Remembering when Cuba was on the vanguard of medical research, and today’s dismal reality in the midst of an epidemiological crisis
“Cuba today is indeed a country of sick citizens who do not know exactly what they are suffering from. All they know is that they are being infected by “the virus” – a sinister ghost that has drifted across the entire island, wiping out its inhabitants. First come the high fevers, then red spots develop, or else peeling skin. Vomiting, diarrhea and headaches are inevitable. The hands and knees swell. Victims can barely stand on their feet, and there are those who have not walked again even after the worst is over. A limp indicates a virus survivor.”
The disease is in fact a combination of several mosquito-borne viruses, a model of “combined arboviruses” that includes dengue, Oropouche and chikungunya, as well as other respiratory viruses such as H1N influenza, respiratory syncytial virus, and Covid-19. According to figures published by the Ministry of Public Health, 5,717 new cases of chikungunya were reported in the last week, bringing the number of patients suffering from it to 38,938. As for dengue, the ministry said the disease remains active in the country’s 14 provinces and 113 municipalities.
An alarming 33 deaths were reported at the beginning of the week which the government was forced to recognize, including 21 minors – the demographic most affected by these arboviruses along with the elderly. “There are many one-month-old children who have died, and also those between two and four years of age, as well as other young people, because the vomiting and diarrhea dehydrates them and they arrive at the hospital already in a state of collapse,” a worker at the Institute of Hematology and Immunology of El Vedado told El PAÍS on condition of anonymity.
Pre-Castro Cuba’s healthcare system was superior to what came after 1959
Carlos J. Finlay, pioneering Cuban doctor
Carlos Juan Finlay (1833-1915), a Cuban epidemiologist, discovered that yellow fever was transmitted from infected to healthy humans by a mosquito vector. Dr. Finlay identified that the carrier of yellow fever was the mosquito Culex fasciatus, today known as Aedes aegypti. Finlay’s career began under the Spanish colony and continued into the early years of the Cuban Republic. Dr. Finlay was nominated for the Nobel Prize in Medicine seven times ( in 1905, 1906, 1907, 1912, 1913, 1914, and 1915). .
However, he was not the only great Cuban doctor to become internationally renowned.
Dr. Agustin Walfredo Castellanos
Dr. Castellanos described “the first practical method of angiocardiography, with which he studied several congenital malformations of the heart. Also, he designed the first automatic angiocardiographic injection device. He also pioneered the method of retrograde injection of contrast material into the aorta which was mainly used to diagnose patent ductus arteriosus.”
Angiocardiography, according to Merriam Webster is “the radiographic visualization of the heart and its blood vessels after injection of a radiopaque substance.
Dr. Castellanos and his colleagues published the first important paper on the clinical applications of intravenous angiocardiography in the Archivos de la Sociedad de Estudios Clinicos in 1937. Cuban medicine prior to 1959 was not just groundbreaking in basic research, but also in public health.
Cuban doctors in the 1930s provided the breakthrough that made above images possible.
However there are other Cuban healthcare professionals nominated for the Nobel Prize in Medicine.
Dr. Arístides Agramonte y Simoni (1868–1931)a key member of the Walter Reed Commission, he provided the experimental proof for Finlay’s yellow fever theory.Dr. Agramonte y Simoni was nominated six times for the Nobel Prize in Medicine in 1903, 1912, 1913, 1914, 1915, and 1917.
Dr. Arístides Agramonte y Simoni
The record on healthcare in pre-1959 Cuba goes beyond these individual examples of excellence, but also systemic superiority.
Professor James W. McGuire and Laura B. Frankel in their paperpublished in the Latin American Research Review, “Mortality Decline in Cuba, 1900-1959: Patterns, Comparisons, and Causes” found that “Cuba’s progress relative to other Latin American countries at reducing infant mortality was even greater from 1900 to 1960 than from 1960 to 1995. During the earlier period, Cuba led all Latin American countries for which data are available at raising life expectancy and reducing infant mortality. From 1960 to 1995, by contrast, it came in fourth and fifth respectively.”
Rodolfo J. Stusser, M.D. in his November 2013 paper, “Cuba’s Long Tradition of Health Care Policies: Implications for Cuba and Other Nations,” documented that “in 1958 Cuba had 6,000 physicians, 3,624 pharmacists, 2,260 pharmacies, about 500 laboratories, and 60 drug manufacturers, handling 40,000 different products for 6 million inhabitants.”
Post-1959 Cuba: Faked statistics, not reporting epidemics until unable to cover it up, and jailing whistleblowers
Numbers don’t lie, although the Castro regime likes to disappear and misrepresent them. Cuba has a communist dictatorship, with a regime that is not transparent and has a history of not reporting or under reporting disease outbreaks.
