HAVANA, Cuba. – “I don’t understand what is happening in our country, but please, at least guarantee medications for our sick people so that no one has to suffer what I am suffering.”
“Patients have to bring their own syringes from home, there is no surgical thread with which to suture wounds, nor gauze, nor intravenous supplies (…) one has to bring repurposed vinyl gloves to the hospital.”
“(My two-year-old niece) waited for hours in a hospital, and finally had to be transferred in a truck (…) because there was no fuel for the ambulances (…). There is no surgical thread with which to suture wounds; pregnant women are not getting treated for vaginal discharge because there’s no medication in supply for treatment (…) only emergency surgeries are being performed.”
“There were no bed sheets. The beds and mattresses were disgustingly filthy. There was no running water. The bathrooms were horrendous. The food was terrible.”
If you wanted the doctor or nurse to see you, you had to go out looking for them, and make a scene.” “I had to procure the medications on the street, overpay for them, and even then, I wasn’t treated well,” is what several Cuban patients published on Facebook.
These are brief excerpts of doctors and patients’ testimony about hospitals in Cuba.
On social media alone and via independent journalists, one can read on a daily basis, complaints about the precarious state of medical services in the island; about deaths due to medical negligence; about the lack of essential medications in local pharmacies; about ambulance services in a country that has available only 100 vehicles from its national fleet in the whole country; about the mistakes, the mistreatment and bad practices on the part of professionals that only make life more painful for the sick and their families.
The Communist Party’s ideological department prohibits journalists from their propaganda outlets to investigate thoroughly, critically and impartially any issue concerning public health. Also, there are no trustworthy statistics available on the matter, although a short visit or stay in any hospital for-Cubans-only would be enough to confirm how dismally different are the conditions of hospitals where foreign tourists and high-ranking government officials are treated.
“On the western part of Havana, in the Siboney suburb, stands the International Healthcare Center La Pradera, a very pleasant natural environment enhanced by fresh breeze and generous vistas, a luscious green landscape and spacious hotel installations, is designed for a calm and restful stay. La Pradera is a corner of Cuba that in the last 13 years has allowed 58,500 Venezuelans to not only recover their health but also improve their quality of life through the Cuba-Venezuela Comprehensive Agreement.”
“Patients enjoy a pleasant stay at La Pradera, along with a five-star hotel, and all the comforts and services at their disposal. By the same token, family members who also travel to Cuba to accompany their relative that is receiving treatment, will in many cases be treated as well should they become ill.”
“La Pradera is 9.3 miles from the center of Old Havana, and 15.5 miles from Jose Marti International Airport. During their stay, patients can visit the city conveniently and enjoy themselves there, all part of the comprehensive treatment the Cubans offer.”
“La Pradera is synonymous of quality of life. Within the spaces earmarked for rehab, the humanism and solidarity of Cubans is also part of the therapy. There are gyms where Cuban doctors provide physical therapy to handicapped patients; there are also special facilities where therapists treat children on motor skills and to stimulate their ability to walk.
“Other open spaces are used to conduct outdoor exercises; there are massage therapy rooms, oncological services, and educational lectures on addiction problems. The trees at La Pradera provide ample shaded areas, and along with the swimming pool, are there for the enjoyment of both patients and companions.”
“There are stores and sitting rooms in the reception area; the main dining room is close by, as well as a café where snacks can be enjoyed.”
The paragraphs in quotations above are taken from an article published in December 2013 on the website of the Cuban embassy in Venezuela.
Although the reason for this article was to celebrate over a decade of the “Cuba-Venezuela Comprehensive Agreement” (better known as the “physicians for oil” agreement), in truth it is but one of a thousand similar reports, notes and videos that helps the government in Havana to promote Cuba’s health tourism through its embassies, particularly the services offered at La Pradera, a hybrid hospital-hotel that on health tourism packages sold to foreigners alone had generated (until 2013) an income of approximately 270 million dollars annually. These patient and cost-of-services statistics were published by La Pradera itself.
Of this amount, at least 100 million annually were provided by Hugo Chavez on account of the 58,500 Venezuelans treated between 2000 and 2013.
