The Miami Herald
Jan. 10, 2008

Author disputes Cuban healthcare 'myths'


Before Katherine Hirschfeld went to Cuba for post-graduate studies, she read dozens of academic research papers on the country's healthcare system. All were glowing reports about how the Castro government offered good care for everyone, and that's what she expected to find.

Then she went to Santiago de Cuba for an extended stay and saw the system for herself, including three days in a hospital when she came down with dengue fever. The result is a highly critical book -- Health, Politics and Revolution in Cuba since 1898 -- which she will discuss Thursday night at the University of Miami.

Her stays were mostly in Santiago, from 1996 through 1998, when she was a graduate student at Emory University and Cuba was in the midst of a dengue fever epidemic that the government tried to hush up.

When she experienced the symptoms -- aching joints, fever, nausea, sore throat -- she was taken to a Santiago hospital and placed in a large ward guarded by a man with a gun. She asked to make a phone call to tell people where she was. The guard said there were no working phones.

' `Oh my God,' I thought to myself. 'This place doesn't exist,' '' at least not officially, because the epidemic was a state secret.


During her stay, she says she never saw a doctor. She was given one pill -- a vitamin. Fortunately, she had a mild case. Because there were few nurses, she and other patients who were able did what they could for the sickest, especially those who were bleeding or vomiting.

Now an assistant professor of anthropology at the University of Oklahoma, Hirschfeld says living with a family in Santiago while doing her research made a big difference in her viewpoint.

''Most academic work about Cuba is based on little or no field research,'' Hirschfeld said. U.S. academics often rely on official government studies or do short stays on the island, spending perhaps two weeks, sleeping in government-approved facilities.

She found women in Santiago gravitated to the kitchen, where she learned that even preparing a meal was revealing about the economy. ''Lunch is sometimes a counter-revolutionary event,'' because of how the family had to scramble outside the rationing system to find enough to eat.

Hirschfeld found even more basic public health problems, such as a lack of running water in the city. Residents compensated by catching rain water in barrels -- breeding grounds for mosquitoes, which transmit the dengue virus.

Cubans who needed treatment often used social networks or bartered favors to have doctors see them outside the official clinic settings. If people had to go to the hospital, they tried to prepare in advance, getting surgical thread and bandages on their own, even obtaining drugs from the United States if they could.

Hirschfeld says her research showed that healthcare in pre-Castro Cuba was of mixed quality. Many people in the cities received inexpensive, regular care through memberships in clinics, but those in rural areas and those of African heritage were less likely to get care. A clean water supply was problematic because corrupt officials often stole the money rather than using it to maintain and improve the system.

When she finished her doctorate dissertation about the problems in Cuba's healthcare, she says it was not initially well received by her review committee, which pointed out that most other academic researchers disagreed with her. She believes her unusual views delayed her getting her doctorate by at least a year.


Since Hirschfeld did her research, most experts say Cuban healthcare has gotten worse, primarily because 36,000 doctors and other healthcare professionals are now working overseas, many of them in Venezuela, according to official figures.

A dissident doctor in Havana, Darsi Ferrer, told The Miami Herald last year that because of the shortage, ``One doctor now has to take care of four or five offices.''

The situation has become so bad that last month the vice minister of public health, Joaquín García Salaberría, took the highly unusual step of admitting on Cuban television that there were shortages of doctors and nurses. 'It's not guaranteed that doctors and nurses will remain in the doctors' offices, as had been promised,'' García said.