Cuban Medicine Today
by Dr. Hilda Molina, a former member the Cuban National Assembly, is one of Cuba's most distinguished scientists. She broke with the government on the issue of medical apartheid, the denial of medical care or medicine to Cubans while the same services are provided to dollar-paying foreign patients. In this report, smuggled out of the island, she says that she "opposed the use of Cuban patients as laboratory animals." Dr. Molina is founder of Havana's International Center for Neurological Restoration. She is a virtual hostage on the island, and despite repeated requests, she and her elderly mother have not been permitted to travel abroad.
Since I joined the health sector in 1968, the Cuban government has repeatedly asserted that "a central objective of the Revolution is the entitlement of free, quality medical care for everyone." The government systematically rejected the use of medicine as a means of making money. In 1989, Fidel Castro told me that he was "roundly opposed to charging for medical services," and that he "would even prefer that such services be given free of charge to foreigners who need them."
But, beginning in 1989, 1 began to notice an unfortunate change of attitude. Cuban authorities have established mechanisms designed to turn the medical system into a profit-making enterprise for the government. I witnessed this firsthand at the International Center for Neurological Restoration, which I directed from 1990-1994.
Beginning in 1989, Servimed (Servicios Médicos) of Cubanacán was strengthened to market "health tourism" and medical services to bring in additional foreign currency. Its representatives were toured worldwide to form relationships with international tour operators and doctors. These foreign associates were encouraged to recommend that their patients seek medical attention in Cuba, at a cost of roughly 10 to 20 percent of what it would cost in their own countries.
Cuban hospital directors who had sufficient facilities to treat patients from other nations were urged to accept foreigners' applications for treatment. Though the government, not the hospital, received the foreign patients' medical payments, the hospital directors were encouraged to devote a specific percentage of their budget (normally between 30 and 60 percent, depending on the time of year) towards this end.
II. Cuban Medical Services for Foreign Income
There are several significant flaws in this new Cuban medical system. Foreign patients are routinely inadequately or falsely informed about their medical conditions to increase their medical bills or to hide the fact that Cuba often advertises medical services it is unable to provide. Patients are often forced to pay intermediaries fees in excess of the 10 to 20 percent benchmark established by the Cuban government. There is also a deficiency of medical attention for both foreign patients and Cubans.
The lack of adequate professional qualifications, the absence of medical ethics, and the drive toward financial enrichment also characterize Cuba's medical system and often yield unfortunate results.
At present, all the medical institutions that government leaders believe are minimally equipped to treat foreign patients have been informed that the government will no longer provide financial support. Instead, they are expected to support themselves by selling their services. With the exception of the International Center for Neurological Restoration, these hospitals have not yet raised enough resources to cover their costs.
The driving force of this shift away from traditional primary healthcare goals towards making a profit has been Servimed's bureaucratic supervisors, who often have scant medical background and whose primary responsibility is soliciting foreign income. Servimed has associated itself with tour operators (some with questionable reputations) who also do not possess any medical qualifications. Fraudulent and corrupt relations exist between Servimed's authorities and their foreign correspondents, who are both illicitly enriched at the expense of sick people.
Authorities are careful not to distinguish individual Cuban medical specialists, but instead keep everything anonymous ("The quality of Cuban medicine is in its totality an achievement of the Revolution"). This ensures that foreign patients are channeled through Servimed, rather than directly to the hospitals, and facilitates the Cuban government's collection of foreign currency while scoring propaganda points abroad.
Foreign income earned from the sale of medical services goes directly to the Banco Interno de Cubanancón, a state agency. According to the Bank's director, this money is generally used to finance foreign trips by Castro and high-ranking functionaries. While in theory, the hospitals responsible for raising this money are authorized to draw between 30 to 60 percent of their contributions from the Bank, the reality is that the government often denies these financial transfers, demanding self-sufficiency.
