EspañolJuan Afonso is a Cuban-born physician. He lived, studied, and worked in Cuba under the communist health-care system. But far from the praise that uninformed observers heap on Cuba’s medical care, Afonso says the reality is much different. He fled Cuba for Chile in the 1990s, and says he could hardly afford to feed himself on his monthly salary on the island.
He speaks with a split accent, a perfect mix of Chilean Spanish and Cuban slang, after living in the Andean country for over 20 years. Some 280 kilometers away from the Chilean capital of Santiago is Talca, where Afonso currently lives and has established a private practice, on top of his shifts at a primary-care emergency room.
Prior to arriving in Chile, Afonso took part in a state-sponsored mission in Laos, and says he dreamed of the day the regime would allow him to buy a car. He confesses that the thought of escaping on raft heading toward Miami entered his mind more than once.
After reading a PanAm Post report on the Cuban health-care system, published on October 6, Afonso decided to get in touch and share his experiences as a doctor on the island.
How would you describe the Cuban health-care system?
The Cuban medical system is not healthy. I have family, people that I love that still live in Cuba, and I would like to see the country thrive. But nothing can be fixed without recognizing the essence of what’s going on here.
Many talented people have moved to the United States and elsewhere; good people, experts, have been forced to leave. It’s not that they don’t love their country and have abandoned their brothers, but you need to be practical. If you are starving in your own country, and they [the regime] are having a laugh at your expense — with low wages, no chance for a raise, and unpaid shifts — what are you going to do?
I look at my university professors. If they would have left in 1959 to the United State, they would be very wealthy by now … but they stayed. They sacrificed themselves, and trained thousands of future doctors.
When I saw how those brave doctors were abused by a group of leeches and bureaucrats, I told myself: “What am I doing in this country? I wasn’t born to be slave.” And I don’t regret it, despite the government not allowing me to return to my country, and especially now that I’m speaking out publicly. They would throw me in jail.
One has to be consistent. I’m only talking about things I’ve experienced: my own experience. I hope one day Raúl [Castro] will show some compassion and actually speak with the doctors in the country. About 20 years ago, he asked the public for their opinion on the matter, but I don’t think he read a single reply. The government has been making fun of us for a long time now.
How much does a doctor like you make in Cuba?
I will tell you something: I would have liked to stay in Cuba. I left because I could barely afford to buy a single egg to eat a day.
I remember the Argentinean crisis of 2001, when the banks froze people’s accounts, and a man on TV held up a package of spaghetti and said, “Look at all we have to eat!” When I saw that, I remembered what we experienced in Cuba when the Russians left in the 1990s, and the terrible famine we went through. With a pack of spaghetti, I would have been the happiest man on Earth.
In 1993 and 1994, the hunger was terrible. At that time, I earned US$18 per month, in a country where prices are the same as everywhere else. I have a Cuban friend living in Chile who is a dermatologist. He used to tell the shoemaker, “Today, I’ll buy only the left shoe.” He was kidding, but it had some degree of truth.
I used my bicycle to visit my patients’ homes. It was my only means of transportation, and changing a flat tire cost CUP$400, which was roughly my monthly income.
Then I started listening to Radio Martí, and a friend of mine, who happens to be a prosecutor, told me I should stop [criticizing the regime], because they would put me in jail. There is no separation of powers between the executive and the judiciary in Cuba.
Why is the communist propaganda about health care still effective?
They’re good at it. They have been selling the idea of an ideal health-care system that has never existed. The government has taken advantage of the internet and mass media, and the openness present in democratic countries.
But it’s all lies. Following the fall of the Soviet Union, public health care in Cuba languished. Terrible things were done. Hospitals are now falling apart, and the government doesn’t invest in them.
Doctors have been using the same medical equipment for the last 20, 30 years. The regime also uses doctors as propaganda tools to clean up its image around the world, sending them off on humanitarian missions to places like Bolivia or Venezuela, as if they were the saviors of the world.
What happens with the doctors that defect?
Many doctors drink what we call the “Coca-Cola of Forgetting.” But the Cuban government knows how to blackmail us. People who disobey the government, and speak to the press about the country, are not allowed to return. The regime owns your passport. They can prevent you from reuniting with your family in a new country.
And the doctors that stay in Cuba say nothing about this?
Most of the tourists that visit Cuba turn a blind eye to what’s happening. The propaganda will stop only when doctors are able to speak without fear of retaliation.
Tell us about your experience as doctor in Cuba.
Things here in Chile are not perfect, and yet doctors are paid well, so just imagine how medicine works in a country where doctors have to bring their own paraffin to turn on a burner. The needs of doctors in Cuba conspire against the quality of health care.
I was told that during a meeting of the [Communist] Youth, an Olympic athlete stood up and said he thought doctors should work extra shifts for free. The whole world applauded, and the motion passed unanimously. There is no union to defend doctors in Cuba.
Many of us would wake up around midnight from hunger pains, and no one ever gave us anything; maybe a slice of bread, at the most.
I felt like going to those beach resorts in Varadero, where carrying bags for tourists could earn you in two days what I made in one month. Once you reach that point, and you have nothing to eat, you must be practical.
What do you make of the claims in Michael Moore’s Sicko?
That’s easy to explain. There are two health-care systems in Cuba: one for ordinary people, like my family, and another that is exclusive to the Cuban ruling class, who live better than any capitalist.
Those foreigners in the film visited the latter system.
The high-end system sends its doctors to Canada and Europe, where they are trained using the latest technology, and access to the internet. These things are impossible to access for a physician at a regular hospital. These luxurious medical centers are like five-star hotels.
On the other hand, hospitals for ordinary Cubans are falling apart, and patients must bring their own bedding, buckets, and everything else.