Sunday, December 19, 2010

US castigates much-vaunted Cuban health system

US embassy cables: US castigates much-vaunted Cuban health system, Friday 17 December 2010 21.30 GMT
Article history

Thursday, 31 January 2008, 19:52
C O N F I D E N T I A L SECTION 01 OF 06 HAVANA 000103
EO 12958 DECL: 01/25/2018
Classified By: COM: Michael E. Parmly: For reasons 1.4 b/d

1. Sicko
2. Production year: 2007
3. Country: USA
4. Cert (UK): 12A
5. Runtime: 113 mins
6. Directors: Michael Moore
7. More on this film


1. Diplomats believe Michael Moore film "Sicko" was banned in Cuba -
for showing the country's health system in such glowing light that it
would have provoked a popular backlash. Key passages highlighted in yellow.

1. (C) SUMMARY: This cable is a follow up to Reftel and provides
anecdotal accounts from Cubans about their healthcare, based on USINT
FSHP's (Foreign Service Health Practitioner) interactions with them, her
unauthorized visits to Cuban hospitals, and her care of USINT American
and Cuban personnel. End Summary.

2. (C) The following anecdotes were obtained from Cubans of various
walks of life: domestic employees, neighbors in the Havana suburbs,
USINT Local Contract National (LCN) employees, service providers such as
manicurists, masseuses, hair stylists, chauffeurs, musicians, artists,
yoga teachers, tailors, as well as HIV/AIDS and cancer patients,
physicians, and foreign medical students.

-- A Cuban woman in her thirties confides, "It's all about who you know.
I'm okay because I am healthy and I have 'friends' in the medical field.
If I didn't have my connections, and most Cubans do not, it would be
horrible." She relates that Cubans are increasingly dissatisfied with
their medical care. In addition to the general lack of supplies and
medicines, and because so many doctors have been sent abroad, the
neighborhood family physicians now care for 300-400 families and are
overwhelmed by the workload. (Note: Neighborhood doctors are supposed to
provide care for only 120 families. End Note.) In the absence of the
physicians, patients go to their municipality's "polyclinic," but long
lines before dawn are common, with an all too common 30-second diagnosis
of "it's a virus."

-- A 40-year old pregnant Cuban woman had a miscarriage. At the OB-Gyn
hospital they used a primitive manual vacuum to aspirate the contents of
her womb, without any anesthesia or pain medicine. She was offered no
emotional support for her 'loss' and no pain medication or follow up

-- A 6-year old Cuban boy with osterosarcoma (bone cancer) is admitted
to the oncology hospital. Only his parents are permitted to visit, and
then only for limited hours. He does not have a television nor any games
or toys. The hospital offers no social support services. The parents do
not seem informed as to their son's case. When asked by the FSHP what
they know about the management of the disease, they shrug their
shoulders. According to the FSHP, cancer patients do not receive
on-going basic care utilizing testing procedures common in much of the
world to monitor cancer care -- such as blood chemistries and tumor
markers, sonograms, x-rays, CT and bone scans, MRIs, PET scans, etc.
Patients are generally informed of the type of cancer they have, but
know little of its staging, tumor size, metastasis, or prognosis. They
may be offered surgery followed by chemotherapy and/or radiation but are
not given choices to decide an aggressive versus less aggressive
approach, nor are they allowed internet access to learn more of their

-- Many young cancer patients reportedly have become infected with
Hepatitis C after their surgeries. Contracting Hepatitis C after surgery
indicates a lack of proper blood screening prior to administering
transfusions. All blood should be screened for Hepatitis B, C, HIV and
Syphilis prior to use. Patients have no recourse and are not fully
informed of the seriousness of such an inadvertent infection.

