundreds of thousands to flee to exile. Where Batista won a disputed election, a Castro election leaves no room for dispute: Castro allows no opponents, no opposing viewpoints to appear in the press, and, because that might not be enough, his political machine ensures a good turnout by keeping tabs on who votes and who doesn’t: In last Sunday’s national election, Castro managed a 90%-plus “yes” vote, not quite as impressive as Saddam Hussein’s 100% but, among dictators, respectable enough.

Those who revile Batista often point to a decadent economy that relied on mafia-run casinos, prostitution and other demeaning jobs servicing tourists. Tourism was important under Batista – Havana was an east-coast alternative to Las Vegas, complete with the sex and gaming, and the same mafia owners – but never as important as tourism has become today. Cuba’s once diversified economy is gone and Castro is now putting all of his hopes in attracting tourists.

To do this, Castro’s Cuba now permits prostitution, it winks at sex tourism – tourist guide books even include sections on the country’s once-taboo gay and bisexual scenes – and, as under Batista, the country unabashedly invests heavily in tourism. Earlier this week, Castro inaugurated a US$100-million resort on the island’s northeastern coast, broadcast nationwide, to underscore the importance the government places on the new five-hotel complex of 944 rooms able to house 1,500 tourists.

Tourism is now Cuba’s No. 1 source of foreign income, with 1.6 million visitors generating about US$2-billion last year. More tourists come from Canada than from other important sources of foreign exchange, chiefly Germany, Britain, Italy, France, and Switzerland. Castro, like Batista, is eyeing one other important tourist market.

“Our friends from the north are not in this list,” Castro said with a grin, referring to Americans that can’t travel to Cuba due to U.S. government regulations.

Some day soon, perhaps, Castro’s dream may be realized, and Cuba’s economy may once again benefit from U.S. tourism. If it does, Cuba under Castro will have recovered one of the benefits that the country once enjoyed. Forty-four years into the Revolution, Castro will have achieved all the failings, real and perceived, that Cuba had under Batista, and it will have retained few of the virtues.

Click here to read “Responses to Fidel Batista!”

National Post
January 20, 2003

Re: Cuba’s Cruel Joke, Lawrence Solomon, National Post, Jan. 11.

I am truly impressed that a Canadian newspaper has finally captured the very essence of the survival of the Cuban people. As a Cuban-American living in the United States, we have been amazed how long it has taken the Canadian people to admit/realize that the policy of “engagement” with Cuba has only enriched the very repressive regime there and has done nothing for the Cuban people.

We have our pressures here from both Republicans and Democrats who want to follow the lead of “the world” that trades with this brutal dictatorship, particularly that of Canada. Add our press who is still mystified and enamoured with this “revolutionary.” Please let your neighbors down south know: Your policy of engagement with Cuba has not worked. It has only prolonged the misery of the poor people in Cuba!

Elena Merino, Atlanta, Ga.

I have to thank you for letting people know the real side of my country. Some of my friends didn’t believe me totally until they read it. I’m a landed immigrant from Cuba, where I experienced for 27 years what you so truthfully describe.

Cuba is such a wonderful country and the people are so warm and friendly. It is just very unfortunate for my countrymen to live under such a demeaning and hypocritical government. The more people in the world that know the true colours of what is happening in Cuba, the more chances are that such a big lie as communism won’t be spread. There are too many people in Canada who support Castro under the false idea that he’s a hero. Thanks for trying to open up their eyes with your article.

Name withheld, Kamloops, B.C.

Mr. Solomon decries the economic problems in Cuba without referring to that very immoral economic embargo imposed on Cuba by the United States. And why was that embargo imposed? Because after 60 years of exploitation by corporate America, Fidel Castro nationalized the sugar industry, without compensation – a move applauded by many people, including me.

The United States, to its everlasting shame, missed a great opportunity to do something noble and support a genuine revolution of the people, not the usual military junta coup. Alas, it was so convenient to push Castro against the wall and nudge him towards the Soviet Union to justify the embargo.

Only people like Mr. Solomon remember the Batista years as prosperous. Such prosperity as existed was fueled by American tourists who flocked to Cuba for the brothels and casinos run by American interests. The mass of the people were illiterate, dirt poor and toiled in the sugar industry for pitiable wages and working conditions and could not afford to purchase consumer goods, medicines and dairy products as asserted by Mr. Solomon. The only ones who could were in Batista’s orbit, mostly of Spanish ancestry. They are now mostly living in South Florida, having been dislodged from their privileged position. The black Cubans are staying home. With the help of the United States, Cuba today would be a shining beacon for all the Latin American countries. Alas, it was not to be.

Ron Renaud, White Rock, B.C.

Thank you for a dispassionate exposition of Cuba’s current economic reality. Mr. Solomon highlights the ration card system, which most commentators do not do, thereby giving their readers the impression that, 1) Cuba’s privations are merely endemic and generic symptoms of Third World poverty, and 2) that these are merely exacerbated by the U.S. embargo. By noting that the libreta was instituted in 1962, in the very early years of the revolution, before the collapse of the U.S.S.R. and before the U.S. embargo could arguably be held accountable for the levels of indigence that have become common in Cuba, Mr. Solomon alerts the careful reader to the structural nature of the problem and its uniquely Cuban (political) genesis.

