-DATE-
19660227
-YEAR-
1966
-DOCUMENT_TYPE-
SPEECH
-AUTHOR-
F. CASTRO
-HEADLINE-
CLOSING CEREMONY OF THE MEDICAL-DENTAL CONGRESS
-PLACE-
CHAPLIN THEATER
-SOURCE-
HAVANA DOMESTIC RADIO
-REPORT_NBR-
FBIS
-REPORT_DATE-
19660228
-TEXT-
CASTRO SPEECH CLOSES MEDICAL-DENTAL CONGRESS

Havana Domestic Radio and Television Service in Spanish 0307 GMT
27 February 1966--F/E

(Live speech by Prime Minister Fidel Castro at Havana's Chaplin Theater at
the closing ceremony of the Medical-Dental Congress)

(Text) Delegate guests, Cuban delegates to the Medical and Dental Congress,
ladies and gentlemen: You have been working intensely for several days to
carry out this scientific event, the results of which you have had the
opportunity to judge better than anyone else. I have been assigned the
exacting task of summing up this scientific event, and in these matters the
most that I can do is to guide myself fundamentally by the figures and
impressions I have gathered and the impressions of the organizers on the
characteristics and results of this congress.

In the first place, the conditions under which it is taking place--that is,
the medical situation in our country at this time, which is without any
doubt infinitely better than what it was some years ago--can without any
doubt be compared with those of any country of this continent under
conditions similar to ours.

Certainly, on this problem, when we speak of the successes achieved by our
people, we speak with full awareness of the reality of the medical efforts
being made and the lessons being accumulated in Cuba today which can also
be useful to other countries. When we analyze the picture in other
countries we always do so with sorrow, because it is in medical development
that it can be seen how much a country has advanced or fallen behind. It
could be said: "Tell me how medical service is in a country and I will tell
you the degree of development and progress of that society."

Of course, we must say that medical assistance cannot progress
independently of economic development, that superior medical assistance
needs a considerable economic development. However, the case of Cuba has
demonstrated that even within a certain level of economic underdevelopment,
using the resources of the country to the maximum effectiveness, much can
be done in the field of medical development. Considering our situation
before the victory of the revolution and up to 1958, attention to the
public health was characterized, among other things, by the lack of a
unified national policy with respect to standards and functions. Aside from
the insufficient appropriations for medical services to take care of public
health, the portion of those appropriations which was the responsibility of
the state was smaller than that of other institutions which operated with a
practically private character and often with a view toward profit.

Thus, public health activities were carried out in an anarchistic form
through such profit-making institutions as private or mutualistic clinics,
religious institutions, industrial hospitals, state hospitals, and social
insurance--all of which were of only partial benefit and not entirely in
the interests of the workers.

After the victory of the revolution, all public health activities became
basically the responsibility of the revolutionary state, with uniform
standards which guaranteed the progressive realization of the revolutionary
government's position in this field.

Social security law No. 1,100, passed in 1963, covers every worker in the
country and guarantees him adequate service for all types of risks and
diseases and financial assistance both in service and in cash.

Up until 1958, the peasants completely lacked any medical assistance. Not
only was there not a single rural hospital, but they did not have the
services of a doctor, not even a private doctor. This means that rural
medicine did not exist at all in our country, and almost 50 percent of our
population lived in rural areas. After the victory of the revolution,
medical assistance for the peasants was extended to practically all rural
areas through 95 hospital centers and dispensaries.

Some people who come to Cuba are amazed when they learn that there is rural
medicine in our country. There are some figures which on these occasions it
is well to mention. At least they give a quantitative idea of the progress
in this field. One of those figures is the number of beds available to the
population, which in 1958 was 25,745, and in 1965 had reached 49,103,
including those of social assistance, which increased from 3,965 in 1958 to
6,491 in 1965. (Castro is reading statistics from printed sheets--ed.)

The number of doctors and dentists: The total number of doctors and
dentists in 1958 was 1,375 and in 1965 had reached 6,797.

The total number of hospitals: In 1958 there were 87 and in 1965 there were
159.

The budget in 1958 was 22,670,965 pesos, and in 1965 it was 14,510,000
pesos. This is almost a sevenfold increase. The per capita outlay in public
health in 1958 was 3.26, and in 1965 it was 17.86. When we speak of a per
capita outlay of 3.26 in 1958, we are including what was stolen.

We have been discussing quantitative matters, if you like, but the increase
in beds, hospitals, and economic resources has not been the only
extraordinary change; there has also been a revolution in the past few
years in practically the entire concept of public health. And in this way,
as you all know quite well, the special emphasis on preventive medicine
began. As a result of this struggle, significant data is available which is
of great interest. Some of this data doubtless has been discussed during
this congress, so I ask your indulgence if you hear some of these figures
once again. But we must remember that on this occasion we are also offering
this information to the people.

With regard to contagious diseases, we have a series of figures which
reveal the results obtained. For example, acute diarrheic diseases, which
are presently among the primary causes of death in a large number of
American nations, are always considered by hygienists as an index to
underdevelopment.

When the revolution triumphed, the death rate from this disease was 59.2
per 100,000 people. This was the equivalent of 4,000 deaths annually. The
work accomplished since the triumph of the revolution has lowered this rate
to 25.7 per 100,000 people, or the equivalent in 1965 of only 1,902 deaths
annually.