I OPPOSED THE EFFORTS OF DR. OBESO TO EXPORT FETAL TISSUE FOR EXPERIMENTAL USE. IN ORDER TO GET FETAL TISSUE, UNWITTING DONORS WERE DECEIVED INTO HAVING CESAREAN SECTIONS, AND THEN EMBRYO'S DESTINY WAS HIDDEN FORM THEM.
The government's myth that Cuba is on healthcare's cutting edge attracts desperate patients whom Cuban hospitals are not actually in a position to help. It is common for Cuban hospitals to advertise services that they do not have the resources to perform. Moreover, they are incapable of guaranteeing results superior to what patients might expect in their own countries. As a result, patients are often inadequately or falsely informed about their condition and steered toward services they may not need.
For example, all hospitals are under orders to prescribe Cuban-made drugs to patients, including PPG (the so-called Api-farmacos), and products manufactured by Labiofam and by the Center of Hemoderivados, even when they are not needed. Each hospital keeps scrupulous monthly sales records of these products and hospital directors are required to give an explanation when sales do not reach quotas.
In hospitals that treat both Cubans and foreigners, there is an enormous disparity in the quality of healthcare services. Medical services are often immobilized by a lack of resources, so the government is sometimes forced to authorize budgetary allotments as rewards for hospitals that give priority to foreign patients over Cuban.
The Orthopedic Hospital "Frank País"
Although this hospital is open to both Cubans and foreigners, enormous differences exist between the quality of care offered to each. The foreigners are assigned the highest priority, followed by government functionaries and their families, followed by athletes with good records of performance, then dancers, and lastly, ordinary Cuban patients.
Foreign patients are often pressured to have unnecessary operations and treatments to increase the hospital's earnings. In the drive for capital, doctors also feel obliged to perform surgical procedures that they have not fully mastered or that lack scientific backing, such as nerve transplants to the spinal medulla in patients with medullar lesions. Casts and numerous orthopedic devices manufactured at this hospital, and prescribed for foreign patients, are also often unnecessary and sold at excessively high prices.
Dr. Rodrigo Alvarez Cambras, the hospital's director, claims to have developed the transposal of the Omentum Majus to the spinal medullary in patients with medullar lesions, though its originator was the American professor Harry Goldsmith, who introduced the technique into Cuba with me in 1987. Far more serious, Dr. Cambras carries out the procedure erroneously, due to a lack of knowledge of its underlying principles. The result? It does patients more harm than good.
Unfortunately, Dr. Cambras's close friendship with the Minister of Public Health has allowed him to live in a state of near-total impunity in Cuba. The hospital has failed to be self-sufficient because of its excessive costs and mismanagement, and because initial investment and subsequent improvements were excessively costly. Costs have also been increased by administrative disorder and Cambra's habit of traveling abroad at government expense with members of his family.
This institution is replete with large numbers of professionals and technicians who have limited qualifications, resulting in lack of attention to patients and inefficient rehabilitation. Paraplegia and quadriplegia cause enormous psychological problems in patients, many of whom become suicidal. Others lose all sense of control. Unfortunately, hospital authorities take advantage of these dire circumstances; these patients can be found consuming alcoholic beverages (boosting the government's profits on liquor sales) during the hours that they should be spending in physical therapy.
In many hospitals, either with the indulgence (or ignorance) of hospital authorities, the following kinds of incidents often occur:
- Hospital workers demand extra payments from patients in exchange for better service.
- Hospital workers have sexual relations with patients (including the handicapped) and/or those traveling with them, in hopes of obtaining bribes and gifts. There is also prostitution on the part of both sexes.
- Hospital workers sexually abuse some patients
- Patients are pressured to obtain permission and money for hospital workers to leave Cuba in exchange for low cost medical services in the patient's home country. Recently, hundreds of hospital personnel (nurses, rehabilitation specialists, doctors, service personnel) have successfully left Cuba this way. Often, their patients are then abandoned.
