Don’t Forget U.S. Government-Sponsored Terrorism Against Cuba

Stop the Abuse of Cuban Children — and Their Doctors

by W.T. Whitney Jr.

A crescendo of patriotic fervor and cries for revenge follow in the wake of the airplane attacks of September 11. Yet condemnation of the harm done over the years by the U.S. government in the name of “anti-Communism” and control over the world economy has not been entirely silenced. Those with a critical view suggest that the stage had been set for terrorism. But even the great majority, ready to go to war, will likely grant the existence of victims outside the U.S. Yet in the fury that engulfs the nation, the stories of those victims are at risk of being drowned out and forgotten. Here we recall the plight of the children of Cuba. 

The place to begin is the U. S. embargo. Ample grounds for condemnation of that policy can be found from an acquaintance with the laws and regulations that keep the embargo in place, the shortages that it causes, and the statistics of a population’s suffering. My own response, however, is one of outrage, and to communicate the full measure of my horror, I have to recount personal experiences regarding Cuba, including my own.

I am a pediatrician and chose that work mostly because of its concern for the health of all children in the community, not just those in the office or clinic. It seemed different from other medical endeavors. At first I wanted to do something called at the time, “community pediatrics.” Thirty years of practice has taught me that U.S. society accepts as normal striking inequalities in health status among groups of children. In Mississippi, where I taught pediatrics in the 1970s, three times as many babies died in their first 12 months of life as did babies generally in the United States. I think of a little baby with meningitis. Her mother could find no medical care at home, and she came by bus from Hattiesburg to Jackson, half way across the state. Lying on her mother’s lap, the baby had been having seizures all the way.

It became apparent that inculcating skills and knowledge in apprentice pediatricians would not fix the situation. Practitioners’ attitudes had to change, and for that to occur a two-class system of medical care prevalent then and now, in Mississippi and throughout the United States, would, I thought, have to go. Satisfied at the time with incremental reform, I engaged in community organizing and helped start community-directed health centers in Newmarket, N.H., and in Bethel and Norway, Maine. But discouragement set in, despite gratifying association over many years with conscientious, talented colleagues. I began to see the necessity for basic change, of a thoroughgoing nature.

In 1994, I visited Cuba with a group of primary care doctors. Having been a student of history and a very minor participant in the civil rights struggle of the late 1950s, I had applauded the coming of the Cuban revolution in l959 and its victory. But later on, consumed by medical education, residency training, and practice, I lost track of developments there.

During that ten-day trip I learned that the Cuban people were healthy despite crushing shortages. Cuba’s life expectancy and infant mortality rates rivaled those same measures of health outcome in the United States — a nation with a per-capita income 20 times higher than that of money-starved Cuba. After the revolution the Cuban government transformed the constitutional right to health care into a reality. One medical school in 1961 has become 24; 3,000 doctors in l961 became 55,000 in 1994 and now 65,000. With the world’s highest ratio of doctors per capita, every Cuban citizen has had access to free primary care, and even more, free care for complicated illnesses, through an extensive system of research institutions and specialty hospitals that have become referral centers for Latin America.

Then on the last Sunday afternoon of that trip, I walked into a pediatric hospital in Havana where a surgeon took me on impromptu rounds. Two little girls were seen who suffered from corrosive esophagitis, the result, I knew, of swallowing materials that burn healthy tissue. Yes, each girl had mistakenly swallowed homemade soap made from lye — sodium hydroxide — and for over 100 such children he had replaced damaged parts of their esophagus with sections of colon. Cubans have no soap, he noted; the system of rationing allows only four bars per year per person. People were making their own soap.

The U.S. government turned out to have been involved. State Department representatives had informed a Spanish soap manufacturer, one that provided most of Cuba’s soap, that it would lose its U.S. market if it continued exporting soap to Cuba. The same message had been passed on to a Mexican soap-maker, and U.S. officials are said to have arranged for the sale of a soap factory in Dominica to Procter and Gamble, thereby subjecting that soap to embargo rules. I was horrified. For me, this was child abuse.

I came to learn about the actual workings of the embargo. It turned out that foreign companies with even slight connections with U.S. corporations come under embargo restrictions, especially if U.S. components are used in their products or if they have a financial relationship with U.S. corporations. And after the fall of the Soviet bloc, Cuba had come to depend upon the foreign subsidiaries of U.S. companies for food and medical supplies.

In the era of globalization, U.S. companies have extended their reach overseas. Almost 70% of new drugs are now being manufactured or sold by U.S. companies or their foreign subsidiaries. The 1992 law that brought foreign subsidiaries under embargo restrictions did allow foreign exporters to apply for a license to export humanitarian materials to Cuba, but it set up formidable administrative roadblocks. As a precaution against military use or profiteering, exporters were required to document the actual use of their products in Cuba. Faced with bureaucratic obstacles like these, foreign companies rarely apply for licenses, and when they do, action often is delayed for months or years.

