The world mourns the passing away of Fidel Castro. The world has lost one of the most illustrious leaders of our time. As much as the name Fidel Castro is synonymous with Cuba, Cuba is synonymous with good public health. Fidel was a great ruler and a great leader to the Cuban people. Equally, he was a leader par excellence to the world of public health.
As Dr. Dayan Jayathilake said in his weekend article to “The Island”, Fidel was the last of the epic heroes of our time that include Mao Tse-tung, Ho Chi Min, Josip Tito and Che Guevara. And the commonalities among them were great leaders, revolutionaries, and most of all, were visionaries who combined their ideal with action and changed the world they inherited.
The life and times of Fidel Castro
Fidel Castro Ruz was born on 13 August 1926 into a wealthy family in Birán, Oriente, in the eastern part of Cuba. He was a lawyer by profession. On 26 August 1953 he led an armed struggle against the country’s military dictator Fulgencio Batista, and was captured in a failed attack on Moncada Barracks in Santiago de Cuba. This attack famously signifies the beginning of Cuban revolution. After a trial he was sentenced to 15 years’ jail. During his inmate days, Fidel was a voracious reader, and read as much as 16 hours a day. In the face of mounting protest against his imprisonment Fidel was freed in May 1955.
He fled to Mexico, where he regrouped his fellow compatriots including his own brother Raul (the present president of Cuba) and his good buddy Argentine Ernesto Che Guevara. On 2 December 1956, they sailed from Mexico on board the famous yacht “Granma”, invaded Cuba for the second time. This attack too was a failure, led to death or capture of most of the invaders. But Fidel and survivors went hiding in Sierra Maestra mountains, from where they launched a guerrilla war against the Batista regimen.
On 1 January 1959, exactly five years five months and five days after the Moncada attack, Batista regimen fell in the face of advancing rebel forces, and Batista fled to the Dominican Republic. Fidel became the Prime Minister of Cuba on 13 February 1959. He adopted a centrally planned economy with “pro-poor” policies. He introduced sweeping land reforms making peasants the owners of land. He nationalized businesses, which were mainly American owned. This brought in stiff opposition to the new government from the US. Soon Fidel espoused a “pro-Soviet” line. The growing antagonism against Cuba by the US government reached its zenith when the US trained mercenaries invaded Cuba in an infamous unsuccessful “Bay of pigs” attack on 17 April 1961.
Consequent to waned relations between the two countries, US in February 1962 imposed a full economic embargo against Cuba (topping up the partial embargo that was in effect since October 1960). This embargo, commonly known as the “blockade”, is in existence to this day (despite president Obama’s call to end it during his visit to Havana in March this year, which has just limited to words).
In October 1965, Fidel founded the Cuban Communist Party. To this day Cuba has a one-party system with a parliament (National Assembly of People’s Power) comprising 612 members, representing municipalities, trade unions and students.
An internationalist in every sense, Fidel during his heydays, militarily supported democratically elected regimens and leftist guerilla armies in various parts of the world, who were fighting oppressive forces. Among these a long drawn battle in Angola, Namibia (South African border war during apartheid time), Congo, Bolivia (where Che Guevara died fighting), Ethiopia, Nicaragua and El Salvador stand out.
Fidel was also a frontline leader of the Non Aligned Movement (NAM) since its inception, Cuba being the first Latin American country to join the Movement. Havana hosted the NAM summit twice in 1979 and 2006, the only country to do so.
The collapse of the Soviet Union in 1991 plunged Cuba into a grave economic crisis. Double burdened by the economic embargo, Fidel and the Cuban leadership faced a tough time in the immediate aftermath years. But through prudent economic management coupled with some austerity measures (sparing children) and “reforms” Cuba came out of the calamity in double quick time. In this regard, Cuba relied heavily on its educated and skilled professionals and advancement it has gained in technology, especially in the field of bio technology.
Later speaking to director Bill Fletcher, in the documentary “Fidel Castro: the Untold Story”, Fidel admitted the government experimented certain reforms during the “special period”. But the bottom line was that it didn’t compromise any of its social development programmes. Cuba went into limited partnerships with Canada and some European countries to develop its infrastructure (in tourism industry) and research capacity, especially in the field of biotechnology. Capital, market and technology were the areas Cuba went into partnership with its Western allies.
Fidel is also famous for his long speeches. In June 2005, I together with Jayathilake de Silva and Subramaniam Nagendra travelled to Havana to attend the International Conference against Terrorism, for Truth and Justice, where Fidel spoke for three long days. (Among the speakers at the conference were Daniel Ortega the incumbent president of Nicaragua, and Schafik Jorge Handal, the famous Salvadoran guerilla leader).
