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Context of '1989: Cuba’s Secondary and Tertiary -levels Health Care Infrastructure'

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The US begins a 40-year plus trade embargo on Cuba. (Perez 1995; Guardian 11/28/2001) The embargo applies to a wide range of goods including both food and medicine. (Perez 1995; Guardian 11/28/2001) Beginning in 1992, the UN General Assembly will annually condemn these sanctions against Cuba. (Guardian 11/28/2001)

The Federation of Cuban Women (Federacion de Mujeres Cubanas, FMC) is founded to promote gender equality and the full integration of women into the economic, political, social, and cultural life of Cuba. (Partido Comunista de Cuba 7/29/2006; Cuban Education Tours 7/29/2006) The FMC, a non-governmental organization, will liaison with the Cuban government through the People’s Health Commissions to promote women’s health. (Feinsilver 1993, pp. 32) Some of the organization’s members will serve as brigadistas sanitarias (health brigade members), helping polyclinic (see 1964 and after) nurses provide women with first aid, injections, and general health information. They are also responsible for seeing that all women in their district regularly have pap smears, and that all pregnant women do not skip any of their prenatal exams or check-ups. When Cuba implements its Family Doctor Program (see 1984) many of the brigadistas sanitarias’ responsibilities will be taken over by the family physician-nurse teams. The role of the brigadistas sanitarias will focus mainly on health education. They will also occasionally assist family doctors and nurses. (Feinsilver 1993, pp. 66)

The US fails in an attempt to invade Cuba using 1500 exiled Cubans in what becomes known as the Bay of Pigs. (Perez 1995; Central Intelligence Agency 1998)

Cuba transforms its health centers into “polyclinics.” Each of the polyclinics administers health services to a specific geographical region comprised of between 25,000 and 30,000 people and serves as the point-of-entry for most patients. (Feinsilver 1993, pp. 35) In addition to treating patients, the clinics educate patients by holding daily lectures on health care in clinics’ waiting rooms. (Feinsilver 1993, pp. 67) The region served by a polyclinic is further divided into health sectors. Within these sectors, all people are seen by the same medical teams, which after 1976 are mostly comprised of a physician and nurse trained in the same specialty. So for example, within a health sector, all children have the same pediatrician and all women have the same gynecologist. The polyclinic medical teams operate according to a paradigm known as “medicine in the community” which aims to treat patients as a biopsycho-social being in their respective unique environments. The medicine-in-the-community model is also designed to focus on disease prevention by identifying risks present in the environment before they become health problems. By the 1980s, it is apparent that something more needs to be done to achieve these objectives. The polyclinic medical teams fail to establish close relationships with their patients and have little time for prevention. This shortcoming leads to the creation of Cuba’s Family Doctor Program in 1984 (see 1984). (Feinsilver 1993, pp. 35-40)

Cuba’s public health ministry launches an education campaign promoting physical fitness as part of an effort to combat negative health conditions associated with sedentary lifestyles. (Feinsilver 1993, pp. 71)

The World Health Organization’s (WHO) representative in Cuba states that “there is no question that Cuba has the best health statistics in Latin America.” (Chomsky 1993, pp. 151)

A study prepared for the Congressional Joint Economic Committee acknowledges Cuba’s successes in education and health care. “[T]he Cuban revolution has managed social achievements, especially in education and health care, that are highly respected in the Third World…. [These include] establishment of a national health care program that is superior in the Third World and rivals that of numerous developed countries,” the report says. (US Congress 3/22/1982, pp. 5; Feinsilver 1993, pp. 81-5)

Sergio Diaz-Briquets, in his book The Health Revolution in Cuba, concludes that universal health care access, along with the narrowing of the gap between mortality rates in urban and rural populations “appears to be the main causative factor behind Cuba’s impressive gain in life expectancy.” (Diaz-Briquets 1983, pp. 113; Feinsilver 1993, pp. 92)

Cuba launches its Family Doctor Program. This new system is designed to make up for the shortcomings of the “medicine in the community” model (see 1964 and after) which did not create the intended close relationships between physicians and patients and which had failed in the area of preventative care. Under the new system, Cuba aims to put a physician and nurse team on every city block and in the remotest rural communities. The plan calls for the creation of 25,000 such teams by the year 2000, 5,000 of which would be assigned to factories, schools, ships, and homes for the elderly. The teams are charged with providing comprehensive medical attention to everyone in their districts, both healthy and sick. Each district consists of between 120 and 150 families. Special emphasis is placed on prevention and people are encouraged to exercise, eat well, and avoid unhealthy lifestyle habits such as smoking. (Feinsilver 1993, pp. 35, 40-42) Implementing the system also requires corresponding changes in the country’s medical schools. All medical graduates except surgeons, nonclinical specialists, and future medical school professors are now required to complete a residency in family medicine before completing a second residency in a specialty area. (Feinsilver 1993, pp. 30) After the Family Doctor Program is implemented, medical costs begin to drop. The reduced costs are attributed to decreased hospitalization and emergency room use, better health monitoring, improved patient fitness, and more effective prevention. (Feinsilver 1993, pp. 35, 45)