- Patients' and companions' money and personal effects are stolen.
- Patients are obliged to pay prearranged ranged fees, then fail to receive the services promised.
- Patients suffer avoidable complications such as dermatological infections or gastroenteritis (because of insufficient sanitary precautions in food preparation).
- Patients show no improvement after their treatment or even worsen because of misdiagnoses or incorrect treatment.
III. My Experiences with Cuba's Health Care System
Inspired by developments in the new scientific field of neurological restoration, in 1987 I led a small group of specialists in the neurosciences in creating the first Cuban research hospital dedicated to work in this area. After much negotiation and extensive efforts, our plan was approved. We were given a semi-destroyed house on Avenida 25 for experimental laboratories, the nineteenth floor of the Hospital "Hermanos Ameijeiras" for consulting facilities, and a budget of $3 00,000 (US) to construct and maintain our Center. With a small group of workers we trained an inefficient construction brigade, readied the facilities and acquired a minimal amount of equipment. Our work was initially limited to Cuban patients. The institution applied research and intensive, personalized neurorestorative treatment to patients affected by Parkinson's disease, cerebrovascular illnesses, lesions of the spinal medulla, relative alterations to cerebral aging, cerebral tumors, and craneocephalic trauma.
Hospital "Hermanos Ameijeiras"
This Center is comparable to any low quality private Latin American clinic. Although its facilities have been extraordinarily expensive to install and maintain, services have deteriorated rapidly due to a poor record of maintenance and a lack of government funding.
The Hospital Board, particularly its director, Dr. Raul Gómez Cabrera, systematically hides or minimizes the institution's deficiencies. This irresponsible approach, dangerous in any healthcare facility, has led to a general deterioration in plant and equipment, and to the collapse of any sense of ethical obligation on the part of the staff.
The enormous negligence found in the intensive care unit is worthy of mention. [While it was directed by Dr. Negrín various patients died there, personnel of the hospital assured me]. The energetic arguments I had, and the efforts I made to rectify negative situations were not adequately addressed by the authorities. Rather, I found them impervious to the problem, firmly supportive of Dr. Gómez Cabrera and his subordinates, and inclined to criticize me for raising the issue at all.
These new therapeutic methods employed state-of-the-art neuropharmaceutics, neurorestorative surgical techniques, integral and intensive neurorehabilitation, and biophysical stimulation. The Center could also perform brain transplants, first of the medulla suprarenal; later, the tejido nervioso embrionario in patients with Parkinson's disease.
The Center developed rapidly, generating increased support from foreign researchers and increased demand for services among foreign patients. As a result, we were assigned a larger facility, completing construction of the new hospital within a year.
Fidel Castro seemed fascinated by the Center's results and, particularly, by its international prestige. He visited numerous times, showing that he was personally assigning a high priority to our Center and goading other institutions to achieve similar progress.
Center of Medical-Surgical Research (CIMEQ) This institution provides services only for Cuba's elites, diplomats and leaders of international governments friendly to the Cuban authorities, leaders of international revolutionary movements in other countries supported by Cuba, fugitives from justice in their own countries and international figures who have been granted asylum here. This Center has been placed in a separate area and enjoys resources and luxuries rarely found in Cuba.
The Center recently decided to broaden its activities to provide services to foreign patients willing to pay in US dollars. However, this hospital is incapable of offering services different from, or better than, treatment people could receive in their own countries. Foreign patients are obliged to share their facilities with military personnel, since the hospital functions in many ways as a military installation. Hospital authorities work closely with unscrupulous recruiters abroad who funnel patients to it via misleading information. The services offered to foreign patients are inefficient. This is particularly the case in the intensive care unit.
Although this hospital always enjoyed the support of the late Interior Minister, General José Abrahantes, there have been incidents of corruption and illicit diversion of funds. There also is evidence that Abrahantes used it to cover up his own trafficking in narcotics.