Few days before his 80th birthday, on 31 July 2006, Fidel with signs of failing health, handed over the leadership of Cuba to his brother Raul. Since then he has been a prolific writer, writing articles under the theme “Reflections by Fidel”.
In 2006, the year Fidel resigned from leadership, Cuba was the world’s only nation that met the United Nations Development Programme’s definition of sustainable development, with an ecological footprint of less than 1.8 hectares per capita and a Human Development Index of over 0.8
Fidel Castro died on 25 November in Havana, at the age of 90.
Cuban legacy of Public Health
Fidel always set great store by developing a sound healthcare system in Cuba. By the end of the Cuban revolution (in 1959) healthcare was limited only to the rich and was almost nonexistent to the poor in the rural areas of the country. Fidel believed funding for health as a human right as well as an investment, a worthy investment towards having a healthy workforce and student population. Today, Cuban government spends 11.1% of its GDP on health (on comparison, meager 1.3% by the Sri Lankan government).
A sound primary healthcare structure where efficient family physician – public health nurse combination together with a comprehensive paramedical team remains the cornerstone of Cuba’s public health system. In the formative years valuable theoretical inputs were provided by Che, the Minister of Industries, who was also a doctor himself. Health teams were sent to the hitherto underserved rural areas of the country, where sugarcane and tobacco plantations were in abundance. Immunization campaigns were started against the childhood killer diseases like polio and measles with resounding results. A healthier populace ensued, who contributed immensely to Cuba’s growing economy, which soon became one of the world’s foremost sugar producers.
Soon, the impact of the widespread public health programme established in the post-revolution Cuba had telltale effects on the country’s health indicators. Country’s Infant Mortality Rate almost halved from 37.3 (per 1,000 live births) in 1960 to 19.6 in 1980. In 2010 it stood at 4.5; (the average for the European Union that year was 4.2). The under five mortality, another robust indicator of a country’s health status, dropped from 43.7 in 1970 to 24.2 in 1980, and further to 6.0 in 2010. The life expectancy grew from 70 in 1970, to 73.5 in 1980, and further to 78 in 2010. Amazingly, its doctor to population ratio from 1: 1,400 in 1970, rose to 1: 640 in 1980, and in 2010 stood at 1: 170 (or 590 doctors per 100,000 population), the country with the highest doctor population ratio in the world. (You may notice most of these figures are unavailable for 1960, the year following the fall of Batista rule. Only since then the health system was structured and record systematic keeping commenced in Cuba).
By 1990s Cuba has eliminated polio and measles from its shores. It also has the most effective dengue control programme and the lowest HIV/ AIDS rate in the Americas. In the recent years, it has the highest rates of treatment and control of hypertension in the world, and has reduced cardiovascular mortality rate by 45%. There is many a leaf from the Cuban public health book the world could adopt in effective NCD control, and for that, the World Health “pundits” should be ready to do that.
As in defence, health is another field Cuba excelled in “internationalism”. This holds water for both training and service delivery in healthcare. Medical internationalism is part of Cuba’s foreign policy as well.
The world’s largest medical school, Latin American School of Medicine (ELAM), established in Havana in 1998, is a classic case in point. Medical education at ELAM is absolutely free, from tuition, to books, to lodging, to food. At present, around 20,000 students from over 100 countries around the world (including the US) study medicine and allied sciences at ELAM. (Even before the establishment of ELAM, the Havana Medical School provided free medical education for students from around the world for decades).
Medical diplomacy – Cuba’s most important export commodity
Deploying Cuban healthcare workers in friendly countries that were in need began in the early 1960s when Cuba dispatched small medical brigades to Algeria, at the time of that country’s civil war. This trend later continued in Guinea-Bissau and Angola. In some of these countries, later, Cuban doctors outnumbered the local doctors and Cubans organized the healthcare systems.
At present there are around 50,000 Cuban professionals working in over 100 countries around the world, as part of various bi-lateral arrangements of their government. Of them, 30,000 are health professionals, and 25,000 are doctors. It is said that Cuba alone provides more healthcare workers to the developing world than all G8 countries put together. (In Sri Lanka too Cuban doctors were manning health services in number of rural and war stricken areas till the turn of the century. This writer too had the opportunity to work with a team of Cuban doctors in Polonnaruwa Base Hospital, in the mid 90s).
