Discussion on health care, centered now within the Obama administration, has centered on costs and lack of access. The plea here is that unmet need share the stage with funding considerations – or better, take over.

“Access to comprehensive health care is a human right,” declared a physicians’ health care reform group in 2003. Dedication to that proposition complicates the matter of compromise. Yet compromise is surely involved when decision making depends on balance sheets. Where judgments on feasibility rule, there implementation of the human right to health care likely will suffer. .

While Cuba’s experience is hardly transferable to U.S. society, health care achievements across the Florida Straits demonstrate what happens where the right to health care is paramount.

Cuba’s infant mortality last year fell to a new low. Out of every 1000 live births, only 4.7 babies died during their first year, a rate down from 60 in the 1950’s, 10.7 in 1991, 6.5 in 1999, and 5.3 in 2007. Decline during the nineties coincided with severe economic hardships. The United States registered 6.3 in 2008 (estimated), other industrialized nations, around five. Every year the death rate for African American babies is more than twice that of U.S. infants generally.

Social support, adequate food, high educational levels, supportive families, prioritized prevention, and ready access to health care contribute to this result. Special networks of nutritional and medical care are available for pregnant women.

Changes over time are revealing. In 1962 only 3000 physicians remained in Cuba. By 2007, there were 72,417. Medical schools expanded from one to 22. The physician per population ratio there is 1/155 – 1/330 for Western Europe, 1/417 in the United States. Nearly 30,000 practitioners of “comprehensive general medicine” team with a nurse to provide preventative and curative care in neighborhoods for 99 percent of the population. Cuba’s GDP dropped 34 percent after 1991, but over seven years the health care portion of the national budget rose from 7.4 to 13.1 percent. Recent economic upswing has brought construction and refurbishing of clinics, hospitals, and medical equipment.

Another astounding venture, decades in the making, has come to fruition. Steve Brouwer recently reported on Cuba’s worldwide export of health care and medical education (Monthly Review, January, 2009). As of November, 2008, 38,544 Cuban health workers, 17,697 of them physicians, were caring for patients or teaching in 75 countries. Over 7000 physicians and 3000 dentists from Cuba, plus hundreds of specialists, work in Venezuela, and 1500 physicians, in Bolivia.

Disaster relief teams of hundreds, even thousands, of Cuban doctors have gone to Pakistan, Bolivia, Guatemala, and Indonesia.
In Venezuela, the work of Cuban doctors led to one primary care doctor there serving 3,400 people, down from 17,300 people. The infant mortality rate fell from 21.4 to 13.9.

Presently 24,000 foreign students are studying medicine free in Cuba. Since 2005, The Latin American School of Medicine has graduated 1500 – 1800 students annually. Students in that six year program have come from 40 Latin American, Caribbean, and African nations.

Cuban and Venezuelan specialists pioneered in developing a curriculum in “comprehensive community medicine” aimed at students learning medicine in their own communities and staying there to practice. Some 12,000 Cubans now attend “medical school without walls” plus 17,000 others enrolled in traditional medical schools. In Venezuela, over 20,000 young people have completed two to three years of this six year innovative course of medical study. Cuban doctors do most of the teaching.

According to Steve Brouwer, students interact with patients from the start, hear lectures daily, utilize innovative audio-visual modalities, and rely on resourceful, world-experienced physicians serving as tutors. (See www.venezuelanotes.blogspot.com).

Brouwer visited some of the 42 medical students living in and around Sanare (pop. 39,000) in northeastern Venezuelan. Nearby Monte Carmelo (pop. 800) was home to eight young people studying locally and one in Cuba.

Cuba and Venezuela’s total medical school enrollment approximates the 65,000 total of students attending U.S. schools. They, on graduation, will be looking for work lucrative enough to pay off individual medical school debts averaging almost $200,000. By contrast, their Cuban and Venezuelan counterparts will work where they are needed – at home, in poor neighborhoods.

Greeting the Cuban people on May 1, 2000, former President Fidel Castro had set the stage: “Revolution means…being treated and treating others like a human being,”

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