Jewelsin the crown
Protecting the gains of the Revolution in healthcare and education...

photo by WAYNE ELLWOOD

The Moncada Barracks in the city of Santiago is one of Cuba’s political shrines. It was here on 26 July 1953 that a young Fidel Castro and a hundred other young men attacked the second largest military garrison in the country, hoping to spark a mass uprising against the corrupt Batista regime. The attack was a spectacular failure: most of the rebels were captured, tortured and murdered. A handful of others, including Fidel, were sent to prison on the Isle of Pines.

Today there is a small museum in the front of the barracks where the bullet holes from the attack are still visible. Inside, several rooms covered with newspaper blow-ups recount the assault. In a glass display case there is a meticulous scale model of the barracks and the surrounding streets with checked lines outlining the routes of the insurgents.

But most of the once-despised buildings have been turned into a school, the Ciudad Escolar 26 de Julio. As I make my way through the grounds, the old barracks buildings echo to the shrieks and laughter of a thousand children. It’s the end of the day and kids are careening around the yard, bouncing balls, playing tag and hopscotch. Each wears the jaunty primary school uniform seen across the country: red skirt or trousers with a white shirt or blouse and a blue or red bandana tied around the neck. Parents and grandparents make their way through the narrow gate preparing to walk their charges home.

Free education is one of the great accomplishments of the Revolution. School is compulsory up to the age of 16 and Cubans are rightly proud of the system they’ve built. Literacy levels of 95 per cent are comparable to Canada or Sweden. And with just two per cent of Latin America’s population the country has almost 12 per cent of its scientists. Out of a population of 11 million, more than half-a-million are university graduates.

The other major accomplishment of the Revolution has been healthcare, which is free to every citizen by right. In all of the Third World no country has achieved such remarkable success in such a short period of time. Basic health indicators are head and shoulders above Third World norms and in some cases ahead of Western countries. According to UNICEF, the infant mortality rate in Cuba fell from 60 deaths per thousand in 1958 to 7.9 in 1996, roughly half that of Washington DC. That accomplishment is even more remarkable knowing that the country has a gross domestic product lower than any other Latin American nation and less than a twentieth of the US. Average life expectancy is 75 years, far ahead of the Third World average of 57.

There is an impressive layered system of healthcare delivery from consultorios (small family clinics) to polyclinics, to hospitals and national research institutes. Family physicians and medical services are readily available from one end of the island to the other.

Diolaida Guzman is a nurse at a consultorio in the countryside near Baracoa, at the north-east tip of the island. The clinic services the local farming community and the lush mountains surrounding it are planted with cocoa, coffee, coconuts and oranges.

‘I visit families with children under a year old every 15 days,’ she explains. ‘I teach them about hygiene. I check to see if the child’s crib is clean, if the utensils are clean, if they’re boiling water. But we don’t get many serious illnesses with children here.’

The most common adult complaint is hypertension, a disease more usually associated with rich countries than poor ones. ‘Those patients come every day to have their blood pressure taken,’ says Diolaida. ‘We talk about the need for rest and a change in diet, especially to lower their salt and fat intake. If something is serious enough we send patients to the polyclinic in Jamal five kilometres from here.’

Free, high-quality healthcare and free education are the foundation of the Castro Government’s legitimacy. Yet, despite Havana’s best efforts to maintain health and education budgets, cracks are beginning to show. Schools are bereft of supplies, buildings are crumbling. Teachers work in impossible conditions for miserable wages. Laritza, a 22-year-old English teacher, hitchhikes an hour-and-a-half each way to her school in West Havana. ‘We have almost nothing,’ she says softly, ‘no paints, no pencils, no notebooks, no chalk. And now children are coming to school with little in their stomachs.’ Laritza makes eight pesos a day (35 cents). But she also works twice a week teaching privately for 30 pesos a session and lives with her mother to save money.

The country’s healthcare facilities are also badly run-down and getting worse with the impact of the US economic blockade. A 1996 report by the American Association for World Health (AAWH) found that the tightened US embargo since 1992 has led to ‘a marked decline in surgical services, delays in diagnosis and treatment, a decline in quality of hospital care and increased rates of water-borne disease, malnutrition, unnecessary suffering and premature death.’

Many basic drugs for the treatment of heart disease, asthma and cancer are no longer available since purchases from foreign subsidiaries of US drug companies were outlawed. Even over-the-counter patent drugs like allergy medications and headache tablets are in short supply or available only in dollar stores, thus effectively denying them to millions of Cubans. Pharmacy shelves are empty.

Despite these constraints, doctors and healthcare officials put on a brave face. Still their outrage is palpable – and so it should be. As in Iraq it is individual Cubans – the young, the ill, the elderly – who are suffering most from the destruction of their healthcare system. That is a tragedy. But it is also a crime for which the American Government should be held accountable. The AAWH investigation found that ‘only the excellence of the system and the extraordinary dedication of the Cuban medical community have prevented infinitely greater loss of life and suffering’.

The Impact of the US Embargo on Health & Nutrition in Cuba, American Association for World Health, Washington, 1997.