Among the other things, disaster management became an avant-garde of Cuban Medical Internationalism. Cuban medical missions were swift to move into the disaster hit regions of the world, where they promptly initiated rescue and healthcare programmes. This is happening since 1960s, and happened in Chile, Nicaragua, Iran and Pakistan following devastating earthquakes, in Venezuela following a disastrous mudslide, in Honduras, Guatemala and Haiti subsequent to hurricanes, and in Sri Lanka and Indonesia aftermath the 2004 Boxing Day tsunami. Our memories are still fresh about the Cuban presence in Koggala following the tsunami, where their medical team spent an extended period providing healthcare to the villagers under very trying conditions. (In August 2005, following Hurricane Katrina that devastated New Orleans, Cuba was prepared to send a team of 1,500 doctors in a humanitarian mission to the US, but the offer was turned down by the Bush administration).
Cuba’s Medical Aid to Venezuela
In the early 2000s, in a novel programme called “oil for doctors”, Cuba provided Venezuela with 31,000 doctors, dentists and paramedical staff to provide healthcare and train 40,000 Venezuelan medical personnel. In exchange, Venezuela provided Cuba with 100,000 barrels of oil per day.
In July 2008 Fidel and his then Venezuelan counterpart the late Hugo Chávez launched another out-of-the-box programme named, Operation Miracle to expand health care services in Venezuela. Restoring the vision of millions of low-income patients was the initial purpose of the mission. This initiative later extended to other parts of the Latin America, Caribbean and Africa (and rest of the world) as well. These programmes are still underway.
Humanitarian assistance to HIV hit Africa
In another similar initiative Cuba sent medical assistance by way of doctors, nurses and pharmaceuticals to a number of HIV/AIDS worst hit sub-Saharan African nations. Started in the early 2000s this programme is still continuing. Cuba, the first country in the world to eliminate mother to child transmission of HIV has state-of-the-art expertise in handling HIV, both in hospitals and community. Once in Africa, Cuban doctors’ role was not limited to the provision of HIV care. They also helped establishing health infrastructure and programmes in those countries. Now that some parts of the sub-Saharan Africa have checked the mother to child transmission of HIV effectively, the worth of Cuban intervention stands out obviously.
Later, Cuban medical assistance was also extended to curtail the spreading Ebola epidemic in West Africa with resounding success.
Above all, the most striking thing about the development of the post revolution Cuba is the fact that it took place in the midst of a damning embargo imposed by the US, almost throughout its entirety. The embargo prohibits any form of trade with Cuba, travel, employment and whatnot. Unacceptability of this embargo in today’s economic and political terms goes without saying as the vote against it in the UN has always been won resoundingly by Cuba. In 2015, 191 countries voted against the embargo, while only two (US and Israel) voted in favour. Yet, the embargo continues !
When all what is said here and more speaks for itself about the role Fidel and Cuba played towards the upliftment of downtrodden masses of Cuba and the rest of the world, some elements in Miami and their lackeys in the Western media continue beating and insulting Fidel, even after his death. The answer for that lies in the famous quote by none other than the former US president Franklin D. Roosevelt, which goes as “judge someone by the enemies he has made.”
While Cubans mourn the death of their beloved leader Fidel, there are many reasons for the world to celebrate his life.
Viva Fidel! Viva Cuba! Viva la Revoluсion !
Step 1: Define the patient’s problem
Step 2: Specify the therapeutic objective – What do you want to achieve with the treatment?
Step 3: Verify the suitability of your Personal-treatment – Check effectiveness and safety
Step 4: Start the treatment
Step 5: Give information, instructions and warnings
Step 6: Monitor treatment
(Adopted from Guide to Good Prescribing – A practical manual, World Health Organization, Action Programme on Essential Drugs, Geneva)
Dr.Anidu Pathirana, Consultant Cardiologist, National Hospital of Sri Lanka, joining the discussion prompted by the article “Learning Medicine from Maneka Gandhi” (published in “Health & Society, “The Island” of 18.11.2016.) pondered on some facts for consideration when selecting a Drug.
Firstly, the drug should improve the quality of life. It should address the immediate needs of the patient. If he is in pain, then the drug should relive it. If he has fever, it should relieve it.
Secondly, it should have a proven effect against the diseases progression. Or in other words, it should be proven to halt or alter the course of the disease.
Thirdly, the benefit of the drug should overweigh the risks of side effects, if there are any. Or in other words, it is worthless trying to cure a patient at the expense of making him a cripple.
Fourthly, especially when selecting drugs for the young people, special consideration should be made regards to fertility. We should make sure that the drug won’t have any long term effects on fertility. We should not make the patient sub-fertile or his/ her offsprings have birth defects as a result of the drug.