By this date, Cuba has 6.0 medical assistance beds per 1,000 inhabitants and 1.3 social assistance beds per 1,000 people. The island boasts a total of 263 hospitals, 420 polyclinics (see 1964 and after), 163 dental clinics, 229 dispensaries, 3 medicinal spas, 148 maternity homes, 23 blood banks, 11 medical research institutes, 153 homes for the elderly, and 23 homes for the physically and mentally impaired. These facilities are distributed relatively evenly across Cuba, though there is a slightly higher concentration of beds in those provinces that serve as regional health centers. The Havana province also has a larger number of beds per capita because it is a national referral center. (Feinsilver 1993, pp. 58-59)

UNICEF publishes a report on the “State of the World’s Children,” which concludes that “Cuba is the only [Latin American] country on a par with developed nations” with regard to infant mortality rates. (Chomsky 1993)

Cuba has sent 25,000 doctors to developing countries—more than the World Health Organization (WHO). Currently, it has almost 2,000 doctors working in 14 countries. (Xinhua News Agency (Beijing) 4/15/2000)

Under the leadership of Jean-Bertrand Aristide, the Haitian government engages in cooperative projects with Cuba and Venezuela. The Chavez government offers to provide oil at significantly reduced prices, and treaties between Haiti and Cuba result in a presence of more than 800 Cuban medical workers in Haiti. In an explicit challenge to US domination of the regional trade patterns, Haiti works with other island nations to create a regional trading bloc that “may be a bulwark against the FTAA and other [US-led] initiatives.” Haiti and other Latin American countries regularly discuss regional strategies to reduce US hegemony in the region. (Reeves 9/7/2003)

Twenty detainees are transferred from Guantanamo to their home countries. Whether they are to be released upon arrival or to remain in detention in these countries is not revealed. (US Department of Defense 11/24/2003) Two days later, about 20 new detainees arrive. The total number of detainees at Guantanamo now stands at approximately 660. Little information about the identities and home countries of the detainees is released to the public. (US Department of Defense 11/24/2003)

The Defense Department reports that are about 590 detainees being held at Guantanamo Bay, Cuba. (US Department of Defense 7/27/2004) This is a decrease from its maximum number of about 660 detainees in about November 2003 (see November 21-23, 2003).

Venezuela and Cuba sign a number of deals, deepening economic ties between the two countries. One of the deals made is that the two countries will construct a joint shipyard in the western Venezuelan state of Zulia where naval ships will be built and repaired. The Cuban government also agrees to purchase from Venezuela food products such as canned sardines, gelatin, puddings and marmalades, chocolate drinks, condensed milk, as well as work clothes, including 400,000 pairs of boots. Additionally, Venezuela says that the 53,000 barrels of oil it began selling to Cuba on preferential terms in 2000 (see Late April 2005) has been increased to 90,000 barrels per day. In exchange, Cuba will increase the presence of Cuban doctors working in Venezuelan slums and rural hamlets from 13,000 to 30,000 by the end of 2005, in addition to providing training to 40,000 new Venezuelan doctors. (Canadian Press 5/5/2005; Associated Press 7/13/2005)

For the fourteenth consecutive year, the UN General Assembly, in a record 182 to 4 vote, calls on the US to end its four-decade-old embargo against Cuba (see 1960). Voting against the measure are the US, Israel, Palau, and the Marshall Islands. Micronesia abstains, while El Salvador, Iraq, Morocco, and Nicaragua do not vote. (Lederer 11/8/2005; CBC News 11/8/2005; EuroNews 11/9/2005) (The Palau Archipelago was administered by the United States as the last UN trust territory until 1994. The Marshall Islands, taken by the US during World War II, became self-governing under US military protection in 1976, achieving free-association status in 1986. The combined population of Palau and the Marshall Islands is less than 80,000.) (Columbia Encyclopedia, 6th ed. 2005; Columbia Encyclopedia. Sixth edition 2005) Before the vote, speaker after speaker in the General Assembly debate speaks out against the US sanctions (Lederer 11/8/2005) , while Ronald Godard, a deputy United States ambassador, asserts that “if the people of Cuba are jobless, hungry, or lack medical care, as Castro admits, it’s because of his economic mismanagement.” (New York Times 11/9/2005) After the votes are tallied up, many delegates in the General Assembly hall reportedly burst into applause. (Lederer 11/8/2005) US Ambassador to the UN John Bolton, calls the vote “a complete exercise in irrelevancy.” (Lederer 11/8/2005)

The US Department of State releases its 2005 edition of Country Reports on Terrorism, in which it states that Cuba remains a “state sponsor of terrorism, while Venezuela virtually ceased its cooperation in the global war on terror.” According to the report, Venezuela has been “tolerating terrorists in its territory and seeking closer relations with Cuba and Iran.” (US Department of State 2006, pp. 155 pdf file)

Carl Kropf, chief of media relations for the Office of the Director of National Intelligence, says that Venezuela and Cuba “have deepened their relationship and both countries continue to stifle opposition and constrict democracy.” (Washington File 8/21/2006)


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