Health care myth and reality

Many blogs have commented on this essay (pdf, via Miscelaneas de Cuba) by Katherine Hirschfeld of the University of Oklahoma. It appears in the University of Miami’s journal, Cuban Affairs.

UM promotes the essay as a state-of-the-art critique of Cuba’s health care system, the perfect antidote to Michael Moore’s Sicko.

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 Cuba, it contains little information. Mainly, it’s a warning to researchers not to accept the Cuban party line at face value, and to beware of measuring public opinion in a place where speech is limited. Fair enough. The essay’s main point is that foreign researchers often paint a rosier picture of Cuban health care than Cubans do, although this “is not to say that Cubans had nothing positive to say about their health care system.”

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 U.S. embargo “exacerbates material shortages on the island.” It describes the economic reforms of the 1990’s as “privatization,” which is quite a bit off the mark.

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.

But in Cuba one can see patients going to family doctors and clinics, and going to pharmacies to try to get prescriptions filled. The system is frayed, but it is not dysfunctional.

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 Cuba’s political system distorts international perceptions of its health care system. But her intention, she says, was not “to answer this question so much as to argue for its relevance.”