Note: This article is the introduction to the collection Episodes of the Revolutionary War. The collection is Che’s story – of how a small band within a few months was transformed into a Rebel Army. Originally published in 1968, the Revised Edition includes a new Foreword by Don Fitz, author of Cuban Health Care: The Ongoing Revolution. It appears in Green Social Thought courtesy International Publishers (intpubnyc.com). To order a copy of Episodes of the Revolutionary War, go to: https://www.intpubnyc.com/browse/episodes-of-the-revolutionary-war/ As Che remarked: “…I was more a medic than a soldier.” Fitz takes this observation as a starting point and highlights how the seeds of Cuba’s world renown health care system were planted in the mountains of the Sierra Maestra.
Having published Cuban Health Care: The Ongoing Revolution about a year before being asked to write this Introduction, it piqued my interest to explore how Che Guevara balanced the dual roles of physician and revolutionary during the guerrilla struggle in the Sierra Maestra. A critical aspect of this story actually began at least two decades before the 1959 revolution with conflicts inside Cuban medical associations. Many doctors were only interested in profiting off the system while others promoted a thorough change, including their own working conditions. Though demands for better working conditions permeated the period, a deep concern for the lack of adequate rural health care was central for the progressives.
At the same time, as they addressed needs on a national level, many physicians offered what care they could to the poor on a daily basis. Clearly, their ideas for better medicine were a fusion of broad programmatic changes with individual dedication.
Within five years of January 1, 1959, almost half of Cuba’s physicians had deserted their homeland for the comforts of Miami. The half who remained were left with the seemingly insurmountable task of simultaneously: (1) fulfilling the revolution’s promise to extend medical care to the poorest Cubans; (2) reconceptualizing the entire care delivery system; and (3) training new generations of care providers.
As Cuban physicians expanded health care to the furthest edges of the island, they reached a cliff that begged them to jump off. This led them to the millions in Africa and Latin America who had never seen a doctor. As they crafted a model of how to provide global medical care Cubans developed techniques and medications that were among the best in the world. They extended life expectancy and reduced infant mortality until they surpassed those in the colossus to the north. When Covid-19 hit, the US dawdled for months as Cuba mobilized its population for local and global medical action.
The path to these monumental changes would often be problematic. In fact, the beginnings of the journey to a new medicine were anything but pleasant.
In the Sierra Maestra
The revolutionaries who set sail on the vessel Granma on November 25, 1956, believed that they would change the world. Much of what they experienced on that voyage and in the Sierra Maestra (Sierra) foreshadowed encumbrances that Cuban doctors and troops would have during oncoming decades. In the late 1960s doctors accompanied military forces going to the Congo (former French Congo), Zaire (former Belgian Congo and future Democratic Republic of the Congo) and Guinea-Bissau. From 1975 to 1986 doctors would again join troops in the Angolan wars.
Once in the Sierra preparing for the first battle of Alegría de Pío, Che could not carry both a “knapsack full of medicine and a box of ammunition.” He defined his primary role as being a soldier by selecting the later. Other aspects of this battle served as omens of what would befall Cubans in Africa. After marching through swamps in new boots the men suffered blister, sores and fungus. Then, setting up a campsite that was visible from the sky, they were attacked by planes.
Other hardships that Che describes during battles from December 2, 1956, to December 31, 1958, provided Cuban commanders experiences they would encounter during future campaigns. Often they were fighting against an enemy with superior arms, having some comrades who “were using a weapon for the first time,” and traveling on such rugged terrain that a compass could not always point in the right direction.
As did Cuban doctors and troops in the Sierra and ensuing confrontations, Che anguished over the deaths of one comrade after another, especially his close friend Camilo Cienfuegos. The Sierra Maestra experience was not without little joys, as when Che received the “royal gift” of a hammock, which allowed him to end sleeping on the ground. And there were the big joys of winning battles, which culminated in taking Havana. The adversity that Che overcame in the revolutionary war prepared him for strategy meetings during late 1964 and early 1965 with leaders in Algeria, Ghana, the Congo, Guinea, Mali, Dahomey, Tanzania, and Egypt.