-- During chemotherapy and radiation treatments, patients receive little
in the way of symptom or side-effects care (i.e., severe nausea,
vomiting, low blood counts, fever, diarrhea, radiation burns, mouth
sores, peripheral neuropathies,etc.) that is critically important in
being able to continue treatments, let alone provide comfort to an
already emotionally distraught victim. Cancer patients are not provided
with, nor can they find locally, simple medications such as Aspirin,
Tylenol, skin lotions, vitamins, etc. Most Cuban patients are not
offered Hospice Care or any social support programs for children,
adults, or their care providers.

-- HIV positive patients have had the letters 'SIDA' (AIDS)

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stamped on their national ID cards. Needless to say, in a country where
the national ID card must be shown for everything from getting monthly
rations to buying a train ticket, the person is stigmatized for life.
There is no patient/doctor confidentiality and discrimination is very
strong. (Note: According to Pan-American Health Organization (PAHO)
officials in Havana, stamping ID cards used to be the case but is no
longer the practice in Cuba, something we could not independently
corroborate. End Note.)

-- Some newly diagnosed HIV/AIDS patients are held in what has come to
be known as "Prision de Pacientes con SIDA de San Jose" (Prison for AIDS
patients). There they are started on antiretrovirals AZT, D4T, 3TC. It
is unclear to them why they were put in this prison-like facility but
believe it is plain discrimination due to their homosexuality. The
average period spent at this facility seems to be 18-24 months.

-- AIDS patients are not given prophylaxis medication for the prevention
of PCP (Pneumocysti carinii pneumonia), and for lack of newer medicines
some patients are re-started on antiretroviral regimens that were
stopped due to significant side effects. The Cuban family physicians who
care for these patients' primary care needs do not have the authority to
treat their HIV/AIDS disease. There is only one facility in Cuba,
Instituto Pedro Kouri, located in Havana, where HIV positive patients
can receive their specialty care, antiretroviral medications and
treatments. According to HIV positive Cubans known to FSHP, one usually
waits for months for an appointment, but can often move ahead in line by
offering a gift or hard currency. We are told five Cuban convertible
pesos (approximately USD 5.40) can get one an x-ray and more can get one
a CD4 count. Patients on the island must travel to the capital city for
their specialist visits and medication. Due to the lack of island-wide
transportation and the cost of travel, many HIV-positive patients may be
seen only once per year.

-- While the GOC claims there is a network of organizations that provide
social support for HIV/AIDS patients, many of our sources say they have
never been to one. Because they are "marked" as HIV positive, many are
prevented from pursuing university studies and few can find gainful
employment -- many must resort to menial jobs to survive.

-- A physician XXXXXXXXXXXX told the FSHP that he works 14 hours every
other day, then has to hitchhike home because he cannot afford to own a car.

-- XXXXXXXXXXXX stated that Cuban authorities have banned Michael
Moore's documentary, "Sicko," as being subversive. Although the film's
intent is to discredit the U.S. healthcare system by highlighting the
excellence of the Cuban system, he said the regime knows the film is a
myth and does not want to risk a popular backlash by showing to Cubans
facilities that are clearly not available to the vast majority of them.
When the FSHP showed Sicko to a group of XXXXXXXXXXXX, some became so
disturbed at the blatant misrepresentation of healthcare in Cuba that
they left the room.

-- Even the Cuban ruling elite sometimes goes outside of Cuba for the
best medical care. Fidel Castro, in July, 2006 brought in a Spanish
doctor during his health crisis. Vice Minister of Health Abelardo
Ramirez went to France for gastric cancer surgery. The neurosurgeon who
is Chief of CIMEQ Hospital (reportedly one of the best in Cuba) went to
England for eye surgery and returns periodically for checkups.

-- According to a local pediatrician, the approximate breakdown of Cuban
physicians' salaries are: 1st & 2nd year residences earn 325 pesos
monthly (USD 15.00); 3rd year residences earn 355 (USD 16.00); 4th year
residences (specialists) earn 400 pesos monthly (USD 18.00). For every
four years of medical practice thereafter, a physician receives an
additional 20 pesos (USD 0.89 cents) per month.

