RECORD IN MEDICAL CARE
“Text of a Speech by Fidel Castro
[The following is a translation of the Spanish text published in the September 11 issue of the Havana daily Revolucién.]
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Comrade Graduates:
Comrade Students:
With this simple and moving ceremony we are celebrating the graduation of 250 new doctors, This new contingent of doctors is . _ of great significance for the Revolution, inasmuch as it marks a victorious step ahead on our road, despite the difficulties, Two hundred and fifty new doctors means much to the people because it signifies 250 doctors for the people.
It used to be that graduation meant a lot to the student, to the graduate, to his family. It could mean much or it could mean nothing for tne people, In the old days, the conditions under which the youth grew up -- not through any fault of theirs but due to the circumstances in which they lived -- were such that their feelings, their aspirations, their thoughts on a day like this were quite dif. ferent, Everything was linked to a strictly personal future, Today everything is linked with the future of the nation, of the people,
And I believe, without the shadow of a doubt, that the enthusiasm, the humane feeling that animates these comrades is inevitably quite different,
It is good news for the whole country, but above all for that part of the country where the doctor often used to be something beyond reach, in some instances a personage never seen. For them this graduation is the most important news. And because of this it appears quite natural and just that the certificates awarded the graduates today should be given in the name of the peasants, because it is precisely the peasants who will be the first to enjoy the bene- Fit of the knowledge that you have gained,
It is good news for the Ministry of Public Health, because the ever increasing needs, the needs that have not yet been satis-~ fied, can be met through you, ‘And the fact that the school of Rural Medicine has been extended to two years, will greatly alleviate these needs, since the number of graduates -- which was relatively small in the first years along with the number of university students and the number of registrations in the University -- made it necessary to distribute them in a not very rational way while at the same time taking care of certain things in connection with a degree of specialization, . Lo
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Often a new doctor who replaces another one in a hospital or in the countryside makes it possible for this doctor to undertake special study, And as the number of doctors increases, we will be able to provide a more complete service in all the fields of medicine.
As the comrades representing the graduate students and the Association of Students of Medicine aptly put it, this graduation is marked by a series of special features. It was the students who began in 1956, whose studies were interrupted by revolutionary aotivities -- in which the students participated to such an extraordinary degree ~~ and the new layer, already responding to a new conscious~ ness, responding to new changes, responding to new realities and in consonance with these realities, who are now coming forward as doc~ tors to practice socialized medicine, public medicine, And this has a high moral meaning, since it is known that. under the country's new economic conditions, with the better incomes which families have today, any doctor practicing private medicine could gain more than by placing his services at the disposal. of public medicine since remuneration there corresponds to the present economic possibilities of our country.
. This is oceurring in practically all the spheres of knowledge in these revolutionary times. -It's the reverse of former times when the. most. serious problem: facing. any graduate of a university, an. institute or trade school began -~ in general -~ precisely when his studies were completed. The Revolution has created conditions .under which all knowledge is in immediate demand, every skill is utilized immediately, These are the conditions which the Revolution is creat- -ing through its proposal to work for the masses. These are the conditions which the Revolution has been creating since the moment it sought the welfare, not of a minority, but of the whole country andall its citizens. Thus it is that under the conditions established by the Revolution it is impossible to have the problem of men whose skills are underutilized or not utilized at all.
This used to be true in all the professions and the case of the teachers is well known. -When the Revolution triumphed there were 10,000 unemployed graduates; that is, 10,000 unemployed teachers, In addition, conditions in:the past were such that doctors were concentrated in certain zones, urban zones above all, where the num. ber of graduates in professional occupations and medicine was extra~ ordinarily high,
Statistics giving the number: of dootors: per inhabitants: pro-. vide a relative measure ~~ that is, the relationship between the. total number of inhabitants and. the total number of doctors, The truth is that in many regions of the country the number can be |. extremely low, This is true of many countries in Latin America,
At present medical personnel-is being distributed in accord~ ance with needs, and the distribution is being made more and more
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equitable, We are holding to the policy of offering all the services, even the most specialized, in all regions of the country.
