#126 – The Expat Files: Cuba’s Medical System and Surveillance

Automatically transcribed from the original recording; names and wording may contain errors.

[00:03] Hi everybody, I'm Johnny Mueller and you're listening to The Expat Files, living in Latin America. The show that tells you what it's really like to live, work, play and or retire in Latin America. I tell it just like it is, not the version they give you in those glossy travel magazines, or the picture they paint for you in those international traveler websites, where they're only trying to sell you something. What's it really like for expats living in Latin America? Well, it's time to take off those rose-colored glasses and find out. So let's get started. Now in a previous show I was talking about Big Brother in the United States versus the Big Brother Effect in various Latin American countries. And when any of us think of the words Big Brother, of course we think of the United States and England as the absolute last word in government spying and prying, no one thinks

[00:48] of the former Soviet Union anymore or its satellites, like Poland, Czechoslovakia or East Germany. When you think these days about the oppressive communist version of Big Brother, we don't think of the Soviets anymore, we think of North Korea and maybe China. And even Cuba when you think of its massive state-run organizations with half of the adult population working for the government, that's 50%. But still, when you go to Cuba to visit, and I've been there a couple times myself, you really don't feel like there's any kind of Big Brother structure at all, even though half the adult population works for government. And why is that? Well that's because they don't have the technology, they don't have cameras everywhere, or body scanners, or even any great numbers of computers. That's one thing that you notice right away. In fact, if you go to most places in Cuba, you see computers there about as often as we saw computers about 30 years ago back in the states.

[01:34] None of the mom and pop stores, or even the medium-sized stores have them. Only businesses owned and operated by first-worlders seem to have them. And forget about surveillance cameras, they might have one or two in a big modern building. And the big first-world buildings like hotels and tourist complexes that were built by Spanish companies and Canadians. And it's true with cell phones too, only about 10 or 15% of the Cubans have them. Which means they've got a long way to go, since the rest of the world is practically saturated one for one. Every time I've been to Cuba, it seems to me they've got like a 20 or 30 year lag going in all the smart technology that everybody in the first world seems to have. In fact, one time I went to a Cuban hospital with expat Eddie because he fell down the stairs at a salsa club and thought he broke his ankle. And by the way, there's nothing more pathetic than a drunk gringo at a salsa club who thinks

[02:23] he can actually dance. So anyway, we're in this hospital with Eddie's swollen ankle, and in the hallway alongside the emergency room, there were some rows of medical diagnostic machines, and the dials and switches had Spanish lettering, and right underneath, they had Russian lettering. Which I thought was very cool, but when I tried to take a shot of it with my camera, a guard came over and yelled at me. But when I gave him two bucks, he not only let me take the shot, he posed right in front of the stuff with a big smile, only he was missing a front tooth. How do you like that? I thought if you work for the people's hospital, you'd at least get free dental. Oh well. There was a big variety of medical equipment there, and me being the curious engineer type, I walked over and took a good close look at the stuff. I mean, we were sitting there twiddling our thumbs for over an hour, so why not? Waiting and waiting for Eddie's x-ray results.

[03:08] So in that respect, it was no different than a first world hospital. Long lines, long waits. Anyway, stacked in the hall was an x-ray machine, a cardio pulmonary machine, and what looked to me like a kidney dialysis unit, only Soviet style, like three times bigger and ten times heavier than it had to be. I took a look at the backside of one of the bigger machines, and there was some big ventilation vents and a fan going inside this machine. I'm telling you, this machine looked like it came out of a Hollywood backlot of a Frankenstein movie. And inside the casing of that machine with the vents, I saw rows and rows of vacuum tubes. Now up in the first world, we got rid of all our vacuum tubes in about the late 1960s. Actually, even earlier than that, that's why transistors and integrated circuits were invented, to get rid of vacuum tubes, because vacuum tubes were big, bulky, they used a

[03:56] lot of energy, and they produced a lot of heat, so eventually they'd burn themselves out. In fact, the only time you'll ever use a vacuum tube in the United States, or in the first world for that matter, is in audio equipment to get some distortion, like in guitar amplifiers and certain microphones that you want to get a warm, mellow kind of sound out of. It's very old technology. It goes back to about 1910 or 1915. The thing is, most people alive today have never even seen one, except in a museum display depicting a family around big old radio or a television, circa World War II or the 1950s. But that's the kind of equipment they're using in Cuban hospitals. It's all pre-1989 Soviet leftover technology that they gave to Cuba when they were allies during the Cold War. And that's what I don't understand about the Cuban medical system.

