Inter Press Service - January 16, 2002
Dalia Acosta

The decade-old economic crisis has failed to bring down the country's health indicators. And there has even been progress in some areas, such as the reduction of infant mortality, which fell from 7.2 per 1,000 live births in 2000 to 6.2 per 1,000 last year.

Maternal mortality also saw a decline, from 5.4 to 4.8 for every 10,000 live births in the same period.

"There are days when we do not have even the most necessary items to perform our jobs, but the doctors know they cannot allow the death of even one child or mother," said Herminia Díaz, a nurse with 17 years' experience.

Díaz remembers "the golden age", the 1980s, when the Cuban public health system had everything it needed to provide complete medical attention. "The hospitals were impeccable. Now days go by when we don't even have cleaning supplies," she added.

The country's situation changed radically beginning in 1990, when its major trade partners - the Soviet Union and the European socialist bloc - collapsed, bringing about an economic crisis that continues to affect the island's 11.2 million inhabitants.

But, in spite of the crisis, public health continues to be among the government's top priorities. It is still one of the privileged sectors when the national budget is drawn up at the beginning of each year, allocating the state's limited resources.

Cuba this year has earmarked 1.9 billion pesos (one peso equals one dollar at the official exchange rate), 88 million more than in 2001, as part of a general budget of some 6.2 billion dollars approved by the National Assembly (congress).

This strong political will and a health coverage system that is well structured and community based are the reasons that, even with the crisis, the main health indicators in Cuba remain steady or improve.

Deaths do indeed occur among Cuban mothers and newborns, but the number is very low compared to figures reported in other Latin American countries, and even compared to those of many industrialised nations.

The Public Health Ministry reports that last year's infant mortality rate was 6.2 for every 1,000 live births, the second lowest in the Western Hemisphere after Canada, where the rate was six per 1,000.

Figures from the United Nations Children's Fund (UNICEF), meanwhile, show that Chile, with 11 deaths of newborns per 1,000 live births, ranks second in Latin America for this indicator, following Cuba.

On the other extreme are Peru, Dominican Republic and Guatemala, where infant mortality - or death before reaching 12 months - ranges from 42 to 45 for every 1,000 live births.

A report published by Cuba's state-controlled media says the principal causes of death are related to congenital anomalies, accidents, or perinatal ailments, such as hialine membrane disease, congenital pneumonia and newborn sepsis.

The decline in maternal deaths and improved birth-weights were two important achievements in the Cuban health arena in 2001, says Miriam Aliño, director of the maternity-infant programme at the Public Health Ministry.

Maternal mortality rates were 5.4 for every 10,000 live births in the year 2000, and 4.8 per 10,000 in 2001. Last year in Cuba 58 pregnant women died from tubal pregnancies, amniotic fluid embolisms or heart attacks, among other causes.

As far as the reliability of these statistics, keeping in mind the conditions in which some health institutions operate and the lack of resources, obstetrician Bárbara Suárez commented in a conversation with IPS that "the figures might look like a miracle, but they aren't."

The specialist said that mortality continues on the decline due to the rigorous prenatal care and follow-up provided to all pregnant Cuban women and to the high level of training of the professionals who work at the maternity clinics.

"The hospital may be lacking things that are considered basic to medical care, but in the intensive care ward we have all necessary medications for handling emergency cases and situations in which the life of the mother or the child is in danger," said Suárez.

"We work under a great deal of pressure," admitted the doctor, explaining that "each physician has to present well-founded justifications before the health authorities if a death occurs during his or her shift."

More than 98 percent of the births reported in Cuba take place in a clinic or hospital. This socialist-run island has one doctor for every 169 inhabitants, 272 hospitals, 442 clinics and a community health system providing almost universal coverage.

"When I became pregnant, the doctor gave me a large card that he used to record all of my visits, and occasionally there were medical tests involving my husband. My daughter is now one year old and has her own medical card," says Mariela Cabrera, 27, an engineer.

Her husband, Rafael Fernández, 29 and also an engineer, admitted that at first he did not understand why he had to attend some of the appointments and submit to blood tests.

Women begin receiving specialised medical attention prior to the fourteenth week of pregnancy under a programme that includes at least eight medical appointments, even "housecalls".

When a pregnancy is considered high risk, for example if the mother has diabetes, hypertension or a vaginal infection, all necessary medical tests are conducted and the woman is closely monitored.

Furthermore, the soon-to-be mothers undergo testing for congenital deformities in the foetus, sickle-cell anaemia, human immunodeficiency virus (HIV), syphilis and hepatitis B.

The father is also tested to determine potential risks for the foetus, whether genetic or disease-related. Abortion is legal in Cuba and is an alternative couples have if severe malformations or other serious health problems are detected.

The newborns, meanwhile, have an average of 25 medical visits in their first year so that health professionals can monitor their growth and development. All Cuban children are covered by a national programme that inoculates them against 12 diseases. (END/IPS/LA/HE/TRA-SO LD/DA/DM/02)
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