Saturday, February 18, 2012

Cuba Medicine and an Offended Doctor / Miriam Celaya

Cuba Medicine and an Offended Doctor / Miriam Celaya
Miriam Celaya, Translator: Unstated

Following the publication of the post "The Broken Showcase" in this
blog, in which I noted several criticisms of the Cuban health system and
the loss of professional ethics by not a few doctors, a reader was kind
enough to send me the letter of a doctor with the surnames Alemán
Matías, which circulated on the web, not in response to my post but in
response to a note which was published some time ago in the Letters
section, a feature that appears every Friday in the Granma newspaper.

However, as somehow the topic is related, and as I have opposing views
to those wielded by the aforementioned doctor, today I propose to my
readers to comment on the letter, transcribed in full below, and whose
writing, spelling and style I have respected without altering them in
the slightest. I do not cite the web source because I'm transcribing
directly from the message of my reader. I urge readers, in order to
avoid misunderstandings, to bear in mind that Dr. Alemán refers to a
letter published in Granma and not to my post of last Monday, February 6:

And the patience of the doctors?!

On Friday, November 4, 2011 was published another letter of the many
that have already been published, constantly criticizing the medical
staff that still has the dignity of working in the National Health
System. The letter in this case, entitled "Patience of patients,"
doesn't speak about the myriad difficulties faced daily by health
workers, but superficially criticized and, in a way that has become a
tradition, in a non-constructive way.

In other words, the doctor has no right to speak, amid all her
difficulties must remain stoic, and can not comment to her partner over
a breakfast she can't eat that morning because if she did she would miss
the bus and not arrive early to attend to the patient who would later
feel every right to criticize her, and so this is one of what are
countless examples of what doctors could talk about that would not fit
in all the pages of a newspaper.

That doctor has to have all the patience to sit and wait for a bus, to
arrive at the school of her child where they tell her there is no
teacher or they do not have lunch, to arrive to buy detergent for the
month in CUC, a currency in which she does not receive her wages, and to
wait for the clerk to finish gossiping with the one next to her, to
deign to check out everything she would buy.

Patience to come and pick up the garbage cans, overflowing outside her
home and on every corner, the community workers, who surely have the
right and time to have pleasant conversations so that they forget they
have to clean up the city trash.

I speak as a doctor, because it is because of this that I arrive at ten
o'clock in the morning in the operating room without having been able to
have breakfast and having to tell my co-worker next to me how hungry I
am! And knowing that there is no snack and that lunch will arrive at
2:00 pm and at that hour I will be able to have lunch although it will
be a taste of what they give the doctors and the rest of the workers in
this section.

But the physician continues standing there, giving the best care to the
patient she is operating on, and who will later have "every right to
criticize all doctors" who although conversing, gave him quality medical
care, which all Cuban doctors continue doing, and all which all the
people of Cuba should be proud of, yet they continue to judge us without
having the least idea of the inhuman conditions in which we work and how
much we contribute to society.

I will end with the same question: Should we get used to this?

Dra. A. Alemán Matías

Specialist 1st grade of Anesthesiology and Reanimation.

So much for the letter-catharsis of the doctor. Now, from my personal
perspective it is obvious that the evil is deeper than many thought. For
starters, it would seem that Dr.Alemán understands that doctors are some
particular kind of breed to be placed above the rest of humanity.That
is, the vast majority of Cubans of any profession, occupation or trade
pass through identical material deprivation and problems, they have to
wait for the bus for long hours, often have nothing to eat breakfast,
are paid in local currency and need products that are sold only in hard
currency and, to round it off, they get sick. Therein lies our greatest

I believe that every patient is within his rights to demand better
treatment and better care from the doctors, regardless of whether or not
they have eaten, particularly because the patients are not responsible
for the material privations and the personal problems of the physicians.
Health is the most precious of treasures, which explains the concern and
anxiety of the patients when they are forced to go to consultations from
which they often emerge without a diagnosis, in hospitals where
frequently the necessary equipment to perform complete exams doesn't
exist, or where there are no reagents for the lab tests. We have
experienced going to the labs where, in addition, "they don't have"
intravenous needles, which rapidly appear when we open our wallets. It's
an irrefutable reality that happens with such regularity it's become a
tradition. Not to mention the shortage of medicines.

If the patient requires hospitalization, then his concern and that of
his family members increases exponentially. You are almost always
admitted using your own resources, your own bedding and personal effects
in every detail, generally you must bring your medications from home and
your family must guarantee your food to avoid your consuming the
gastronomic offal that is hospital food. The conditions of the rooms and
bathrooms are another chapter of horror: lack of water, blocked drains,
cockroaches, filth, are a constant in most hospitals. And I am referring
only to the hospitals in the capital, with two or three honorable and
rare exceptions. I urge Dr. Alemán to disprove something of what I've
asserted here.

