The Human Cost of Crippling Castro
Health care is still pretty good in Cuba--unless you die waiting for embargoed supplies.
A joke making the rounds in Cuba:
Q: What are the three greatest accomplishments of Fidel's revolution?
A: Health, education, and sports.
Q: What are the three greatest failures of Fidel's revolution?
A: Breakfast, lunch, and dinner.
On a recent trip to Cuba, I walked through Havana's crumbling neighborhoods to the Hospital Nacional Hermanos Ameijeiras. I found myself in a modern lobby with the size and feel of a new airport terminal and, with my feeble Spanish, talked my way into meeting some fellow surgeons. I asked them to show me around. I was interested, I said, in what they could do. But what I really wanted to see was what they couldn't do--and why.
For 36 years, the United States has resolutely tightened the screws on trade with Cuba in an effort to topple Castro's regime. However, in the weeks since the pope spoke in Havana against the U.S. embargo, the pressure seems to have lessened. Not long after the papal visit, Clinton allowed humanitarian flights and the sending of money to Cuban relatives. Congressional legislation to end bans on the sale of food and medical supplies is gathering bipartisan support, and a Senate vote is expected this spring. Embargo defenders, however, say the harm is more rhetorical than real. Cuba can get supplies elsewhere, they argue, and trading with a dictator is immoral. Here I had a chance to see the effects for myself.
The hospital, one of Havana's best, was impressive. It has 900 beds and 39 specialties and offers the services of a top U.S. hospital. Its surgeons perform microsurgery, neurosurgery, and organ transplants. And ordinary Cubans seem to have no trouble getting access to this care. Later on my trip, for example, I met a woman who had no special connections but had been sent here after she developed frightening stomach pains. One gets a sense of the priorities in Cuba: A teacher who couldn't put meat on her table (what little she finds she gives to her son) was able to obtain a full medical work-up including endoscopy and biopsy of her stomach. A parasite from the drinking water had invaded her stomach lining.
Still, for all the resources Castro provides, the system founders from an unreliable supply of materials. Dr. Nilo Rodriguez, a cardiac surgeon, told me, "We can do any kind of surgery, but not always."
Rodriguez appeared to be in his 50s. His office was spacious, but his bookshelf was bare except for a single textbook (American), a few patient files, and some knickknacks. Like the other doctors I met, he was quick to brag about his high-tech accomplishments. He described the heart transplants and complicated valve replacements he performed. But I wondered how he, a surgeon, could spend an hour meeting with me at the spur of the moment. He admitted that, for all he was capable of doing, he operated on only five patients per week.
Atul Gawande, a surgical resident in Boston, is a staff writer on medicine for The New Yorker and author of the new book Complications: A Surgeon's Notes on an Imperfect Science.