According to figures in scientific publications of the World Health
Organization (WHO) of August 1964, the situation of other American nations
with regard to this disease is as follows: The death rate for acute
diarrheic diseases, Guatemala--223.5 per 100,000 people; Columbia--127.6
per 100,000 people; Costa Rica--24.2; El Salvador--64.2; Chile--61.9;
Paraguay-60.3; Venezuela--48.1; Cuba--25.7 at present; United States--4.8
per 100,000 people.

Among the contagious diseases which our nation can say has been practically
eradicated is poliomyelitis. It is a disease which has afflicted our people
since 1909. An annual average of 300 cases caused some 100 deaths, in
addition to the very sad cases of crippling. Ever since the first
vaccination drive which began in March 1962, there has been no new epidemic
in our country. Analyzing the health tables of other nations, we can report
the following: In 1965--because, of course, this was eradicated
gradually--but by 1965, in Argentina there were 218 cases; Ecuador, 188
cases; Guatemala, 198 cases; Chile, in 1964, 380 cases; Colombia, 216
cases.

And here, for example, in the rates per 100,000 inhabitants, the magazine
of the Pan American Health Organization with respect to poliomyelitis cites
various cases. In the various cases I believe Argentina has 4.4; Brazil has
5.9; Canada has 0.6; Colombia has 2.8; Costa Rica, 1.3. Chile, for example,
has 1.4; Ecuador, 3.6; Salvador, 3.5; and so forth. The United States
appears with 0.2; and Cuba appears with 0.0. (applause)

This is a disease which formerly was a kind of scourge, if you wish, not so
much because of the number of cases but because of the degree of
uncertainty which it caused in all families. It is one of the many diseases
that has been fought successfully--in this case completely
successfully--because obviously, although it was not easy, thanks to the
participation of the people, particularly because of the awareness that was
created in the people, such a high level, such a high percentage of
vaccination was achieved that the disease was eradicated.

There were two previous years--I do not know if it was in 1963 and
1964--that one case appeared each year, and when these were checked it was
discovered that these were cases that had not been vaccinated. There was
even some prejudice at the beginning. Now no great effort has to be made by
our ministry, because all the population shows up at the appointed day and
hour to ask for the vaccination, and practically no child is disregarded.

Malaria: This is another plague which can be said to be very prevalent
throughout the continent. Before the victory of the revolution there was no
possibility of knowing the exact number of cases which occurred in our
country, because there was no system to report this disease. All
antecedents indicate that there were no less than 5,000 cases.

In 1962, when the first serious statistics were gathered, and after two
years of intensive work, there were 3,519 cases, and this was after the
success of our work. In 1965 there were only 127 cases of malaria, and
these were in a very small area of Oriente Province. In January of this
year there were only 3 cases; in February, 7 cases. This means that all
indications show this disease will continue to decrease, and at a given
moment it can be considered eradicated. Thus, in 1962 the situation was
that we had 50.1 cases per 100,000 inhabitants; in 1963 we had 11.9; in
1964, we had 8.6.

Naturally we still have to arrive at the figures for 1965, which of course
are smaller. We also have the figures for other countries. In 1965, when we
already had 127 cases, the 1965 alone in Ecuador there were 3,669 cases; in
El Salvador, 30,037; in Guatemala, 12,761; in Nicaragua, 8,940; in
Paraguay, 6,194; in Colombia, 7,127; and in Venezuela, 4,598.

With respect to other diseases, for example, tetanus, against which we have
also fought intensely, in 1962 we had a rate in our country of 8.5 per
100,000 inhabitants. In 1963 we had 5.5; in 1964 we had 4.5; and in 1965 we
had 1.8.

Diptheria: In 1962 we had 20 cases per 100,000. In the previous case,
tetanus, we find, for example, that in 1900 the rate of other countries
such as Colombia was 7.8; Salvador 16.1; Guatemala 11.7; Haiti 15.6. This
was with respect to the rate per 100,000 inhabitants in 1962. Now, in
Cuba's case the diptheria rate was 20 per 100,000 in 1962, 12.9 in 1963,
8.8 in 1964, and 8.5 in 1965.

Typhoid fever: In 1962 there were 1,067 cases, which is equivalent to 14.9
per 100,000 inhabitants; in 1963 there were 478 cases, which is equivalent
to 6.7 per 100,000; in 1964, because of an outbreak in the Sagua de Tanamo
region in Sagua la Grande, it increased to 948 cases or 13.1 per
100,000--and this is practically the only sickness in all these years that
recurring in 1964. But in 1965 it declined to 257 cases, or 3.6 per
100,000. This means that despite its recurrence it is already declining
since that previous year.

These figures demonstrate the importance of preventive medicine, although
there exists in different branches of preventive medicine that which is
basically referred to as hygienic measures, such as vaccination,
eradication of certain insects which are disease carriers, and reduction of
percentages by other measures.

As regards to medical personnel, what is the present situation in our
country? Comparing 1965 with 1958, the number of physicians has increased.
This increase in absolute figures is not high, and it is not high, as you
know, because of the number of physicians who chose to leave the country.
However, the hours of work by physicians in hospitals and the distribution
of medical personnel has varied considerably. As you all know, in the past
almost all physicians, that is to say, the majority of the nation's
physicians, were concentrated in the capital, while almost half of the
nation lived in the countryside and needed medical assistance. For example,
in Havana in 1958 there were 3,971 physicians. There are now 3,595 in
Havana. However, in Pinar del Rio where in 1958 there were 226, in 1965
there were 337; in Matanzas where there were 285 in 1958, there are now
393; in Las Villas there were 661, there are now 826; in Camaguey where
there were 406, there are now 493; in Oriente where there were 747, there
are now 1,171. That means that today there are 6,815 physicians in
comparison with 6,286 in 1958, but they are distributed in a more
reasonable manner and, furthermore, with a participation in social medicine
which is incomparably superior to that of the past.

