Many blogs have commented on this essay (pdf, via Miscelaneas de Cuba) by Katherine Hirschfeld of the
UM promotes the essay as a state-of-the-art critique of
But if you read it, it’s pretty thin soup.
It has academic references out the wazoo, but considering that it’s based on nine months of research in
It says the research was done “in the late 1990’s;” a version of the same paper presented a year ago said it was 1996. It points out that the
It makes the sweeping assertion that in one community, “no one used the formal health sector at all for commonplace medical complaints.” (The author keeps the name of this town a secret.) Which would mean that in that community, family doctors’ consultorios are either vacant or are mere social meeting places, that doctors don’t make house calls or otherwise have much to do.
Except, that is, to work in the black market, as illustrated in an example of a dentist who slowly gathered the wherewithal to operate on a wisdom tooth, and did so on a Saturday. There’s another example of a dental patient who got anesthesia only because she knew the nurse, and the nurse was looking out for her.
Surely, there are doctors that work on the side, and there is a black market in medical supplies and drugs, and it helps if patients know the right person inside the system.
Then there’s another set of far-reaching claims: that there is no such thing as informed consent, Cubans have “no right to refuse treatment,” and doctors are sort of CDR’s in white coats, charged with “monitoring their neighborhoods for any sign of political dissent.”
On page 17, just when you’re ready for anecdotes and data from nine months of observation, the essay ends with a tentative conclusion. Hirschfeld poses a good question – whether