-DATE-
19690108
-YEAR-
1969
-DOCUMENT_TYPE-
SPEECH
-AUTHOR-
F. CASTRO
-HEADLINE-
CASTRO SPEECH AT VALLE DEL PERU POLYCLINIC
-PLACE-
VALLE DEL PERU POLYCLINIC
-SOURCE-
HAVANA DOMESTIC RADIO
-REPORT_NBR-
FBIS
-REPORT_DATE-
19690110
-TEXT-
CASTRO SPEECH AT VALLE DEL PERU POLYCLINIC

Havana Domestic Radio and Television Services in Spanish 2330 GMT 8 Jan 69
F/C

[Speech by Cuban Prime Minister Fidel Castro at dedication of Valle del
Peru polyclinic--live]

[Text] Workers and peasants of Valle del Peru: A few days ago the school
was completed and, more recently, the polyclinic was completed. The initial
phase of this school plan was incomplete until the polyclinic was ready.
Similarly, some days back the school and polyclinic at El Cangre were
inaugurated. The Valle del Peru polyclinic was built in 30 days. A brigade
of vanguard workers and party militants worked without rest in a truly
revolutionary way, and they built [applause] this hospital which will
provide so many benefits for the people of this area.

The revolution has built scores of hospitals. Since our 10th anniversary
and a few days ago we discussed at the Plaza de la Revolucion the problems
connected with the progress of agriculture and the economic development of
the nation, and at the El Cangre meeting we talked about the educational
advancements of the revolution which are also extraordinary, as proved by
statistics, above all by the fact that more than 300,000 adults have
completed a sixth-grade education after the literacy drive.

The questions of health and education are two very important matters for
all the people. As with the development of education and culture in
general, the question of health has to be based on economic development,
which bears the main weight of our efforts during these years. The health
situation in the underdeveloped world is very serious. For example, here
are some data on a continent which was subjected to colonialism for
hundreds of years, the African continent. Here in this MAGAZINE OF WORLD
HEALTH, it is reported that one-third of the African children die before
they reach 5 years of age. That is one-third or one out of every three
children. [Castro reading] This great tragedy and sorrow and heartbreak for
so many mothers deprives the African nations of many of the people they
need to build a solid economy. [Castro aside] Well, it may deprive them of
the persons they need to build a solid economy, but, above all, it deprives
them of life, the opportunity to live and create, which is the most
painful.

Another magazine called HECHOS, which reveals health progress and is
published by the Pan-American Sanitary Bureau, reports: The mortality of
children under 3 years of age constitutes 40 percent of all deaths in Latin
America. This is compared to 8 percent in the United States. While the
mortality of, children under 5 years of age is 8 percent in the United
States, in the continent exploited by imperialism 44 percent of the deaths
are of children under 5 years of age. Forty-four persons out of every
hundred who die each year are children. This means that approximately
999,000 children under 5 years of age die every year in Latin America. This
is almost 1 million.

The same magazine reports that dirarrheal diseases, measles, and whooping
cough cause an estimated 226,000 deaths among children under 5 years of
age. In the United States, 5,000 children of the same age group die from
these diseases. You can begin drawing comparisons here. For example, in
this health magazine again, it says: 26 nations in central Africa had 4,700
doctors in 1962 and in 1965 they had 4,400. The number of physicians
decreased. The ratio of doctors to the population was one for every 18,000
in 1962 and one for 20,500 in 1965. The United Nations' projected ratio
for 1970 is one for 10,000. This statement shows that they are moving
backward instead of forward.

Then is says: Paradox of the 20th Century: Some 1,200 doctors, half of them
from the developing nations, migrate to the United States every year. This
phenomenon has been labeled technical assistance in reverse. No nation
knows precisely how many of their nationals do not return to their country
after studying abroad, but there is no question that the number is
considerable.