How is the education, that is, the training, of physicians, including
auxiliary personnel? This is the situation here; in 1958 there were only 3
training hospitals, whereas in 1965 we had 23; in 1958 there were 1,500
beds at medical school hospitals, but in 1965 there were 10,257; in 1958
there were no full-time professors, but in 1965 there were 177.

In specialized medicine, there is now a total of 558 graduates during the
present regime in the 26 medical specialties which are recognized in the
nation.

Up to now graduations in medicine in the past five years have ranged
between 350 and 400 per year. These figures will be (?doubled) in 1968.
Under the new curricula, the present course in the basic science schools as
well as in the training hospitals, the professor-student ratio is 1.18.
Thus, the complete dedication of the professorate and the scientific
principles which prevail in medical training are producing the physicians
our nation needs.

Medical and auxiliary medical personnel graduated by the directorship of
medical training: The average number graduating between 1959 and 1965 was
12,901; of these, 7,588 correspond to nursing personnel.

The situation in our nation is also unfortunately very different from that
of our brother nations of this continent. Based on the figures on the
number of doctors in Latin America in 1962, an estimate has been made of
the number of doctors which will be needed by 1975 if the same ratio of
doctors per population is maintained. This report is the report of an
advisory committee on the planning of hospitals and other health services
convened by the Pan-American Health Organization and covers the period
26-30 July 1965. Using the known figures on doctors in Latin America in
1962 and estimating the number of doctors that would be needed by 1975 if
the same ratio of doctors to population is maintained, it explained this
situation as follows: For a population of 244 million, it is estimated that
there are now 134,000 doctors in Latin America. To maintain the same
services in 1980 for a population of 374 million and a ratio of 5.5 per
10,000 people, 206,000 doctors would be needed. In other words, an increase
of 72,000 would be needed during that span of time.

Are the medical schools prepared to provide the number of doctors
indicated? A total of 6,500 doctors a year graduate from the existing 104
medical schools.

According to the estimate, in the next 15 years 100,000 doctors will
graduate. Part of the doctors now active and some graduates will be removed
from medical practice because of death, retirement, and so forth. Supposing
that this attrition is one percent a year, or practically 15 percent for
the period under consideration, 25,000 doctors will be needed to replace
them. It is deduced from this that if Latin American medical schools
continue to train professionals at the same rate, by 1980 they will be at
the same level as at present. And it is known how many deficiencies beset
the present level.

Of course, this also takes into account the doctors who are taken off the
rolls for one reason or another. But one must also take into account the
situation of the emigration of doctors from Latin America to the United
States, despite the fact that these nations from which many doctors
emigrate have been far from carrying out any type of revolution similar to
ours.

The cases of some nations are worse than others, and some figures in this
regard are given here. Here also in this journal of the World Health
Organization are some statistics concerning medical personnel. It says: At
present Latin America has 100,000 practicing doctors. In other words, it
supplies a figure lower than that given for 1962 by the Pan-American Health
Organization. The World Health Organization says: At present Latin American
has only 100,000 practicing doctors. It is admitted that the desirable
minimum is 10 doctors per 10,000 people--a (?frightening) figure for the
most developed nations and those less developed. Latin American does not
even have half the doctors it should have. And in 1980 350,000 doctors will
be needed. This figure is much higher than could be obtained with the
training means available today.

When it comes to graduate nurses and nurses aids, the shortage is even
greater. It is estimated that at present the number of graduate nurses in
all Latin American countries does not exceed 37,000. On the basis of the
minimum recommended norms--3 graduate nurses and 4 or 5 nurses aids per
10,000 people--the present deficit is enormous.

In 14 of the 20 Latin American nations, the number of graduate nurses is
much lower than the recommended minimum and in some cases does not even
reach a tenth of the norm. There are 94,000 nurses aids instead of the
263,000 which according to estimates would be necessary.

This is the continental picture. (Castro pauses to shuffle papers) Now we
have 4,988 students of medicine and dentistry. There are 4,516 in medicine,
distributed in this way: Havana, sixth year internship, 391; Havana, fifth
year, 516, Santiago de Cuba, 40; Havana, fourth year, 475, and Santiago de
Cuba, 137; Havana third year, 680, and Santiago de Cuba, 215; Havana,
second year, 944, and Santiago de Cuba, 190; Havana, first year, 752, and
Santiago de Cuba, 176. This is a total of 3,758 in Havana and 758 in
Santiago, for a grand total of 4,516 in medicine.

In dentistry, Havana, third year, 29, and Santiago, 25; Havana, first year,
175, and Santiago, 59; this is a total of 341 for Havana and 131 for
Santiago, and a grand total of 472.

Here we can see a certain reduction in the number of students in the second
and first years. This shows how, despite the fact that all students are
offered infinite possibilities in various branches of university and
preuniversity education, the number of students who graduate as bachelors
is still insufficient to satisfy our optimum wishes for admissions to the
university. It is because the enormous mass of youths who in future years
can reach those levels as a result of the progress of Cuban education in
general has not yet reached university level. If one takes into account
that the number of students in primary education practically doubled and
that we have more than one million adults studying, and that this program
was initiated at the very beginning of the victory of the revolution and
has been continued year after year, we will reach the point when those who
begin to study, for example, medicine and dentistry, can be counted not by
the hundreds but by the thousands every year.