-- There is reportedly such a shortage of nurses that within the last
few years, a high-school graduate is now offered an

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accelerated training course of just ten-months duration entitled,
"Enfermeras Emergentes" (Emergency Nurses). These "quasi" nurses are not
trained to start Intravenous lines, interpret lab results or draw blood.

-- Few medical professionals are allowed access to the internet and are
rarely allowed to travel to participate in international conferences or
continuing education courses. Access to up-to-date medical literature is
not available. Some physicians have confided to the FSHP, "All of us
want to leave." They are dissatisfied with their salaries and their own
medical care. They receive no special privileges - most of them do not
even have access to care at the better foreigner hospitals, even if they
work there.

-- As described in reftel, the best medical institutions in Cuba are
reserved for foreigners with hard currency, members of the ruling elite
and high-ranking military personnel. These institutions, with their
intended patient clientele in parentheses, include: Clinica Central Cira
Garcia (diplomats & tourists), Centro Internacional de Investigaciones
Restauracion Neurologica (foreigners & military elite), Centro de
Investigaciones Medico Quirurgicas (military & regime elite), Clinica de
Kohly (Primer Buro Politico & Generals of the Ministry of Interior), and
the top floors of the Hermanos Ameijeiras Hospital (foreigners) and
Frank Pais Hospital (foreigners). These institutions are hygienically
qualified, and have a wide array of diagnostic equipment with a full
complement of laboratories, well-stocked pharmacies, and private patient
suites with cable television and bathrooms.

4. (C) Below are first-hand observations from USINT's Foreign Service
Health Practitioner's (FSHP) impromptu and unauthorized (by the GOC)
visits to major Havana hospitals where average Cubans receive their
healthcare, and from conversations with Cubans in many walks of life.

A. Hermanos Ameijeiras Hospital

-- Address: San Lazaro #701 Esquina A Belascoain, Centro Habana, Havana

-- Date of visit: October, 2007

-- Built in 1982, this newly renovated 600 bed, 24 story hospital is
depicted in Michael Moore's film "Sicko," where some 60 surgeries are
performed daily including heart, kidney, and cornea transplants, mostly
to patients who receive free treatment as part of Operation Milagro
(mostly from Venezuela, but also from the rest of Latin America). The
two top floors (shown in the movie) are the most modern and are reserved
for medical tourists and foreign diplomats who pay in hard currency. The
hospital has three intensive care units and all medical specialties
except Pediatrics and Obstetrics/Gynecology and has no emergency room.
The facility has a CT scanner (often said to be out-of-service), MRI and
hyperbaric chamber capabilities.

-- Upon entering the building the FSHP was struck by the grand and
impressive lobby with a four-story ceiling, polished terrazzo floors and
an elegant center reception booth. No one was in the reception booth,
which displayed a digital streaming ticker-tape announcing an outdated
hospital event; 30 or 40 people were sparsely scattered in the
leather-like chairs throughout the lobby. There were no wheel chairs or
other obvious signs this was a hospital.

-- She was told the majority of patients came from Venezuela and each
received weekly one bar of Palmolive bath soap, Palmolive shampoo, and a
tube of Colgate toothpaste. She was also told the Venezuelan patients
frequently take these items outside to the front parking lot and sell
them to local Cubans. Cuban in-patients receive one tube of Colgate
toothpaste and no other toiletries.

-- Due to the high volume of foreigners receiving treatments and
surgeries, most Cubans do not have access - the only chance might be a
through a family member or connection working there and a gift or 20
CUCS (USD 21.60) to the Hospital Administrator. Cubans are reportedly
very resentful

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that the best hospital in Havana is "off-limits" to them.