Money and Hell behind La Pradera Paradise
Like similar facilities in Cuba and in spite of the fact that it is regarded as a health entity, La Pradera offers lodging, gastronomy and recreation services. All services, including health, are arranged for, promoted and sold by a diversity of tour operators as part of their varied “health tourism” programs aimed at foreigners. La Pradera is a hotel-hospital to which native Cubans who reside in the island have no access.
In fact, when in March 2008, then president Raúl Castro eliminated restrictions that had been imposed by his brother Fidel and authorized that Cubans be given access to tourism hotels –for deeming those prohibitions “absurd”- centers for health tourism like La Pradera; like the international clinic “Cira García”, the “Camilo Cienfuegos” Retinitis Pigmentosa Center, to mention only the well-known facilities, continued to be inaccessible to Cuban nationals except to those who live abroad permanently and, therefore, can pay for the services in U.S. dollars.
The Cuban regime’s justification of this segregation has always been that “health tourism”, as well as the sale of pharmaceuticals, blood derivatives and medical services in other countries, is only a strategy to generate foreign financing aimed at the application of 100% of profits to the national public health system. However, the precarious conditions of the health for-Cubans-only system in the island, in general, calls into question the veracity of such ends.
Data gathered by numerous publications, doctoral thesis and Cuban Communist Party press reports included, speak of a notable unevenness between product marketing income (including tourism and export of related goods and services) and annual expenses on the part of the Cuban State on public health.
Keeping in mind the annual budgets approved during the last two decades, and even if those represent close to 30% of the State budget, those budgets represent not even half of the net profits derived from marketing. This means that the Cuban state has never spent on health, per capita, more than US$ 800, which places Cuba very much at the bottom of the list of countries –even below others in Latin America- which hold Cuba as a leader in the region. This is the direct result of “diplomacy” and “health tourism”.
On treatment for vitiligo and other skin conditions in Venezuelan patients alone, the comprehensive agreement generated for Cuba between 2000 and 2012, over 2 billion US$. This has been confirmed, under condition of anonymity, by a high-ranking official at the Ministry of Foreign Relations closely linked to the collaborative agreement signed by Fidel Castro and Hugo Chavez on October 30, 2000.
This former official stated that, “The agreement established specifically the exchange of personnel and services for oil, but also considerable financing in excess of 2 billion US$ mostly in the form of credits, to finance the pharmaceutical industry, the purchase of supplies and materials, and the training of professionals in the island.” He revealed further details about the treatment for vitiligo and the production of Melagenina.
“It’s not untrue that there were problems with gathering placenta tissue at the hospitals (to manufacture Melagenina and Coriodermina),” he explained. “Some of that money was used in the purchase of cars; in modernizing the processing plant; in the manufacture of packaging (…), it was also used in transporting and lodging some patients not traveling as part of Misión Barrio Adentro (Into the Neighborhoods Mission), or directly with the office of the Venezuelan presidency. They were patients that joined the program through other means. (…) There were many Colombians, who did not reside in Venezuela but still travelled to Cuba under the agreement (…), we are talking about thousands of patients with skin conditions, and if we add those to the cancer patients, the diabetics, organ-transplant patients and plastic surgery patients, the total reached 100,000 in ten years (…). It overloaded capacity at La Pradera and the “Cira García”. They were forced to strike agreements with many hotels (…), to make reservations for several months at a time doe the patient plus three or four companions in some cases; they also arranged for travel, which Venezuela would pay. All this money was going into Cuban coffers under the agreement, and it went to tourism: it did not get invested in health services. It represented profits for the tourism companies, both Cuban and foreign,” according to this source.
As with La Pradera, other hospitals in Cuba were engaged, to the tune of 40 specialized centers in a network that served foreign tourists only.
In order to have an idea of the profits that health tourism generated for the economy, between substance addiction treatments, therapies for lung cancer, curing diabetic foot ailments, plastic surgeries, medical checkups and vitiligo therapies, according to the scarce, loose and unreliable data published, between 2010 and 2018, “health tourism” and the sale of pharmaceuticals abroad together generated approximately 4 billion US$ per year.