In this aspect of medicine we have always believed that we should not place
a limit on the number of those who want to study for careers in medicine
and dentistry. Although we are in a much better position than the majority
of countries--if not all of them--and we will be better off every year, and
the distribution of doctors will be better every year, that same terrifying
picture of the countries of this continent--without taking into account the
situation of other countries which as a result of exploitation remained in
the greatest backwardness--we find that very frequently they ask us for
technical assistance and doctors, doctors for a hospital or a surgeon, an
anesthetist so that many of these countries will have at least one in a
hospital, we will need to graduate many more than we ourselves need.

In addition, with the levels we are reaching, we must not set ourselves the
goal of having 1 for every 500, for example, as long as there are countries
that have one per 50,000 or 20,000 or 10,000, and they ask us for help. At
the present time we have one for every 1,200 plus.

However, these figures contained in the magazines of the World Health
Organization hide a reality. They give the total number of doctors. They
give the number of doctors per x-thousand inhabitants. As a result, when
you divide the number of doctors into the total number of citizens, they
say: "It is frightful. There are not enough." However, if they go not by
figures but by realities, and if they analyze the distribution of those
doctors as it exists in all these underdeveloped countries, they will find
the same phenomenon that we had in our country, a hypertrophy, an immense
development of the cities, particularly in the capital, and the worst type
of economic conditions of living and hygiene in general.

We will find that those figures do not give a real idea in spite of the
fact that they are admittedly frightening. They do not analyze. If they
analyzed, if they analyzed the difference between the rural population and
the urban population, they would find that the situation is much worse.
However, if they include in their analysis all those medical
professionals--how many of them are dedicated to the practice of private
medicine or to giving medical assistance to very restricted circles of the
population--we will find that there are circles that have an extraordinary
level of medical assistance as against the immense majority of the country
whose situation is much worse than the statistics reveal.

However, figures that are the result of this situation and which are much
more expressive of reality concern the number of deaths among children, for
example. This same magazine paints a truly hair-raising picture when it
says: After all, what must be counted are the dead. They say much more than
the rates. It says: Among the children of less than five years of age, half
of the deaths are attributed . . . (Castro apparently loses his place--ed.)
no, it says: From the Rio Grande to Cape Horn, that is, in Latin American
territory, one coffin of every two contains the remains of a child who has
died before reaching five years of age. I repeat, from the Rio Grande to
Cape Horn one coffin out of every two contains the remains of a child who
died before reaching five years of age.

It says: Among children of less than five years, half of all deaths can be
attributed to malnutrition--two out of each coffin bears a child of less
than five (Castro presumably means that one of every two coffins bear a
child of less than five--ed.), and one of every two children, it says here,
can practically be said to die of hunger; his death can be attributed to
malnutrition.

It does not speak of any other causes, such as epidemics, living
conditions, poor hygiene. Here it shows a picture--and do not think that
this is a subversive pamphlet; I hope that many of these pamphlets are
distributed, because in the long run I do believe that they are subversive
since nothing else can be more eloquent in pointing out the need for a
change in this situation, regardless of how it can be done; yes, and
although this is a medical congress and not a political congress, by any
means that can be used. (applause)

Truly it is not the revolutionary struggle which claims the most lives, but
poverty and exploitation. (applause) That is a great statistical truth.
(applause) What societies are those, what social order is that, and who can
defend a social order where one out of every two coffins bears a child of
less than five years, and where one of every two children dies of hunger?

Here, this magazine, which from what can be seen they are going to have to
outlaw, (laughter) has a photograph of some children carrying the coffin of
another child. It says: According to an old custom, the young friends of
the family carry the coffin of the dead child. In the inner pages there is
a picture of a children's cemetery. Many of those who lie here had not
reached their fifth year when they were taken away by malnutrition or
diseases caused by a lack of hygiene. This means that those who are not
killed by hunger are killed by poverty, or by another means--the lack of
housing and the most basic conditions of hygiene. But what kills them? They
are killed by poverty, and what is poverty but the result of exploitation.
(applause) A cemetery for children in a Latin American country! More
corpses than can be seen here or even produced on the battlefields of the
great wars!

Of course, this subversive pamphlet continues giving some explanations.
Here it says: The relation between housing and health strikes the eye.
According to what it says here, that which takes place today is no worse
than that which is coming, because it says that due to the constant
increase in population, the production of food per inhabitant is today
slightly less than what it was before World War II. It says: The population
of Latin American increases by 2.5 to 3 percent per year. This increase is
more rapid than anywhere else in the world and almost double that of the
world's population.

The increase calculated for the coming 50 years is 265 percent in Latin
America, 180 percent in Asia excluding the Soviet Union, 160 percent in
Africa, and 150 in the world as an average. In other words, the population
of the Latin American countries appears destined to double during the next
20 to 58 years. This in spite of all the deaths.

In 10 or 12 years there will be a new generation. The situation is
aggravated even more by the fact that Latin American agricultural
production, in spite of the rate of increase, which for some years has been
among the highest, has not managed to altogether satisfy the growing needs
of its people. In a more concrete example, during the past two decades the
production of food in Latin America has increased by 79 percent, but due to
the increase in population production per inhabitant is slightly lower than
it was before World War II.