Another feature of the Cuban health system is the absolute impunity with
regard to medical patients. Cubans do not have the slightest opportunity
to challenge a diagnosis or to sue doctors and hospitals for
mismanagement or fatal errors. The examples of silencing them abound.
About two years ago a cousin of mine died in the Naval Hospital in East
Havana. Unknowingly she had an ectopic pregnancy and in the face of
severe abdominal pain that came on suddenly she was rushed into surgery.
From there, shortly afterwards, she emerged dead. She was 40, a healthy
and beautiful wife, mother of two children, and in the matter of a few
hours she was dead. It was the consequences of the effect of the
anesthesia, whether this was fatal or there were other complications we
will never know. She, Ana Margarita Celaya, was cremated, a family left
devastated, but the doctors of that unfortunate surgical intervention
continued practicing. At best, what happened that day, is that they had
not eaten breakfast, go figure.

My father was diagnosed with a metastatic brain tumor just five days
before his death, although for more than six months we had been
frequenting consultations and specialists in various branches of
medicine. The scanner could not detect his illness and only the MRI,
that my older brother and I managed to "resolve" — that is, arrange for
— through some friends, discovered too late his impending death. Up to
that moment we were wandering around hospitals, trying to figure out
what strange illness was making my father lose his balance, be so
confused, forget even my phone number, become more and more melancholy,
suffer sleep disorders and lose control of his legs and even speech. The
doctors said it was "stress," that he had "anxiety," and prescribed one
psychotropic after another for months. Perhaps knowing earlier what he
was suffering from would not have changed the outcome, but at least he
would have had a better quality of life in his last months. I will never
forgive the health care system — the political system, a source of many
evils — for my father's terrible agony.

For me, personally, on January 28 they diagnosed me at Calixto Garcia
hospital with a kidney infection I never had. They did no analysis of
any kind and prescribed me oral antibiotics. I, who was vomiting, almost
dehydrated. Of course, it was my fault for coming to a consultation
without "sponsors," knowing as I do what the system is.

Dr. Alemán should convince Yoani Sanchez of the ethics of the doctor who
attended her after she experienced the beating given to her in a closed
car by various minions of the political police. I saw the bruises from
the blows and helped my friend through her painful convalescence. The
doctor, who initially recognized the marks of the blows and the bruises
on Yoani's body, soon retracted under pressure from the agents of the
repressive forces. A monument to Cuban medical ethics, I think.

If I were to list here all the personal anecdotes of my friends and
acquaintances in their experiences as Cuban patients, I couldn't do it
in a single blog nor in my entire lifetime. So I cannot accept that a
doctor feels particularly offended by the criticisms leveled against the
Cuban public health system and some doctors. It's very bold of her to
speak on behalf of all doctors when she says that patients are given
"quality medical care, which all the Cuban doctors still offer." Not
true. I know that there are still doctors who provide excellent
treatment to their patients with a professional zeal that is
increasingly deficient in half of them, but far from "all." Recently I
heard of a doctor of Centro Habana who does not even take the blood
pressure of pregnant women in his consultation "because he has to attend
to many" and ultimately they even stopped paying him the 25 CUC a month
that he received for having completed an international "mission." If
that is ethical I prefer to "die in my own bed" before going to a doc
like that.

For the rest, I suggest to Dr. Alemán that she properly focus her anger.
The best would be that she complain to her superiors about the bad
working conditions, the low salary, and the dreadful food offered her
during her workday. That she protest and focus her outrage upward, not
downward. The patients shouldn't have to resolve her problems, much less
suffer the consequences. In any case, all doctors who ever decided to
study for such a humane career and to take their Hippocratic oath, know
what the Cuban conditions are. It doesn't seem to disgust many of them
to go and sacrifice themselves in Haiti or in the most remote village of
some obscure country, amid the filth and disease at the risk of losing
their own health, to be able to acquire household appliances, other
trashy little things and a little more money. With all due respect, I am
not convinced that they do if from a stroke of pure altruism. When a
doctor is mobilized to some remote destination outside of Cuba, he
doesn't say, "No, I mustn't abandon the patients of my clinic." But if
they send him to some lost village in Las Tunas or the Sierra Maestra,
he howls to the heavens. And it's that in Cuba spiritual values have
deteriorated almost irreparably, faced with the material miseries of life.

No, we Cubans really don't have much reason to feel the pride the doctor
asks of us. Much less the appreciation. Instead, we feel helpless,
abused and often humiliated. We feel powerless because we have no choice
other than to seek the services of doctors of dubious quality. To go to
a clinic at random in Cuba has now become a kind of Russian roulette:
only if you're lucky do you save yourself. I don't play.

February 13 2012

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