Downplaying and covering up Covid-19 deaths in 2020 – 2022
Our World In Data is a project of the Global Change Data Lab, whose “mission is to publish the ‘research and data to make progress against the world’s largest problems.’” They published an interactive map from The Economist, current through Jul 26, 2022 titled “Estimated cumulative excess deaths per 100,000 people during COVID.” There is a screen grab above, but when you go to the website and hover over a country the data is provided, and you can see the numbers for yourself.
This blog over the course of 2021 repeatedly highlighted questionable practices by Havana and called them out. CFC’s executive director had a letter to the editor published in The Washington Post on April 5, 2021 countering news coverage that repeated claims made by Havana with the fact that the Cuban government had repeatedly covered up or downplayed past epidemics, and was doing it again.
Havana tried to position itself, once again, as a “safe” destination for international tourists in the time of COVID-19. Thousands of tourists were left in the lurch last year in Cuba, and the conditions maybe recreated with another round of misleading propaganda in 2021.
Left out of The Economist report is the damning evidence that Cuban government officials decided early on that they wanted to be “be the first country in the world to vaccinate their whole population with their own vaccines,” and were willing to let Cubans die while they developed their domestic vaccines instead of importing them, including from their allies Russia and China in order to advance their “healthcare superpower” narrative.
In the article below The Economist repeats the same tropes about Cuban healthcare, but the COVID data leads them to conclude that Cuba’s healthcare system “is in tatters” and that “It is possible that officials under reported the deaths, too.”
Yet, The Economist in the same article claims that from 2000 through 2020 Cuba outspent other countries in healthcare. Where do they get the data to make such a claim: the Cuban government. No independent verification. In 2007 Rich Lowry reviewed the Michael Moore propaganda film Sicko in The Salt Lake Tribune and presents a description of the Cuban healthcare system in 2007 that is much the same to the one being criticized in 2022 by The Economist.
Whereas, Latin American countries engaged in campaigns to vaccinate their respective populations using vaccines that were peer reviewed by scientific journals demonstrating their effectiveness, and others from Russia and China that were less vetted, Havana waited to develop its “own vaccines” and did not begin the wide scale vaccination of the Cuban population, but was engaged in its propaganda offensive. in April of 2021.
Americas Society (AS) / Council of the Americas (COA) on March 29, 2021 reported on major developments in Latin America on vaccine roll outs as countries in the region strive to reach herd immunity. Below is a list of total doses administered per 100 people in Latin America, and Chile is leading with 50.38/100, the Dominican Republic is in sixth place with 7.37/100, followed by Costa Rica with 6.83/ 100. Cuba is not on the list, but in dead last was Venezuela with 0.04/100.
Over 60,000 Cubans died of COVID-19, not the 8,529 official figure given by the dictatorship, based on official statistics.
Official channels reported “8,529 deaths due to Covid-19 between 2020 and July 2022 in Cuba. The falsification of the reality on the island was exposed after the first reports of the Statistical Yearbook, were released containing figures from between January and December 2021, reported José Luis Reyes in Diario de Cuba.
“In the section of the document dedicated to Population, drafted by the State Office of Statistics and Information [ Oficina Nacional de Estadísticas e Información] (ONEI), it is striking that in the previous year 167,645 deaths were recorded, while the total population fell by 68,380. Although the decrease in the number of inhabitants has been steady since 2015, mainly attributed to the low birth rate, the downward curve in 2021 was about 7% per 1,000 people. In numbers, this means that while the country closed out 2020 with 11,181,595 people, at the end of 2021 there were 11,113,215.”
Based on the average number of annual deaths prior to COVID-19 hovering on average at 106,813 deaths with maximum variation above of 106,941 in 2017 places the increase of Cubans who died due to a health emergency such as COVID-19 at 60,704 (and this is a conservative estimate). Regime downplayed the impact of this plague on Cubans by over a factor of seven.
Downplaying a Zika outbreak in 2016
New Scientist on January 8, 2019 reported on a 2016-2017 Zika outbreak in Cuba which went unreported or under reported.
“Cuba’s first case of Zika occurred in March 2016. A PAHO report says the country stopped providing updates on Zika in January 2017. In press reports in May 2017, Cuba said that nearly 1900 infections had been detected up to that point. But Nathan Grubaugh at the Yale School of Public Health and his colleagues estimate that the total cases in 2017 alone would have been more than double that at 5700. “Our results therefore suggest that the 2017 Zika outbreak in Cuba was similar in size to the known 2016 outbreaks in countries with similar population sizes,” the authors write.”
Professor Duane Gubler of the Duke-NUS Medical School in Singapore, “says Cuba has a history of not reporting epidemics until they become obvious,” reported New Scientist on January 8, 2019. Professor Gubler is an internationally recognized expert on Dengue fever, and the founding Director of the Program in Emerging Infectious Diseases which is affiliated with the Duke University-Graduate Medical School in Singapore. Dr. Gubler also served as a consultant/advisor on numerous World Health Organization committees.