However, differences and confrontations between the directorate of the Center (which I headed), and the Provincial Communist Party, the Ministry of Public Health, and other government authorities soon emerged. I never attempted to forge special friendships with political leaders nor did I allow them privileged access to the services of the Center. I did not participate in their parties and attended only those required by protocol, remaining the minimum time possible. I did not ask for, or receive, benefits of any other kind from the Cuban government.
Ignoring Cuban government restrictions, we established direct relationships with the international scientific community to encourage the rigor and responsibility of our work and to enrich our medical knowledge. This put the Center's staff in a different situation than most Cuban biomedical researchers who remain in scientific isolation with the international community, avoiding the rigorous demands and accountability. Cuban authorities were not in favor of the Center's approach because it demonstrated to the international community that the US economic embargo did not have to affect scientific work. It also revealed the superficiality, irresponsibility, and even scientific cowardice of other Cuban institutions. I was considered a threat because I regularly obtained visas to enter the United States while other Cuban scientists were denied them.
THE INTERNATIONAL CENTER FOR NEUROLOGICAL RESTORATION IS NOW LIMITED TO FOREIGN PATIENTS WHO CAN PAY IN US DOLLARS.
I also refused to engage in political propaganda during my scientific visits abroad and refused to participate in the Cuban government's efforts to recruit foreign scientists for nonmedical tasks. Despite government opposition, the Center managed to maintain contact with the world's most prestigious neurological restoration specialists.
Central Clinic "Cira García,"
This clinic was the first Cuban institution established to provide medical services to foreign patients capable of paying in US dollars. I do not possess much in-depth information about its current operations, but I do know that the problems plaguing the aforementioned institutions also exist here. A succession of directors has come and gone for various reasons: inefficiency, misuse of funds and financial deals with patients or their families. This institution is equivalent to any other private hospital in Latin America where standards are either mediocre or of low quality. The international patients who come here for treatment could receive the same services in their own countries: there is no benefit to spending additional money to travel to Cuba.
The propaganda being broadcast abroad, advertising the Clinic's services, is full of misrepresentations and false promises. For example, the Clinic claims to have a "very effective" treatment for multiple sclerosis that has generated enormous hope to thousands of MS patients and their families. However, the centerpiece of this treatment is a Cuban drug called Timocina, and many patients travel internationally to this clinic without ever obtaining Timocina or other forms of treatment that might improve their condition.
The Clinic's doctors are poorly prepared professionally, so the majority of services rendered are actually carried out by specialists from other hospitals who work on an ad-hoc basis as outside consultants. As a consequence, the patients in residence receive only sporadic attention from qualified professionals.
The Center selected personnel based on merit, contracting employees only after a trial period during which they had to demonstrate their scientific and moral qualifications as a capable healthcare worker. Those who failed to do so were promptly dismissed. We firmly refused to rehire such people, despite the Provincial Communist Party's pressure on us to take back even people found guilty of serious crimes.
I was also prohibited from and criticized for attempting to create a chapel at the Center for those patients who wanted to worship.
Another area of confrontation with the government was the Center's determination to provide the same services to both Cuban and foreign patients, contrary to official instructions. Although I accepted requests to increase the number of foreign patients, we attempted to eliminate the role of Servimed and its foreign representatives, establishing direct links to the foreign patients instead. This enabled us to provide the patients with more rapid and efficient service, and relieved them of the fees to Servimed and its correspondents. Hospital workers used the gratuities they were sometimes given by foreign patients to purchase basic necessities such as soap and milk, rather than sending it to the Provincial party officials as was required.
Rehabilitation Hospital "Julio Diaz, "Pediatric Hospitals "William Soler" and "Juan Manuel Márquez"
These institutions do not possess the resources required to guarantee even minimally adequate treatment. They are comparable to private clinics of low quality in any Latin American country, and despite misleading advertising, do not offer services that are different or superior in any way. The "Julio Díaz" Hospital advertises services in other countries that it is in no position to offer. The Hospital promotes a therapeutic procedure which it claims "cures paraplegics": the application of peripheral electro-stimulation, with devices manufactured in Cuba. The advertising for this therapy is full of misrepresentations, and the claims lack any scientific basis.