The onus for the pauperization of the Cuban economy is on the government and the Communist Party, for turning a pre-1959 free-market system (with the imperfections inherent in the market and the defects particular to developing economies) into one of the most rigidly centralized and collectivized in the old Soviet Bloc, with virtually the entire economy under state control. This has culminated in the virtual dissolution of the sugar industry for unproductivity and non-competitiveness on the world market.

In this light, the rationing system must be understood as a fundamental element of social control that goes well beyond its avowed purpose. This purpose was not to overcome a momentary emergency in supply or distribution, but to institute (the appearance of) egalitarianism as a matter of ideology.

I would quibble with only one characterization: Mr. Solomon says that Cuba was once the most prosperous country in the Caribbean. Cuba was, rather, one of the most prosperous countries in Latin America, which, in 1959, included the then-wealthy and resource-rich Argentina, Brazil, Uruguay, Chile and Venezuela. It was, by some reckonings, on the threshold of attaining the status of a developed economy, and was much closer to the developed world in its social structure, constitutional welfare provisions and income distribution, than to countries such as Mexico, with its extremes of wealth and poverty, traditionally characteristic of underdeveloped economies. It was also a more prosperous country in terms of living standard – as measured by per capita income, literacy, various health indices, caloric intake, per capita ownership of cars, radios and TV sets, total number of TV and radio networks, total number of newspapers and magazines, etc. – than the USSR itself and Eastern Europe. This can be contrasted with today’s prohibitions on access to the Internet for the general Cuban population, and on the bleak prospects for acquiring a computer on a per capita income that is among the lowest in the world.

Ricardo Fernández, Miami, Fla.

Congratulations on your excellent article describing the Cuban situation. I have never read anything written in the United States that is so accurate and so informative in regards to Cuba. Mr. Solomon’s article should be sent to everyone who has an interest in Cuban affairs, and it should also be sent to millions of uninformed people in Latin America who believe Castro’s propaganda.

Dr. Joaquin de Posada, San Juan, Puerto Rico

Everything Mr. Solomon explains in his article I know already, and yet his discourse brought tears to my eyes. These are my people whose lives he describes, and he has made so realistically painful their everyday acrobatics for survival.

If only more folks in this country and around the world could understand exactly what was so apparent to Mr. Solomon, we wouldn’t have wealthy American and European businessmen wining and dining Castro as if he were a Third World genius who delivered his people from hell. What Castro has accomplished is precisely the opposite: Castro has delivered the Cuban people into hell.

Ileana Fuentes, guest columnist for El Nuevo Herald, and Cubaencuentro.com, Miami, Fla.

We have just returned from our fifth trip to Cuba, and I concur with all of Mr. Solomon’s findings. On each trip, we are saddened to find the Cuban quality of life more diminished.

We noted the frequent shortages of toilet paper throughout our four-star hotel and unexplained electrical outages which sometimes lasted for hours. The waitstaff at the hotel restaurants seemed under duress most of the time and sometimes had a surly attitude. I watched the waitstaff pack up desserts in shopping bags once the buffet lunch was closing and saw a weary chambermaid leave for the day with a garbage bag full of toilet paper and supplies over her shoulder. Native Cubans who swam near our hotel on a Sunday were quickly approached by guards and promptly escorted off the beach.

We had lunch in Havana on calle Obispo, probably only doors down from where Mr. Solomon had eaten. I had seen the homeless dogs in the streets and saved some chicken for them. When I hit the street mid lunch to give it to a passing dog, a toothless woman stepped forward with her young baby to claim that it was her dog and promptly left with the scraps and bones.

Anna Butt, Toronto

Read Lawrence Solomon’s article, “Cuba’s Cruel Joke”

Lawrence Solomon
National Post
January 18, 2003

The shelves in the neighbourhood pharmacy, like those in the other neighbourhood pharmacies I had seen in Havana, were half empty and full of dust, the small selection of medicines on display arranged in lonely rows of old-fashioned little bottles. Customers were as scarce as the medicines.

One bottle on a shelf contained a fungicide, another aloe ointment. A third countered diarrhea. The odds of finding a specific medicine to treat a particular malady were vanishingly small. “What is this bottle for?” I asked the woman behind the counter. “Memory,” she said. “It’s good for memory and for circulation.”

“Do you have Aspirin,” I asked, wondering if average Cubans could obtain the world’s most familiar pharmaceutical staple. The answer was no. Her pharmacy only stocked drugs manufactured in Cuba and available for purchase in pesos, the currency used by Cuba’s poor. “For Aspirin, you must go there,” she said, pointing to a nearby hotel that housed a pharmacy for customers able to pay in dollars.

