Pundits have been debating the merits (or not) of Fidel Castro鈥檚 legacy amid his funeral and . The country鈥檚 health service is often said to be one of El Comandante鈥檚 greatest achievements. But how great is the system really? As someone who trained as a doctor in Cuba, I can provide an insider鈥檚 view.
The Cuban health system, born out of its revolutionary socialist ideology, regards accessibility to healthcare as a fundamental right of its citizens. It focuses heavily on preventative medicine and on offering services ranging from the simplest check-up to the most complex surgery for free. Dental care, medicine and even home visits from doctors are all covered by the system.
The Caribbean island has the health statistics to support this seemingly impeccable system: an infant mortality rate of 4.2 per thousand births (compared with and 6.9 in the US), life expectancy of 77 years for men and 81 years for women (on a par with the UK鈥檚 ) and a doctor-to-patient ratio of one to 150, which surpasses many developed nations (the UK ratio is ).
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It is no surprise, therefore, that the secretary general of the UN, Ban Ki-moon, hailed Cuba鈥檚 health service as 鈥溾��.
But is all this just propaganda? No. I had the opportunity to spend seven years in Cuba as a medical student and saw the positives and the negatives of its health system.
Healthcare missions
As a US citizen, I was always impressed by how much Cubans accomplished with so little. The professionalism and humility healthcare workers displayed was commendable. These people, receiving paltry salaries (doctors earn about $64 a month), are often overworked because thousands of their colleagues have been sent to countries such as Venezuela and Brazil to participate in .
In addition, they do this despite lacking the latest diagnostic technology and having to wait weeks for basic equipment to arrive at hospitals for procedures that must sometimes be carried out without electricity or running water. Yet they still find the strength to overcome these obstacles and challenges to deliver a service worthy of praise.
Cuban doctors say that becoming a doctor is about the need to help others. This was one of the first things I was taught in medical school there. Although a noble sentiment, money is a big issue with the Cuban model. The government spends roughly $300-$400 per person each year on healthcare but gains about $8 billion 聽a year as a result of its overseas medical missions. It鈥檚 difficult to say where that money is invested.
Many doctors opt to participate in these missions as the salaries are a lot higher than they are for staying at home. Sending thousands of doctors overseas, although commendable, leaves the domestic system under pressure. With fewer doctors and specialists at home, queues at hospitals and clinics are longer, as are waiting times.
As a result, doctors have more work to cover in a stressful profession with limited resources. And a patient may end up travelling to another province to visit a specialist because the one stationed nearest to them has been sent to Venezuela. This may be why many more medical professionals are currently being trained across Cuba to help fill the void left by those sent around the globe.
US trade embargo
Health infrastructure also requires serious attention. Some clinics and hospitals are in dire need of repair and there is an urgent need for more modern medical equipment and stable electricity and water supplies. The blame for these problems, however, cannot be solely placed at the feet of the Cuban government as the US trade embargo has also had a detrimental effect. One example is medical equipment having to be sourced from as far away as China instead of the US. With all these difficulties, the country鈥檚 continued may be the key to its success.
Cuba continues to offer hundreds of scholarships each year to foreign students including those from the US like me. These are generally open to students from low-income families who may have been unable to attend medical school at home because of their socioeconomic background. The Latin American School of Medicine (Escuela Latinoamericana de Medicina) is one of the largest medical schools in the western hemisphere, with thousands of students from more than 100 different countries.
The Cuban health service has stood the test of time. It has created globally competitive and . It has afforded a foreigner like me the opportunity to study for a career free of charge, while many of my colleagues are thousands of dollars in debt after attending US medical schools.
It doesn鈥檛 turn people away from treatment because of their socioeconomic status. This ensures that open-heart surgery doesn鈥檛 result in lifelong indebtedness. It is a system that has been there for its people. Yes, it has flaws and challenges that need remedying, but it is not merely a propaganda tool for the powers that be.
This article was first published by 