There are some figures that speak more eloquently than any arguments about the great advances that our country has achieved in the field of medical assistance, The comrades of the Ministry have assembled some of these figures which are worth citing on an occasion like this,
In the first place, all of you are aware of the efforts made by the enemies of our Revolution to deprive us of doctors, to promote the departure of doctors from our country. In many instances it wasn't necessary to do much propagandizing, Certain wealthy sectors emigrated from the country absolutely voluntarily, Along with them also went -- on some occasions, because there were always honorable exceptions ~~ the doctors who looked after these classes, But in other instances there was a deliberate policy to deprive us of even doctors, Because our enemies not only sought to deprive the’ people of the most elementary means of progress and of life, but even up to something so humane -- something that should be so sacred ~~ ag the work of a doctor, |
But while they were trying to deprive the country of its doc= tors, the Revolution was trying to train new doctors, Thus, in 1958, the number holding medical degrees -- this doesn't mean the number of doctors working for the people -- was 6,257, In 1965, this figure had dropped to 6,239 doctors, -But in 1964 the figure is already up to 6,500 doctors, This means that we already have 200 more doctors than the total number of doctors in the country when the Revolution triumphed, But above all ~- most important of all -- is the fact that of these 6,500 doctors, 4,563 are working in the Ministry of Public Health and 1,459 in the co-operative societies.
And above all, more important than the total number of doctors, is their distribution, Today a considerable number of these doctors are practicing in regions where formerly there were neither doctors nor hospitals, This is the case with the Rural Medical Service, which is one of the most valuable creations of our revolutionary medicine, with 45 new hospitals and more than 100 dispensaries.
We have had opportunities on occasion to visit some of these centers, and only seeing them, only visiting them, you can get a good idea of what this means for the regions where they are located, for the population of these regions, and the extraordinary services they provide and how grateful the peasants are for this service,
The training of our doctors has changed radically. Froma training that was almost exclusively theoretical to a training that includes intense practice united to theoretical knowledge,
For example, before the Revolution, only 28 doctors in the © yearly course had the right to practice as interns, Of these, ten
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or twelve were able to be resident doctors in seeking special train-« ing. The others, a considerable part of them, emigrated from the | country. . » in those days for other reasons == simply because there was no employment for them in our country.
In the past there were only two teaching hospitals, Today in the whole country there are twenty teaching hospitals. A year as an intern is obligatory for all graduates; likewise considerable opportunities have been opened up for specialized studies.
Returning to the figures, right now we have more than 350 resident doctors taking specialized training. Seventy doctors graduated in 1963 and this year, some eighty will graduate, Since the triumph of the Revolution, 2,111 doctors have graduated; 1,594 doctors have gone into rural medicine,
As an “example of the work of these doctors, in the ‘past year of 1963 they helped a total of 1,946,049 patients, including 960,548 adults and 985,461 children. Among the adults were 95,663 cases of women in pregnancy and 235,643 births.
In the past scarcely a single one of these persons would have received medical care, not one of these mothers, not one of these children already. born or on their way.
The Rural Medical Service has served in addition to create a tie between the doctor and the people; the recently graduated dector in providing his services in such circumstances. can acquire a clearer understanding of the value and importance of his work,
The data on rural hospitals has. already been mentioned me 45 rural hospitals, with a total of 1,200 beds, and some 100 dispensaries.
