What is it like being a doctor in Cuba today? An Interview with Aleida Guevara, Che's daughter By Liz Else

December 27, 2004

The New Scientist Dec. 26, 2004

Aleida Guevara March - her full name - studied medicine at the University of Havana, spending her final year at the University of Managua in Nicaragua. She specialises in children's allergies. She has worked as a doctor in Angola, Nicaragua and Ecuador, and she helps run the Che Guevara Studies Center of Havana. Her father qualified as a doctor in 1953, specialising in dermatology, and he and his wife Aleida March travelled the world between 1961 and 1965 as ambassadors for Cuba. He was killed in Bolivia in 1967 when young Aleida was six

Were you following in your father's footsteps by becoming a doctor?

I follow the steps of my people!

But had you always wanted to be a doctor?

Yes, at the age of 4 I said I was going to be a doctor specialising in children. And I was loyal to that. I always liked children. My mother gave birth to four children, and for every one she had a Caesarean. The last time there was something that was not right. There was a stitch that wasn't right when the Caesarean was done with that last baby and it got infected. I helped disinfect the area with a bit of alcohol. I was just four-and-a-half when that happened.

What is it like being a doctor in Cuba today?

Sometimes people joke that we are always giving away doctors. There are thousands of Cuban doctors in Venezuela. We've got 25,000 health specialists helping other people around the world. So the ones remaining in Cuba have to work more. We offer our help to whoever wants it. This is very important now. Fidel Castro has said to the developed world that we will bring the human element, but they have to bring the material things. So we have been taking part in very interesting projects in developing countries with the UK, France, Germany. They send money to buy medicines and materials and we provide all the professionals.

How many doctors are there in Cuba per head of population?

One doctor per 164 inhabitants.It used to be 1 per 168 but it has come down. We live as a poor nation but we die as a rich one.

What kind of effect does the US blockade still have on Cuba?

The US is isolating Cuba, and that is very costly for the country. For example, my hospital, the William Soler Children's Hospital in Havana, has 400 beds but it has only one X-ray machine, and that is more than 40 years old.

Are you short of medicines?

Thanks to European solidarity, there's a project in Europe called MediCuba in which they buy raw materials and send it to Cuba. We manufacture the medicines, and they are sold at the price it costs to manufacture them. So that organisation skirts the blockade, and it also encourages Cuba to promote its own pharmaceutical industry. We don't get all the materials we need, but it has been an important help. We buy other raw materials with funds from tourism.

Sometimes we have to use intermediaries because if the US detects who has been selling the raw materials to us, they sanction them. So it's very expensive for Cuba - and it's very difficult. Something that would normally cost $500, Cubans might have to pay $20,000 for it.

That sounds like you need your own full-blown pharmaceutical industry?

The objective of every country is to develop its own industry. It's not good for us to receive things if we are unable to produce them. While there has been some progress, I think that we are doing better in areas like biotechnology.

So Cuba has great ingenuity, but still very little in the way of scientific equipment or state-of-the-art technology?

Yes. It's a problem. But we manage, thanks to courageous companies who are interested in having their techniques used in Cuba. For example, when we started to deal with haemorrhagic dengue fever, we discovered that in Europe they were producing interferon. We learned from them, and now we are producing it better than those who taught us, because we have access to plenty of blood in Cuba and we can work with more certainty.

Why is that?

Because the people of Cuba will always donate blood. We have to tell them stop giving blood. When the Twin Towers were attacked, Cubans gave blood to New York citizens immediately - our quarrels are not with them - and it was sent. When there are catastrophes in South America or other places, Cubans always give blood. We think that the duty of a nation is to help other nations, and we can do it. It is beautiful. It is important to feel good with yourself, and Cuban people feel satisfied when they do this type of thing. I think they are very positive things. And we've got to do more.

You've worked as a doctor all your working life - and now you are also speaking for Cuba at all sorts of international events.

I've been a doctor since I was 23. I'm now 43 and I've been campaigning round the world for a while, since my daughters were grown up. But before that I was working a lot behind the scenes.

Should science have a higher profile with people who say another world is possible?

We who are of the left are fighting so that there will be more people in the world who will have all of the possibilities. I think that for us science is crucial, starting from the way we use our resources to the way we will be able to use whatever comes to us. For example, in the early 1960s my dad said that he would like to study nuclear science because at the time it was something from the future.