An African medical figure declared recently in this regard: This
hemorrhage, which deprives the African nations of the assistance of
high-caliber personnel which is indispensable at the very moment such
personnel have been trained, is one of the great paradoxes of the 20th
Century. No foreign aid can ever compensate for the weakening effects of
such a bloodletting. While high-caliber medical and health personnel
continue to prefer the easy path and go abroad to flee from the miserable
life in their own country, it would be rather futile to keep on talking
about peace and progress for the world of tomorrow. Miracles should not be
expected from foreign aid, whatever its origin or importance. [Castro
continues to read]

What is the present situation? There are 11 medical schools in eight
central African nations. They are in the Congo, Ghana, Madagascar, Nigeria,
and Uganda. They predate these nations' independence. The medical schools
in the Ivory Coast, Rwanda, and Tanzania were established after
independence and additional schools are foreseen for Cameroon and Kenya.

There is no nation in Asia and Latin American with a population of more
than 3 million which does not have a medical school or college. But nine
nations in Africa still do not have a medical school, and in seven of them
none has been planned so far. It is foreseen that some 400 doctors a year
will graduate until 1970 from the 11 medical schools now open.

In Latin America, the number of doctors who leave for the United States is
equivalent to the number of graduates from 20 of the 80 medical schools.
This means that something over 20 percent of the doctors who graduate in
Latin America leave for the United States. And in the nations where they
are needed, in which out of every 100 people who die, 44 are children under
5 years of age, in which they have all the problems, from the poor and
underdeveloped nations--these are the nations from which the doctors and
technicians leave and go the United States in which eight children die. And
it is not just the doctors who are graduated in the United States but the
ones they buy, in short, they import doctors.

Here also in the publication HEALTH IN THE WORLD OF TOMORROW, there is an
article by Dr Abraham Horwitz, director of the Pan-American Sanitary
Bureau, on the occasion of World Health Day, on 7 April 1968, in which he
says: Today's urgent necessities move us to consider the health of the
Americas of tomorrow just to the end of this century and to anticipate that
it will not be like modern science and technology would lead us to dream it
would be, unless we change the factors which led to the urgent situation of
the present. Among these, and perhaps the most serious, is the imbalance as
to what is known and for which there is solid experience and as to what is
applied with available resources. The effect is death and diseases which
could be avoided and whose number is much greater than in technologically
advanced nations.

[Castro continues to read] The Americas are a continent in transition in
regard to the nature and dynamics of health problems. The Americas
distribution in the societies reflects the degree of their development and
among the most tragic expressions is infant mortality and the mortality of
children under 5 years, the ratio of which does not compare with the
cultural tradition and spiritual wealth of the nations. More than 800,000
children under 5 years die each year in Latin America and the Caribbean
area. [Castro aside] He says more than 800,000. Actually, it is
approximately 1 million. These children would live if the mortality rates
prevailing in North America were in effect here.

Even more serious is the computation of these who could survive, that is
about 800,000 a year, if there were adequate medical techniques. Even more
serious, we know how to prevent disease, and above all the death of most of
these children. Among the survivors, among those who do survive, there are
many who have grown distressingly with advanced malnutrition, with the
consequences it has for their intellectual development. That is the general
panorama of the world and scene sufficiently resembling the one we had
here.

Now the situation in Cuba. For example, a number of diseases; how we have
fought them. In 1965, for example, poliomyelitis: In Brazil, 541 cases;
Mexico, 477; Peru, 444; Columbia, 330; Honduras, 265; Ecuador, 217; Chile,
206; United States, 72; Venezuela, 118, Cuba, 0. [applause]

Malaria, for each 100,000 population: in Nicaragua, 8,307 cases; Paraguay,
6,728; Salvador, 34,217; Brazil, 110,306; Costa Rica, 2,563; United States,
147; Venezuela, 4,794; Mexico, 10,114; Cuba, in 1965, 1.7 for every 100,000
inhabitants. In Cuba in 1968, 0. [applause]

Typhoid fever, we also have cases, for every 10,000 population: in Peru for
1965, there were 97 cases out of every 10,000; Chile, 65.3; Columbia, 56.3;
Ecuador, 42.7; Mexico, 11.4; Dominican Republic, 12; Venezuela, 9.3;
Uruguay, 9.1; Cuba, 3.1 in 1965. This year it increased to 930 odd cases
because of an epidemic in the Bayamo area. It was checked and left 11
cases, 11.4 for every 100,000. [as heard] That is, there was with this
epidemic a retrogression in percentage but it was quick;y controlled.