The number of hospital beds in 1958 was 21,780; in 1963, 59,701; and, as you are aware, increases have just been made, inelud= ing some pig hospitals like the "Lenin Hospital" which will begin . functioning the first quarter of next year. ~
It would be well to draw some comparisons between the present status of medical care in Cuba and the status in the rest of Latin America because it can be stated that Cuba now stands at the head in Latin America with regard to medical care; not only in education, | where we already have achieved first place by a wide margin, but in. medicine where we lead by a margin that is getting wider all the > time,
And it is logical that we note these things with satisfaction. since the Revolution is no longer talking about what we are going to do3; the Revolution is talking about what it has done despite the ferocious hostility of Yankee imperialism, despite the conspiracy of all the reactionary forces of this continent, which, in a vain
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attempt to block the inevitable march of history, are trying to get around or at least postpone the hour of freedom for. the suffering and exploited peoples, which are trying all means.to place obstacles in our road, formulating plans and promises they .will never carry out, because we know <-- and we have the right to know -- which road is tne only one on which things can be done, which road is the only one that leads forward; a difficult and hard road in face of the cumulation of retrograde forces that are. trying to. stop us. . . but the only road,
We spoke about the increase in beds in our hospitals, They have virtually doubled in number and are possibly ten times superior in quality .-- because these figures give quantities but never speak of quality. And the difference in quality between the medical care of yesterday and today is practically impossible to put in figures, because the difference is immense between miserable, humiliating services, that were often granted as a favor, as charity, and services that are the right of any citizen in any hospital in the country,
But we have already raised the number of beds to 5,5 per thousand inhabitants. Let!s look at some comparative figures for some other countries. Venezuela has 2.6 per thousand inhabitants; Peru, 1.8; Colombia, 2,4; Panama, 2.3, In other words, we already have more than double any of :these countries,
The figures with regard to the number of doctors for every 10,000 inhabitants in many countries of Latin America are impressive, Bolivia has 1,9 doctors for 10,000 inhabitants; Brazil, 4. In Canada we have ll, which. is logical, Colombia, 4.3; Costa Rica, 5.9; Chile, 6.23 Rouador, 364; El Salvador, 1.8; the United States, 13.4; Guate-~ mala, Pals Honduras, 2el5 Nicaragua, ° ‘3,53 Panama, 5,8; Paraguay, 5.3; Peru, 4.7; the Dominican Republic; 1.5; Venezuela, 7. %In our country the number of doctors is now already close to 10 per 10,000 inhabi~ tants, 9 and a fraction.
Naturally when it is said that Bolivia has 1.9 nobody is going to think that the indigenous masses who constitute the majority, the peasant mass, has an average of 1,9, It is possible that in some regions it is 1 per.50,000. This is because the figures are reached by dividing the total population by the total number of doctors, And this gives an idea of the situation with regard to medical care in the continent,
On the number of doctors graduated each year, In Bolivia 24 graduate each year; in Chile 218 graduate; in El Salvador 26 graduate; in Guatemala, 59; in Haiti, 343 in Nicaragua, 25; in Panama,. 13; in Paraguay, 513 in Peru, 67; in the Dominican Republic, 1523 in Venezuela, 255, There: are some, like Argentina, that graduate 281; and Brazil, with a population | of 80,000,000 inhabitants, graduates 1,578,
But these data, taken from an information bulletin of the Pan-
American Organization of Health, explain the fact that the total number graduated «= because some countries are larger, some like . Brazil, which is the only country that graduates more than 1,000 doctors -~ is some 7,000 doctors; and approximately an equal’? number of 7,000 doctors graduate inthe United States,-
And according to this information bulletin, 88 medical sohools in Latin.America graduated 6,722 doctors in 1957, For the number of doctors in this part of the hemisphere to reach the proportion of 10 per 10,000, this annual figure would have to be increased two and a half times. But what is happening? .Of the 7,000 graduates, some 2,000 emigrate to the United States; so that the United States, in addition to its own 7,000 graduates, gets 2,000 additional, ending up with 9,000, And the United States, which has 13,4 for every 10,000, oan naturally maintain this level; whereas Latin America, graduating 7,000 while needing 18, 000, actually ends up with the services of 5,000. -
“Some additional data on the training of doctors in Latin America, The Bulletin says: ."Approximately one~seventh of the schools accept more than 300 students a year, and one-third admit less than 503 in many schools enrollment is Sow and for this very reason the cost per student is relatively high, In other schools too many students are enrolled in proportion to laboratories, class rooms, libraries and other equipment needed for clinical experience,
. "There are schools that have no full-time professor, and many others have less than five such professors, An inquiry.on the teaching of pediatrics revealed.that only 2 out of 69 schools had fulltime professors of pediatrics; in 68 Latin«American schools only 20. per cent of 2,100.professors of the fundamental Medical Sciences taught on a full~time basis, Sixty-five per cent of the schools were below the optimum level of 300 hours established for a study course of the WHO.” That's the World Health Organization. At present.in our country the figure is 330 hours, and we have one year's intern ship.
