Thursday, September 27, 2012

Cuba Surgeons Write to Raul Castro About Disastrous Health Care System

Cuba Surgeons Write to Raul Castro About Disastrous Health Care System
Translating Cuba

Open letter from the General Surgery Department of the "Calixto Garcia"
Hospital to the First Secretary of the Cuban Communist Party and
President of the Councils of State and Ministers, Army General Raul
Castro Ruz

To be good is the only way to be happy.
To be cultured is the only way to be free.
But, given human nature, one needs to be prosperous to be good.
José Martí

The "Calixto Garcia" hospital in Havana takes as its mission to provide
specialized preventative-curative medical care and rehabilitation
without interruption to the population through high-quality medical care
and high professional standards [1]. With its 100-year history it has
been a permanent school of surgeons in the country, and an important
element in our country's struggle for independence; many of our
professors were clandestine combatants [2] and brilliant doctors on
international medical missions of great importance.

Surgeons at the hospital, respecting the Hippocratic Oath [3], have
historically been characterized as being critical and self-critical, but
especially combative in the face of difficulties, bad decisions taken,
and the multiple errors that affect our nation, and that little by
little are endangering the future, taking health as a pillar of the
transformations arising in the Revolutionary period, and our duty to
provide a professional and dignified medical care, in accord with the
scientific advances of the 21st century.

After countless reports to the head of the service, hospital management,
discussions within the core of the Cuban Communist Party, and our long
standing inability to participate in discussion at other levels with the
leaders of the ministry, where medical personnel present their
uncensored opinions [8] and ways to solve the major problems currently
plaguing the health sector, which include everything from training to
direct care, a group of surgeons felt it their elementary duty [8, 9,
10] and agreed to send this letter to the head of the service, for the
sole purpose of informing him of the extremely serious elements in
healthcare delivery to the Cuban people, which apparently at this time
when it is happening in public health in general, and in our hospital in
particular, the lack of immediate plans to resolve them are unknown by
the top political leadership of the country, contrasting inversely with
the official discourse of our media.

Medical care, and especially surgery in our center is a great disaster,
characterized by:

A hospital with a destroyed physical structure, due to its age and
innumerable poor quality and short-term repairs.
A lack of important resources for the care of patients, because of
inadequate distribution, insufficient management, or excess work because
of the reduction of this activity in other hospitals for similar reasons.
Human mental deterioration accompanied by the loss of the minimum
attention to the person, who spends long days of free labor for a
significant number of hours, and in a country where the "free perks"
have been ended, and where working conditions are below those of any
poor place in the world.

In our hospital the surgical services have been declining and the number
of operating rooms has been reduced from about 30 for all specialties to
no more than 10 at present, which although greatly destroyed still
provide this vital service to the people. The irregularities in these
operating rooms, their constantly broken air conditioning, lack of
water, lack of adequate equipment in some of them, means that cancer
patients cannot be operated on in time in our institution, others with
benign conditions, susceptible to immediate treatment when diagnosed,
develop complications because of delays in the resolution of their problems.

And as if that weren't enough, the urgent conditions also present great
difficulties. These, which constitute an important number of cases, are
referred from some other place in the city, many times transferred
poorly, which puts the lives of these patients in danger and even kills
them when theoretically this could have been avoided. Despite the fact
this this is the only surgical priority this hospital serves a good part
of the time, they must sometimes wait more than 24 hours between their
arrival and their emergency surgery, mainly because of the lack of
available operating rooms and of sufficient and adequate personnel, but
also because of the physical exhaustion of the doctors who raise these
issues and raise them again and discuss these problems at every possible
level and/or a good part of the time put the responsibility on the
orderlies, cleaners, and in addition put the full responsibility for
sick patients on their families, the sick patients themselves, and society.

The deficiencies in the health care system are so serious, in our
opinion, that we are forced by these issues and others of resources that
continue in a temporary or permanent way, to provide care to our people
that is not professionally ethical or dignified, as is our sacred duty.

Moreover, the repairs undertaken at our hospital, that have been
underway for more than 10 years, have done little to change the
unviability of a horizontal hospital in current times; the majority of
the repairs are putting make-up on old buildings, performed with
terrible quality and, of course, lasting a short time, which increases
the frequency of new repairs.

Rooms that have waited 10 years for repairs, today crumble four months
after they open, with the first downpour; leaks, collapses of the false
ceilings, and a number of important areas declared inhabitable, are a
daily fact of life in our work and our patients' stays.

The suspension of operations because of the weather, water, insufficient
rooms, or whatever cause, is no longer unforeseen but rather is
commonplace. As the operating rooms are no longer available to solve the
problems of the patients, now it is us, the surgeons, who must
prioritize one or another patient in an an unfortunate and exhausting
search for surgical opportunities for a Cuban whom we only know, sadly,
because of his illness.

