What’s So New About Cuba’s Medical Internationalism?

[EX500rider]

6. Problems within Cuba's health system, including:

Low pay of doctors.
Poor facilities—buildings in poor state of repair and mostly outdated.
Poor provision of equipment.
Frequent absence of essential drugs.
Concern regarding freedom of choice both for patient and doctor.
Katherine Hirschfeld, an anthropology professor at the University of Oklahoma, did her Ph.D. thesis on the Cuban health system, spending nine months conducting ethnographic work in Cuba in the late 1990s. According to Hirschfeld, "public criticism of the government is a crime in Cuba", which means that "formally eliciting critical narratives about health care would be viewed as a criminal act both for me as a researcher, and for people who spoke openly with me". Nevertheless, she was able to hear from many Cubans, including health professionals, "serious complaints about the intrusion of politics into medical treatment and health care decision-making". She points out that "there is no right to privacy in the physician-patient relationship in Cuba, no patients’ right of informed consent, no right to refuse treatment, and no right to protest or sue for malpractice". In her view medical care in Cuba can be dehumanizing.

Hirschfeld explains also that the Cuban Ministry of Health (MINSAP) sets statistical targets that are viewed as production quotas. The most guarded is infant mortality rate. To illustrate this, Hirschfeld describes a case where a doctor said that if the ultrasound examination revealed "some fetal abnormalities", the woman "would have an abortion", to avoid an increase in the infant mortality rate.

Hirschfeld refer to well-documented research about the Soviet Union and the People's Republic of China, showing that "revolutionary" efforts "can also include such practices as deliberate manipulation of health statistics, aggressive political intrusion into health care decision-making, criminalizing dissent, and other forms of authoritarian policing of the health sector designed to insure health changes reflect the (often utopian) predictions of Marxist theory". But, according to Hirshfeld, "the true extent of these practices was virtually unknown in the West", where "social scientists frequently cited favorable health statistics supplied by [these regimes], without critically looking at the ways these were created and maintained by state power".

Hirschfeld concludes that "Cuba’s health indicators are at least in some cases obtained by imposing significant costs on the Cuban population -- costs that Cuban citizens are powerless to articulate or protest, and foreign researchers unable to empirically investigate"

http://en.wikipedia.org/wiki/Health_care_in_Cuba#Criticism