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    CUBA
    Author disputes Cuban healthcare `myths'
    The author of a new book will speak Thursday at the University of Miami
    about problems in the Cuban healthcare system.
    BY JOHN DORSCHNER
    jdorschner@MiamiHerald.com

    Before Katherine Hirschfeld went to Cuba for post-graduate studies, she
    read dozens of academic research papers on the country's healthcare
    system. All were glowing reports about how the Castro government offered
    good care for everyone, and that's what she expected to find.

    Then she went to Santiago de Cuba for an extended stay and saw the
    system for herself, including three days in a hospital when she came
    down with dengue fever. The result is a highly critical book — Health,
    Politics and Revolution in Cuba since 1898 — which she will discuss
    Thursday night at the University of Miami.

    Her stays were mostly in Santiago, from 1996 through 1998, when she was
    a graduate student at Emory University and Cuba was in the midst of a
    dengue fever epidemic that the government tried to hush up.

    When she experienced the symptoms — aching joints, fever, nausea, sore
    throat — she was taken to a Santiago hospital and placed in a large
    ward guarded by a man with a gun. She asked to make a phone call to tell
    people where she was. The guard said there were no working phones.

    ' `Oh my God,' I thought to myself. 'This place doesn't exist,' '' at
    least not officially, because the epidemic was a state secret.

    NO DOCTOR IN SIGHT

    During her stay, she says she never saw a doctor. She was given one pill
    – a vitamin. Fortunately, she had a mild case. Because there were few
    nurses, she and other patients who were able did what they could for the
    sickest, especially those who were bleeding or vomiting.

    Now an assistant professor of anthropology at the University of
    Oklahoma, Hirschfeld says living with a family in Santiago while doing
    her research made a big difference in her viewpoint.

    ''Most academic work about Cuba is based on little or no field
    research,'' Hirschfeld said. U.S. academics often rely on official
    government studies or do short stays on the island, spending perhaps two
    weeks, sleeping in government-approved facilities.

    She found women in Santiago gravitated to the kitchen, where she learned
    that even preparing a meal was revealing about the economy. ''Lunch is
    sometimes a counter-revolutionary event,'' because of how the family had
    to scramble outside the rationing system to find enough to eat.

    Hirschfeld found even more basic public health problems, such as a lack
    of running water in the city. Residents compensated by catching rain
    water in barrels — breeding grounds for mosquitoes, which transmit the
    dengue virus.

    Cubans who needed treatment often used social networks or bartered
    favors to have doctors see them outside the official clinic settings. If
    people had to go to the hospital, they tried to prepare in advance,
    getting surgical thread and bandages on their own, even obtaining drugs
    from the United States if they could.

    Hirschfeld says her research showed that healthcare in pre-Castro Cuba
    was of mixed quality. Many people in the cities received inexpensive,
    regular care through memberships in clinics, but those in rural areas
    and those of African heritage were less likely to get care. A clean
    water supply was problematic because corrupt officials often stole the
    money rather than using it to maintain and improve the system.

    When she finished her doctorate dissertation about the problems in
    Cuba's healthcare, she says it was not initially well received by her
    review committee, which pointed out that most other academic researchers
    disagreed with her. She believes her unusual views delayed her getting
    her doctorate by at least a year.

    FROM BAD TO WORSE

    Since Hirschfeld did her research, most experts say Cuban healthcare has
    gotten worse, primarily because 36,000 doctors and other healthcare
    professionals are now working overseas, many of them in Venezuela,
    according to official figures.

    A dissident doctor in Havana, Darsi Ferrer, told The Miami Herald last
    year that because of the shortage, “One doctor now has to take care of
    four or five offices.''

    The situation has become so bad that last month the vice minister of
    public health, Joaquín García Salaberría, took the highly unusual step
    of admitting on Cuban television that there were shortages of doctors
    and nurses. 'It's not guaranteed that doctors and nurses will remain in
    the doctors' offices, as had been promised,'' García said.

    http://www.miamiherald.com/548/story/373512.html

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