Revolutionary Compassion – Revolutionary Solidarity
In December 1951, Che embarked on a break from medical school to travel by motorcycle through South America. One of the things he sought was practical experience with leprosy. When at La Colonia de San Pablo in Peru he swam across the river to walk through the leper colony.
Che was not satisfied to study and sympathize with lepers – he wanted to be with them and understand their existence. The trip, which put him in contact with people who were poor and hungry at the same time they were sick, transformed Che. He envisioned a new medicine with doctors who would serve the greatest number people.
Fidel showed his compassion aboard the Granma. The last day of the trip, the entire crew was thrilled when they finally approached Cuban land. During a swell of the waters at about 1 a.m., a man holding the boat’s antenna fell into the Caribbean Sea. Despite getting afloat, he was soon far away. Hearing the cry “Man overboard!” Fidel ordered that the yacht stop and rescue him. It took about three-quarters of an hour of going in circles trying to find him. They finally did so only with the dim light of a flashlight.
Once in the Sierra, the feelings that the revolutionaries had for each other spread to the poor rural residents they encountered. Che peered deeply into the lack of health care. He observed that “most cases were quite similar, typical of life in the Sierra: toothless women, who had aged prematurely, children with tremendous swollen bellies, parasitism, rickets and avitaminosis due to lack of vitamins.” How would a doctor explain “to a young mother of several children who complained of fatigue that she suffered simply because she did not have enough to eat?”
Solidarity with peasants suffering in the Sierra went far beyond pity and became part of revolutionary strategy. Che noted that “The idea of an agrarian reform became crystal clear. Communion with the people ceases to be a mere theory, to become an integral part of ourselves. Guerrillas and peasants began to merge into a solid mass… the ideas became reality and we became a part of the peasantry.” Even though “Many of the Sierra peasants did not know how to read or write…” they became a critical part of guerrilla operations.
He recalled that “In spite of many difficulties, we always received aid from the people in the countryside. Always we found someone to be our guide or scout, or to provide us with the necessary food to go on.”
Compassion strongly affected their interaction with Batista’s forces: “Our attitude to the wounded was in sharp contrast to the enemy’s. They not only killed our wounded but they abandoned their own. This difference greatly impressed the enemy forces and it was instrumental in our victory.”
The New Cuban Medicine
When in the Sierra Maestra, Che understood that the absence of health care was not an isolated phenomenon. He “became firmly convinced of the need for a compete change in the life of our people.”
Once in power, the revolutionaries addressed every aspect of oppression, including the re-design of medicine. An understanding of the failings of disconnected social systems led the new government to build hospitals and clinics in under-served parts of the island at the same time it began addressing crises of poverty, food, sanitation, literacy, education, racism, and housing, which were all part of a unitary whole.
Among Cuba’s most notable efforts were its vaccination campaigns. In 1962, just three years after the revolution, 80% of all children under 15 were vaccinated against polio in 11 days. In 1970, it took one day for the same national effort.
Cuba eliminated polio in 1962, malaria in 1967, neonatal tetanus in 1972, diphtheria in 1979, congenital rubella syndrome in 1989, post-mumps meningitis in 1989, measles in 1993, rubella in 1995, and tuberculosis meningitis in 1997. The repeated success of vaccination efforts won trust in the government’s stated goals. When the Covid crisis hit in 2020, there was no “anti-vaxx” hysteria as plagued many other parts of the world.
In the late 1980s and early 1990s two disaster threatened the existence of the country. The first AIDS victim died in 1986 and Cuba quarantined soldiers returning from war in Angola who tested positive for HIV.
A perfect storm for AIDS infection loomed on the horizon. The HIV infection rate for the Caribbean region was second only to southern Africa. US “sanctions” reduced the availability of drugs (including those for HIV/AIDS), as it made existing pharmaceuticals outrageously expensive and disrupted the financial infrastructures used for drug purchases. Desperately needing funds, Cuba opened the floodgate of tourism, which predictably brought an increase in prostitution and made an increase in HIV infection very possible.
A hate campaign against Cuba claimed that the quarantine reflected prejudice against homosexuals. But the facts showed that (1) soldiers returning from Africa were overwhelmingly heterosexual (as were most African AIDS victims), (2) Cuba had quarantined dengue patients with no outcry, and (3) the US itself had a history of quarantining patients with tuberculosis, polio, and even AIDS.