[04:44] Cuba has more doctors per capita than any other country in Latin America. In fact, it has the second highest doctor-patient ratio in the world. They've got one doctor for every 150 persons in Cuba. The only country that has more doctors per person is Italy, and who knows why that is. And those numbers seem very impressive compared to the US, which has about one doctor for every 400 persons. Which almost makes us sound like the third world now, doesn't it? And even worse is Canada, which has about one doctor for every 500 persons. Which is the crappiest doctor-patient ratio in the whole western world. Even Greece beats out Canada. But we're not here to beat up on Canada's healthcare system. We're talking about Latin American healthcare. So what's the story on Cuba? Why all those doctors? Why such crappy antique medical equipment in the hospitals? That really doesn't fit the image most of the enlightened first world has about the

[05:33] Cuban medical system. They think there's some kind of socialist miracle going on that has transformed their medical system into something better than the first world ever had. You must have heard that before. I have. A hundred times. But to have all those highly trained doctors and that crappy Russian equipment, and I'm sure most of it doesn't even work. Why also to be stacked up in the hallways gathering mold and dust? That really doesn't make sense now, does it? That's like training a race car driver and then giving him a horse. And that's why it seems, every time I go to a party and the subject of Cuba comes up, you always hear someone defending Cuba solely based on their so-called great medical system that beats out everything first world at a tenth of the cost. And the guy or girl at the party pushing that argument is usually a first world liberal arts college student, by the way, or a backpacker.

[06:19] Same thing. And you know, in every case I've ever gotten into a discussion about the Cuban medical system, the person that praises that Cuban medical system the highest is always a guy or girl who's never been there. Now I have been to Cuba and I've also been to a Cuban hospital or two. And I've also been to a few of their medical clinics and to a few of their pharmacies. Though I haven't yet got the nerve to walk into one of their dental offices because just like the rest of Latin America, we're looking at a society that hasn't discovered dental floss yet. Anyway, I'm here to tell you the reason why Cuba gets such a good rap about its medical care system is because every time there's an international disaster somewhere, a hurricane, tsunami, volcano, or earthquake, Cuba offers to send a few hundred doctors over. And they do send them. And they send them for months, even years at a time. Can you think of any better PR than that?

[07:04] Little Cuba sending hundreds, even thousands of doctors to save little brown poor people in other parts of the world? Man, that kind of PR is priceless, isn't it? And you know what Castro does with his political friends now, don't you? Like Hugo Chavez of Venezuela, Rafael Correa from Ecuador, Noriega from Nicaragua, and Evo Morales from Bolivia. Well, in fact, Castro trades doctors for oil. Because you know the Cuban peso is not a convertible currency. You can't use it to pay for international debts or in commerce because no one will accept it. It's only legal tender within Cuba. It's not like the Mexican peso or the Costa Rican colony or any other Latin American currency where you can go down to a bank and get dollars directly. You cannot do that with Cuban pesos. So the only way they can get imports like technology and oil is through tourism and

[07:50] selling some of the few agricultural products that they have like tobacco and sugar and exporting them on the international market. But those few countries that I mentioned that are very friendly to Castro, especially Venezuela and Bolivia, and Ecuador, well, besides Mexico, those are the only countries in Latin America that have big quantities of natural gas and oil. So in effect, Cuba farms its doctors out like a product. Like India farms out call centers. So Cuba has developed a very nice little niche there. They pump doctors out on an assembly line and they trade them on the open market for slave wages. And here's what you didn't know. Every single Latin American country has its own share of Cuban doctors working in the country on contract. Now you might know that within Cuba, everybody makes between 20 and $50 a month. That's the going rate.

