Covid-19 and the Two Faces of Cuban Medicine

Cuba has made headlines sending battalions of doctors to provide the rest of the world with medical aid amid the coronavirus pandemic.

But medical practitioners on the island, speaking on condition of anonymity, say that they are combating the virus with a lack of even basic protective equipment and hygiene measures.

Cuba has one of the world’s highest doctor to patient ratios, with one doctor for every 116 inhabitants. While this allows the government to offer medical services to the rest of the world, those remaining on the island are forced to work in conditions that are often completely substandard.

One family doctor, Ernesto, said that his first task every day after arriving at work at seven was to collect water in buckets for use at the clinic.

"I see patients in a three-bedroom apartment that has no running water in the sink or the toilet,” he explained.

"Before the pandemic, I had to see 20 patients a day. During the outbreak, this number dropped, but it has peaked again in the last few weeks. Most of my patients are older adults with underlying diseases. They come to collect their regular prescriptions. Sometimes they have to come more than once because there is a shortage of medicines, and their prescriptions expire."

Painkillers like dipyrone and naproxen as well as antibiotics including gentamicin and triamcinolone are both among the most sought-after medicines and difficult to find.

As of the last week of June, the ministry of health had reported 2,300 positive cases of Covid-19, one of the lowest infection rates in the region. In neighbouring Dominican Republic, with a population size similar to Cuba's, the authorities detected more than 16,000 cases.

Ernesto suspects that he himself caught coronavirus when he was despatched to track possible cases of infection among tourists visiting the island and he examined an Italian woman. 

"A doctor examined me and said, ‘go home, what you have is pharyngotonsillitis [an infection of the throat and tonsils],’" Ernesto said. Some symptoms of Covid-19 were similar to those of common diseases, he explained, allowing officials to avoid formally identifying possible coronavirus cases.

Nonetheless, the following day his house was disinfected and he was isolated for 21 days.

"They didn't do any tests, but I knew I had it," Ernesto concluded.

Another family doctor, Mariela, who works in a local surgery in the municipality of Plaza de la Revolución, said that Covid-19 had placed an impossible burden on services.

"Before, I worked from Monday to Saturday. On Saturdays, I'd finish at midday,” she said, adding that she currently also worked on Sundays tracking suspected Covid-19 cases.

With barely any time off, Mariel continued, she was so tired she made potentially dangerous mistakes.

"It is exhausting because we also have to treat patients with other diseases,” she said. “We have to do follow-ups, normal shifts, look after the elderly, and those who live alone. Sometimes I protect myself very well, but other times I'm tired, and I don't pay attention to all protective measures."

Milena, a sixth-year medical student, said that she also felt she was being put at risk - despite being heavily pregnant.

She had hoped that she would be able to finish her studies mid-way through her pregnancy, but instead was despatched to work on the front-lines of the crisis.

“Because of the epidemiological situation, our classes were suspended,” she explained. “Those of us in the sixth year of the career could help in hospitals where there were not enough doctors."

The hospital where she worked started receiving between 25 to 30 ambulances each day, many patients reporting respiratory symptoms.

"We had two groups to treat positive cases of Covid-19,” Milena said. “Intensive care physicians, general practitioners, gynaecologists, and paediatricians had to join one of the groups. It was compulsory. For the rest of the specialists, it was voluntary. Then, when they started to send doctors on missions abroad, more groups were created because we couldn't cope."

Amid the crisis, there was a distinct lack of protective equipment.

"We were afraid because the protective measures were limited,” she continued. “[The health authorities] only provided one cloth mask for a 24-hour shift. We didn't have disposable gowns, surgical caps, or googles, [although] the situation improved a little after we received donations from China."

Now, when on duty, Milena herself brings four or five masks, two sets of protective clothing, a pair of gloves and a surgical cap.

No one at the hospital has told her to stay at home, she said, adding, “they only tell me to take care of myself. But that I know, because during the gestation period, the immune system becomes depressed.

“And if infected with Covid-19, a pregnant woman may develop pneumonia or bronchopneumonia”.

From the start of the crisis, the authorities have taken measures to prevent the inadequacies of its domestic response being publicised.

(See also Cuba Gags Coronavirus Critics).

Ernesto said that in the early days of the pandemic he took part in a meeting at the polyclinic where they were briefed on how to treat cases of suspected Covid-19.

But managers also warned them against publishing any photos or information about conditions at their place of work, stressing "because if you do, you will have to face the consequences".

Cynthia de la Cantera is a journalist for Tremenda Nota y Yucabyte in Havana.