On the other hand, cultivated land in Latin America does not represent more
than four percent of the total area, and if this were not enough, the
production of this fraction is much smaller than it would be if antiquated
methods which are still very common were set aside and new techniques and
modern equipment were used. The greater part of the national economics of
Latin America are based on agriculture and cattle raising, and at least
more than half of the active population works in those fields. This does
not prevent the Latin American peasants from having difficulty in resisting
the attractions of the large cities.

The subsequent expansion, expressly fast, of the urban zones poses new and
serious problems. With an already deficient nutritional situation and an
industry which is not capable of absorbing the surplus rural population,
difficulties tend to become more complicated instead of decreasing. A
decrease in agriculture production accompanied by a proliferation of slums
in the cities would bring unavoidable consequences for collective health
and for social conditions in general.

Of course, there is another type of preventive medicine which could be
considered primary, and that is nutrition. Naturally, the situation as it
is seen here is one of the essential factors for those who cannot survive,
that is, those who cannot reach five years of age. All this reveals a
picture which is truly gloomy, one which, fortunately, our nation has
overcome.

As to the future of our medicine, which as we have seen is tragic for other
nations of this continent, in reference to ours, higher goals are already
proposed. Outlined here in few words are the prospects of public health in
future years proposed by the Public Health Ministry. It says: We consider
that our prospective development can begin in a very general way in the two
principal trends of our growth. First, to systematically promote and
increase the best medical services for the nation, and especially those
many centers of development whose work is highly specialized and has placed
them on the threshold of a higher medical activity. These centers of
development will become the higher training and research institutes of the
nation and in their activity raise the quality of our medicine to the
highest scientific levels we can aspire to.

Secondly, the other fundamental trend is toward an organizational base for
development and leads to sectionalization. We can accept the establishment
of sectors and integral work in these sectors as the most important task
set forth at the present time by the Public Health Ministry.

Those tendencies which were pointed out need not signify that they are the
only important activities of the organization. The development on
intermediate levels of our network service must continue to look toward the
regionals as well as the provinces for an increase in quality that will
permit each one of these centers of development to solve all problems in
its corresponding territory. For our organization, however, the functional
division of the area is obligatory, and health sectors must be created. The
sector then will be the smallest territorial division where a complete
health service will function. The sector's territory will vary
proportionately to the factors already pointed out in the areas, and its
ideal population will fluctuate between 3,000 and 6,000 inhabitants. The
determination of the acceptable population for a sector is based on what is
believed proper for carrying out its activities by the personnel on
hand--the helper for the health workers, the nurses aid for the infirmary
on the site.

Thus the creation of health sectors leads to a new phase in the work of our
organization. The detailed study of the areas presents situations which up
to now have been dealt with in only a very general manner. In fact, we
believe that with this step our organization for the first time enters into
the bosom of the family itself, learning and interpreting all the problems
which assail it at the same time that it finds a solution for them. The
home, the school, the factory as of now are the vital elements toward which
our organization directs its steps. The study of a sick man, isolated from
his environment, contemplating his sickness as his only consideration, has
been left behind.

This means that our medicine, after having progressed considerably in what
could be called intermediate services, now sets itself two essential goals:
one, to raise to the highest possible degree the level of our medicine; and
the other, to change the prevailing concept that citizens go to the
hospital when they get sick to the concept that the hospital should be
taken to the citizen, that is, to take the doctor to the citizen, take
medicine to him so that it can be avoided as far as possible that that man
or that citizen will have to go to the hospital.

This is perfectly understandable. The sick citizen is cared for when he
arrives at the hospital, is isolated from the medium where he contracted
the illness. Many environmental factors could be the cause of the illness,
and this concept involves the participation of the whole country in the
struggle against sickness, the struggle against those factors which
threaten the individual's health, in the medium where the individual is
developed, the home, the school, the factor, the farm, the country,--all
those factors of whatever type which are detrimental to human health. This
is a higher concept.

It is exactly in the country where the highest levels are, hopefully, to be
attained in public health. Because once the need for beds, hospitals, and
medical personnel to attend the sick citizen is met, we must struggle so
that the citizen will not get sick. It is clear that this is possible today
and only today because medicine, that is, medical attention, ceases to be a
privilege and becomes a reality a right. It ceases to be an instrument of
profit and trade and becomes one of social satisfaction, one of the most
human needs of men. That is why our revolution can set this task, this
goal. Because before, medical assistance to the citizen was something that
was granted by the politicians as a big favor to the citizen. Today in our
country it is a sacred right of any citizen. Today in our country it is not
an instrument of trade or profit, and it will be less and less so as time
passes. (applause)

And those who have chosen the true vocation as doctors will not be able to
find objectives better suited for a true doctor's vocation--no social
medium which is better able to satisfy than this vocation. Medicine--and
when we speak about medicine we always include stomatology, that is, we
include all of it within the line of the health of the nation--medicine, we
know, has changed greatly. How much it has improved in quality! How much it
has been improved in nobleness! How much it has improved in its moral and
human sense! We know, we and the doctors and stomatologists of this
vocation all know, how much public health has progressed in our country. If
there is one thing in the development of the revolution which can be
compared to education, a field in which our revolution has taken gigantic
steps, this field is public health. (applause)

A real revolution has been produced, and that revolution intensifies. And
when more than 1,600 areas are organized throughout the nation, doubtlessly
in a few years, in spite of the fact that we are not an industrially or
economically developed country, we will be among the leaders, proof of what
can be done with little when that little which we have is used adequately.

