The suffocation of doctors in Cuba: “I don’t sleep thinking about whether the patients survived”

“I don’t sleep thinking about whether the patients survived,” confesses P., a general surgeon from Pinar del Río, in western Cuba. The doctor, with whom this newspaper spoke via WhatsApp, prefers to remain anonymous. The lack of medical staff, medicines, and basic resources necessary to practice his profession, worsened by the shortage of supplies the island suffers and the U.S. sanctions, leads him to ask himself: “Why am I still here?”. The tension he experiences at work has caused him alopecia, weight loss, and episodes of depression.

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Nowadays, a Cuban hospital resembles a war zone. “I have seen patients die because there was no blood for a transfusion,” recalls P., who accumulates new stories every day, such as leaving a patient’s abdomen practically open due to lack of thread to suture, delaying the operation of a young person with HIV because there were no gloves, or paying out of his own pocket for a patient’s transport because there were no ambulances. “We work like hell and have to invent ways to save lives,” summarizes the surgeon.

Managing health in a country with shortages of electricity, water, transport, and food is extremely complex. Each link affects the other. For this reason, P. believes that even in cases where he manages to operate, it is not guaranteed that the surgery will succeed: “I can perform the best operation in the world, but if the patient is not well nourished, for example, the wound will not heal.”

According to the doctor, some of the measures imposed by the Government to alleviate the health crisis “make no sense.” One of them is the response to the shortage of medicines. Although state pharmacies are out of stock, it is possible to obtain practically any medicine on the black market. However, the State prohibits doctors from using treatments that come from outside the system. Therefore, neither public institutions supply the medication nor is the patient allowed to buy the treatment outside of these. This rule puts professionals in a dilemma, as complying or not can determine life.

The precariousness in public hospitals and health centers differs from those paid for and controlled by the State. On the website of the Central Clinic Cira García, for example, they offer a pediatric medical check-up for 621 dollars or a comprehensive exam for 860. Belraysa, a health tourism agency, offers evaluation and rehabilitation for Parkinson’s for 4,500 dollars or cardiovascular surgery for a price between 22,000 and 32,000 dollars.

The current situation contrasts with the international prestige that Cuban healthcare once achieved: it had nine doctors per thousand inhabitants — more than double the average of the European Union —, 27 medical schools, and a state biomedical research complex capable of developing vaccines, drugs, and treatments against diseases such as diabetes or lung cancer. Cuba also became an important exporter of health professionals with the well-known “internationalist missions.”

Since the beginning of Castroism, the State promoted sending health professionals to other countries, including Venezuela, in exchange for goods such as oil. Thanks to these collaborations abroad, practicing as a doctor was one of the few professions that allowed some economic comfort. Although the amount the professional received was much lower than the economic value of the service the Cuban Government obtained in the agreement, these trips were still an opportunity for improvement.

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But U.S. diplomatic pressure on those countries that maintained agreements with the island, such as Guatemala or Honduras, has brought the professionals back home. However, in recent years Cuba has experienced the largest exodus of doctors in its history, with at least 30% of the total estimated to have emigrated.

Although the health crisis worsened following the collapse caused by COVID-19 and, later, due to U.S. intervention in Venezuela, the country was already experiencing healthcare deterioration since the dissolution of the USSR, its historic ally, in 1991.

The current decline is multifactorial. On one hand, there is the U.S. embargo that prohibits, among other things, selling to the island some technologies produced only by U.S. companies. On the other, internal responsibilities regarding a continued investment deficit and progressive abandonment of infrastructure. P. believes that despite the massive doctor exodus, the Government neither supports nor encourages professionals “with a simple trip to Varadero — a city of tourist complexes —”, something it did in previous periods.

P. earns about thirteen euros a month as a surgeon: seven euros more than the country’s minimum wage and equivalent to the price of a pair of pants. “I was the best student in my class, specialized, earned a master’s degree, and yet, it is my parents who support me.” To survive, like many other doctors and professionals, he has a second job as a messenger in a mipyme — micro, small, or medium-sized private or mixed company legalized in the country in 2021. Compensation in these companies is usually much higher compared to public workers’ salaries. For instance, the cleaning staff hired by a mipyme at P.’s hospital earns three times what he does as a surgeon.

Working as a doctor in Cuba today involves physical and psychological wear that is not compensated. Although P. has requested permission to leave the country, it is extremely complicated for specialized doctors to emigrate legally, and applications can be denied without justification. “I feel imprisoned,” he confesses.

The island’s present imposes itself over a nostalgic echo of what the “revolution” had been. “Cubans are exhausted, we only care about living. And, as that song by Ricardo Arjona says, ‘I’m no longer useful as an enemy and I gave up a long time ago’,” concludes P. 

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