No other embargo engineered by the U.S. government specifically targeted food and medical supplies. I learned that poultry on the dock in a South American country ready to be sent to Cuba had to be held back because the chickens had eaten grain that came from Minnesota. I learned that under international law, the Geneva Conventions demand that in wartime combatants protect the health and well-being of civilian noncombatants.

I will draw upon the composite recollections of an imaginary Cuban pediatrician to describe the impact of the U.S. embargo on children’s health. The material that follows is drawn from my own conversations with Cuban pediatricians, the writings of Dr. Anthony Kirkpatrick of Tampa, Florida, and the 1997 report of the American Association of World Health.

The pediatrician reviews difficulties in treating children in his practice. For example, he refers a child with newly diagnosed leukemia to one of several well-trained hematologists in a nearby city, but realizes that the child’s chances of being alive in five years are 75%, not the 95% chance granted to U.S. children. They are unable to receive Asparaginase, a crucially important drug made only by a U.S. company. He is unable to secure a chest X-ray for a child with possible pneumonia, because the Canadian supplier of film turns out to have been a subsidiary of a U.S. company. Besides, the X-ray machine in the nearby, ten-year old pediatric hospital is broken. There are no spare parts for repair, because the manufacturer, Siemens of Germany, has U.S. connections. He prescribes inhalers for children with asthma, but tells me that he should not have wasted pen and paper. The pharmacy cannot stock the inhalers, and he has only one pen.

He continues his report, noting that there is an epidemic of bacterial diarrhea about, and he worries, because water-borne diseases are now ubiquitous in Cuba. Water for drinking used to be clean, but the pumps and valves of the Cuban water system were of U.S. origin, and they gave out long ago, and replacement parts, of course, are unavailable. The young patient of a colleague has Hodgkin’s disease. The chemotherapy makes her vomit repeatedly, and nothing can be done due to the shortage of anti-vomiting medicines. Anti-cancer drugs are in short supply, and his oncology friends often have to make cruel decisions about treating some of their cancer patients and not others. One of them reports that she sometimes resorts to half-doses—malpractice in any other circumstance.

A patient had been scheduled for urgent surgical repair of his congenital heart condition. He was ready for surgery when the anesthesiologist realized that the backup supply of the drug Isuprel, used postoperatively, was nonexistent. The surgery had to be postponed. The Ministry of Health called suppliers in France and had the drug shipped by air on an emergency basis to the William Solar Hospital in Havana. The pediatrician realizes that when Cuba has to buy drugs from third parties that originally came from U.S. suppliers, costs are high. He also knows that the costs of shipping medical supplies to Cuba are exorbitant, because airfreight has to be used. Ships are reluctant to visit Cuba, because if they do, they are prohibited for the next six months from sailing to the United States. He knows that extra money spent for shipping is unavailable for the scales he needs to weigh babies and sheets for hospital beds.

He is discouraged. The medical school library no longer contains up-to-date, English-language pediatric textbooks and journals. The McGraw Hill company had purchased a Spanish company with the niche market of supplying all of Latin America with medical literature published in English. As a result of the embargo, Cuban pediatricians have been cut off from scientific information they need. My imaginary friend still takes pride in the fact that the population’s basic needs are met. He knows that that achievement required huge sacrifices that have been shared equally among all Cubans. He resents U.S. policies that keep him from practicing the pediatrics he knows how to do. He relishes contact with North American colleagues who admire Cuba’s commitment to social justice and who actively oppose their government’s hostility toward Cuba.

I share the discouragement of my pretend friend. The same spirit of unfairness that for me has characterized health care in the United States extends to Cuba, and it weighs heavily upon the Cuban people. An exemplary health care system is being trashed. I suggest that health care in Cuba, where the ideal of universal, comprehensive health care is taken seriously, stands as a model for the rest of the world. Had universal health care existed 30 years ago in my own country, the practice of community pediatrics might have been a possibility.

In the name of simple decency, I call for action along four lines. We need to lend a hand to health workers in Cuba and honor them for their accomplishments. We need ceaselessly to oppose Washington’s war against Cuban health care. We need to finish off the whole policy of blockade. We need to make a reality of universal health care in our own country.

Where is the good in harassing doctors in Cuba and making their jobs impossible? Why beat up on sick people? Where is the harm in selling antibiotics, or wheelchairs, or bed sheets in Cuba? The U.S. embargo is, I suggest, a crime against humanity, along with the airplane attacks of September 11.  

And the evil of the embargo against Cuba would be much easier to fix than the terrorist attacks. Were the U.S. government to back off from its assault on Cuba’s independence, it might even garner a few friends from unexpected quarters.