[08:36] That's socialism, man. All for one and one for all. No matter what your position, no matter what your career, unless of course you're in a high level position in the communist government, then you get your beach house and your body guards and your cars and your Johnny Walker black label and a blackberry and unlimited and uncensored use of the internet. Something that your regular Cuban never has access to. Anyway, Cuban doctors in Cuba make about $35 to $50 a month. And Cuba has the world's second biggest population of doctors per capita and they keep pumping them out all the time. So what they've done is they've made them a commodity and the Cuban government will farm them out to other non-imperialist third world countries at the surprisingly low rate of $200 to $300 a month. Now how it works in Latin America is this.

[09:22] Almost all the big cities in Latin America have plenty of doctors. They have a very high doctor to patient ratio. There's a very nicely balanced concentration of doctors in cities over 50,000. But when doctors graduate from medical school in Latin America, in for example a country like Honduras or Brazil or Argentina, well, just like in the United States, doctors want to practice in the big cities and the big hospitals where the money is, where the equipment is and they hardly ever go out to the boonies and practice. That's almost never their first choice. They don't want to be country doctors trading chickens and tortillas and iguana eggs for medical services. They want to work in the big city and drive a late model Toyota. And being that there is a big doctor shortage in the boonies, out in the farmlands and in

[10:08] the jungle areas, in the past 5 or 10 years, those Latin American governments, knowing that the rural areas are way underserved by doctors, well, they've found that Cuba is more than willing to strike a rent a doc agreement with them. They'll either contract a big group of Cuban doctors and pay the Cuban government cash for from $200 to $300 a month per doctor, or they'll strike a deal trading doctor services for oil and technology. At any rate, if the going rate to rent a Cuban doctor anywhere else in Latin America is about $200 to $300 a month, and Cuba only pays them $25 a month if they were working in Cuba. Well, the deal is, even if they're working in another Latin American country, let's say Belize, they're still under contract to the Cuban government, and they're going

[10:54] to get their $25 a month, which is the going rate for pretty much every professional in Cuba, plus a little extra living expenses, which works out to be about the minimum wage in a country that they're working in. That means if the minimum wage in Belize is $125 a month, and the Belize government is paying $250 a month to Cuba for each doctor, the extra $125 a month over the minimum wage that the doctor makes gets kicked right back to Cuba. So the way it works out is, every doctor that Cuba has working offshore in another Latin American country, the Cuban government gets a kickback anywhere from $100 to $200 a month. And how many of these sweatshop doctors does Cuba farm out to the rest of the world? Well, just think of this, Venezuela has 15,000 Cuban doctors right now, and Venezuela is

[11:42] only one of 20 Latin American countries. Not to mention that Cuba farms out doctors all over the world, not just in Latin America. And that's just one of the reasons why so many college liberals that I run into praise to high heaven Cuban doctors and Cuba's medical system. Even though they've never been there, and they don't know how much the doctors make, and they don't know that these doctors who are farmed out, once they get to another country and realize what it's like to live in a free society, at least a lot freer than theirs, well, it turns out that every one of them, to a man or a woman, ends up wanting to stay in the country that they've been farmed out to. But the system's set up so that they really can't. They almost always end up going back to Cuba after the contract's up. And how do I know this stuff? Where do I get my information? I ran into a group of these Cuban doctors myself in El Salvador not so long ago.

[12:30] I was staying at a little hotel right next to a big medical clinic, and I went into a little restaurant and saw a couple of doctors sitting there and realized they had Cuban accents. And by the way, that's how you can tell your Spanish is getting good down here. You start recognizing accents from different Latin American countries, because they are pretty distinct. Anyway, I was sitting next to these doctors, and I said, hey, are you guys from Cuba? I thought I picked up on your accent. And they were, and so I got into a little discussion with them, and they told me some very surprising things that explains a lot why so much of the world believes the propaganda that Cuba has a medical system that's even a notch above first world medical care. Well, first of all, everybody cites the fact that Cubans live a very long time. They have a life expectancy that's actually a few years more than that of the United States, Canada, and Europe. So how do you explain that?