The nursing staff is deficient at all three centers, as are hygienic conditions. The doctors and technicians at "Julio Diaz" are especially incompetent. The specialists and technicians charged with rehabilitation possess limited qualifications, and many also have deficient medical and personal ethics.
As in the other hospitals I have mentioned, there is a significant difference in the quality of medical attention offered to Cuban and foreign patients. Even Cuban children are treated as second-class citizens.
I refused to prescribe unnecessary treatment to patients, although on many occasions I was pressured unsuccessfully to perform more operations to increase our income. I persuaded various international firms to donate drugs to be given free of charge to thousands of Cubans suffering from Parkinson's disease.
Although some of my fellow directors have (since my departure) surrendered to the pressures of the government either out of fear, opportunism, or some other cause, while I was in charge, they fully supported me in my confrontations with government authorities.
The International Center for the Treatment of Retinitis Pigmentosa "Camilo Cienfuegos"
This Center is only open to foreign patients and specializes in retinitis pigmentosa, an incurable disease whose cause is perceived to be hereditary. The symptoms are serious, progressive alterations in vision and shrinkage of the visual field. The institution's director, Dr. Orfilio Pelaez, created a surgical treatment for this disease, but it has only caused improvement in very few cases, and to a very modest degree. Furthermore, it is impossible to buttress his results with solid scientific arguments. It is not surprising, therefore, that he has refused to discuss his work at any length with the international scientific community or to publish his findings on the grounds that he does not wish to have his techniques "stolen" from him. The Cuban government has repeatedly supported and defended these absurd ideas and practices.
To offer false hope to victims of this ailment is to dangle illusions before desperate people. Nonetheless, this is precisely what is occurring through the institution's massive propaganda campaign designed to attract thousands of international patients suffering from various kinds of optical defects.
A great number of patients who are suffering from other eye diseases (not retinitis pigmentosa) have been subject to this operation, following false diagnoses. Once this treatment begins, patients are pushed into two or three operations, followed by therapeutic treatments that include drugs, all of which increases the total cost to them and ensures larger returns for the Cuban government.
The Center has also dreamed up other methods to generate more foreign currency, including the hiring of health professionals and technicians for outpatient care. In spite of these profit-seeking measures, the Center has not managed to cover its costs. Ironically, Dr. Pelaez took his wife and son for costly medical treatment in the United States at a private clinic.
The government was determined to demonstrate that Cuba was actually more advanced in performing embryonic transplants than the United States and Sweden, and sought to prove this point by performing this technique on a massive scale, often overlooking internationally accepted procedures.
Government authorities expected me to comply with their plans to perform numerous embryonic transplants on foreign patients to make the procedure a major source of foreign income. However, I categorically refused to do the operation unless it was needed. The Center made a careful selection of cases which were subject to the strictest observation, as prescribed by international protocols. We welcomed prestigious international specialists and commissions to periodically evaluate our work. Cuban authorities criticized these elaborate measures, suggesting that we should "lighten up increase the number of operations, shorten hospital stays, and reduce overhead costs.
I also opposed efforts to carry out transplants through a highly risky surgical procedure that required a wide opening in the skull. I opposed the efforts of Dr. José Angel Obeso to perform functional surgery in cases of Parkinson's disease, judging them as too risky for patients and insufficiently studied. In other words, I opposed the use of Cuban patients as laboratory animals.
Instead, I pressured the government to purchase the necessary equipment to perform a noninvasive, low-risk procedure, with the same outcome. Only after my extensive efforts, and after the Center produced much more foreign income than was required to pay for the equipment, did the government approve the purchase so the transplants could safely proceed.
