December 1, 2016, 9:16 pm
The
world mourns the passing away of Fidel Castro. The world has lost one
of the most illustrious leaders of our time. As much as the name Fidel
Castro is synonymous with Cuba, Cuba is synonymous with good public
health. Fidel was a great ruler and a great leader to the Cuban people.
Equally, he was a leader par excellence to the world of public health.
As Dr. Dayan Jayathilake said in his weekend article to "The Island",
Fidel was the last of the epic heroes of our time that include Mao
Tse-tung, Ho Chi Min, Josip Tito and Che Guevara. And the commonalities
among them were great leaders, revolutionaries, and most of all, were
visionaries who combined their ideal with action and changed the world
they inherited.
The life and times of Fidel Castro
Fidel Castro Ruz was born on 13 August 1926 into a wealthy family in
Birán, Oriente, in the eastern part of Cuba. He was a lawyer by
profession. On 26 August 1953 he led an armed struggle against the
country’s military dictator Fulgencio Batista, and was captured in a
failed attack on Moncada Barracks in Santiago de Cuba. This attack
famously signifies the beginning of Cuban revolution. After a trial he
was sentenced to 15 years’ jail. During his inmate days, Fidel was a
voracious reader, and read as much as 16 hours a day. In the face of
mounting protest against his imprisonment Fidel was freed in May 1955.
He fled to Mexico, where he regrouped his fellow compatriots including
his own brother Raul (the present president of Cuba) and his good buddy
Argentine Ernesto Che Guevara. On 2 December 1956, they sailed from
Mexico on board the famous yacht "Granma", invaded Cuba for the second
time. This attack too was a failure, led to death or capture of most of
the invaders. But Fidel and survivors went hiding in Sierra Maestra
mountains, from where they launched a guerrilla war against the Batista
regimen.
On 1 January 1959, exactly five years five months and five days after
the Moncada attack, Batista regimen fell in the face of advancing rebel
forces, and Batista fled to the Dominican Republic. Fidel became the
Prime Minister of Cuba on 13 February 1959. He adopted a centrally
planned economy with "pro-poor" policies. He introduced sweeping land
reforms making peasants the owners of land. He nationalized businesses,
which were mainly American owned. This brought in stiff opposition to
the new government from the US. Soon Fidel espoused a "pro-Soviet" line.
The growing antagonism against Cuba by the US government reached its
zenith when the US trained mercenaries invaded Cuba in an infamous
unsuccessful "Bay of pigs" attack on 17 April 1961.
Consequent
to waned relations between the two countries, US in February 1962
imposed a full economic embargo against Cuba (topping up the partial
embargo that was in effect since October 1960). This embargo, commonly
known as the "blockade", is in existence to this day (despite president
Obama’s call to end it during his visit to Havana in March this year,
which has just limited to words).
In October 1965, Fidel founded the Cuban Communist Party. To this day
Cuba has a one-party system with a parliament (National Assembly of
People’s Power) comprising 612 members, representing municipalities,
trade unions and students.
An internationalist in every sense, Fidel during his heydays, militarily
supported democratically elected regimens and leftist guerilla armies
in various parts of the world, who were fighting oppressive forces.
Among these a long drawn battle in Angola, Namibia (South African border
war during apartheid time), Congo, Bolivia (where Che Guevara died
fighting), Ethiopia, Nicaragua and El Salvador stand out.
Fidel was also a frontline leader of the Non Aligned Movement (NAM)
since its inception, Cuba being the first Latin American country to join
the Movement. Havana hosted the NAM summit twice in 1979 and 2006, the
only country to do so.
The collapse of the Soviet Union in 1991 plunged Cuba into a grave
economic crisis. Double burdened by the economic embargo, Fidel and the
Cuban leadership faced a tough time in the immediate aftermath years.
But through prudent economic management coupled with some austerity
measures (sparing children) and "reforms" Cuba came out of the calamity
in double quick time. In this regard, Cuba relied heavily on its
educated and skilled professionals and advancement it has gained in
technology, especially in the field of bio technology.
Later speaking to director Bill Fletcher, in the documentary "Fidel
Castro: the Untold Story", Fidel admitted the government experimented
certain reforms during the "special period". But the bottom line was
that it didn’t compromise any of its social development programmes. Cuba
went into limited partnerships with Canada and some European countries
to develop its infrastructure (in tourism industry) and research
capacity, especially in the field of biotechnology. Capital, market and
technology were the areas Cuba went into partnership with its Western
allies.