[13:16] Well, they explained it. They told me that the average Cuban has an 1,800 calorie a day diet, well below the 2,500 to 3,000 calorie a day diet of the first world. And first world people eat the most unhealthy diets in the world. They didn't have to tell me that. Those Cuban doctors knew quite well that first world diets were just loaded with saturated fat, red meat, additives and preservatives in junk food. Basically, Cubans don't eat processed food at all, and they only eat red meat or chicken maybe two times a week. And the animals are not fed genetically modified corn or pumped up with antibiotics or growth hormones either. That kind of stuff just does not exist down there. Only tourists and high level government functionaries can afford to buy that stuff, since it's all imported and at first world prices. And interestingly enough, the doctors said that obesity just has not hit Cuba yet, except

[14:06] of course with tourists and government functionaries. So Cubans just don't suffer the common first world ailments, like high blood pressure, high cholesterol, hardening of the arteries, early onset coronary problems, osteoarthritis, rampant tooth decay, and diabetes. Conditions like that that affect 50% of everyone over 50 years old, up in the first world, just don't surface till much later in life down in Cuba. So it's not the number of doctors, or the so-called higher quality of medical care in Cuba. According to these Cuban docs, the answer is much simpler than that. It's the fact they don't have first world eating habits, though you don't hear people talking about that at parties now, do you? And the other half of that good health equation in Cuba is due to the fact that less than 5% of Cuban families have a car. So they walk everywhere and get at least 10 times the exercise that the average first

[14:56] world person gets in a day. So that's one myth exploded, and the second big propaganda myth about the so-called superiority of Cuban health care is this. Everyone that hasn't been to Cuba seems to think that the reason why the HIV infection rate in Cuba is so low, in fact it's one of the world's lowest, is due to the high-level health care that the Cubans get. Which is BS according to the Cuban doctors that I talk to. They say the reason why the HIV level is so low is because it's illegal to be a drug addict in Cuba and it's illegal to be a homosexual. So if you get caught shooting up speed or heroin, or you get caught in the act of, well, being a homosexual, they basically toss you in jail and throw away the key. And the HIV statistics that are published throughout the world are collected by the Cuban health authorities based on the level of HIV in the general population.

[15:44] Not the people who are in prison who aren't counted in those surveys. And according to my three new Cuban doctor buddies, the prison population is just teeming with AIDS cases. But you'll never see those in the national statistics, because, well, they're just not counted. Which brings us to the third myth about the Cuban health care system. That every Cuban citizen has equal access to the highest level of medical care provided within the system. And of course, we read in the papers about Cuban advances in optical surgery, lasers, stem cell research, organ transplants, advanced drug treatments and genetic therapies. And that first worlders, especially Europeans, make special trips to Cuba to get advanced treatments not yet even available in their home countries. When I brought this up to my three fine Cuban doctor friends, one of them laughed and said,

[16:32] yeah, if you have the money or you're high up in the party, then you could get stem cells or a new cornea or some gene therapy. Because it turns out that Cuba has two medical systems. One medical system for 98% of the regular population, the common man who makes between $20 and $50 a month. And yes, the common man does have access to plenty of clinics. Doctors, pharmacies and hospitals, but they don't have access to any of the modern high tech equipment that you see in first world hospitals. They don't have CAT scanners and tomography and million dollar pieces of medical equipment like that because that stuff comes from the first world. And the Cuban government is very resistant to buying anything that isn't made in Cuba itself or in a Latin American country, which means they kind of lose face every time they have to buy something from a company like GE Medical or Siemens, which are prime examples

[17:21] of giant capitalist companies that are in the business of exploiting the proletariat. So says the Cuban government. But those are the rules for the common man in Cuba. But lo and behold, some of those first world machines have made it to the island. But the average man on the street is never going to get his chance to lay down and get a scan on a million dollar machine like that. But get this, there's two levels of care in Cuba, wouldn't you know? The doctors told me Cuba has over 50,000 health care tourists a year that bring in over 100 million bucks and they go to special clinics that the regular public can't go to. Only foreigners, high level party members and diplomats are allowed to use those hospitals. Foreign patients travel to Cuba for a wide range of treatments, including eye surgery, neurological disorders, multiple sclerosis, Parkinson's, cosmetic surgery, treatment

[18:11] for addictions, retinitis pigmentosa, and all that experimental stem cell and skin grafting stuff you hear about in the press so much. And the doctors also said that in Cuba, as a patient, you have no right to privacy, no informed consent, and you can't sue for malpractice. There's no such thing. And if you go to a Cuban emergency room, you can't refuse treatment. The doctors are the boss and they can do anything they want to you. You have no right to say no. So if you're a Jehovah Witness or a Rastafarian and you refuse a blood transfusion for religious reasons or you don't believe in vaccinations for whatever reason, too bad you're gonna get one anyway. And when the doc said Jehovah Witnesses, I said, man, Jehovah Witnesses in Cuba? He said, yeah, they've got quite a few. I mean, Michael Jackson was one, wasn't he? But in Cuba, who'da thunk?