Of course, we not only work in the field of therapeutic medicine or
preventive medicine through hygienic norma, vaccinations, and so forth. We
must also work in social development, in economic development. This will
contribute, beyond any doubt, to saving the lives of the children, to
raising health standards, to decreasing the death rate. Education programs
are being carried out; thousands of new schools will be built in the coming
years, so that hundreds of thousands of children will have the opportunity
to attend nurseries, to attend schools where they will also be fed. Our
revolution has begun to carry out the first pilot school plans in the
country where children will be given medical assistance, food, clothing,
and shoes. They will be able to attend school from Monday through Friday.

Logically, in 10 years we could not expect to solve all housing problems
facing the country. However, in a period not much longer than 10 years,
virtually all children and all rural youths will have school
centers--nurseries where they will live under optimum conditions. Even with
the massive building of houses, we could not meet all housing needs. Even
though we have built many houses, even when we aspire to meet that need,
our resources are limited by our basic construction industry, by our cement
production. In any event, within the next four years it will practically
double.

Since we have so many needs of all sorts, we cannot say with certainty how
long it will take to solve the housing problem. However, we can build many
schools, many nurseries, and above all, we can gradually improve the
nutritional condition of the people. This year, as you all know, there has
been much more fruit, many more green vegetables, many more root
vegetables. All basic agricultural sectors are working to improve the
nutritional conditions of the people.

When we spoke of the number of students in the university schools, we
recalled that presently in a single branch of agriculture alone--the
technological institutes for cattle raising--there are 16,500 students.
(applause) However, in this case these technological centers have not been
filled with secondary school pupils. Most of them are workers, adults from
worker or peasant stock, who are receiving or have received refresher
courses and who are pursuing or will pursue these courses. From that
overall figure of 16,500 not more than 4,000 are young students.

We also have the teachers schools in which about 20,000 youths are now
studying. This explains to a certain degree the competition existing with
the other scientific branches. However, I mentioned that figure to give an
idea of how in the training of technicians, with the application of science
and technology to agriculture, we have had to create subjective factors
because, if we were in a very bad predicament in one field, that field was
agriculture. If in a sector of our economy the technicians were scarce and
their technical proficiency poor, it was in the agricultural sector.

We must say that our country formerly produced very few agricultural
technicians, and most of them were "book" technicians who had never seen
the fields. However, it is fair to mention that there were a few
exceptions, as there are exceptions in every case. There are a few men who
truly had a talent for agriculture, who studied and reached high education
levels. In fact, however, very few fell in this category.

We became aware that it was necessary to carry technology and science to
the fields. Yet we knew that this could not be done overnight. Efforts are
being made in this direction. Above all, over the years we must train the
personnel who will direct that enterprise, will culminate, so to speak,
that project, and will form the industrial base needed by our agriculture.
We feel that these technicians--these thousands of technicians--are called
upon to produce good health for our population. On occasion I have jokingly
told the comrades in the ministry--not that I believe this entirely--that
our technicians from the technological institute will do more for health
than our doctors. Naturally, what they will do is reduce the doctors' work
considerably.

If medicine advances as it should, then it must create conditions in the
human organism, it must develop to the maximum the human organism's own
defenses against disease. You will have an opportunity to see the
relationship between agriculture and health in the two books which all
doctors have received. One of the books was written by Voissin and the
other, by a North American author, has a very suggestive title, and I am
sure it will make a deep impression on the doctors. The title is "Silent
Spring."

Naturally, I am not in a position to render a technical judgment on these
subjects, but I can mention some things that make one think, that arouse
one's interest in something. Without doubt, these books suggest that
interest. We have tested this with medical students, and these books have
aroused great interest among them. There are a few other books, for
example, "The Influence of Microelements in Viral Diseases," and others
which deal with a series of factors which until now were virtually
unmentioned. We are translating these books. We believe that they contain
many suggestive and new things. We will try to make them available to the
doctors once the comrades from the university have translated them.

One of the two books deals with the influence of soil on human health
through food, and the other with the influence of the uncontrolled use of
insecticides on human health, insecticides which have been applied
indiscriminately in the world for commercial purposes, with no
consideration whatsoever to the effects that they could have, and above
all, to the cumulation effects that they could have on human health.

We are giving these books to doctors and future farmers because we must
create awareness. The comrades from the ministry explained to us the
importance of creating awareness when they told us of the great
difficulties they were meeting in having some of the food enterprises
improve further the hygienic conditions of their centers.

And now on many occasions the comrades of the enterprises were making
demands on the ministry. They have created such an awareness that these
enterprises are requesting things that are beyond the ministry's
capabilities to provide. In this battle for human health, to create
awareness is of great importance. By creating awareness regarding
vaccinations and hygiene, battles against diseases have been won. However,
we must create much more awareness in yet other aspects among the citizens
and the doctors themselves. Medicine is a science that is constantly
undergoing changes, changes that demand perhaps more than others that all
involved keep abreast of what is happening, that require the capabilities
of analysis and observation, that cannot stand routine. Hence the need not
only to keep abreast of what is achieved in other places, but also for
constant study, analysis, and improvement.