B. Ramon Gonzalez Coro Hospital

-- Address: Calle 21 #856 between 4th & 6th Avenues, Vedado Plaza, Havana

-- Date of visit: July, 2006

-- What is today the Obstetrics & Gynecology (OB-Gyn) hospital for
Havana, used to be a private clinic prior to the revolution. The
hospital has: 300 beds and reserves 12 beds for foreigners; an Intensive
Care Unit for women as well as a Newborn Intensive Care Unit (using a
very old infant 'Bird' respirator/ventilator - the model used in the
U.S. in the 1970s); an Intermediate Newborn Care Unit; one room for
babies less than five pounds needing weight gain; a Genetics Department
with a specialized laboratory; and five surgical suites.

-- The FSHP visited this hospital with a pregnant USINT American
patient. Normally USINT staff is required to go to Cira Garcia Clinic,
but because there were possible OB complications the FSHP was able to
arrange, through a Cuban medical contact, for the patient to be seen by
a highly-recommended obstetrician.

-- This hospital, located in the densely populated residential area of
Vedado, had a dilapidated and crumbling exterior. The FSHP was stopped
at the entrance by a guard, but upon mentioning the name of the doctor
they were to see, were allowed to proceed to the second floor -
supposedly the nicest part of the hospital, which is reserved for
foreigners; it reminded the FSHP of some of the poorest hospitals she
had seen in Africa - unkempt rooms, old wrought-iron beds, flat
mattresses with only one sheet, no A/C, no TV, no amenities. At the
nursing station there was no nurse, but a metal cabinet with glass doors
that had one jar filled with cotton and one half-full 16 ounce bottle of
isopropyl alcohol. There were no other supplies nor any indication this
was a nurse's station - no stethoscopes, no computers, no medical
charts, no papers or pens on the desk - there was a lone dial-type black

-- After waiting 15 minutes a nurse in a white uniform appeared and told
the FSHP and her patient to wait. She wasn't friendly. There was no
waiting room, so they found some chairs in the hall. It was very hot and
the patient was very anxious and in pain. After 45 minutes and several
attempts in a polite manner to move things along, a young female doctor
came out smiling and asked for the patient - she asked that her husband
remain in the chair, but did allow the FSHP to go with her upon
insisting. At the end of a long hallway, the FSHP and the patient were
guided into an "exam room." There were no chairs, screens, posters, any
medical supplies or equipment; only one old rusting sheet-metal table
without any covering, extensions or stirrups. She asked the patient to
undress and climb on the table with no intention to drape her. Having
worked in third-world countries, the FSHP brought with her a bag of
supplies that included paper drapes, which she placed on the table and
over the patient. The doctor pulled out of a nearby drawer an old Pinard
fetal heart stethoscope made of aluminum (funnel-shaped, like those used
at the turn of the Century ) to listen for the baby's heart beat. The
FSHP could not believe her eyes -- this was one of the best OB/GYN
hospitals in Cuba. When the FSHP offered the doctor a portable fetal
Doppler she had brought from the USINT Health Unit (HU), she gladly

-- Although the doctor appeared to be clinically competent, she was
abrupt and rough with the patient. FSHP believes this to be typical of
the hierarchical doctor-patient relationship in Cuba. She stated, "She
has an infection and needs an antibiotic," and gave the FSHP a written
prescription for an antibiotic generally not recommended during
pregnancy. Upon returning to the HU the FSHP did a culture that returned
negative for a bacterial infection. Needless to say, the FSHP did not
give the prescription to the patient. As a result of this experience,
the FSHP concluded that the best care for her unstable female pregnant
patients in Havana -- barring a MEDEVAC to the U.S. -- would

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be by the FSHP in their own home with telephone consults to an
obstetrician in the U.S.