In December 1991, the Soviet Union collapsed, ending its $5 billion annual subsidy, disrupting international commerce, and sending the Cuban economy into a free fall. From 1989 to 1993 it shrunk 40-45% and, making things much worse, the world price of its main product, sugar, fell throughout the decade. Nutritional deficiencies hit hardest on adult men, who lost an average of 20 pounds. The 1990s became known as the “Special Period.”
The US imagined this to be the time for a “final solution” to its Cuba problem. The 1992 Torricelli Bill prohibited foreign-based subsidiaries of US companies from trading with Cuba. Trade bans included medicines and food. The bill’s author, Robert Torricelli, bragged that it was designed to “wreak havoc on the island.”
The Helms-Burton Act sought to dissuade non-US companies from trading with Cuba. Bill Clinton signed it into law on March 12, 1996. These “sanctions” imposed on Cuba during the 1990s are also referred to as the “embargo” or “blockade.” George W. Bush escalated the embargo and threatened the country militarily and his Secretary of State Colin Powell planned for island’s forced transition to capitalist domination.
Those who screeched most noisily about Cuba’s “anti-homosexual” quarantines remained silent regarding sanctions, which seriously hindered the government’s efforts to bring antiretroviral (ART) drugs to HIV victims. To the surprise of the world, Cuba made changes which allowed it to overcome the intense hardship of sanctions and resolve the AIDS crisis while developing drugs comparable to those created in rich countries.1
Cuba had only 200 AIDS cases when New York City (about the same population as Cuba) had 43,000 AIDS cases. In 1997, Chandler Burr wrote in The Lancet that Cuba had “the most successful national AIDS programme in the world.” Despite having only a small fraction of the wealth and resources of the US, Cuba had implemented an AIDS program superior to that of the country seeking to destroy it.
Branko Marcetic neatly sums up how “Cuba’s biotech sector has thrived: it manufactures nearly 70% of the roughly 800 medicines that Cubans consume and 8 of the 11 vaccines in the country’s national immunization program. It exports hundreds of millions of vaccines a year…The sector is internationally acclaimed. Cuba has won 10 Gold Medals from the United Nations’ World Intellectual Property Organization (WIPO) for, among other things, developing the world’s first meningitis B vaccine in 1989. In 2015, Cuba became the first country to eliminate mother-to-child transmission of HIV and syphilis, a result of both the retroviral drugs it had produced and its robust public health care system.”2
Cuban Medicine during Covid
At the same time that Donald Trump was foolishly downplaying mounting dangers of Covid, every day Cuban TV carried press conferences with detailed information on the status of new patients, results of cabinet meetings on Covid, and shows announcing the best way for citizens to protect themselves and others.
Even when Joe Biden became president, he was unable to duplicate the trust that the Cuban medical system generated on the island. Each day Cuban medical students knocked on doors to ask citizens how they were. Cuba’s medical researchers immediately went to work developing vaccines as they had since 1962. Though vaccine development is not at all unusual for rich countries, Cuba is the only poor country in the world to develop multiple vaccines against Covid.
Cuba had 87 Covid deaths by July 21, 2020, when the US had experienced 140,300. While the US population is only 30 times that of Cuba, it had 1,613 times as many deaths.
But a year later, beginning in June 2021 there was an enormous increase in Covid cases and deaths. Exacerbating the crisis, the main production plant of medical oxygen broke down amid continuing US economic sanctions. Nevertheless, Cuba intensified its efforts to combat the surge and, by September had “registered a death rate of 0.80%, well below the 2.08 worldwide and 2.51 in the Americas.”3
Something else happened that month: On September 2, 2021, Cuba became the first country in the world to vaccinate children of 2 to 11 years old. At that time, the US was still trying to finalize preparation of child vaccines. The number of Cuban Covid cases decreased from 10,000 during the summer of 2021 to 243 on November 15. Cuba’s medical miracle was continuing.
The New Global Medicine
The initial focus of medicine after the revolution was extending care from the cities to rural areas. It appeared that the next step should be extending care beyond Cuba. The solidarity with poor peasants that Che described in the Sierra Maestra laid the foundation for this global solidarity which was powerfully exhibited in Angola, Haiti, Sierra Leone and Venezuela.