[18:58] But those non-existent patient rights are just for the general population. Not for that special medical care you get as a health care tourist. Because you see, a foreigner or a diplomat flying in to get a facelift or a kidney treatment. That's the 100% capitalist side of Cuban medical care that no one ever talks about. Because it's against the law to criticize the Cuban government, including the medical system. And there are 5 to 10 thousand people doing time right now, or exiled for life to the tobacco plantations, just for opening their mouth and complaining. But the bottom line when I got out of those 3 Cuban doctors is this. They said if the average American would just eat a Cuban diet, which is extremely low in saturated fat and has almost zero preservatives, additives and junk food, and if a first world person would just walk to work instead of drive, then it wouldn't be necessary at all

[19:46] to spend the $10,000 per person it takes in the United States to get health care. While in Cuba, they only spend $300 per person to get the same life expectancy. And the Cuban doctors attribute almost all of that to diet and exercise. But here's the funny thing. 2 out of those 3 doctors sitting with me had pretty big pot bellies and looked a bit out of shape. And when I mentioned it a bit slyly, of course, one guy said, yeah, Jorge likes McDonald's and Christian's got a car. I guess they proved their point, huh? Oh yeah, and by the way, they'd been in Salvador for 3 and a half years already and they'd had their contracts renewed twice, which was just fine with them because they didn't want to go back. So they were very used to being outside of Cuba. But they said they'd go back when the contract was up because they had their families there. And all 3 of them were married.

[20:32] And they told me you couldn't enroll in the doctor exchange program unless you were married. Even if you read in the first world press that it isn't true that it's all volunteer, it's not. You can only go if you're married. That way they know you're going to come back and you're not going to skip out. Because when they first started the program, about 20 years ago, a lot of young doctors right out of medical school weren't married and had no ties. So when they shipped them off to Venezuela or Brazil or wherever, when their contract stint was up, most of them didn't come back. They skipped. But the Cuban medical court administrators are smarter now. And just one last thing. Those Cuban doctors before I left said this to me. If you do ever run into someone that's insistent that the Cuban medical system is far and away superior to first world medical systems, just remind them that Fidel's own personal staff of doctors are Spanish and German.

[21:20] Hmm, do I detect the little lack of confidence in your system there, Fidel? Maybe. Anyway, I started out today talking about the big brother effect in Latin America and how even in a place like Cuba where half the working population is in the government, you hardly even realize it. You don't as a tourist anyway. Even 15 or 20 years ago when I made my first trip down there, you didn't see the military or gun-toting cops in every corner. Like you always imagined there would be. Though, I have to admit, in Cuba you always get the feeling that someone's watching you. Yeah, and they probably are. But mostly I think the people are just watching us, at least out of the corner of their eyes. Because us tourists are just fatter, taller, louder, and dressed a lot nicer than the average Cuban. But any time you talk about big brother, it's easy to slip into a conversation about the military. Because every time you talk about a large big brother state, you're talking about a

[22:07] large police force and a large military. After all, that's how you enforce a big brother state, right? So once again, here's the facts. The United States military runs around 3 million strong, even more than that. But if you look it up on the CIA fact sheet, you'll see that it says there are about 1 million and a half active duty soldiers in the US. But they don't tell you about all those contract auxiliaries, like those multi-billion dollar Halliburton and Blackwater contracts. And I know because of a bunch of scandals, they don't call themselves Blackwater anymore, but I forgot what they call themselves. But if you add all the active duty military and the contract auxiliaries, you're talking about over 3 million people in the US military, which is about 1% of the total population. Which means that 1 out of 100 Americans is active military or has been hired by a military contractor. Now we all think that because Latin American countries are already squabbling with each