The “dollar pharmacy” did indeed have aspirin, along with other pain killers, cough medicines, syringes, Band-Aids, Alka-Seltzer and all the other common medicinal products familiar to Westerners. Its shelves were piled high – literally to the ceiling – with some 500 items, including tampons, disposable diapers, and other drug store items that were more conveniences than necessities. Pesos – the national currency and all that most poor have access to – bought nothing in this government-run establishment. The dollar pharmacy only welcomed dollars, and those who carried them.

Earlier in the day, a Cuban had stopped me on the street, pulled out his asthmatic child’s puffer, and asked for help in getting it refilled. He could not get the drug, he explained, but I, as a tourist, could. Begging for medicines is common in Havana – next to begging for money to feed children, it is the most common plea – because the government won’t use its scarce foreign exchange to import basic drugs that the populace needs. Doctors won’t even prescribe drugs for the poor that aren’t available in the local pharmacies – the state frowns upon that – but many will write the name of the drug that’s needed on a scrap of paper.

“This is what you need,” the doctors will tell desperate patients, in effect sending them out into the streets on a mission of what can amount to life or death for themselves or their children. Cubans with access to dollars – typically those in the tourist industry who receive tips in dollars – can obtain the drugs they need. Others have relatives in the United States who can ship them. The rest – middle class Cubans included – must resort to begging, the black market or, increasingly, to prostitution.

Cuba is renowned for having a universal health-care system and, in fact, doctors are plentiful and doctor visits are free. But without access to antibiotics, insulin, heart drugs and other life-saving medicines, doctors cannot perform their duties. Too often, for lack of medicine, doctors have no choice but to amputate limbs, or to put patients through painful therapies without painkillers. In one celebrated case, Dr. Hilda Molina, the founder of Havana’s International Center for Neurological Restoration, returned the medals that Fidel Castro had awarded her for her work and resigned in protest, outraged that Cubans were denied critical care in order to treat foreigners.

Byron (not his real name) is a 30-year-old doctor in Cuba, a former medical student from Africa who came to Cuba on a Commonwealth country scholarship. Because he speaks fluent English and French, and understands three other European languages, the government assigns him to treating tourists whom, he confirms, lack for nothing in Cuba. The tourist hospitals are excellent, the quality of care delivered to a high standard, as high as any you will find in any Western country, he says. The hospital pharmacies provide whatever drugs tourists require.

Care for top government officials and those in the military is also excellent. “They also lack for nothing,” Byron said. But after providing for the needs of tourists and the top government officials, the health system has little left for the general public. I asked Byron about a man I had seen sitting on the pavement, wrapping raw lesions on his foot with filthy rags. The care with which he was tending his gaping holes made an impression on me, and made me wonder why he lacked proper care.

Byron identified the man’s malady – a disease that slaves had brought to Cuba from Africa 400 years ago – as one easily treated, but not with the medicines available in the peso pharmacies.

“The government doesn’t give a shit about the poor,” he stated matter-of-factly. “The poor have no medicines, no painkillers, no nothing.”

Before Castro seized power in his 1959 Revolution, Cuba had one of the world’s best medical systems, its ratio of one physician per 960 patients ranked 10th by the World Health Organization (England, in contrast, had one physician per 1,200 people, Mexico one physician per 2,400 people). Cuba had Latin America’s lowest infant mortality rate, comparable to Canada’s and better than France’s, Japan’s and Italy’s. Its population was well fed, with a per capita food consumption that was the third highest in Latin America.

Today, Cuba ranks last in Latin American per capita food consumption – cereals and especially meat and milk consumption are down dramatically – but it has not lost its medical capabilities. Instead, Cuba has reoriented its medical system to the task of earning foreign exchange. To do this, Cuba pioneered “health tourism” through agencies such as Servimed, which markets medical services abroad. Cuba is “the ideal destination for your health,” it boasts, frankly admitting to being “a tourist subsystem.”

With an annual growth rate of 20% in health tourism, Servimed has done well in its task of marrying health and tourism. Many Italians now couple their annual vacations to Cuba with their annual dental work, while others come for cut-rate knee replacements or eye surgery. But perhaps Cuba’s most popular medical service, and the one it heavily promotes to tourists abroad, is cosmetic surgery. Cuban doctors have become expert at breast implants, tummy tucks, liposuction and nose jobs, giving some doctors international reputations while letting them serve the Revolution as one of the country’s best earners of foreign exchange.

It’s a “win” for the elite doctors and a “win” for privileged patients, who benefit from what has become the world’s most extreme two-tiered medical system. It’s also a “win” for the Cuban elite, from Castro on down, whom Byron describes as participating in a fitness culture. “When I treat tourists of 75 years of age, I am treating fit people with many healthy years ahead of them,” he said. This is also the case with members of the Cuban elite. “Castro is fit, the others at the top in government, at age 75, are fit. They take care of themselves.

“But an ordinary Cuban of 63 or 64 years is already feeble, an old man.” For the poor, beaten down by the system and denied basic medical care, the medical system is all “lose.”

Related articles by Lawrence Solomon :

Castro’s dupes
Fidel Batista!
Cuba’s cruel joke
Triumph of freedom