November 2015        

Letter from Havana

Seán Joseph Clancy

As I write here on the 27th of October an overwhelming majority of 193 member-states of the United Nations, at their General Assembly in New York, for the twenty-fourth consecutive year categorically called for the lifting of the 55-year-old illegal US blockade of Cuba.
      In the vote of 191 to 2 in support of the Cuban proposal, only the United States and Israel opposed the motion. There were no abstentions this year, revealing not only the insidious, bloody and vile nature of the diabolical US-Israel alliance generally but also the growing rejection of their joint and individual political and military aggressions and the rapidly diminishing capacity of the United States to forcibly dictate foreign policy or to intimidate even the most economically vulnerable, most dependent and smallest countries.
      The vote is another diplomatic, political and moral victory for Cuba and another well-deserved bloody nose for the United States.
      The irony of their nonsensical and sad rhetoric, chanted morbidly as an apologetic explanation of the twisted logic of their position, did not seem lost on even the weary diplomat charged with delivering it to the assembly. In what was always a doomed idea, the United States had even suggested a willingness to abstain on condition that it would dictate the wording of the Cuban delegation’s motion.
      The American vote is wholly inconsistent with—and makes a mockery of—the stated position of President Obama and his “new” Cuba policy. It points to his personal and political dishonesty, a profound ethical deficit and a cowardly unwillingness to confront a Republican-controlled legislature, in part perhaps at the behest of his former secretary of state, Hilary Clinton, anxious to tread as smooth a path as possible to next year’s presidential election.
      The myth that Obama is essentially a good president paralysed by the limitations of executive power and a hostile Congress is exposed as much by the vote today as by his increased extra-judicial drone executions and higher Pentagon spending than that of his predecessor, George W. Bush.
      The Cuban public health system, recognised internationally as exceptional and frequently cited by high-ranking WHO officials as an exemplary model of a health service, is one of the areas most adversely affected by the blockade. Access to modern drug treatments, equipment and technology, or the raw materials necessary for manufacturing generic alternatives, is prohibited, resulting in unnecessary suffering and deaths, often for reasons linked more to the protection of exorbitant profits than to any real ideological conflict. Innocent infants suffer the consequences.
      The health system here suffers from the same lack of infrastructural investment and other social malaise that affect every area of Cuban life, but it remains free, universally accessible, and remarkably comprehensive and holistic. “Green” medicine, considered “alternative” elsewhere, is an integral and complementary component of many standard treatments.
      There is a doctor here for every 170 citizens and a family clinic in every rural and urban district, where each speciality—urologist, paediatrician, psychiatrist, cardiologist, etc.—is routinely in attendance to ensure that universal access is no mere catchphrase.
      Where I live, in Trinidad, a town of about 50,000 inhabitants, you could not walk five minutes from any starting-point or in any direction without encountering at least one such clinic. Doctors know their patients.
      There are also two polyclinics—health centres that provide extensive emergency and outpatient services—and a hospital in town. There are dental clinics, old people’s day-care centres and homes, a children’s hospital, a specialist inpatient unit providing pre-natal care to expectant mothers, a special school, and, among many other facilities, inpatient and outpatient psychiatric services. There is no such thing as a waiting-list.
     If a therapeutic intervention or a particular pharmaceutical treatment is not available, the root cause is most probably related to the blockade—possibly because it cannot be imported directly or because some element of the supply chain (such as spare parts for transport, factory equipment, infrastructure, or raw material) is affected.
      The availability of medicines can also sometimes—although less so recently—be interrupted by acts of petty corruption. Medicines out of stock in the local pharmacy can sometimes be found at inflated prices on the street.
      One of the things I began to notice quite soon after I came to live here was the far superior medical, interpersonal and treatment experience within a health system uncorrupted by the culture of litigation, private health and medical malpractice insurance or by drug companies and other commercial interests, one in which professionals—specialist and general—are not exclusively from an elite social class or consider themselves to be eligible now to join that class on the strength of their qualification.
      It is a system that also ensures that truly equal access to all levels of education—from creche to postgraduate and beyond—and career opportunity is an essential element in this regard.
      The general experience of patients and the integrity of the doctor-patient relationship is more respectful, equal, dignified and honest as a result.
      Ten of the eleven most recent cancer treatments available in the world cost more than $90,000 per patient and, because of patents now protected internationally by abominable free-trade pacts, cannot be reproduced for between seven and eleven years. Access is an option for the rich and the very well insured. National governments can be sued for corporate losses and fined multi-million sums should they consider providing, or allowing any other entity within their borders to provide, affordable life-saving generic alternatives.
      The equally effective—or in some cases even more effective—generic or parallel equivalents available in Cuba, despite prohibitions derived from the blockade, are all provided free of charge or at a nominal or symbolic charge. Access is thus an option for all.
      This is true of all treatments—including, for example, costly retroviral HIV/AIDS drugs—and for all diseases and conditions. More than eight hundred drugs are available through the pharmacy system.
      Health care is a guaranteed right here, not a favour bestowed by the state or a consumer product dispensed with a McDonald’s mentality, according to the patient’s ability to pay. Drug election and prescription is on the grounds of need and best practice and not subject to sales-rep incentivised whims.
      As a result, life expectancy for both men and women is now above seventy-seven years, and the infant mortality rate is lower than that of our neighbour to the north.
      Perhaps even more scandalous and inhumane, and indicative of the true nature of the 1 per cent American ruling class, than the effects on the young, elderly and infirm of their blockade here in Cuba is the sad fact that so many effective and affordable Cuban treatments and medicines that could relieve suffering and prevent deaths are denied to deserving and needy American citizens by the obsolete and cruel policies of their own government.
      One obvious example is the highly successful therapeutic treatment developed and manufactured here for the treatment of diabetic foot ulcers. Around the globe, tens of thousands of amputations have been prevented as a direct result of its administration, while only 90 miles across the Florida Strait it might as well not exist.
      Imagine the accumulated suffering and hardship in this instance alone as a result of such politics.
      There are tens of thousands of Cuban medical professionals serving in more than sixty countries around the world. Their solidarity, ability, courage and stoicism in the face of recent Ebola and cholera epidemics and natural disasters have been extensively lauded.
      The ideological values on which the Cuban public health system is established, and their very tangible expression in services provided under complex and challenging conditions, represents—in addition to being one of the very real conquests of the Revolution—absolute proof that anything less than global, free, universally accessible and comprehensive health and education systems constitute organised blue-collar (or blue-scrub) crimes against humanity, warranting prosecution and sanction by all right-minded men and women of conscience.

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