-- XXXXXXXXXXXX told the FSHP that XXXXXXXXXXXX foreign medical students
are increasingly covering for the gross shortages of physicians in Cuban

C. Calixto Garcia Hospital

-- Address: Avenida De Universidad Y 27 De Noviembre, Vedado, Havana

-- Date of visit: November, 2007

-- Built in the late 1800's, this dilapidated 400-bed hospital was the
first teaching hospital in Cuba and is only for Cubans. FSHP believes
that if Michael Moore really wanted the "same care as local Cubans,"
this is where he should have gone. The 22-bed emergency room receives
all the major trauma and accident victims from Havana City, plus there
are large Intensive and Intermediate Care Units. It also has a CT
scanner and an MRI, which are reportedly often out of order. The
hospital provides specialist care in all medical fields except OB-Gyn
and Pediatrics.

-- During the hospital visit, FSHP was struck by the shabbiness of the
facility -- no renovations were apparent -- and the lack of everything
(medical supplies, privacy, professional care staff). To the FSHP it was
reminiscent of a scene from some of the poorest countries in the world.

-- In an open-curtained exam room inside the emergency room, FSHP saw a
middle-aged man lying on a gurney in his own soiled clothes with a large
bloody bandage wrapped around his head - he was breathing, but was
neither moving nor talking - there was no IV, oxygen (in fact no
piped-in oxygen at all at this facility) or monitoring equipment.
Neither did there seem to be any sense of urgency to his care.

-- The hospital is spread out over several city blocks consisting of
many two-story buildings with various specialties: Internal Medicine,
Cardiology, General Surgery, Orthopedics, Ophthalmology, and Neurology,
etc. Each building is set up in dormitory style, with 44 metal beds in
two large open rooms.

-- The laboratory equipment is very rudimentary - a simple CBC (complete
blood count) blood test is calculated manually by a laboratory
technician looking through a microscope and counting the individual
leucocytes, lymphocytes, monocytes, etc.

-- As the FSHP exited a building, XXXXXXXXXXXX drove up in a badly
dented 1981 Moskovich that belched exhaust fumes. The private car, which
is a luxury in Cuba, was a gift from his deceased father. He was a thin
man, appearing disheveled, unshaved, with a cigarette between his lips,
wearing a tattered white lab coat without a shirt underneath. He said
his salary was 565 pesos (approximately $22) per month.

D. Salvador Allende Hospital

-- Address: Calzada Del Cerro # 1551, Cerro, Havana

-- Date of visit: November, 2007

-- This 400-bed hospital is located in Cerro - a poorer and more densely
populated section than the others visited in Havana. It is an old,
run-down facility similar in appearance to Calixto Garcia Hospital in
that there are several two-story buildings each with a medical specialty.

-- The FSHP was dropped off a few blocks away so the guards wouldn't see
the diplomatic plates. When she walked in, the guards smelled of
alcohol. In the emergency room there were about 40 mostly poor-looking
Afro-Cuban patients waiting to

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be seen. It appeared to be very orderly, clean, and organized.

-- The rest of the buildings were in shambles . The FSHP did not see any
"real" medicine or nursing practiced during her almost one-hour walk
through most of the buildings. As she saw patients, she could not help
but think that their own home might provide more value-added than
remaining in that hospital. Patients had to bring their own light bulbs
if they wanted light in their rooms. The switch plates and knobs had
been stolen from most of the rooms so one had to connect bare wires to
get electricity. There was no A/C and few patients had floor fans.
Patients had to bring their own sheets, towels, soap and supplemental
foods. Hospital food service consisted of rice, fish, rice, eggs, and
potatoes day after day. No fresh fruits, vegetables, or meat were available.

5. (C) Comment: After living in Cuba for two and a half years, treating
numerous Cuban employees at USINT, and interacting with many other
Cubans, the FSHP believes many are malnourished and psychologically
stressed. Hypertension, diabetes and asthma are widespread, but poorly
treated. Common prescription and basic over-the-counter medications are
unavailable. Given the large number of chronic diseases treated by the
FSHP, preventive medicine in Cuba is a by-gone ideal, rather than the
standard practice of care. PARMLY

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