[22:56] other, and the occasional dictator pops up and they have petty revolutions once in a while, and the occasional coup d'etat like in Honduras a few years back, where they institute martial law and all that, well you think since that's the case, Latin American countries would have huge militaries. And why not, every time you see news footage of a Latin American uprising somewhere, or a strike or a protest, there's tons of military on the street, right? Well that might be true according to the news footage, but in reality that's not the case at all. Nearly every single Latin military in all 20 Latin American countries in fact are quite small and they're spread really thin. They're so small in fact, that they're about one tenth the size of the US military per capita. Plus, they're terrifically underfunded except in a few cases like Venezuela and Argentina

[23:41] where they have the money to buy big military purchases from the first world. And they also have twice to three times the amount of military personnel than the rest of the 20 Latin American countries on average because they have the dough. But even if those countries have seemingly big militaries, the US still beats them out by having six or seven times as many soldiers per capita than they do. And then there's that special case of Colombia that has more soldiers per capita than any other country in Latin America. And that's because they've been fighting the FARC guerrillas in the countryside for 30 or 40 years and they're trying at the same time to counter that big military build-up that Chavez is putting up right now in Venezuela with all that oil money. So it's kind of like a cold war right now between Venezuela and Colombia. And they're both having a small version of an arms race. But if they were ever to go to war, and who knows, Colombia would wipe Chavez's troops

[24:30] off the map because the United States has at least six big military bases in Colombia and thousands of troops, and the US funds half of Colombia's military, ostensibly to fight the narcos in the drug war within Colombia where so much of the world's cocaine comes from. A drug war that I might add that we're losing spectacularly, which is another reason why we should throw every single jerk out of Congress except Ron Paul. So anyway, the countries in Latin America with fairly big armies in relation to their populations are Argentina, Venezuela, Colombia, and Ecuador. And except for Ecuador, that tracks very well with the fact that wealthier countries can and do buy bigger armies, but still you're talking about armies that are five to ten times smaller per capita than the US armed forces. For example, let's take Guatemala, which had a history of armed conflict for 35 years.

[25:19] And since they signed a peace treaty over 10 years ago, of course they still have an army, but only a little less than one in a thousand Guatemalans are in the army, compared to one in a hundred in the United States. That means if there was some kind of civil uprising, and every single soldier took to the street with his gun, and the population took to the streets to go against the army, with nothing but rocks and machetes, I'd hate to be the soldier when that came down. Every soldier'd be outnumbered more than 900 to 1. And that's why I say you should never worry a bit about excessive military in these Latin American countries. Not only are they virtual skeleton crews compared to first world armies, but they're so underfunded it's ridiculous. For example, the Guatemalan military has a grand total of 12 tanks. And like I said in the past show, it's got a yearly budget so small, that one of the

[26:05] new Lockheed F-22 Raptor jets that the United States has, just one of these things, costs one and a half times more than the Guatemalan military budget for an entire year. So if the Guatemalans decided to buy one of these Raptor jets, if they could, just one now remember, they'd have to close down every military base and fire every soldier to do it. And they'd still be in debt to Lockheed Martin for 50 million bucks. Now when you talk about Latin American militaries, you have to talk about the US presence in these countries. The US at one time or another had bases in a dozen or so Latin countries. And the US usually leases them on a 10 year basis. But lately Latin American countries have been saying no. As these 10 year leases come up, Latin American countries are refusing to renew them. In the very recent past, the US has had leases on bases in Ecuador, El Salvador, Cuba, Honduras,

[26:57] Panama, Colombia, and Paraguay. And it looks like in a matter of 3 to 5 years, the only US bases left in Latin America are going to be in Guantanamo and in Colombia. Which is a dramatic change from the past, and it shows how the US is losing its grip and losing its friends and its influence in Latin America. And I don't know how most of you listeners feel about that, but most of us expats think it's actually a pretty good start. And by the way, if you're wondering what happened to expat Eddie in that Cuban hospital, he thought the nurses were hot, but he was pissed off at the doctors. They only gave him three generic Vicodins, and he thought an injury like that was at least worth a couple dozen. You've been listening to The Expat Files, living in Latin America, coming to you each

[27:42] week from somewhere south of the border. And don't forget you can email me on anything at all about Latin America, The Expat Files at gmail.com. Once again, The Expat Files at gmail.com. See you next time. Nos vemos!