Cuban troops had helped Angola to protect itself from South Africa since 1975. On May 4, 1978, South African planes launched a major air strike inside of Angola at the Cassinga camp for Namibian refuges. The raid killed 16 Cubans and 600 Namibians.
The first Cubans that 12-year old Sophia Ndeitungo saw were its soldiers who came to the rescue in Cassinga. Since most Cubans in Angola were white, she feared that they were South Africans. She understood for the first time that not all whites are bad. Sophia then went to Cuba’s Isle of Youth to study far away from the bombs. She graduated from medical school in Havana, married another Cassingan refugee, and after returning to Namibia, became head of its armed forces medical services in 2007. For thousands of black Africans, Cuban doctors and soldiers were the only white people who showed them any kindness.
Cuba sent 700-800 medical professionals to support its troops during the Angolan wars of 1975-88. Approaches to the Angolan war by Cubans and their allies from the Soviet Union were decidedly different. Africans noticed how quickly Cuban soldiers, doctors, and others stationed near them melded into their society. A recruit from South Africa observed that the Cubans ate what they ate, slept in tents like them, and lived as they did.
A devastating earthquake hit Haiti in 2010. Cuba sent medical staff who lived among Haitians and stayed months or years after the earthquake was out of the news. US doctors did not sleep where Haitian victims huddled, returned to luxury hotels at night, and departed after a few weeks. Those observing this difference coined the term “disaster tourism” to describe the way that many rich countries respond to medical crises in poor countries.
When viruses that cause Ebola Virus Disease (mainly in Sub-Saharan Africa) increased dramatically in fall 2014, much of the world panicked. Soon, over 20,000 people were infected, more than 8,000 had died, and worries mounted that the death toll could reach into hundreds of thousands. The US provided military support; other countries promised money. Cuba was the first nation to respond with what was most needed: it sent 103 nurse and 62 doctor volunteers to Sierra Leone. With 4,000 medical staff (including 2,400 doctors) already in Africa, Cuba was prepared for the crisis before it began.
Since many governments did not know how to respond to the disease, Cuba trained volunteers from other nations at Havana’s Pedro Kourí Institute of Tropical Medicine. Cuba taught 13,000 Africans, 66,000 Latin Americans, and 620 Caribbeans how to treat Ebola without themselves becoming infected.
Medical associations in Venezuela and Brazil often claim that Cuban doctors take jobs from their own physicians. Yet, they cannot find enough of their own doctors to go to dangerous communities or travel to rural areas by donkey or canoe as Cuba doctors do.
Nurse Del Valle Marquez recalled when the first Cubans came to her small Venezuelan community of Altos de Lidice in 2018. Many villagers had never seen a doctor visit their town. But when the Cubans arrived “we opened our doors to the doctors, they lived with us, they ate with us, and they worked among us.”4
Over the past six decades more than 400,000 Cuban medical professionals have worked in 164 countries and improved the lives of hundreds of millions of people. Additionally, Cuba has brought thousands of students to study medicine in Havana to be trained as doctors. In 1999 Cuba founded the Latin American School of Medicine for these international students. By 2020 it had trained 30,000 doctors from over 100 countries.
Medicine for the World during Covid
Even with the huge economic harm that the island was experiencing from the embargo and increased sanctions by the Trump administration, Cuba did its best to help other countries during Covid. In the 1980s, its medical researchers had created Interferon Alpha 2B to treat dengue fever. It prevents complications that could worsen a patient’s condition and result in death. It is also helpful for other viral diseases. In 2020 it became vitally important in the treatment for Covid. The US corporate press seemed to have zero intention of letting people know that 72 countries had requested Cuba’s Interferon Alpha 2B for Covid.
An event of March 18, 2020, brought back memories of the many ways Cuban medical professionals exhibited their international solidarity through the decades. Nearly 50 crew members and passengers of the British cruise ship MS Braemar either had Covid or were showing symptoms as it approached the Bahamas, a British Commonwealth nation. Since the Braemar flew the Bahamian flag as a British Commonwealth vessel, there should have been no problem disembarking.