Deaths from gastroenteritis in Cuba: In 1958, there were 2,784. In 1968
there were 1,346. That is, that was in 1968. There was a reduction from
2,784 to 1,346 from 1958-68. Gastroenteritis, for example, deaths for every
100,000: in Columbia, 105.4 died; Costa Rica, 136.8; Chile, 68.4; Ecuador,
124; Salvador, 63; Guatemala, 229; Venezuela, 47.8; Dominican Republic,
98.5; Peru, 81.3; Nicaragua, 87.7; Mexico, 111.2; Cuba, 28.1. That is, the
lowest figure in all the countries mentioned.

There is here something very important and quite new in Cuba: the cytologic
tests for early diagnosis of cancer in the uterus. That is new. In 1966
there were nine positive cases discovered; in 1967 there were 106 positive;
in 1968 there were 303 positive tests. A total of 418 cases were cured in
these 3 years. [applause]

Suspected cases: In 1966 there were 58 cases; in 1967 there were 742; in
1968 there were 1,614. These 2,414 cases were cured. [applause] We already
have about 3,000 persons who were cured by an early diagnosis of cancer.
These tests were taken in 255 polyclinics, done in 11 laboratories which
have 50 technicians in cytology. The testing goal for 1969 is 150,000
persons, in 1970 half a million persons to be tested for the early
discovery of an illness which is a scourge and which, by discovering it in
early stages, can be cured.

Births in hospitals: In 1963, several years after the revolution, the
number of births in hospitals had increased considerably. Out of 256,900
there were 164,396, that is 64 percent were born in hospitals. In 1964,
there were 67 percent born in hospitals. In 1965, the percentage was more
than 73; in 1966, it was 80 percent; in 1967, it was 86.4 percent; and in
1968, it was 90 percent born in hospitals. In some countries of Latin
America there is nothing comparably to this percentage.

What characterized medicine at the time of the revolution? 1) The absence
of a national public health plan: 2) low quality of government service and
better quality in the quasi-government and private sectors; 3) orientation
to the curative aspects of medicine; 4) government service in large cities,
abandonment of the rural areas and some urban ones, private medical
practice, medical hucksterism, and competition among private services; 5)
administrative centralization; and 6) the people were unfamiliar with
services which could help them.

Following the revolution: 1) planning, all health tasks are done in a
planned way; 2) all health activities must keep up with progress in medical
science; 3) health tasks are executed in the light of prevention and cure;
4) the health of the people is the responsibility of the state, public
health activities must be free of charge and be within reach of the entire
population; 5) centralization of standards and executive decentralization;
and 6) participation of the masses in health tasks.

The nation budget for public health: In 1959, when the revolution
triumphed, it was 25 million pesos. In 1968 it was 220 million pesos, nine
times what used to be spent. [applause]

In Cuba... [Castro interrupted by a litter-bearer] A stretcher over there,
speaking of medical treatment and [crowd laughs], there was need for a
stretcher. [Castro pauses] There is no statistic, no case of death in mass
rallies like this, fortunately. [crowd still laughing]

When the revolution triumphed there were 6,300 doctors in Cuba. It is known
that just as in other nations some of them left for the United States, and
other also left because of the revolution. They were allergic, they
suffered from a disease known as revolutionary allergy, [crowd laughs] and
so they left. Of course, imperialism pursued a special policy. In addition
to the doctors it spontaneously steals from the whole world, it instituted
a special policy to leave the nation without doctors.

In spite of this, owing to the revolution's educational programs and the
graduation of doctors, we now have 7,148 doctors in 1969. [applause] We
have more doctors with the advantage that they are distributed throughout
the nation. And in 1970, we will have 8,000 doctors. And so in 1969, we
have a doctor for every 1,100 persons. You recall the figures I read. These
doctors are distributed to every corner of the nation, and there are 6,000
medical students at this time. By 1971, we will have one doctor per 1,000
persons. And by 1975, we will have one per 800 persons, and by 1980, we
will be more or less a minimum of one per 650 persons. In other words, the
level of doctors, real doctors per population, doctors at the service of
all the population, is 1,100 now. In 1975, we will have one per 800
persons, and in 1980 the ratio should drop to one per 650 persons

How many doctors served the public in hospitals, that is the hospitals
which served the public? In 1959, there were 1,003 doctors throughout the
nation. You know that to be admitted to a hospital--well, that is a
well-know story, recommendations, and all that, votes, electoral card, and
so forth. In 1968 there were 6,500 hospital positions for doctors, from
1,003 to 6,500 positions for doctors in hospitals serving the public.