The procedure was limited to a handful of foreign patients: one Soviet, one Uruguayan, one Dominican and one Puerto Rican. In all cases no other options existed; in the first two cases, the operations were performed free of charge, although I have no way of knowing if Cubanacán imposed additional charges without telling us.
I opposed the efforts of Dr. Obeso to export fetal tissue for experimental use. In order to get fetal tissue, unwitting donors were deceived into having a Cesarean section, and then their embryos' destiny was hidden
From them, It was argued that a Cesarean facilitated easier access to the fetal tissue. I opposed this, and to ensure donor's safety, we bought a sophisticated ultrasound device and other equipment, which allowed us to abort through low-pressure transvaginal vacuuming, a relatively non-traumatic method. I also demanded that the donor be told the truth about the outcome of their fetus. However, when my son visited the Maternity Hospital in November and December 1993, we learned that the doctors had lied to us: Women continued to be deceived and subjected to unnecessary psychological pressures, while all the equipment we had donated was underutilized
IV. The Cuban Government and the Center
A permanent conflict between the Cuban leadership and our staff developed. The authorities used subtle methods of repression to bend our will, adopting measures intended to put us out of business. While they pretended to be cooperative, they withdrew all the financial contributions our Center warranted, so that we were forced to become self-financing within the country's tight Communist restrictions. They tried to reroute foreign patients to other institutions. They excluded me from everything they could and forbade me from accepting invitations to travel abroad. They repeatedly and randomly I inspected the Center. They unsuccessfully tried to organize whispering campaigns against the Center and against They introduced persons into the Center whose purpose was to sow dissent between management and staff. They promoted and supported protests among workers whom we had dismissed for immoral actions.
This led me to understand that the problems which, in my naiveté, I had attributed for years to individual errors, were part of a larger system; one with neither scruples nor any sense of ethics. I shared these judgments with other senior staff members. In retrospect, I believe one or more of them were in contact with State Security and passed on our ideas and purposes. We nonetheless decided to remain in Cuba in hope that we would be in a better position to carry out useful work.
In spite of our precautions, in December 1993, the Provincial party launched a campaign against me and attempted to politicize the Center. Our staff was forced to attend innumerable party organized meetings, interfering with patient care and operation schedules. The message from these meetings was clear: I was required to follow all the party's instructions. I was forced to rehire a group of rehabilitation specialists who Were members of the Communist Youth, despite the fact that they had been discharged for engaging in a range of illegal activities including robbery, sexual abuse, prostitution and extortion. I also was prohibited from giving resources to the Center's staff who were in deficit from government allotments and who were required to donate their tip money to the Provincial party.
In February 1994, 1 had a meet into discuss my leadership status with Dr. Julio Teja, the Minister of Public Health, and with Dr. Julión Alvarez, the Vice Minister of Science and Technology, whose agency had direct responsibility for our Center. Because of my scientific qualifications and international prestige, I could continue as the Center's director, but would be required to have a "political commissariat" functioning alongside me to ensure that the Center operated along government- prescribed lines.
Refusing to accept these conditions, I was relieved of my position. I subsequently resigned from the Center, the Communist Party, the Cuban Federation of Women and the National Assembly. My unexpected departure forced the government to ask Vice Minister Alvarez to keep his bureaucratic position and take over direction of the Center. (That's why Dr. Alvarez, a gastroenterologist now directs a hospital dedicated to the neurosciences.)
After my resignation, the authorities harassed me and attempted to discredit me both personally and professionally. They followed all my movements for at least two months, and during this entire period, an occupied automobile was always parked outside my house. They tapped my telephone (I also received various anonymous phone threats) and they intercepted and opened all my personal correspondence. My staff was intimidated and prohibited from speaking with me, and all areas of my work were scrutinized in an unsuccessful attempt to find some pretext for censuring my qualifications.