Fidel is also famous for his long speeches. In June 2005, I together
with Jayathilake de Silva and Subramaniam Nagendra travelled to Havana
to attend the International Conference against Terrorism, for Truth and
Justice, where Fidel spoke for three long days. (Among the speakers at
the conference were Daniel Ortega the incumbent president of Nicaragua,
and Schafik Jorge Handal, the famous Salvadoran guerilla leader).
Few days before his 80th birthday, on 31 July 2006, Fidel with signs of
failing health, handed over the leadership of Cuba to his brother Raul.
Since then he has been a prolific writer, writing articles under the
theme "Reflections by Fidel".
In 2006, the year Fidel resigned from leadership, Cuba was the world's
only nation that met the United Nations Development Programme's
definition of sustainable development, with an ecological footprint of
less than 1.8 hectares per capita and a Human Development Index of over
0.8
Fidel Castro died on 25 November in Havana, at the age of 90.
Cuban legacy of Public Health
Fidel always set great store by developing a sound healthcare system in
Cuba. By the end of the Cuban revolution (in 1959) healthcare was
limited only to the rich and was almost nonexistent to the poor in the
rural areas of the country. Fidel believed funding for health as a human
right as well as an investment, a worthy investment towards having a
healthy workforce and student population. Today, Cuban government spends
11.1% of its GDP on health (on comparison, meager 1.3% by the Sri
Lankan government).
A sound primary healthcare structure where efficient family physician -
public health nurse combination together with a comprehensive
paramedical team remains the cornerstone of Cuba’s public health system.
In the formative years valuable theoretical inputs were provided by
Che, the Minister of Industries, who was also a doctor himself. Health
teams were sent to the hitherto underserved rural areas of the country,
where sugarcane and tobacco plantations were in abundance. Immunization
campaigns were started against the childhood killer diseases like polio
and measles with resounding results. A healthier populace ensued, who
contributed immensely to Cuba’s growing economy, which soon became one
of the world’s foremost sugar producers.
Soon, the impact of the widespread public health programme established
in the post-revolution Cuba had telltale effects on the country’s health
indicators. Country’s Infant Mortality Rate almost halved from 37.3
(per 1,000 live births) in 1960 to 19.6 in 1980. In 2010 it stood at
4.5; (the average for the European Union that year was 4.2). The under
five mortality, another robust indicator of a country’s health status,
dropped from 43.7 in 1970 to 24.2 in 1980, and further to 6.0 in 2010.
The life expectancy grew from 70 in 1970, to 73.5 in 1980, and further
to 78 in 2010. Amazingly, its doctor to population ratio from 1: 1,400
in 1970, rose to 1: 640 in 1980, and in 2010 stood at 1: 170 (or 590
doctors per 100,000 population), the country with the highest doctor
population ratio in the world. (You may notice most of these figures are
unavailable for 1960, the year following the fall of Batista rule. Only
since then the health system was structured and record systematic
keeping commenced in Cuba).
By 1990s Cuba has eliminated polio and measles from its shores. It also
has the most effective dengue control programme and the lowest HIV/ AIDS
rate in the Americas. In the recent years, it has the highest rates of
treatment and control of hypertension in the world, and has reduced
cardiovascular mortality rate by 45%. There is many a leaf from the
Cuban public health book the world could adopt in effective NCD control,
and for that, the World Health "pundits" should be ready to do that.
Medical Internationalism
As in defence, health is another field Cuba excelled in
"internationalism". This holds water for both training and service
delivery in healthcare. Medical internationalism is part of Cuba’s
foreign policy as well.
The world’s largest medical school, Latin American School of Medicine
(ELAM), established in Havana in 1998, is a classic case in point.
Medical education at ELAM is absolutely free, from tuition, to books, to
lodging, to food. At present, around 20,000 students from over 100
countries around the world (including the US) study medicine and allied
sciences at ELAM. (Even before the establishment of ELAM, the Havana
Medical School provided free medical education for students from around
the world for decades).