There were 250 dentists and now there are 1,081. There were 46 pharmacists
and now there are 380. In addition to this, 1,531 doctors are studying to
become specialists. Thus, in the next 2-3 years we will have 1,531 new
specialists. In other words, now it is not a quantitative growth in doctors
but a qualitative training growth.

In 1963, there were 13,874,666 visits to doctors and in 1967, there were
23,452,059 such visits. In 1963, there were 700,802 visits to dentists and
in 1967, there were 2,548,797. The total grew in 4 years from 14,575,478 to
26,000,856. The estimate for 1968 is 30-32 million. In 1959, it was
estimated that 5 million visits were made to state institutions.

Regarding technicians and assistants, that is nurses, and laboratory
technicians, in 1959, there were 1,669. Now there are 20,800. This is the
number of medical care assistants.

In 1959 there were six nursing schools. Now there are 13. In addition,
there are 58 nursing courses in the hospitals. This is apart from the 13
schools.

There are 54 hospitals in 1959. In 1968, there were 180, not counting this
one and the other one. [Castro aside] I always... [applause] The total
number of beds in 1959 was 25,745. That was why they had to put two persons
in one bed. Now there are 47,660 beds.

Deaths because of diseases such as acute diarrehal diseases: In 1959, there
were 7,000; in 1968, there were 1,300. Poliomyelitis: It has disappeared.
There used to be 300 to 400 cases a year. In 1962, there were 1,469
diphtheria deaths; in 1967, there were 435. In 1962, there were 1,402
deaths due to tuberculosis; in 1967 there were 940. Since June 1967, there
have been no cases of malaria. There was one blood bank in 1958; now there
are 15.

Nutrition: Some 10,000 people die of starvation every year in the world
because of nutritional problems. It is estimated that in the next 10 years,
50 million children will die of starvation in India.

Consumption of foodstuffs: For example, in the United States they consume
five times more eggs than in Latin America, and three times more milk, and
so forth, compared to the exploited nations.

As you know, the rural medical service was created. It brought medical care
to all the corners of the country, to places such as Oriente where hundreds
of thousands of persons were without a single doctor.

By now the successes of the revolution in medicine are generally
recognized. It says here in the December World Health Organization (WHO)
magazine, according to a 27 December 1968 dispatch datelined Geneva: What
is expected to be achieved in 1988 in Latin America countries is a reality
in Cuba already, the magazine of the World Health Organization has
underscored, commenting on an optimistic article on the future of health in
Latin America.

[Castro still reading] In an interview in the December issue of the
magazine, Dr A. Horwitz, director of the Pan-American Sanitary Bureau,
regional office of WHO for the Americas, says that in most Latin American
and Caribbean nations mortality will be reduced to one half in 1988 and the
children born then will live an average of 10 years more than the present
generations. Despite this optimism, Dr Horwitz acknowledges the present
situation of these nations and says that health services are still
insufficient quantitatively and qualitatively, especially in the rural
areas and in the poor districts which have recently cropped up around most
of the large cities.

Existing data, he adds, show that in Latin America there is a large amount
of contagious diseases, malnutrition, poor sanitary installations,
unhealthy housing and working conditions, illiteracy, lack of adequate
clothing, and low per capita income.

