Rare private doctors fill
medical gaps
Vanessa Bauzá. Published
January 23, 2005 in the Sun-Sentinel.
HAVANA · Dr. Aurelio Domech's private
pediatric practice in his Havana home has
been around so long that many of his original
patients now bring their grandchildren in
for checkups.
Across town, at Dr. Narciso López's
apartment, patients line up as early as
6:30 in the morning to secure a place on
his 1940s-era dental chair.
Both are relics of a bygone era, doctors
and dentists -- in their 70s and 80s --
who run Cuba's few remaining private practices
in an otherwise universal, government-run
health-care system.
They are not listed in Havana's Yellow
Pages, and often a discreet plaque by the
front door offers the only clue that there
is a doctor in the house.
Still, generations of patients have sought
them out for minor aches and pains as an
alternative to the government's free dental
and medical clinics.
"When you pay you have the right to
demand good work. At a state clinic it's
free and, as the saying goes, you shouldn't
look a gift horse in the mouth," said
Febe Lescay, 32, who went to a private dentist
to fill a cavity in a tooth because she
couldn't wait for an appointment at a government
clinic.
At López's central Havana home office,
his patients don't seem to mind that his
old dental chair has seen better days. They
say they prefer coming to him rather than
waiting months for a root canal or dentures
at a government clinic.
"At the clinics there is one dental
chair next to the other and a lot of noise
and distractions," said Susana Garcia,
32. "A root canal can take two months,
from one appointment to the next. Here you
can get it done in a week."
Dr. José Gilberto Fleites, 79, a
gynecologist, said his private practice
serves a dual purpose: It keeps him tied
to his lifelong medical vocation and helps
supplement his $11 monthly state pension.
Like other doctors his age, Fleites had
a prosperous clinic that was nationalized
after Cuba's 1959 revolution. In those tumultuous
years, about half the island's 6,500 doctors
left. Fleites stayed behind and became a
medical professor. Like others who could
prove they owned private practices before
1963, Fleites was allowed to continue seeing
patients at his home office.
"I am from the capitalist era, and
socialism got me," Fleites said.
At private medical practices, patients
pay about $1.50 for checkups and physical
examinations. Dentists charge about $1.50
to pull a tooth and $5.50 for a root canal.
Partial dentures cost about $10. The fees
are paltry by U.S. standards, but for the
average Cuban worker they can be steep.
Some patients pay with gifts or services.
"Some people still come like in the
past, with a chicken or eggs," said
Domech, 85, the pediatrician.
"Others say, 'I don't have the money
to pay you. God will repay you.'"
Like other parents and grandparents in
Domech's sunlit waiting room, Hugo Posada
said he prefers paying for a checkup for
his grandson to waiting hours at the government's
clinics.
"Domech examines the children in depth.
He talks to the mothers, he goes into detail.
He has a lot of accumulated experience.
That's not common," said Posada, who
began bringing his infant daughters to Domech
22 years ago.
Cuba's universal healthcare system extends
into rural communities across the island
and offers free medical care, from cancer
treatments to brain surgery. Havana research
centers have developed unique vaccines.
This month the Cuban government announced
the infant mortality rate had dropped to
5.8 per 1,000 live births, lower than the
United States' rate.
But the Cuban system suffers from chronic
shortages. Many medications are scarce and
equipment is often outdated. Hospitals are
badly deteriorated and patients must often
bring their own buckets to bathe with because
of dilapidated plumbing. Doctors are paid
about $25 a month, spurring a system of
bribes in exchange for special treatment.
Private doctors say they can only treat
minor ailments because they are lacking
the sterile conditions and equipment required
for medical procedures. They can write prescriptions
for government pharmacies, but patients
must go to government clinics if they require
a referral for laboratory work.
Cuba's private doctors and dentists predate
other "private entrepreneurs,"
who were licensed for work in the mid-1990s
and have since dwindled because of strict
regulations and high taxes.
Officials at the government agency that
collects taxes from the private doctors
and dentists said they could not provide
information on the number of home practices
in Cuba. Doctors and patients say only a
small number remain.
Renowned cardiologist Dr. Guillermo Franco
Salazar, 79, who has written medical textbooks
and helped establish two medical schools
in eastern Cuba, compared his modest home
office to that of an old-time family physician.
"Patients like to feel like a person,
not a cog," he said. "I give them
that. I maintain a Cuban tradition that
the doctor was a friend to the patients."
Vanessa Bauzá can be reached at
vmbauza1@yahoo.com
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© 2005, South Florida Sun-Sentinel
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