Together with income generated from the export of medical services during the same period, estimated at 9 billion US$ annually, the total figure would be much higher than the budget Cuba destines annually for public health in the island. That amount had decreased 1.4 percent by 2017, compared to 2016, which represented barely 10.45 percent of the GDP.
In addition, since its inauguration in 1996 and until March 2019, more than 50,000 plastic surgeries were performed at La Pradera, at a cost that oscillates between US$ 700 and US$ 4,000 per surgery, not including medications and post-operative stay.
Also, more than 200 kidney transplants were performed, at a cost of over US$ 30,000 minimum per patient, including doctor visits, the surgery itself, both pre-and-post operative recovery periods both of for patient and organ donor, as well as lodging and other expenses for companions.
“I don’t think so many are being performed today, due to the pandemic. There might be few, but they are still being performed. (…) Until 2019, we were performing between five and ten plastic surgeries per day,” according to Dr. Beatriz Reyes, based on her own medical work at the “Cira García” Central Clinic, in Havana.
‘When the agreement with Venezuela was enacted, other rooms had to be readied at the “Ameijeiras” Hospital. Patients were treated, also, in Santa Clara, Holguin and Santiago de Cuba. There were more surgery specialists in the health tourism program and in Venezuela than were available in the island to care for Cuban patients. Today it’s still chaotic because a single surgeon, for example, performs surgery at La Dependiente hospital today, and tomorrow that same surgeon will do surgery at the Julio Trigo Municipal Hospital in Arroyo Naranjo. The reason is that all alone, he must attend to thousands of Cuban patients who are waiting their turn for an operation, or worse: awaiting the availability of a surgical room, which brings us to another issue. Most surgical rooms are closed because of terrible conditions,” according to Dr. Reyes. Her testimony is corroborated by that of her colleague Leonardo Labrada, an orthopedist who was not linked to the health tourism agreement between Hugo Chavez and Fidel Castro, but who experienced personally the other side of health tourism.
“The number of doctor’s offices was reduced for lack of specialists. They closed the existing ones at the policlinics and opened a single, multi-specialist facility at the hospital (…). That one facility opened once a week for an entire municipality. That is what they did for most medical specializations because either the doctors were on medical missions, or were taking care of Venezuelans. There were so many of the that some were relocated to the Information Science College (UCI), for the same salary earned at any hospital. A doctor from La Pradera made the same as a doctor from the Julio Trigo Hospital (considered one of the hospitals in worse condition in Havana),” lamented Dr. Labrada.
At that time, a doctor’s salary in Cuba was the equivalent of less than US$40 per month, at the official exchange range with Cuban pesos. In 2014, the government decided to increase it to a maximum of US$64 per month, and more recently, due to Cuban doctors’ accusations against the Cuban government of labor exploitation and slave work, it raised salaries to just under US$200 tops. Simultaneously, due to monetary reform, it dollarized the economy, raised prices of consumer goods and services in a retail market that is totally lacking. This means that the real value of a salary is way below what it was before when compared to previous that were just as critical.
Only for Those Who Can Pay
For Roxana, a young woman who suffered burns on her face in a traffic accident, it took more than three years to have surgery to correct her severe skin injuries.
Neither plastic nor reconstructive surgery are a priority in the Cuban health system. The notable deformities on the left side of her face and neck were affecting Roxana psychologically. She was no longer the happy young woman that enjoyed gathering with friends. She did not want to leave the house, and even quit the technical school she was attending so as to remain socially distant.
Nevertheless, over time she decided to seek therapeutic help to recuperate her self-esteem, although she says it didn’t help her much. Sessions were scheduled irregularly; the specialist would often change their meeting site and that meant having to go across town to make the appointments. Also, she received no referral for surgery consultation, which had been the main objective in getting counseling from a psychologist.
