The Doctors’ Revolution

Spring 2011

Dan Smith talks to Michael Tynan who has just completed a film on the Cuban health service which features an interview with Fidel Castro and draws on his decades of professional exchanges wth the island’s medics

Michael Tynan, Emeritus Professor of Paediatric Cardiology, first visited Cuba in 1987 to provide expert advice to a new children’s heart unit at the William Soler Hospital in Havana. Over 20 years later and Cuba is the only country in the world to offer foetal heart scanning as a standard part of pre-natal care, infant mortality is one of the lowest in the world and Michael has just finished making a documentary film - The Doctors’ Revolution - charting the struggle and success of Cuba’s health system.

Cuba first began to focus on pre-natal heart defects in the 1980s when infant mortality had been brought down to Western levels. Maternal obstetric care was sorted and children were no longer dying from curable diseases such as malnutrition and pneumonia. Tynan differentiates Cuba from other developing countries:

“In a Third World context, infant deaths resulting from heart disease are almost irrelevant because you’re more concerned with clean water and maternal care. As far as I can interpret, Cuba realised that congenital heart defects were an increasingly important proportion of the now pretty low infant mortality.”

The Doctors’ Revolution tells the story of a young boy, Felix, with a congenital narrowing of the aorta. Although it required major and potentially dangerous surgery, a relatively simple piece of equipment could have been used to open up the valve leading to Felix’s heart.

Unfortunately, due to the blockade, and aside from a complicated - and in Tynan’s view overly bureaucratic - procurement system, the hospital was unable to order the equipment internationally because it was manufactured in the United States.

Although there is scope for limited humanitarian medical exchange between the US and Cuba, Tynan explains that Cuba’s internationalism and record of offering healthcare to developing countries is seen by the US as an attempt to profiteer:

“Before Felix there seemed to be a tightening of restrictions. The United States government decided that equipment being exported to Cuba was being used by children from other countries and this contravened their rules. They assumed - because this is how healthcare in the West goes - that this was being done for financial gain so they intensified the embargo and wanted details of every child that was using the equipment. What right does the US government have to demand the medical history of a patient in another country? This turn of the screw meant there were long hold-ups and difficulties in getting specific pieces of equipment.”

The situation with the US government is further complicated because, if there is an irregularity, then the person liable for prosecution is the person responsible for where it originated in the States. As Tynan notes, this has resulted in medical equipment coming to Cuba from the US in very roundabout ways: “Things from America could go via France or Madagascar and, by the time they got to Cuba, they were more expensive because everybody had had their piece of the action along the way”.

Considering the intensification of the blockade, Cuba’s achievements in the field of healthcare - particularly in the areas of infant mortality, life expectancy and internationalism - are nothing short of miraculous. As far as Tynan is concerned, it is the organisation of the Cuban health system which lies at the heart of this success:

“The most impressive thing about the Cuban health service is the organisation of preventative medicine through the family practitioner. If you don’t take your insulin for your diabetes then the GP wants to know why and it’s not left to you to go along and ask for a prescription. That’s the most impressive thing - even more than the high-tech medicine.”

After the revolution, public healthcare was based on the Soviet model of the polyclinic and it wasn’t until the late 1970s that they moved to a family-centred model based on preventative and proactive medicine. There are still a high proportion of un-booked new born deliveries in Britain - but that’s very rare in Cuba because GPs live within the community they serve. As Tynan says:

“It’s very much a patient-family-community healthcare system. The number of doctors they have - and the number of nurses who are just as important - is amazing. They have as many doctors in Cuba for 11 million people as we have in Britain for 60 million.”

Cuba’s commitment to public health has been the heartbeat of their socialist programme - both domestically and internationally - since their struggle against Batista in the 1950s. Following the exodus of significant numbers of doctors after Castro’s victory, Cuba needed to train large numbers of doctors and nurses in a programme Tynan equates in size and significance to the literacy campaigns.

“It was central to their ideas when they started and I think it was intensified by their experience during the revolution in the Sierra Maestra. The enemy had cannons and tanks but they had a doctor - and the people had never seen a doctor before. The basic socialist ideas were reinforced by what they saw of the peasant life in rural areas. And of course Che Guevara must have had some input because he’d been through Latin America and seen various levels of healthcare,” states Tynan.

The diversity of the medical profession in Cuba testifies to the increased opportunities ushered in by the revolution. On Tynan’s first visit to Cuba he met a young doctor who attributed his success to the victory of the 26th July Movement:

“He was the son of a garage mechanic and, although it’s not beyond the realm of possibility that the son of a garage mechanic could become a doctor in England now, it was well beyond the realm of possibility in Cuba before the revolution. The medical school in Havana was dominated by the white middle-class of Spanish decent.”

Although called The Doctors’ Revolution - because Tynan himself and many of the people he interviews are doctors - Tynan recognises and praises the work of all health workers in Cuba:

“Just like any healthcare system the doctors are just the head on the beer. They have the most glamorous role but plenty of people would die after surgery if they didn’t have physiotherapy. Then there are all the radiology technicians whose expertise is central and the people working in pathology departments, dieticians, dentists and nurses.”

Cuba’s commitment to public health and its associated success - at home and around the world in developing countries and disaster zones - is not only remarkable considering the economic and political context in which it exists, but it stands as a shining beacon to the Western world of what is possible if you prioritise public health and international solidarity.