The only thing we need to add to this depressing picture is the working
conditions of the doctors and the personnel in general, starting with
wages that are not enough to support a family, degrading working
conditions; including lack of a place to rest during long days of
surgery or work, the several miles walked between rooms, in the dust,
the sun, and many times the rain; the terrible quality and quantify of
food; the lack of a decent place to take care of one's physiological
needs; and no showers to cool off in the intense heat or to clean up
before contaminating a surgery, almost force us, when they become
permanent, to change our mentality.

The fatigue leads to well studied complications [4, 5, 6, 7]; if on top
of that we add the ridiculous figure of 2-1/2 gallons of gas a month for
those fortunate enough to have cars, not even enough to go to and from
work for the first week of the month, among many other mistreatments; it
all completes the picture of deteriorations that definitely have a
bearing on the medical care that is offered to the people.
Today it is impossible to ask doctors, even with a car, to come to the
hospital in the middle of the night to check on their surgical patients,
or to come on Sunday, as was common among surgeons historically; and
what's more it's impossible to ask them to perform a new operation on a
patient with complications at 10 PM and you don't have to be very
intelligent to know what happens with a case when a patient has been
repeatedly operated on five times by different surgeons.

We believe that this situation generates unquestionably disastrous
complications in patients, where studies show that after six hours of
work of a surgeon's complications multiply [4, 5, 6, 7]; and of course,
that's talking about working with appropriate comfort. Also in many
cases, death, which we cause when we have a terminal patient with almost
no hope; it is not ethically dignified because we can't do for him what
he deserves or should have, at the time it should be done: we have
multiple examples from all the surgeons who work in this hospital, and
the great number of the population who observe and criticize, that what
is said in the media has no connection to our country and our hospitals.

We think that our government has a commitment in all this, because it
exists to meet the needs of the people, to solve the problems of the
people, of the workers, simply because they are responsible for
maintaining the hospitals, for properly training the workers in a high
quality and fair educational system, for developing an ethical education
consistent with the work they will be doing, or anyone thinks why do
doctors, engineers, builders undertake the missions they do in their
work: they do it because their work makes things better, for their
family and the society they live in, but unfortunately that is only
achieved in our country by leaving it, leaving the country that gave us
birth [10], which is ours by right, and nobody, absolutely nobody, has
the right to take away our identity under any circumstances, and for
which we must give even our lives for our nation to remain independent.

The misfortunes narrated here do not come alone, they come about slowly
when the investment is maintained for years in the living standards of
the people with their ability and dedications, the socialist law well
known by everyone: "to everyone according to his work." When the
leaders, with their laws, decrees, special circulars, and their
decisions and provisions, are compromising the future, how long will we
thank the centenary generation for having fulfilled their duty and
obligation of liberating Cuba, while our generation wants to fulfill its
duty to develop and give our families, our children, our Cuban brothers,
the life they deserve, while the destructive tracks of corruption run
riot with a singular debauchery on every side of society where we turn
our gaze?

As José Martí said: "given human nature, one needs to be prosperous to
be good." The government is responsible for all this, not only for
knowing it, but also for fixing it. So, and before it's too late,
leading to events like those at the Mazorra hospital [where 40+ patients
starved and froze to death], we decided in this group of doctors,
sacrificing, hard-working, dedicated, ethical, and above all badly
treated, to report to you and to those responsible all of our concerns,
in our modest opinion serious ones, from this place so undervalued on
the social scale, which is the heroic and historical general surgery
service of the oldest hospital in our beloved country.

[3] Juramento Hipocrático.
[4] Editorial. Revista Canadian Medical Association Journal
[5] Journal of the American Medical Association

[8] "Now whomever wants to speak will speak, good or bad, but whoever
wants to will speak. Not as happened here, when only those who spoke
evil spoke, there will be freedom." Speech by Fidel Castro. Parque
Cespedes, Santiago de Cuba, on January 1, 1959.

[9] "… How can we say 'this is our homeland' if the homeland does not
have anything? 'My homeland', but my homeland does not give me anything,
my homeland does not sustain me, in my homeland I'm starving. That's not
a homeland! Will the homeland be for a few, but not a homeland for the
people. Homeland does not mean only a place where one can shout, talk
and walk without being killed; homeland is a place where you can live,
homeland is a place where you can work and earn an honest living, and
also earn what is fair pay for your work. Homeland is where the citizen
is not exploited, because if they exploit the citizen, if you take away
what belongs to him, if you steal what he has, that is not homeland."
Speech by Fidel Castro Ruz, at the Town Square of Camagüey, the January
4, 1959.

[10] "… it is precisely the tragedy of our people not to have a
homeland. And the best evidence, the best evidence that we have no
homeland is that tens of thousands of children of this land are leaving
Cuba for another country to live, but they have no homeland. And not
everyone who wants to leave goes, only those who can. And that's true
and you know it." Speech by Fidel Castro Ruz, at the Town Square of
Camagüey, the January 4, 1959.

Taken from, 22 September 2012

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