This Bulletin also explains that the gravest lack in public health personnel is nurses and nursing assistants, And it says that "the quality of teaching is frequently a reflection of the amount of time dedicated to it by the teaching staff."
Our present situation is that in our University of Havana we have 420 fifth-year students, 450 fourth-year, 500 third-year, 550 second~year, and 1,000 first-year. There are 700 students in the two-year premedical. Course..
As you know, even these figures, which show a considerable increase in the number of medical students, are far from constitute ing our optimum aspiration, We hope to be able to enroll some.2,000 students annually in the School of Medicine, Reality has shown us, however, that. it will not be possible as yet to reach these figures
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although we have already gone above 1,000 and hope to increase the number next year, This is due to the existence of gaps in our secondary and pre-university training,
The mass of students entering the Secondary Schools or the Pre-University Schools is growing, and growing at a much faster rate than those entering secondary teaching, It is understandable that we must have a little patience because you can't speed up the years. And naturally it takes years for the gigantic wave of students, resulting from the efforts of the Revolution, to reach the university level, .
If you take into account the number of those who have gradu- . © ated from sixth grade and, above all, if you take into account the number of those enrolled in the primary grades, which in the current year it is thought will reach 1,300,000, if you take into account the constantly improving conditions, the constantly improving resources in installations and teachers, a time will come in which we can have for all the University Faculties whatever number of admittances we wish, no matter how high and-ambitious this number may be, The day will come when we will be able to register our students in upper schools by the tens of thousands. And. then, when this time comes, and this time is not far off, because five and a half years of Revo~ lution have not passed in vain, although in these five and a half years.you can discount the time we needed to learn, things.from the . Revolution and in acquiring experience =~ but since they have not. passed in vain and since with each year that passes, experience and resources are accumulating «~ the day is not far off when the comparison of our educational realities, of our realities in the matter of skills, will stand above any comparable figure in any other coun~ try on this continent. The day can come when our level in the matter of doctors per inhabitants will be superior to the number of dootors per inhabitants in the United States itself and the day will come in which we will have a doctor for every 500 inhabitants, much higher than the figure for the United States, although the United States steals almost 30 per cent of the doctors graduated in Latin America, This is the Alliance for Progress,
In all these aspects ‘hinging on human energy, human will | power, the Revolution has registered extraordinary progress, There are material realities that human will power cannot alter, and our impoverished and colonized countries, which are trailing farther and farther behind the industrialized countries, constitute a terribly hard reality, a reality that imposes difficult conditions, This was the situation we were in, and to change this situation the Revolution came into existence; the Revolution is laboring to change this situation, It is impossible to realize the same progress where the results do not depend exclusively on human will power but on the real, concrete resources available to the country, and what this country faced was infinite needs and ridiculous resources,
The faith of the revolutionists, the will power and the tena-
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city of the revolutionists, is meeting these difficult realities and prevailing over them; it. is meeting the difficulties which the enemies of freedom for the peoples are placing in their road, and. prevailing over them,
Thus the. history of our Revolution is being written all the | more beautifully, 911 the more gloriously,.and all the more honor-— ably, the greater the resentment, and the hate, and.the fear it has aroused in the exploiting circles of this continent. . It is this history of the realities in our country which our enemies are. trying — to hide by all possible means, This is the reason why they prohibit trips to Cuba. This is the reason ~- among other things -- for the "chewing gum curtain" that imperialism has placed around our country, going to the ridiculous length of prohibiting people from visiting Cuba. Gentlemen, how little faith you have in these visitors, or rather what tack of confidence you display!
There are realities that are not reported in the cables of | the UPI and the AP. There are realities: that are not reported in the continental gossipmongering. There are realities that are not reported in the yellow press or by the mercenary pens in the service of the big exploiting interests. And the bosses of the immense , majority of the newspapers, of the radio stations and television stations, don't publish these realities, In a brazen effort to keep the peoples fooled, to prevent the’ peoples from opening their eyes, all these forces do everything possible to keep the blindfold on just as they used to keep the blindfold on us, this blindfold which the Revolution lifted from the eyes of the * people, this blindfold which in many situations and circumstances only revolutions can remove from the eyes of people. Because as long as the enemies are in charge of the schools ~- the enemies of the workers and peasants -~ as long as the exploiters are in charge of the schools, of the uni~ » versities, of the newspapers, the movies, the radio stations and | television, and all the means of communication, it is not easy to . tear this blindfold away from the eyes of the people.