Medical diplomacy - Cuba's most important export commodity
Deploying Cuban healthcare workers in friendly countries that were in
need began in the early 1960s when Cuba dispatched small medical
brigades to Algeria, at the time of that country’s civil war. This trend
later continued in Guinea-Bissau and Angola. In some of these
countries, later, Cuban doctors outnumbered the local doctors and Cubans
organized the healthcare systems.
At present there are around 50,000 Cuban professionals working in over
100 countries around the world, as part of various bi-lateral
arrangements of their government. Of them, 30,000 are health
professionals, and 25,000 are doctors. It is said that Cuba alone
provides more healthcare workers to the developing world than
all G8 countries put together. (In Sri Lanka too Cuban doctors were
manning health services in number of rural and war stricken areas till
the turn of the century. This writer too had the opportunity to work
with a team of Cuban doctors in Polonnaruwa Base Hospital, in the mid
90s).
Among the other things, disaster management became an avant-garde of
Cuban Medical Internationalism. Cuban medical missions were swift to
move into the disaster hit regions of the world, where they promptly
initiated rescue and healthcare programmes. This is happening since
1960s, and happened in Chile, Nicaragua, Iran and Pakistan following
devastating earthquakes, in Venezuela following a disastrous mudslide,
in Honduras, Guatemala and Haiti subsequent to hurricanes, and in Sri
Lanka and Indonesia aftermath the 2004 Boxing Day tsunami. Our memories
are still fresh about the Cuban presence in Koggala following the
tsunami, where their medical team spent an extended period providing
healthcare to the villagers under very trying conditions. (In August
2005, following Hurricane Katrina that devastated New Orleans, Cuba was
prepared to send a team of 1,500 doctors in a humanitarian mission to
the US, but the offer was turned down by the Bush administration).
Cuba’s Medical Aid to Venezuela
In the early 2000s, in a novel programme called "oil for doctors", Cuba
provided Venezuela with 31,000 doctors, dentists and paramedical staff
to provide healthcare and train 40,000 Venezuelan medical personnel. In
exchange, Venezuela provided Cuba with 100,000 barrels of oil per day.
Operation Miracle
In July 2008 Fidel and his then Venezuelan counterpart the late Hugo
Chávez launched another out-of-the-box programme named, Operation
Miracle to expand health care services in Venezuela. Restoring the
vision of millions of low-income patients was the initial purpose of the
mission. This initiative later extended to other parts of the Latin
America, Caribbean and Africa (and rest of the world) as well. These
programmes are still underway.
Humanitarian assistance to HIV hit Africa
In another similar initiative Cuba sent medical assistance by way of
doctors, nurses and pharmaceuticals to a number of HIV/AIDS worst hit
sub-Saharan African nations. Started in the early 2000s this programme
is still continuing. Cuba, the first country in the world to eliminate
mother to child transmission of HIV has state-of-the-art expertise in
handling HIV, both in hospitals and community. Once in Africa, Cuban
doctors’ role was not limited to the provision of HIV care. They also
helped establishing health infrastructure and programmes in those
countries. Now that some parts of the sub-Saharan Africa have checked
the mother to child transmission of HIV effectively, the worth of Cuban
intervention stands out obviously.
Later, Cuban medical assistance was also extended to curtail the
spreading Ebola epidemic in West Africa with resounding success.
Above all, the most striking thing about the development of the post
revolution Cuba is the fact that it took place in the midst of a damning
embargo imposed by the US, almost throughout its entirety. The embargo
prohibits any form of trade with Cuba, travel, employment and whatnot.
Unacceptability of this embargo in today’s economic and political terms
goes without saying as the vote against it in the UN has always been won
resoundingly by Cuba. In 2015, 191 countries voted against the embargo,
while only two (US and Israel) voted in favour. Yet, the embargo
continues!
When all what is said here and more speaks for itself about the role
Fidel and Cuba played towards the upliftment of downtrodden masses of
Cuba and the rest of the world, some elements in Miami and their lackeys
in the Western media continue beating and insulting Fidel, even after
his death. The answer for that lies in the famous quote by none other
than the former US president Franklin D. Roosevelt, which goes as "judge
someone by the enemies he has made."
While Cubans mourn the death of their beloved leader Fidel, there are many reasons for the world to celebrate his life.
Viva Fidel! Viva Cuba! Viva la Revoluсion!
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