You know about the problems that have arisen with many medications. Many
doctors prescribed medicines which were effective in curing countless
diseases years ago-antibiotics, for example--and which gradually have lost
their efficacy. I have heard doctors speaking of these problems and
discussing the preventive use of such antibiotics in operations and about
these antibiotics having some ineffective and how other biological methods
are being developed currently to fight various diseases. In any event, this
is not my field, but I see perfectly well that if there is a dynamic
science in constant development, which need constant study and attention,
that science is medicine.

It would be pointless to be aware of this if at the same time we were not
aware of the minimum material base needed. Considerably study material has
been gathered in our medical schools. Research has started in many
hospitals. A new scientific research center is under construction.
Presently, there are seven electron microscopes in the country, perhaps
more than are really needed. A scientific information center has been
established so that you may receive information on the most recent
publications, so that you may have catalogues available to request the
proper items. If that center operates properly, if it is up to date, if all
requests are attended quickly, we would have made considerable progress. It
would be an inexpensive means by which all our doctors and stomatologists
can be kept abreast on the latest achievements reached in the world in each
of the various branches.

But there was also the problem of books. It was no longer a matter of
journals and information, but also of books. The same thing happened in the
case of the university, where the shortage of books was creating serious
problems, and it was demonstrated that the problem was not so hard to
solve. All measures are being adopted, and the problem of university
textbooks is now being solved. But textbooks for professional men, for
graduates--not textbooks, but reference books, books for study--and not
just this kind of studies--we have heard that many doctors are studying
certain subjects, for during the period of their schooling they had no
opportunity to receive complete preparation in those subjects; we have
heard of doctors who are studying biology, biochemistry, basic sciences. In
short--that is to say, it would not be at all unusual if many graduates are
obliged to obtain some of the most modern books on the subject in order to
brush up a little on what they had an opportunity to learn while they were
students.

It must not be forgotten that we were all students, and we were students of
a former day; we are not criticizing any group; all of us students of that
time were must like. In general we did little studying. Our chief concern
was to get passing grades. That is not the case today among students, not
even those who studied previously, because those who had studied in our
university before have been obliged to return to their studies and study
more seriously, more thoroughly. And besides, new knowledge has been added
to many of those subjects at a great rate.

And therefore I was saying it was necessary to solve the book problem.
Today a step was taken in that direction; the cards were filled--probably
some have not filled out the cards because they may not have been present
when the cards were filled out, but they do not need to worry. We believe
these cards will give an idea of the titles needed and more or less in what
quantity. So we will make available not just the ones requested there, but
many more than have been requested, taking the cards that were filled out
rather as a sample.

We feel it is indispensable that every time a book is wanted there should
be a fast, easy way of obtaining it (applause), and we believe this will be
necessary not only for you but for the other technical branches too. As for
textbooks, we have taken a step which consists of furnishing them to
students free. (applause) These students face new conditions, new living
conditions, different standards for matriculation, and we thought--and it
is a step, and every step we take brings us nearer the ideals for which we
are fighting, that men should have what they need merely because they need
it--when a solution was sought in the matter of books, we decided that
students, when it is a case of textbooks for a corresponding course--if
some student (?of another) school is interested in some other subject, then
he can buy the book practically at cost. We must see to it that books are
in the reach of the people and the technicians. We still cannot propose our
goal in the case of professional technicians--that is, they will not be
free, but they will be cheap. (applause)

All this may require the creation of an institution, perhaps a book
institute. Life itself is showing us new needs; it is showing us new
solutions. To be sure, in the early days of the revolution bodies were set
up with their charts and things. Some of those organizational charts are
subjective, imaginary; they are not fully adapted to reality. We have no
doubts as to the efforts put forth by the comrades in charge of importing
books for solving the book problem, but good will is not about to overcome
the inconsistencies that may be intrinsic in some institutions. It is
necessary to create a means by which every scientific or literary want can
be speedily recorded. Means must be created for providing ample information
about everything that is published throughout the world (applause), for we
accomplish nothing with the distribution of a leaflet--as the comrades who
organized the book exhibit did in good faith--they handed out a leaflet
with the titles of all the books. All this can do is create an appetite for
books; but an appetite for books must not be created if there is no means
of satisfying it. (applause)

We must keep up with what is published throughout the world on all kinds of
subjects that are of interest to our country, so information is available;
because if there is no knowledge of a book's having been published, how are
we to feel or arouse interest in that book? And of course this is not a
matter of big league baseball. It is not of basic interest who won, the
National League or the American League, the Yankees, or Brooklyn, or
whoever. Our sports could develop fine.

But how are our science and technology to develop if we lack the means of
knowing everything that is being done in that field? And what is the use of
arousing universal interest in studying, what is the use of creating in the
entire nation a spirit of study, of research, of knowledge as an essential
material and spiritual necessity, unless we arrange to provide the means
that are needed, the means to satisfy that eagerness, that desire to study?
(?And since this is one) of the things it is not hard to solve, that we
believe can be solved, we are going to solve it. (applause) And we must
solve it for every branch.

There should, then, be a center where any person interested in something
can write and receive a reply and get a problem solved. And everybody can
know, all technicians--for this is a country where there will be more and
more technicians, and at various levels--that by writing to that address,
asking about a book or for some information on a specified book, they will
get it, and they will get the book. Reality teaches us that we must create
the means of obtaining this.