And because of this the inevitable road is through revolutions, and because of this, in many circumstances, the inevitable road is through armed revolutionary struggle, because it is not. only necessary to tear the arms away from those who maintain exploitation of the peoples through force, it is necessary to tear away from them the wealth that constitutes the base of this exploitation, and it is necessary to tear away. from them.the means by which they keep people in ignorance. And because of. this, the necessity for revolutions such as we have carried out in our country, in which in the first place we deprived the state. of the arms.which it was utilizing as it saw fit to maintain its grip, of the wealth on which it based its iniquitous means.of rule, and of all the other instruments, in order to put them at the. service of the people, .
No longer are these means in the service of the economic inter ests, no longer are they in the service of lying business propaganda;
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they are in the service of the people in education and training. And we don't deny it: the exploiters have no access to these means, because these means are no longer the private property of any corpora tion, of any magnate, of any gang of magnates, This is the famous freedom of the bourgeois press; the private property of newspapers where they write what they like and what is profitable for the rich owners of these means of communication that belong to the exploiting class. ts
Let's take a look, for example, at some of the date which ‘they don't publish, which appears only in some scientific bulletin, the comparative data on the eradication, for example, of one. type of disease, gastroenteritis, as it has been slowly. declining.. With regard to the years before the Revolution, we can't say anything; there were no figures, they did not yet record cases of illness, nor deaths, nor births either, It was not known in many cases who was born or who died, still less what they died from, but since the Rural Medical Service was set up, we have obtained some statistics, From January to August in 1962, in Cuba 2,943 children died from gastroenteritis; from January. to August in 1963, 2,2963;. from January to August. in 1964, 1,489. This means that already within only two years, the yearly rate of decline is practically 50 per cent. This means that between 1962 and 1964, 1,454 lives were saved, lives that would have been irremediably lost without the progress ain medical | care in our country. And this is only in comparing years since the © Revolution, not the preceding years.
In the same way, the rate of death from this disease for every 100,000 inhabitants in 1962 was 59,23 in 1965, 42,4 for 100,000 inhabitants; and, in 1964, 30 for every 100, 000 inhabitants. Compar~ ing it only during the years of the Revolution, the decline in the rate is practically 50 per cent in two years, If data existed for the epochs prior to the Revolution, the difference, the contrast, would be much more striking, | oo
Thus, while we have reached 30 in 100,000, let's see - how many die in Brazil, using the data provided in the Scientific Bulletin No, 64, a summary of four-year reports on health conditions in the Americas from 1957 to 1960, data taken -- not in the mountains where the peasant population lives, not in the countryside, because there no statistics of any kind are taken == but statistics from zones having better conditions.
This means that we have 30 for every 100,000, taking the country as a whole; and now taking the other countries, not as a whole, but only as represented by zones where statistics exist, which are not. exactly the worst areas, we have the following data, and these data refer Tundamentasi to the capitals of these countries ~- to the capitals: In Brazil, in 1959, there were 192,2 for 100,000; in Chile, 88,5; in Guatemala, 233.23 "in Venezuela, 66.2; in Nicaragua, 102.43 in Colombia, 132.93; in Costa Rica, 120.2; El Salvador, 65,63 Panama, 65.2; the Dominican Republic, 206.6; Peru, 103.5; that's for
the capitals,
Let's see: Canada, 5.5; the United States, 4,4, Here is the. empire; there are the colonies, the “Allies for Progress, " the allied colonies} .
Other diseases, Diphtheria: number of cases for ‘each 100,000 inhabitants, in 1962, 20; in 1965, 10.5. South America; several. = countries: Chile, 1960, 38,9; Brazil, 19.3; Venezuela, 16.5; the Dominican Republic, 15,5; the United States, 0,5; Canada, 0.3.
Tetanus, number of cases. In Cuba, 1962, 8.5 for each 100,000 inhabitants;. 1965, 4.7. El Salvador, 14,1; Haiti, - 12.8; Paraguay, 20. 35 Venezuela, ie. 9; the United States, 0.2; Canada, 0.1.