Their campaign against me was also aimed outside Cuba. All my communication with colleagues abroad was blocked. The authorities discredited my scientific reputation and tried to send other specialists in my place to the medical congresses to which I was invited, though foreign scientists refused to accept the replacements. The government went so far as to try to "expropriate" my foreign professional friendships. They tried to "buy" many of the specialists with whom I had established professional relations. This tactic met with limited success.
IN HOSPITALS THAT TREAT BOTH CUBANS AND FOREIGNERS, THERE IS AN ENORMOUS DISPARITY IN THE QUALITY OF HEALTHCARE SERVICES.
My family was also affected, When my son and his wife prepared to visit Japan, both were detained at the airport and were subject to a brutal assault and incredible harassment. They had obtained all the necessary travel documentation, but it appeared that they would be forbidden to travel. Though they managed to leave two hours later, I sent an energetic letter of protest to the authorities, demanding an explanation. Their reply referred to my scientific and professional merits, and begged apologies, alleging that "there had been a regrettable confusion in the course of a sweep intended to capture someone who was traveling on a false passport."
Since I was removed as Director of the Center, Cuban patients have been given treatment inferior to that given to foreign patients. The hospital facility is now limited to foreign patients who can pay in US dollars, leaders and bureaucrats of the regime and their friends and family. Everyone else is required to be treated in an annex that lacks many basic facilities. The Cuban victims of Parkinson's disease are not guaranteed the scarce and expensive drugs they need, and the practice of prescribing unnecessary Cuban drugs continues.
The quality of the Center's staff has diminished. There has been a proliferation of acts of robbery, corruption and illegal diversion of funds. Hospital workers are clandestinely promoting and selling medicine to patients. (The drugs in question could be adulterated or fake.) Continuing scientific and professional staff education has been replaced by unproductive, demagogic political assemblies, since far greater emphasis is now placed on the Center's role in propagandizing the supposed virtues of the regime. The Center has lost complete contact with the international scientific community, largely because specialists in other countries refuse to work with an institution so heavily politicized and so sloppy in its professional discipline.
The Center advertises and performs restoration surgery, yet the specialist assigned to this work is a generalist and possesses neither the proper qualifications nor the necessary training. Soon the Center will carry out functional surgery on patients suffering from Parkinson's disease, a form of treatment which has not been adequately studied. These operations will also be carried out by young, unqualified physicians. Many of the professionals charged with rehabilitating patients have been trained in education or sports and thus lack the proper background to deal with neurological patients. The wavering attention to hygiene in the preparation of food in the hospital has frequently resulted in cases of gastroenteritis and enterocolitis. Obscure practices have invaded the institution --even in the presence of patients, procedures of santería and witchcraft are practiced.
Since February of 1994, the negative practices I outlined earlier have become standard in all Cuban hospitals that sell medical services to foreign patients. The main objective of many Cuban hospitals is generating foreign cur currency, by any means necessary. International relationships are driven by business logic and the need to make a profit. Acting as intermediaries, unscrupulous foreigners promote Cuba's services and recruit patients, many of whom are subject to deception or fraud. For example, through an association with the Italian businessman Guiseppe Dell'Osso, drugs past their expiration dates are promoted and sold at excessively high prices. Quite frequently, unnecessary surgical procedures are recommended just to generate more income. The operations are carried out by young physicians who lack the necessary experience or knowledge to perform them successfully.
Why have I taken the trouble to write down all these terrible situations? Because I hope it will convey the unscrupulous nature of the Cuban authorities regarding the provision of medical services as an income source. I hope that it illustrates how those same authorities are capable of destroying work that benefited thousands of sick people, and attacking individuals who have committed no crime, save to defend ethical and moral values and to refuse to bend to government pressure. I am not moved by any personal interest, much less by a desire for revenge. But I do consider it my obligation as a physician to defend both ethics and truth. Let those who read these pages do with the information what they consider best.
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