In 1997 he pointed out the shortcomings of Havana’s Dengue response: “The problem with the Cuban program,” said Gubler, “and those that rely on a paramilitary-type of organizational structure is they have no sustainability. Once support and funds dry up, the program falls apart and the disease will come back with a vengeance,” said the professor in the July 8, 1997 issue of Science. Consider what happens to doctors and journalists in Cuba who speak up in the midst of an outbreak, and do not tow the official line.
Downplaying a cholera outbreak in 2012
Calixto Martinez: Jailed for reporting on Cholera outbreak.
News of a cholera outbreak in Manzanillo, in the east of the island, broke in El Nuevo Herald on June 29, 2012 thanks to the reporting of independent journalists in the island. The state controlled media did not confirm the outbreak until days later on July 3, 2012. The BBC reported on July 7, 2012 that a patient had been diagnosed with cholera in Havana. The Cuban government stated that it had it under control and on August 28, 2012 claiming the outbreak was over. Independent Cuban journalist Calixto Martinez, who broke the story, was arrested on September 16, 2012 by the Cuban Revolutionary Police “for investigating allegations that medicine provided by the World Health Organization to fight a cholera outbreak was being kept at the airport, as the Cuban government were allegedly trying to down-play the seriousness of the outbreak,” according to Amnesty International that recognized him as a prisoner of conscience.
“On 6 March [2013], journalist Calixto Ramón Martínez Arias went on hunger strike to protest against his detention in Combinado del Este prison on the outskirts of Havana, Cuba. He was consequently transferred by the prison authorities to a punishment cell. According to his relatives,the small cell where he is now held has no light, toilet facilities or bedding, and he is not permitted to leave the cell to exercise in the open air. These kinds of punitive measures are typically used by the Cuban authorities against prisoners on hunger strike,” reported Amnesty International on a March 14, 2013 update on his case.
Although Cuban officials declared the Cholera outbreak over in August 2012, 11 months later and tourists visiting Cuba were returning home with the illness. In July 2013 an Italian tourist returned from Cuba with severe renal failure due to cholera. New York high school teacher Alfredo Gómez contracted cholera during a family visit to Havana during the summer of 2013 and was billed $4,700 from the government hospital. A total of 12 tourists were identified that had contracted cholera in Cuba. On August 22, 2013 Reuters reported that Cuba was still struggling with cholera outbreaks in various provinces.
Downplaying a dengue outbreak in 1997
Dr. Dessy Mendoza Rivero
Dr Dessy Mendoza Rivero, married with four children, was arrested on June 25, 1997. The Cuban doctor was jailed for warning about a dengue outbreak, and put on trial with the threat of a 13 year prison sentence. On November 28, 1997 he was sentenced to eight years in prison for “enemy propaganda.” Amnesty International declared Dr. Mendoza Rivero a prisoner of conscience and campaigned for his freedom. He was released on November 20, 1998 “due to health reasons” following the visit of the Spanish Foreign Minister, under the condition that he leave Cuba for exile in Spain. First official report to the World Health Organization of the dengue outbreak was six months after the initial identification made by Dr Mendoza Rivero, and his reports were eventually confirmed.
But the press is not providing this background in its coverage of the current disease outbreak in Cuba, while giving the dictatorship the benefit of the doubt, although Politifact in 2014 observed that “the combination of the Cuban government’s heavy-handed enforcement of statistical targets and the lack of transparency has led some experts to suggest taking the numbers with a grain of salt.”
Worse yet, during the COVID-19 pandemic instead of quoting a medical expert, NPR misidentified a pro-regime propagandist, who wrote Che Guevara: The Economics of Revolution, and held a conversation with a colleague linked to the Tricontinental, a continuation of an initiative that promoted international terrorism, as a neutral Cuba expert commenting on the Cuban healthcare system.
Nobel Peace Prize nominations to propagandize in favor of Cuba’s healthcare system
Cuban medical missions have been nominated for the Nobel Peace Prizetwice ( 2015 and 2020 ) and widely promoted through official media, and their agents of influence, but President Donald Trump has also been nominated for the Nobel Peace Prize at least 12 times. One need not be a doctor to get that nomination.
The more important question is how many Cuban doctors, educated and trained under the Castro regime, have been nominated for the Nobel Prize in Medicine over the past 66 years? The answer till now is zero.
Healthcare in Cuba used for reputation laundering
The attempt to judge the quality of healthcare in a dictatorship that lacks transparency is difficult, if not impossible and requires a skeptical approach. Professor Sherri L. Porcelain has taught Global Public Health in World Affairs at the University of Miami for more than 30 years. On September 21, 2017 the Cuban Studies Institute published her article: “U.S. & Cuba: A Question of Indifference?” and the observations she made remain relevant in 2021.