As a contrast to this situation existing in Latin America, the magazine
carries in the same issue an article entitled "Cuban Service for All."
After affirming that Cuban health is an example for the whole continent,
the article goes on: In the country's outreaching rural regions, hospitals
were built. The physicians are to work in the provinces and all the active
population has been registered in order to fight diseases. The magazine
highlights the Cuban Government's efforts to overcome the lack of
physicians and health personnel through a broad education program and adds
that these efforts are successful. It then cites the specific case of
Oriente Province and writes: Before the revolution this region was the most
underdeveloped of all. There was no medicine, public assistance, or social
programs. Now in less than 10 years, 30 hospitals have been built in this
province. The article concludes by referring to the enthusiastic
participation of the people in the effort to fight disease and points out
that results are apparent in the successful elimination of polimyelitis,
the drastic reduction of the transmission of malaria, and the reduction by
less than half of gastroenteritis cases. Then it admits how gains have been
achieved in Cuba, that is, it is already admitted that at this time what
the Latin American countries hope to achieve in 1988 if they can, has
already been achieved in Cuba.

Now, with this polyclinic next to the school, like the one at El Cangre, a
new development is beginning in which the school and the polyclinic and the
road are included. The importance this polyclinic has is that it is an
advanced hospital; it is now the medicine of the year 1980. That is what we
sought for in 1980, before we obtained what we have now, 10 years earlier.
Because this, this is the school of communism, and the medicine of
communism. And what is the program of this polyclinic? I am going to read
the program. The program is a little tiring, but I believe that we must
explain this topic, so as to have an idea of the type of struggle we must
wage against disease.

Child welfare consultation: This is for healthy children, with the same
actions tending to preserve and promote health. All children under 15 will
be attended in the following way: those nursing, under 1 year old, a week
following release from the maternity ward, a month after birth and every
month up to the 6th month, and bimonthly up to a year--in other words, nine
consultations during the first year. Since there are 56 children less than
1 year old, 494 consultations will be held in a year to attend all the
babies that are nursing in this area.

In this consultation the pediatrician will ask for the pediatric card, will
perform a complete physical examination, will check growth and development,
weight, height, head circumference, teeth, and pshychomotor development. He
will offer nutrition guidelines, insist on breastfeeding, good dietetic
habits, will suggest vaccination and revaccination following the Health
Ministry plan, will carry out, together with the auxiliary personnel, both
individuals and groups, discussions on hygiene as well as special care for
infants exposed to risks: general dystrophic cases, premature, retarded,
and those with congenital anomalies, and will record all these conditions
in the medical history.

Preschoolers 1 to 4 years old will be given three checkups per year. In a
population of 218 children, 654 checkups will be given a year. The
pediatrician will oversee vaccinations, phychromotor development, bone
deformations, will teach the mother how to avoid accidents, will perform a
compete physical, will perform laboratory exams: hemoglobin, fecal mantux,
and so on.

School children 5 to 14 years old will be given two preventive, educational
consultations. With 569 children, 1,138 checkups will be give a year. This
way all children in the area will be given welfare consultations twice a
year. For the school children, the pediatrician will perform the physical
examinations, vaccinations, will attend, as far as possible, to the
psychological problems which children those ages might face, will order
laboratory exams. The welfare consultations will be supported by lectures
given by personnel in the field on visits to the homes.

Stomatology care for all the children in the area requesting it, a
gynecology and obstetrics program, and curative, preventive, and
educational measures will be undertaken. Obstetrics will care for the 28
pregnant women in this area at present though the preparation of a clinical
history, will perform cardivascular examinations. Examinations of the
respiratory tract, will send the patient to the stomatogolist. The patient
will have a complete gynecological-obstetrical examination, a tetanus
vaccination if they do not yet have it, hemoglobin, urine, and fecal
examinations, serology examinations, blood typing, the RH factor, chest
X-rays after the 6th month, taking all the essential precautionary
measures, psychological tests, and so forth. These measures will apply
equally to all pregnant women.

Prenatal: Each pregnant woman will receive a total of 12 consultations: one
per month until the 7th month, one every 15 days in the 8th month, and one
weekly in the 9th month. Since an average of 60 pregnant women per year is
calculated for this sector, a total of 720 consultations will be made,
which represents an average of 60 consultations per month. This care will
be closely linked with the work of the area nurse.

Postnatal: At least one consultation with the pregnant woman will be made 6
weeks after delivery concerning weight, temperature, and blood pressure.
There will be a urine test, a cardiovascular test, and an external and
internal genital examination.

