CastroCare In Crisis: Mounting Strains
August 23, 2010
For years, Cuban hospital patients have needed to provide their own syringes, bed sheets and towels. Some say they fear getting infections while visiting clinics because of shortages of soap, disinfectants and sterile equipment, says Laurie Garrett, a senior fellow for health at the Council on Foreign Relations.
A preventable form of cancer, cervical carcinoma, now ranks as the fourth leading cause of death for Cuban women:
- In most of the world, cervical cancer is on the decline thanks to annual gynecological screenings (with the Pap test) and the use of the human papillomavirus vaccine.
- In Cuba, however, the number of routine Pap tests performed has fallen by more than 30 percent and the number of diagnosed cervical cancer cases has doubled since 1985, according to the country's 2008 Annual Health Statistics report.
- Cervical cancer is the number one malignancy for Cuban women aged 15-44.
- Some women say they no longer undergo routine gynecological exams and prevent their young daughters from doing so because they fear infection from unhygienic equipment and practices.
Another problem in Cuba's health picture is maternal mortality. Because the country's birthrate is low and its population is aging, the state has placed great emphasis on infant care and survival. But this effort has meant paying insufficient attention to postpartum maternal care, says Garrett:
- Mothers often are forgotten after childbirth, and most deaths occur during delivery or within the next 48 hours and are caused by uterine hemorrhage or postpartum sepsis.
- Cuba also has unusually high rates of death among women with histories of induced abortion, a very common procedure there.
Cuba's doctors are increasingly strained, says Garrett:
- Physicians return from years abroad because they must, both contractually and to avoid repercussions for their relatives in Cuba.
- They then must accept whatever assignments the government gives them, including sometimes years of service in a remote village, a Havana slum or a sparsely populated tobacco-growing area.
- Many doctors and nurses leave the health care system altogether, taking jobs as taxi drivers or in hotels, where they can earn convertible currency.
- Large numbers of defections among doctors, meanwhile, have caused the Cuban regime to cut back on physician placements to some countries, such as South Africa.
Source: Laurie Garrett, "CastroCare in Crisis: Mounting Strains" Foreign Affairs, August 2010.
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