The search on the informal market for medicines that have disappeared from state pharmacies, and payments for medical care and treatments, including operations, carried out at public hospital facilities, have already become part of Cubans' daily lives.
The new Cuban Public Health Law, 2023, states that "among the rights of users are free access to care, protection, and recovery services; as well as those medicines and health products or supplies necessary to promote, preserve and restore health, through the regulations established in this regard." The health system's implosion, however, has forced the population to pay for what are supposedly free services to deal with their medical emergencies.
The government knows this, as does the entire country. On July 17, in the National Assembly of Popular Power, after hearing a report by the sector's minister, José Ángel Portal Miranda, the representatives agreed that to "address and prevent crime, illegalities and acts of social indiscipline in the Cuban Public Health sector, collective responsibility for services and resources is essential."
The Public Health crisis is reflected in the long waiting lists for surgeries, and procedures like the extraction of wisdom teeth, due to the shortage of medical supplies and the state of hospital facilities. The desperation of those affected and the government's inability to respond to them leads them to seek "alternative" solutions.
"Among the most affected specialties is Stomatology. There is nothing at the clinics, and when something comes in we try to help family and friends," said a dental clinic assistant who asked to remain anonymous.
"Patients come with the anesthesia…and we do the work of extracting the tooth, or doing the filling, as the case may be. Prosthetists are the most affected, as materials are expensive and almost nothing comes in," she explained.
The existence of illegal private practices was recognized by Minister Portal in his remarks before the National Assembly. He referred to them as "an issue that not only violates the most elementary ethics and principles of the national health system, but also affects the quality and transparency of care."
Katia, a clerk at a small business, and her mother Alina, are clients of a private dentist in Santiago de Cuba. "I got some very high-quality dental implants," Alina said. "I started with the top part. They are fixed, not mobile prostheses, and they cost me 4,000 pesos. Now I have to save up to get the bottom done. The prices are high, but the state clinics don't have the materials, nor do they do work of this quality."
According to Alina, the doctor who treats her is a young entrepreneur who resigned from his position in the government health system. "You can choose the color of the new teeth, so that they resemble yours. I took my daughter and she had a wisdom tooth extracted, which cost 1,500 pesos. When she gets paid, she'll have the other one extracted." She explained that the doctor buys material imported from the United States to Havana.
The purchase and sale of supplies and medicines in Cuba is a common practice on social media, where one find all kinds of medications, anesthetics, sutures, and wheelchairs, among other items. Permitting these offerings is the authorization of "the importation of medicines not of a commercial nature, without limits in terms of their value, exempt from the payment of the Customs tax on food, toiletries, medicines and medical supplies," legislation in force until September 2024.
Illegal surgeries at state hospitals
"We must be more efficient in the management of waiting lists, the discussion of each patient in need of surgical treatment, the planning of activities, and the daily analysis of emergencies. In addition, we must strengthen the pharmacotherapeutic committees, control over authorized signatures, and relationships with external pharmacies in order to combat criminal activity, " said First Deputy Minister of Public Health Tania Margarita Cruz in the National Assembly.
According to Dania, a restaurant accountant, managing to get her husband Rey two inguinal hernia surgeries was a race against time. "He had been on the list for surgery for more than a year. She received a series of excuses: Covid, the OR was being repaired, they were only doing emergency surgeries... Meanwhile, the hernia kept growing, and the lump was increasingly prominent. Finally, we were referred to a doctor at the Military Hospital; he was admitted as an emergency patient, at night, and had the surgery. We gave him 4,000 pesos."
The doctor told them that he would operate on the second hernia when the scar from the first one healed, in two to three months. "That was more than a year ago. The second hernia is now almost the size of the first, and has reached his testicles. He hasn't had the surgery because the doctor went on a mission and hasn’t returned. Now we are looking for a new surgeon in the same way: an emergency treatment, and then paying.
We can't wait until it squeezes the life out of him, which is what makes these cases urgent," she explained.
In light of the strict control measures announced by Minister Portal, it seems that vigilance over the provisioning of services has been tightened. "Now doctors are more afraid of performing emergency operations, but they are being done. It's a shame they can't set up private surgery facilities," said Jose, who works as a medical technician.
Jose took everything for his surgery. "Every time I went to the offices they told me that something was missing. So, I bought the sutures, scalpels, saline solution, cotton... I work in Public Health, and bought everything on the street. I spent like 5,000 pesos. I was admitted to the Clinic on an emergency basis, and had surgery. I should note that I didn't pay anything," he added.
Minister Portal lamented that "when patients pay for procedures at a healthcare unit, it constitutes a failure for Public Health, whose free, universal and humanistic nature is one of the greatest triumphs of the Cuban model."
"We would never sanction a professional for not having the resources to do their work, so we are going to be strict in responding to irresponsible and insensitive actions by our workers," the official said during a visit to Santiago de Cuba in January of this year. "Nothing justifies it, nor do the people of Cuba, or the people of Santiago, deserve it," he said.
However, the strictness promised by the minister has not been accompanied by more resources for Public Health, while Cubans look on as the Government continues to make major investments in sectors such as hotels, despite declining numbers of visitors.