“In some cases medical care and average figures in Canada. are” superior to those in the United States,
Typhoid fever, Cuba, 1962, for each 100,000 inhabitants, 8
cases; 1965, 6.4; Brazil, 51.6; Colombia, 80.5; Chile, 59; El Salvador, 61, 7 Peru, 97.353: * the United States, 0.43 Cmada, 1.5.
Melaria. Guba, 1962, 50. 13.1963, 11.6; Colombia, 167, 93 Costa Rica 136,63 Ecuador, 188, 63; El Salvador, 502. 3;. Haiti, i 033683 Paraguay, 159,23; the United States, 1961, 0.03 Canada, 0.0.
Rabies in humans, 1959, total number of cases in Cuba, 53 1960, 53 1961, one case; 1962, zero cases; 1963, one case; up to this month of the current year, no reported Case. Dogs vaccinated during the. first quarter of 1964, 125,099,
And now we come to. something, a disease in which we have better standing than the United States: polio, Only two cases in the past three years, and these two cases were. children that had not been vaccinated two cases of children not vaccinated, due to their par~ ents, n the United States there were hundreds of cases, Finally, in one. thing, we are above the United States; as to the future, we
shall see,
I have one more sheet before me, This is the sector of medi~ cine in which we have also made notable progress, in the sector of Nurses and Nursing Assistants, which it appears is represented here, Graduated before the Revolution 2,991; graduated at the beginning of 1960, 1,367, A total of 4,358, Students of Nursing now taking the course, 1,408; in October 323 will graduate. Nursing Assistants, general Assistants, 3,888; pediatricians graduated, 214. Total, 4,102, Taking general courses, 942; taking pediatric courses, 305, Thus the number of Assistants, between Nurses and’ Nursing Assistants in relation to the 2,991 and the present number, the number has practically tripled. There will be a continual increase and with it. . improved quality in our medical care. .
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This does not mean that the road is without difficulties, All this has required much effort and will still require much effort, We have had to overcome many difficulties and will have to overcome still more. The merit in these efforts resides in the circumstances under which they were carried out and in the previous conditions that . existed in our country, above all with regard to the development of _our secondary level schools and with regard to the big defects that ‘existed.in our educational programs, The adjustment of our efforts with such conditions and our necessities was, naturally, not easy.
_ In this whole transitional stage, these difficulties could be appreciated. To develop much more efficient and complete programs on the- level of preparation that existed in the secondary schools, with the small number of teaching cadres, required study of programs, adjustments and efforts of all kinds. Every student of medicine knows what we are referring to, because we know the difficulties that must still be overcome to reach a balance between the necessarily rigorous program of study and our limited resources in teaching cadres, the limitations of our levels,. the levels of our former pre-university and secondary schools. :
And we are working on. these adjustments and on overcoming these current difficulties, And the organisms, the Ministry of Education, the University, the Faculty of Medicine, as well as the student organizations, I. am sure that they will find the just and correct solutions to the difficulties that necessarily. still exist at this stage. And I think that these difficulties can be resolved without sacrificing quality -~ because this must be a primary consideration -~- without sacrificing quality, and without sacrificing the health of the students. And I think that the correct analysis of all our experience up to now will gain these objectives, although we will have to saorifice time. (Shouts of "Fidel, Fidel!" and applause, )
We are impatient to have a greater number of practicing doc= ~ tors, as we are impatient for many things. But it doesn't matter having to contain this impatience; what is important is to achieve the aim without sacrificing anything more essential than time, And. in many things it willbe necessary, many times, to hold to the same consideration, the same analysis, To be impatient is proper to revo~ lutionists, however -- those who are not revolutionists are never impatient, because they believe that time will take care of every~ thing and that coming centuries will take care of the present evils -- and to me it seems that impatience is one of the characteristics of a revolutionist, But a revolutionist must learn how to master his impatience and not let his impatience master him. In many aspects of the creative work of the Revolution, we never sacrifice impatience, but also we never sacrifice the.aim, and if we have to sacrifice anything it is better to sacrifice impatience than the aim. (Applause and shouts of "Bravol") a
{To be continued, ]
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