Those books you wrote down on the cards--some may have been translated,
others may not be. If they are in our own language, they will be acquired
in our own language. And if they are not yet translated, we are not in a
position to say we will translate them too. Sometimes it becomes a bit
difficult, because many countries have broken off relations with us. In
those cases we have no reason to deprive ourselves of technical knowledge
because of these political caprices. We believe there is something of a
universal nature, and that is technical knowledge (applause), the advances
of technology and science, and our revolutionary country is prepared to
give up its intellectual property to benefit the rest of the world.
(applause) It is prepared to indemnify, compensate all its intellectual
workers fully.

And we believe that the day when all countries adopt that same measure and
stimulate intellectual production while offering it as available to all
peoples in the world will mark a big step forward, for it is impossible
alongside these realities--whole sections of the world, the majority of the
world, suffering hunger and want in frightful backwardness--to have
technical and scientific selfishness, individualism, and exclusiveness
alongside that situation. (applause) This poor world, this stagnant world,
can only be freed from its want by applying technology and science. If we
want to obey that principle, only through a revolution can technology and
science be applied to its benefit. (applause)

Suffice it to say that in the case of all countries that have broken off
relations, that take part in the blockade directed at us, and thereby try
to deprive us of technical and scientific advances, we are going to
nationalize their intellectual property. (applause)

All that humanity possesses in this field is the result of humanity for the
past thousands of years--from the people who developed language,
mathematics, and the bases of subsequent developments in science throughout
the world. There is a universal heritage which humanity has willed itself,
and that is culture, science, and technology. We underdeveloped countries
which are economically poor, countries which are stagnant and are
underdeveloped as a result of exploitation, we have the right to claim
participation in the cultural, scientific, and technical wealth of the
world. (applause) That is why we respect those rights which are to be
respected, respecting only those interests which it is just to respect and
not what is unjust--we will have books. (applause)

This congress has arrived at a point in which its size begins to become a
concern for future years. Everybody agrees that there is enough
organization; everybody agrees that the merits of that organization are the
results of progress which has taken place in all sectors.

The comrades of the ministry said with all honesty that they were being
congratulated because everything was well organized, but at the same time
they said that prior congresses were a lot of work and that now everything
is easier. They said that there was great cooperation from all
organizations. They also said that the organization of the congress was
like a thermometer. Of course they spoke in medical terms on what has been
achieved in all fields, the cooperation they had received from all
organizations, and how easy everything had been. They spoke of how much
public works transportation, tourism, foreign trade, and all such
organizations had helped them. They spoke of the large number of people who
ate at noon and how the food got there on time. We hope that it was good.
(applause)

But they also said that they did not know if events of this kind could be
held in the future. They wondered whether it would be organized by
specialties, because this congress is too large. They planned for 3,000 and
they had 3,500 registered doctors--I have not yet talked about the
stomatologists--and I believe that some 1,000 more than expected were
registered. I am going to tell you a secret, and this is that they asked:
"Why were we off?" In prior congresses we used to pay for everything. But
this time the doctors paid for everything--expenses, guests, lodging, and
fares. We did not think that we would have this many. And it happened that
many more than were expected came. They were wrong. That is why 4,500
delegates took part, of which 3,700 are doctors and 800 are stomatologists.

Some 900 scientific papers were presented with the participation of more
than 2,000 doctors and stomatologists. The scientific exhibition was 800
meters long and consisted of 225 "exhibits." (spoken in English--ed.) I do
not know what this word is in Spanish or Latin. It was the product of the
work of more than 1,000 doctors and stomatologists. They used 19 halls in
simultaneous sessions and two movie halls. My impression, since I had time
to go there before coming here, is that it is very impressive. It is a
shame that the people cannot see what this congress was. (applause) It is a
shame that it was not better covered in our own press, but we will publish
the summary of this congress soon. (applause)

As soon as the summaries are revised, they will be sent--I hope there is no
charge for them (laughter), free to each doctor who participated in the
congress. (applause) We will send them to all the doctors and
stomatologists who will later protest if we do not, and rightly so.

We will publish some 10,000 memos for ourselves, to send to other
congresses, that is, to complete research and international commitments.
Since we want to be informed of what is going on everywhere, we should
offer what do do so that we can receive what others do. (applause) I
believe that our guests from other countries are satisfied with the
congress and have a good impression of it. (applause) No one will doubt the
efforts carried out and the progress achieved.

We are grateful to all the doctors and stomatologists from other countries
who honored us with their presence at our congress. This is not a political
event, although I sometimes talk about politics--better said, I sometimes
speak about our revolution--but I do not speak on purpose, but out of need
to explain myself. I hope that all are pleased with our hospitality.
(applause) We hope that in future years each one of these events will
improve and that each of these events will become a thermometer of the
development of our public health and the nation in general. We hope that we
can continue our successful progress.

We hope that all the doctors and stomatologists who participated in the
congress and those who were not able to participate because of prior
commitments will be satisfied. We could say more, because there is reason
to be more than satisfied and contented--proud of what today signifies for
our new society, our revolutionary society, at the scientific level, the
moral level, and the revolutionary level of our public health workers.
(applause)

We are pleased with this progress. We are satisfied with the work of our
ministry. We are happy with the spirit of the masses in our medical fields,
of the awareness which has formed in our country, of the method of work
which has prevailed over individual interests--above selfishness and
personal vanity (applause)--in a way that shows there is no individual
triumph without collective triumph, or triumph for man without a triumph
for society and for the fatherland. (applause) And that is why we see this
event and all the triumphs won as triumphs of all citizens, as triumphs of
our nation.

Fatherland or death--we will win!
-END-