But the Bahamian Ministry of Transport declared that the cruise ship would not be allowed to dock and that no one could leave the ship. During the next five days, the US, Barbados (another British Commonwealth nation), and several other Caribbean countries turned it away. Cuba became the only country to allow the Braemar’s over 1,000 crew members and passengers to dock at the port of Mariel.
When right wing fanatics came to power in Latin America, they increased their countries’ suffering and death. Brazil, Bolivia, and Ecuador expelled Cuban doctors who had been working there. This led to increased infant mortality and pneumonia in indigenous communities and catastrophic reactions to Covid. It was so bad in Brazil that, in June 2020, President Jair Bolsonaro asked Cuba’s doctors to return to Brazil.
It is small wonder that, by November 2020, 6,400 legislators, academics and judges had nominated Cuban doctors for the Nobel Peace Prize due to their international efforts to stop Covid.
Racism and Counter-racism
With a huge number of poor black people being concentrated in rural Cuba, anti-racism has been core to its liberation movements. Fidel referred to the anti-apartheid struggle in South Africa as “the most beautiful cause.”
One of Che’s descriptions of the seven-day trip aboard Granma reappeared in the context of confronting racism in solidarity with Africa. Revolutionaries on Granma were generally unprepared for the rocking of a boat and almost all became nauseous.
Less than a decade later, Cuban troops were similarly ill during secret journeys to Africa. African resistance leaders realized that they could use to their advantage the inability of racists to tell one group of Black people from another. The revolutionaries in Zaire requested that the Cubans sent to aid them be Black so they could pass undetected by US and European spies. Guinea-Bissau’s revolutionaries had a policy of denying that their actions involved any foreigners. Their leader Amílcar Cabral asked Cuban officials to send technicians who were Black or dark-skinned so they would blend in.
Since the doctors were all white, there were no problems with anyone seeing them on the ship. But the troops were all Black, and, in order to make sure that none of the passengers or US spy planes would guess the purpose of the mission, they had to stay in the ship’s lower deck, which was hot and had poor ventilation. When the swaying of the ship made them seasick it was highly unpleasant. Cabral’s strategy significantly slowed the ability of Western agents to detect Cuba’ presence.
Beginning in 1975, during the Angolan wars, South Africa served as a proxy for the US, which had been humiliated and exhausted from its defeat in Vietnam. South African views mirrored those of US politicians. A 1971 amendment to a US sanctions bill by former KKK member and Democrat Senator Harry F. Byrd (VA) exempted trade in chrome, thereby removing consequences for the white minority government of Rhodesia. A much-publicized July 1986 speech by Ronald Reagan lavished praise on South African whites who he said gave great opportunity to Blacks.
South African showed utter contempt for Black combatants. Deaths of whites were followed by announcements from the army and newspaper obituaries in the press. Deaths of Blacks were not broadcast either by their military superiors or by the press at home.
Fidel and Raúl Castro’s strategy of victory in Angola meant recognizing the opportunity offered when South Africa had to use its military to quell anti-apartheid disturbances at home, thereby limiting their availability to fight Cuban troops. They secretly deployed Cuba’s best troops and equipment across the Atlantic to score a decisive victory on March 23, 1988, at Cuito Cuanavale. Despite this, US diplomats told their negotiating Soviet counterparts that South Africa would not leave Angola until all Cuban troops were gone. Fidel told the Soviet negotiator to “… ask the Americans why has the army of the superior race been unable to take Cuito, which is defended by Blacks & mulattoes from Angola and the Caribbean?”5
The outsmarting of the US by a largely Black Cuba could have played a major role of such intense and persistent hostility shown for decades.
Persistent Hostility
Hatred against those who sought to improve the lives of Cubans arose before revolutionary success and never ceased. In his Episodes, Che recorded that the spy in their small group who was assigned to kill Fidel had actually slept under the same blanket with him. Che wrote that “… the one who had the greatest faith in the people, who at all times showed his extraordinary powers of leadership, was Fidel,” a factor which played no small part in the hundreds of efforts to murder him.
Over the decades, those who hated everything Fidel believed in spread their malfeasance not only to all inhabitants on the island but to anyone, anywhere who might benefit from Cuba’s generosity. Nothing showed this more clearly than the “sanctions” which began during the Special Period. Its low point came during 1993-1995, when Cuba experienced the most intense hardships of daily life. But Cuba’s education and health delivery systems had benefited from decades of mobilization campaigns for literacy and vaccination.
