Friday, August 23, 2013

Illegal Dental Work on the Rise in Cuba

Illegal Dental Work on the Rise in Cuba
August 22, 2013
Daniel Palacios Almarales* (Café Fuerte)

HAVANA TIMES — Today, Cuba's dentistry field is characterized by
generalized corruption, poor services and the migration of specialists
and technicians towards the private sector.

Though this is by no means unique to dentistry, the fact of the matter
is that having your teeth worked on has gone from being a free to a paid
service. In Havana, the cost of a dental procedure can be anywhere from
10 to 150 CUC (1 USD is equivalent to 0.87 CUC, and the average monthly
salary in the country is 18 CUC), depending on the complexity of this

Cuba's legislation stipulates that services offered at any dental clinic
are completely free of charge. In effect, primary care offered in the
more than 200 clinics of this kind around the country is free.

Securing an appointment, however, can be a long and painful process and,
no few times, people are forced to lose many days of work because of the
many problems that undermine the quality of this service.

"I've come to the clinic three times to get a filling, and it's always a
different story: they have no running water, the instruments haven't
been sterilized, the power is out or there isn't enough filling paste to
treat all of the patients," said Amarilis Soler, a single mother who
works as a cashier at the electrical company.

Soler explained the reasons why Cubans resort to private services, in
spite of the high prices.

"Sometimes you get lucky and you don't have to wait long to see the
dentist, because it so happens they've got all they need that day. But,
in most cases, they're out of one thing and you get an incomplete
service. That's why those who have the money go to private clinics,
because the procedure is much quicker there," she explained.

Illegal Clinics

Generally speaking, dentists with private clinics are specialists or
technicians from the field who continue to work for the State or quit
their day jobs in search of financial improvement. They have clinics
with basic conditions at home and no license to operate. In fact, no one
is authorized by the government to offer health services privately, as a
self-employed professional.

Another practice consists of offering dental appointments and diagnostic
procedures outside State clinics, in private residences, and conducting
the actual surgery in the government institution, using the equipment
and supplies there illegally.

"Our salaries aren't enough to live on and we're forced to make a living
anyway we can. That's why we set up our own dentistry businesses and, in
most cases, use the supplies from the State clinics, which are taken
from the workplace and used for private procedures," a source involved
in this business, who wished to remain anonymous, explained to us.

"Me," he added, "I have 'connections' [contacts] in warehouses and I get
all of my supplies before they're inventoried. Making a huge effort and
facing many problems to earn 20 dollars a month and making 10 dollars
for one dental cleaning in the comfort of your own home are very
different things indeed."

Our source added that some people continue to avoid going to private
clinics for more complex surgical procedures, but that this situation is
rapidly changing.

"We're seeing more and more people unwilling to go through the
disastrous experience of a State clinic and come to us every day," he said.

Waiting for Dentures

The preparation and production of dentures is one of the public services
facing the greatest number of problems in the field. Many a time,
material shortages lead to long waiting times. Most of the materials
used to make dentures are imported and are included under the health
services subsidized – and rationalized – by the State.

A lack of qualified personnel to make these dentures has also resulted
in the suspension of these services at different clinics for prolonged
periods of time. According to several people interviewed, the waiting
time for these dentures can be as long as two years – something which
forces many to resort to the quicker and far more efficient private

"A few years ago, a denture cost you 70 Cuban pesos or less, and you got
them in no time. Now, sometimes you have no other choice but to pay a
good buck at a private clinic, which, many a time, offer their services
in the very premises of the State clinic," said Roberto Mirelles, a
self-employed worker who claims to have paid 20 CUC for a lower jaw implant.

"I don't know where they get their materials from exactly. What I can
tell you is that they do high-quality implants and they do what you
actually need them to do," Mirelles added.

Despite efforts to contact the National Dentistry Office, under the
Ministry of Public Health, we were unable to get a statement on this
situation from any public official.

Patients from Abroad

Rosa Hinojosa, a Cuban residing in the United States, paid 150 CUC for
an upper jaw denture and a cleanup.

"This may be expensive for people living in Cuba. But I didn't have to
wait forever for an appointment and didn't have to pay 300 CUC at a
State clinic that offers services (to foreigners) in hard currency. I
got everything done at someone's home, where they had all of the
equipment, anesthesia and materials they needed. I'm pleased." Hinojosa

In the United States, a complete denture costs around 800 dollars.

The growing number of specialists and technicians who are leaving their
government jobs and gravitating towards the private sector, be it to
offer illegal dental services or become involved in other activities, is
a growing trend.

One such professional (who chose to remain anonymous) graduated as a
dental technician in 2009 and has been working at home since last year.
He alternates between being a "private dentist" and a licensed watch

"My relatives send me some of the supplies I need from the United
States. There are some that are expensive over there and I have to find
some way of getting those from State clinics," the dentist said.

He added that this is a fairly common practice.

Irregular Services

"Most do what I do, and when supplies are deviated to private clinics,
you get shortages in the State clinic. People therefore turn to the
private sector for their dental services. It's a vicious circle and the
only way to break out of it is to respect the work of dentistry
professionals and pay them a proper salary. Failing that, we will
continue to have two options: a free but inefficient service and an
illegal and costly but effective and prompt private service," the
dentist explained.

Similarly, dental technicians who work at State clinics and offer
private services illegally make use of the government workshops where
they work, using the materials and equipment from these clinics,
particularly to make dentures.

Long waiting times for appointments, the lack of sterilized instruments
or equipment needed for certain procedures and incidents such as loss of
power and water supply prevent most Cuban dentistry clinics from
offering the public a quality service.

Increasingly, patients must line-up outside State clinics in the early
hours of the morning in order to be seen by a dentist, for, as the day
progresses, it is not uncommon for supplies to run out and for services
to be suspended as a result of this.
* Former journalist for Cuba's Juventud Rebelde newspaper and author of
the blog "Visor Cubano"

Source: "Clandestine Dental Work on the Rise in Cuba" -

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