Renting Out Medical Specialists
Cuba: Renting Out Medical Specialists / Iván García
Ivan Garcia, 4 March 2017 — Twenty years later, Nivaldo (names changed),
43, an orthopedist, still remembers the hot morning when his parents
said goodbye to him in the old train station in a small village in the
depths of Cuba.
The economy of his native village, with narrow streets of cracked
asphalt and the small of cane juice, revolved around the sugar mill and
the usual thing was that grandfathers, fathers and grandsons worked in
the sugar industry.
It was a sugar mill town like many others. Squat brick houses half
plastered, a handful of white wood houses, guarded by five or six grungy
prefabricated buildings, built after Fidel Castro’s Revolution.
The present and future of the village was to drink alcohol distilled
from cane, playing baseball on scrub ground and taming some lost mare
around some stinking green creek.
But Nivaldo wasn’t a cane cutter nor a worker at the mill. He graduated
as a doctor on a rainy night in 1997 and after completing his social
service in a mountainous area of Santiago de Cuba, specialized in
When he stepped in Havana for the first time, like almost all the
country people, he took a photo at the base of the Capitol, and used a
finger to count the number of floors in the Habana Libre Hotel or the
“My dream was to be a doctor. Have a family and live according to my
professional status. I’m a specialist, I have a marvelous family, but in
order to maintain it I do things I’m not proud of.”
“I have been on international missions in South Africa, Pakistan and
Venezuela. Not out of conviction but simply to earn money and repair and
furnish my house. In Cuba it’s hard to find a doctor who hasn’t violated
the Hippocratic oath, and accepted gifts or money to maintain his
family. In the countries where I have worked, I’ve seen patients under
the table who have paid me. In Cuba I have groups of patients who’ve
given me gifts, a box of beer that costs sixty Cuban convertible pesos,
according to the seriousness of their suffering.”
On the Castro brother’s island a lot of things don’t work. You can wait
an hour and a half to get from one part of town to another because the
chaos that is public transport.
From the time you get up in the morning the problems accumulate.
There’s no water in the tank. There’s no money to buy a pair of shoes
for the kids. Or you have to eat whatever there is, not what you need or
Let’s not even talk about other things, also important for human beings,
like freedom of expression, the right to join a party other than the
communist party, or to elect the president of the Republic.
But healthcare, universal coverage, was the pride of the autocrat Fidel
Castro. It worked well as long as the former USSR was sending checks
worth millions and connected a pipeline of petroleum coming from the
Later with the fall of Soviet Communism the deficit came. Ruined
hospitals, nurses looking like police agents and missing medical
specialists. The Raul Castro regime tried to keep the the flagship of
the Revolution afloat, but it was taking on water everywhere.
The first ones who become fed up are the doctors. If not all of them, at
least a broad segment. The causes vary, but the keys are the low
salaries and the lack of recognition for their work.
Migdalia, a dermatologist points out that “for six years I earned 700
Cuban pesos — about 35 dollars — and the salary was barely enough for me
to buy fruits and vegetables at the market. Now I get 1,600 Cuban pesos
— almost 75 dollars — and it’s not enough either. So I accept patients
who give me bread and ham, or a piece of clothing, or money in cash, and
I give them personalized attention.”
Joel, an allergist, wonders why, if what the international media says is
true and the government gets between 7 and 8 billion dollars from the
sale of medical services, “they don’t pay us salaries consistent with
the inflation in the country. I was in Venezuela two years. The
neighbors gave me food and gave me gifts of clothing and things. Rather
than a doctor, I looked like a merchant buying stuff to sell when I came
back. I got to Cuba, after three years on a mission, between business
and the money I saved I had some four thousand dollars, not even enough
to rebuild my house. Now I’m chasing a mission in Trinidad and Tobago or
Qatar, but to get it you have to pay some official at the Ministry of
Public Health (MINSAP) some 400 or 500 bucks for them to put you on the
list. For these reasons, among others, many doctors decide to emigrate.”
If we credit the statistics, a little more than three thousand doctors
have deserted in the last seven years. Venezuela is a destination that
puts their lives at risk. The delirious criminality in the South
American country has provoked, according to a statistic from 2010, the
deaths of 67 Cuban health professionals.
The lack of high-quality specialists makes it difficult to care for
patients in Cuba. Daniel has been looking for an ear specialist for six
months to diagnose and treat a problem.
“They only treat you as am emergency in a hospital if you’re dying.
Diseases and symptoms that require lab tests, exams with equipment such
as cat scans or x-rays. can only be obtained quickly by paying with
money or gifts. Preventive medicine on the island is in crisis,” Daniel
Twice a month, Marta pays 10 Cuban convertible pesos (CUC) to the
dentist who sees her daughter. “It’s the only way to get high quality
care. If you don’t pay, and try to work through the system, they don’t
fix your mouth or they do it badly.”
Aida, who works for a bank, waited almost a year to get an appointment
with an allergist. “Her appointment at the polyclinic was once a month.
But she never went. With two little bites of ham, two soft drinks and 5
CUC I was able to get an allergist to see me. Then, if they see that you
have resources, then they stretch out the attention to get more money
out of you. Some doctors have become hucksters. It’s painful.”
When you go to appointments at hospitals, you see that the majority of
patients are bringing gifts for the doctor. But it can be a gift in
kind. Though many prefer cash.
Source: Cuba: Renting Out Medical Specialists / Iván García –
Translating Cuba –