The first time infant mortality in Cuba was lower than that in the US was toward the Special Period’s end in 1998, confirming that the many emergency measures to protect newborns during that decade were highly effective.
As the new millennium began, Cuba had adjusted economically to the collapse of the Soviet Union, maintained the structure of its health system, weathered the turbulence of HIV/AIDS, protected the care of mothers and infants, increased the scope of health services, matched the US in life expectancy and surpassed the US in infant mortality. The US embargo proved no more effective in destroying Cuba’s morale than Hitler’s Luftwaffe bombing of London during World War II was for undermining England.
When Katrina hit on August 25, 2005, the US government showed its disdain for Black hurricane victims. Fidel Castro brought together 1,586 medical volunteers with tons of medical supplies ready to make the relatively short trip to New Orleans. US President George W. Bush turned a deaf ear to the repeated offers as the death count mounted to 1,800. Undoubtedly, Bush’s silence reflected thinking of many wealthy Americans who would prefer to see their destitute countrymen suffer and die rather than accept help from Cuba.
In August 2006 the George W. Bush administration began the “Cuban Medical Professional Parole” program to encourage Cuban medical staff on international missions to desert and move to the US. Only 2-3% did so; but the departure of 500 Cuban medical staff (of a total of 40,000) left those poor countries with less care.6 Depriving people of medical care was a price that the US State Department would eagerly pay to satisfy dreams of crushing Cuba.
In 2020, the Trump administration saw Covid as a renewed opportunity to destroy the island’s economy. It added over 230 new sanctions, including a ban on selling ventilators to Cuba. The country’s ability to produce and administer vaccines was hurt from shortages such as test tubes and syringes. When the Democrat Joe Biden became president, he did not lift any of Trump’s sanctions and added new ones.
“Remittances” are money that immigrants to the US send to their families in their mother country. They are critical for many Latin American countries, comprising up to 20% of the Gross Domestic Products of Honduras and El Salvador. Trump’s sanctions included prohibitions on remittances to Cuba, a policy continued by Biden. Actions such as these accomplish no goals other than making life brutally hard for the Cuban people. This is why, on June 23, 2021, 184 United Nations countries voted in favor of the US ending its sanctions on Cuba.
The Unpredictable
All the developments covered thus far have had at least a germ of beginning aboard the Granma or Sierra Maestra. But neither Che nor anyone else could predict changes in the structure of services that would revolutionize medical thinking. Each of the major innovations in the delivery of care arose from contradictions that were ongoing at the time. The three major modifications occurred around 1964, 1974 and 1984. These are merely official dates of innovations that were conceptualized before and continued beyond those years.
The immediate medical task of the revolution was to extend care to those who had never received it before. By 1964, it was clear that too many unconnected service health systems did not know what other systems were doing and this was resolved by creating policlínico integrales (complete polyclinics) which brought all services together. The most revolutionary aspect of this innovation was that every citizen had a single point of entry into the health care system via a geographic area. Cuban medicine is planned to include 100% of the population. This organization continued through each subsequent phase.
Contradictions within the policlínicos integrales emerged by 1974. The system was putting too many requirements on the clinics, and they were not sufficiently connected to communities. Cuban medical planners borrowed staff and ideas from Eastern European counties but realized that a problem with those systems was that clinics were under control of hospitals. Having clinics on an equal level as hospitals was preserved in subsequent phases of transformation of the medical system.
The new system changed clinics to policlínicos communitarios. Previously, patients went to the clinics. Beginning in 1974, clinics would go to the community. These clinics developed doctor-nurse teams based on specialties (such as internal medicine or pediatrics) which would be responsible for the clinic area.
Multiple contradictions emerged within this clinic system, with one of the most important being that doctor-nurse teams based on specialties were assigned areas too large for them to know patients well. By 1984, Cuban medicine began to add doctor-nurse teams in neighborhood offices (consultorios). The teams lived in the neighborhood they were assigned to, had a specialty of general medicine for the most frequent problems, and had an area small enough so that every patient could walk to the consultorio and the doctors and nurses could walk to all homes (in urban areas). This system remains through today and includes nearly 100% of Cubans. The doctor/nurse teams know every one of their patients by name. The neighborhood teams are thoroughly integrated with clinics, hospitals, medical schools, specialty hospitals and research institutes.