It took two years of getting the runaround from the public health system, for Roxana to have surgery, and that was through the personal efforts of someone she met during therapy. He gave her the contact to a surgeon at the Ameijeiras Hospital whom she paid to have him operate on her:
“I solved nothing with the psychologist. He gave me two or three very boring talks which made me even more depressed. No referral to a surgeon. His advice was that I live with the facial scars, and that was that. If my mother had not had the money to pay for the surgery, I still would have been locked up in my room, crying”, tells Roxana. By narrating her personal story, she reveals a phenomenon that transcends her experience.
That the Cuban public health system works very poorly is not a recent happening resulting from the pandemic. Neither is its decades-long crisis a consequence of the U.S. embargo alone –as the Cuban government asserts- in so far as the health tourism system that it so promotes around the world offers excellent hospitals, and is further equipped with the latest medical technology acquired in the U.S. and specialized personnel to meet the personal agendas of each foreign patient.
Medical services offered and the costs for these services at centers like La Pradera, are specified in detail on the institutions’ own websites. They speak by themselves of the existence of two different realities under one health system. Prices for general services of the health tourism program in Cuba are listed in full detail and can be verified in all sites managed by Gaviota S.A., many of them in coordination with tour operators in about 100 countries.
For example, the cost of aesthetic re-shaping breast surgery at La Pradera goes for a minimum of US$1,630; breast augmentation through implants, US$3,640; a tummy tuck or liposuction, US$1,810. This to mention only three of the over-100 types of surgery available to those who can pay, and which are never available to Cuban nationals.
At La Pradera, a foreign patient can have a hair transplant for US$1,050, eliminate flabby skin and fatty deposits around the eyelids, and a face lift, a neck-and-eyelids lift for US$2,635. These prices do not include medications, blood and derivative transfusions if they were necessary, nor food and lodging for a companion (minimum 15 days stay), nor the cost of implants or prosthesis, if those were necessary.
No one knows exactly where this real income from services to tourists ends up. Judging from young Roxana’s story, it’s self-evident that one hundred percent does not revert in offering Cuban nationals the excellent attention that European, Asian, African and other travelers from the Americas receive in the alleged health-paradise of the Caribbean.
In addition to plastic surgery, other health services generate income without need for large investments. According to information published at the promotional site Cubandhealth, at La Pradera, an “addiction treatment” and an “anti-hard-drug and alcoholism rehabilitation treatment” –similar to the one given to Argentinian soccer star Diego Armando Maradona between 2000 and 2010- costs US$16,000 at a minimum.
The price includes one week for evaluation, valued at US$2,500; seven days of lodging including breakfast, lunch and dinner for the patient and one companion (this cost will receive an exemption during the first fifteen days of treatment). The package includes blood tests, image tests, electroencephalogram and electrocardiogram. Treatment usually can take more than three months –and actually can take years, as it did with Maradona- and should there be need for additional treatment after three months, the cost is US$4,500 per month, not to mention that “one the patient is released, should he or she suffer a relapse, treatment shall begin from scratch at the initial cost for the program.”
Opposing realities. A health paradise for foreigners stands on a hell of hardships for the Cuban people. Hospitals, policlinics, maternity clinics and isolation centers for COVID-19 patients, whose building facilities receive no regular maintenance. Pharmacies without pharmaceuticals; a pharmaceutical industry that makes “exportable” vaccines and “magic” skin ointments like Melagenina but is unable to produce saline intravenous solution. The same system that, without proving the effectiveness of its anti-coronavirus vaccine candidates, is already promoting them as “aggregate value” to its tourism market, while Cubans are forced to wait for long periods of time in the emergency rooms, to rely on an inefficient ambulance fleet, and to place their lives in the hands of doctors, nurses and technicians who are troubled with their low wages and dismal working conditions.
Such contrasts and contradictions seem not to matter to the Cuban regime
as long as hospital-hotels like La Pradera serve as showcase to feed the myth, doing most of the diplomatic tasks that help them gain time in power and, of course, money.
Read in spanish here.
Recibe la información de CubaNet en tu celular a través de WhatsApp. Envíanos un mensaje con la palabra “CUBA” al teléfono +1 (786) 316-2072, también puedes suscribirte a nuestro boletín electrónico dando click aquí.