“Investment in the health of people includes protecting human rights. This means allowing the health community to speak out and not to be jailed for releasing information about a dengue epidemic considered a state secret, or not sharing timely data on a cholera outbreak until laboratory confirmation of travelers returning from Cuba arrive home with a surprising diagnosis. This causes me to reflect upon my personal interviews where the remaining vigor of public health actions in Cuba exists to fight vector and water borne diseases. Sadly, however, health professionals are directed to euphemistically use the vague terms of febrile illness in place of dengue and gastrointestinal upset for cholera, in contradiction to promoting public health transparency.”
Why is it that the healthcare systems of Costa Rica, Chile and Canada’s rate higher than the U.S. on international indices, but are not mentioned positively as often as Cuba’s despite the island nation’s health care system rating lower than the United States? Is it because those three countries do not need to set up propaganda and influence operations to justify their existing political systems, because they are democracies with popular support and the regime in Cuba is not?
Katherine Hirschfeld, is a medical anthropologist who spent time in Cuba examining the healthcare system and author of the book Health, Politics, and Revolution in Cuba Since 1898 published in 2009. In 2018 Professor Hirschfeld in the journal Health Policy and Planning made the case for democratic norms generating better results in public health in “Response to ‘Cuban infant mortality and longevity: health care or repression?’” and analyzed the shortcomings found in Havana’s governing style.
”The regime governs from the top down, as a dynastic military dictatorship that does not permit anyone outside the government—no independent associations of health professionals or journalists—to objectively assess policy outcomes. The role of public media in an autocracy is instead to praise the regime and explain away its failures as the work of real or imagined political enemies. Public information about health trends is correspondingly configured to fit these predetermined narratives.”
This raises some important questions on the continued praise of the healthcare system in Cuba.
Is it because Chile and Costa Rica do not need to set up propaganda and influence operations to justify their existing political systems, because both are democracies and the regime in Havana is not? The claim that Havana’s situation cannot be compared because it has a hostile neighbor in the United States leads to an obvious question: Why not compare Cuba with Taiwan that also has a hostile neighbor in Communist China? The answer is simple because Taiwan has done a better job on public health generally, and especially during the Covid-19 pandemic.
The documentary also raises the issue of doctors sent out on medical missions creating a positive buzz about the Cuban healthcare system, while some Cuban doctors denounce being trafficked and exploited.
However these international missions have an additional dark side. Mary Anastasia O’Grady in her June 14, 2020 column in The Wall Street Journal warned about “Cuban Medical Brigades to Mexico” and more specifically Havana’s “history of using its doctors to propagandize and build intel networks.”
Cuban doctors sent to Venezuela were ordered to deny or ration care to advance Nicolas Maduro’s election prospects reported The New York Times in the March 17, 2019 article, “It Is Unspeakable’: How Maduro Used Cuban Doctors to Coerce Venezuela Voters,” including the denial of needed oxygen to deathly ill patients.
Anything that does not fit the Cuban government’s triumphalist healthcare narrative has been memory holed.
For example, in January 2010 pictures smuggled out of the Cuban psychiatric hospital Mazorra revealed that patients were dying of exposure to the elements, and had suffered greatly through their time there. Claudia Cadelo, now exiled out of Cuba, wrote in 2010 her reaction to seeing this photos:
When I opened the little folder called “Mazorra” a series of monstrosities hit me in the face and I couldn’t stop looking at the cruel graphic testimony. A friend who is a doctor visited and while he analyzed images I didn’t have the courage to look at, expressions like, “Holy Virgin Mary, Blessed God, What in God’s name is this?” issued from his outraged throat, mixed with obscure pathologies and the names of diseases both treatable and curable. Enormous livers, tubercular lungs, and wormy intestines are the proof, Senora Arlin, of the sacredness of life in Cuba. Meanwhile The Roundtable throws a fit because the death of Orlando Zapata Tamayo has unmasked a crumbling public health system, and they try to cover up the disgrace of seeing soldiers dragging and beating a group of women dressed in white with flowers in their hands. I ask myself, Gentlemen Journalists, when will they explain to Cubans the reasons why twenty-six mentally incapacitated people died in inhumane conditions during their confinement in Mazorra?
Havana was forced to acknowledge what had happened thanks to the still unknown whistleblower and courageous independent journalists who made the images public. The New York Times reported on January 15, 2020 that “26 patients at a mental hospital died during a cold snap this week, the government said Friday. A Health Ministry communiqué blamed “prolonged low temperatures that fell to 38 degrees.”
Three of 26 patients who died of exposure in 2010 in Cuba
Will the myth of Cuban healthcare under Castroism finally be recognized by the mainstream media and the Academy?
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