The conclusion from these transformations is clear. A revolutionary struggle does not end in a predetermined blueprint of a new society but continues to unfold through the concrete experiences of that society.
Beyond Capitalism
Che’s Episodes briefly mentions his medical practice here and there. Yet, it is imprinted between every line. His account of fighting in the Sierra Maestra is the story of laying the foundations of a society that meets people’s basic needs.
The most critical elements of health care delivery which emerged are (1) the belief that everyone should receive complete health care as a human right; (2) all parts are fully integrated into a single whole, and (3) everyone has input into the system so that it enjoys collective experiences of the country. The US medical system is founded on the principle that every corporation should be able to make as much profit as possible. There are no insurance companies in Cuba to add to medical expenses and dictate patient care decisions to doctors.
The US confronts health crises with “campaigns” whose major elements are grossly inadequate TV commercials. “Campaigns” in Cuba mobilize the entire population for literacy, vaccination, hurricane preparation or Covid responses.
In order to coordinate campaigns as an integral part of its holistic care system, Cuba prepared for 89,000 doctors, 84,000 nurses, and 9,000 students to graduate from medical studies in 2020. While only 11% of US doctors are family physicians, they form the core of Cuba medicine, comprising a full 66% of its doctors.
The non-design of the US non-system of medical care leaves it woefully unprepared for crises. While the US produces a surplus of unnecessary junk, Cuba produces a surplus of health care professionals who are ready to go into action when required. Cuba has 8.2 doctors per 1,000 people while the US has 2.6 doctors per 1,000. When on a 2019 trip there, a recently graduated Cuban doctor told me that he only works about 20-25 hours per week. But during medical disasters, it could easily be 80-100 hours per week.
Of course, racism permeates US medical care, as it does every other aspect of life. During 2020, Covid caused US life expectancy to drop by a year and a half, the most since World War II. But it was not equal for all groups. Life expectancy fell by 9 months for the US white population, by 24 months for Latinos, and by 32 months for Blacks.7
In the world’s rich countries, public funding flows into private corporate coffers to finance lifesaving medicines, including those for Covid. In contrast, Cuba’s biotech research, which developed its critical medicines, is 100% publicly owned, without any money enriching corporations. Cuba has gone in the opposite direction from privatization as it has “de-commodified” economic sectors essential for human health.
It is tempting to either immortalize Che as one who accomplished far more than any solitary human could do or to under-acknowledge him as merely saying the right things at the right time. Or we could say that Che crafted a key – a key that would unlock a medical future that no one imagined in his lifetime. We, like Che, must nurture the idea that, once medicine is motivated by an urge to help rather than profit, a society can reach for its dreams.
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End Notes
1. Chandler Burr, “Assessing Cuba’s Approach to Contain AIDS and HIV,” The Lancet 350, no. 9078 (August 30, 1997), 647. DOI:https://doi.org/10.1016/S0140-6736(05)63342-9
2. Branko Marcetic, “Cuba’s Vaccine Could End up Saving Millions of Lives,” https://jacobinmag.com/2021/11/cuban-covid-vaccine-pandemic-biotech-research
3. Angel Guerra Cabrera, “Cuba Creates and Reinvents Itself,” https://www.resumen-english.org/2021/09/cuba-creates-and-reinvents-itself/
4. Cira Pascual Marquina, “A Caracas Commune Prepares for the Coronavirus Crisis: Four Voices from the Altos de Lidice Communal Healthcare System,” https://venezuelanalysis.com/interviews/14834
5. Piero Gleijeses, Visions of Freedom: Havana, Washington, Pretoria, and the Struggle for Southern Africa, 1976-1991 (Chapel Hill: The University of North Carolina Press, 2013), 356.
6. John M. Kirk and Michael H. Erisman, Cuban Medical Internationalism: Origins, Evolution and Goals (New York: Palgrave Macmillan, 2009).
7. Stan Cox, The Path to a Livable Future: A New Politics to Fight Climate Change, Racism and the Next Pandemic (San Francisco: City Lights Books, 2021)
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