He also wanted to bring it into perspective, bearing in mind the realities of the planet - to develop science without killing the world. That is something we must bring back in our time. The challenge is to make use of the very interesting scientific developments that are being carried out without destroying the environment. There has to be a balance.

What about the relationship between indigenous peoples and science. What have you learned from your travels?

There are big issues here. Many people say that Africans, for example, don't know how to make use of science. But those people don't realise that for Africans there is an element of survival attached to it. If they accept all the scientific development and the industrial development that the white man gives them, then they lose their own culture and they lose the opportunity of being able to keep their land. So we must take care when dealing with aboriginal peoples. We must bring science to them without breaking their important traditions.

Indigenous people can teach us a lot of things. For example, when I was visiting a tribe in Venezuela, a woman said she didn't want to be seen by a white doctor. Why? Because, she said: "What is the link between my name and the pain I feel?" Then I realised that as a doctor the first thing I did when a patient came to see me was to ask for their name, surname, address, age - and only then did I ask what the matter was. The indigenous lady taught me that the first thing I should ask is what's the matter. These are all small things that modify human behaviour.

What would your father have thought of what you do now?

If he were alive I wouldn't be doing it. I would be next to him all the time.

Is he still your hero?

Yes. No doubt about it. He is the most complete man I've ever met.

Do you remember him clearly from when you were a little girl?

I remember very few things as a small child, but my mother loved him very much and she brought that to us and taught us about him. We found out a lot more as we read all the unpublished and published material about him, like The Motorcycle Diaries. That's natural: he became not only my dad, he's now my friend, my teacher. He is very important for me.

Do you still talk to Fidel Castro?

Not as much as I would like. We do speak. He loves me very much like an uncle, and I love him. He says sometimes he dreams my father is still alive.

Poor but proud

Few Cubans would be surprised to know how highly the UN rates their country's level of development. Its 2004 Human Development Report consistently ranks Cuba in the top band, outranking middle-band nations such as Belarus and Bangladesh, and far ahead of the likes of Burkina Faso, Niger and Sierra Leone.

The national health spend shows Cuba allocating just over 7 per cent of GDP to healthcare, amounting to $229 per capita, compared with 13.9 per cent and $4887 per capita in the US, and 7.6 per cent and $1989 in the UK.

Despite the low per-capita spend, life expectancy at birth is an 76.7 years (77 in the US and 78.1 in the UK). Infant mortality has fallen from 34 per 1000 live births in 1970 to 7 per 100,000 now; in the same period, the US figure fell from 20 to 7, and the UK from 18 to 5. Some 98 per cent of Cuban 1-year-olds are fully immunised against measles (91 per cent in the US, 83 per cent in the UK). Cubans, Americans and Britons all have the same level (95 to 100 per cent) of "sustainable access to affordable essential drugs".

Medical excellence

One of the biggest differences is the number of doctors, and here Cuba is streets ahead. According to the UN report, Cuba boasts a total of 596 physicians per 100,000 people, while the US has 279 and the UK only 164. Patrick Pietroni, who organised two GP study trips from the UK to Cuba in 2000 and 2001, says Cuba has a family doctor for every 500 to 700 people, compared with one per 1800 to 2000 in the UK.

Medical exports and services are ranked sixth in the country's economy, earning foreign exchange worth $250 million in 2002, of which biotech contributed $150 million. The country's researchers discovered a meningitis-B vaccine in the late 1980s, which GlaxoSmithKline plans to market under licence in Europe and possibly in the US. Over the past few years, the biggest earner has been a hepatitis-B vaccine, which Cuba has exported to more than 30 countries.

Finding a bigger foothold in the international pharmaceutical game will be tough going, given the US blockade. But Cuba does have some joint-venture European partners to help with the costly process of developing cancer treatments, including the promising TheraCIM h-R3 for head and neck cancer.

http://www.newscientist.com/article.ns?id=mg18424776.200

Earth, a planet hungry for peace

Apartheid Wall


The Israeli Land-Grab Apartheid Wall built inside the Palestinian territories, here separating Abu Dis from occupied East Jerusalem. (IPC, 7/4/04).

The Israeli apartheid (security) wall around Palestinian population centers in the West Bank, like a Python. (Alquds,10/25/03).

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