Gynecology: A minimum of two gynecological consultations per year will be
offered to women of childbearing age, which is equivalent to 1,008
consultations for the 504 women 15-49 years of age, which represents 84
consultations per month for these women.

Program of care for the adult: Medical stomatological care will be given to
all persons over 15 years of age, guaranteeing no fewer than 1,421
consultations per year.

Program of control of communicable diseases: Immunizations: to maintain the
immunity level at 100 percent with triple vaccinations for the 330 children
under 6 years. To keep the imunity level at 100 percent with double
vaccinations for the 215 school-age children. To keep the immunity level at
100 percent with tetanus vaccine for the 190 children between the ages of
10 and 14. To keep the immunity level at 90 percent with tetanus vaccine
for the 1,421 persons over 15 years of age. To keep the immunity level at
100 percent with antismallpox vaccinations for the 264 children between the
ages of 6 months to 2 years and of those that enter this age group. To keep
100 percent of those under 15 years of age protected from tuberculosis by
vaccinating the 684 children with BCG.

Control of the sources of infection: Complete and rapid reporting of all
cases of communicable diseases. Registration and statistics of the cases
reported and confirmed in the official book of registration of illnesses
that must be reported. There will be statistical and graphic tables and
epidemic maps. The following cases will be ordered to a hospital:
diphtheria, tetanus, typhoid fever, paratyphoid, meningitis, encephalitis,
and tuberculosis of the lungs. There will be controlled entries into the
hospital of severe cases of diarrhea, severe cases of respiratory
illnesses, infectious hepatitis, and certain other severe illnesses. These
cases will be handled through the polyclinic, as long as they do not
require more specialized attention or develop complications, in which case
they will be sent to the appropriate hospital. Isolation in the home, after
taking preventive measures and with periodic checks to see that preventive
measures are being enforced, will be ordered in the following cases:
tuberculosis groups two and three, early syphilis, and leprosy.

Epidemiological research: In all cases of communicable diseases, the
epidemiological history of the area or region will be made by the area
doctor with the health team participating in its formation. This includes
nurses aides and epidemiological health workers aside. Diagnosis and
treatment will be made at the polyclinic if the case is presented to it.

Control of people living in the same house or in contact: The prophylactic
measures corresponding to each illness will be carried out by the area
nursing department and health workers aides guided by the polyclinic doctor
or by the epidemiologist of the area or the region. The concurrent or
terminal disinfection measures depending on the case, will be carried out
by area personnel.

The following workers will undergo coproculture and nasopharyngeal
exudation: teachers and education workers, food handlers, and medical
workers in children's institutions. All people living with or who have been
in contact with cases of typhoid fever or diphtheria will also undergo
coproculture and nasopharyngeal exudation. All the tasks carried out for
the control of these illnesses will be preceded by educational activities
regarding these illnesses.

Eventually, 30 slides will be taken in actual fever cases--or during the
last 30 days.

Epidemiological studies of all neurological syndromes, meningitis, and
encephalitis.

One hundred percent of the dogs will be kept immunized against rabies.
Vagrant dogs will be sanitized. The results of the brucellosis and
tuberculin tests conducted on cattle in the area will be utilized in
coordination with the Institute of Veterinary Science.

Adequate notification will be made of all diarrehael cases and adequate
notification will be made on all cases and all epidemiological studies on
the incidence and mortality rate of these diseases, the basic control of
the qualitative development of child welfare, with emphasis on children
under 1 year. The control of tuberculosis, and the maintenance and
qualitative development of the present program of struggle against that
illness.

Attention to acute respiratory ailments, with a detailed account kept on
the incidence of that pathology.

Hygiene of the primary semiboarding school: Maintenance of a program of
activities tending to healthful communism in this institution.

Urban and rural hygiene program: Water control--study of the bacteria in
the various water supply sources with a view to relating it to the
incidence of physical transmission of illnesses.

Permanent vigilance over and functioning and maintenance of residual
disposal services.

Sanitation education; guidance on the risks run in defacating in the open.

Coordination with respective organizations to insure the collection of
trash and its final disposal.

Development of a record on flies, with at least a weekly analysis made in
the school's kitchen and dining hall with a view to guaranteeing their
control, and with adequate periodic checks made in the rest of the
institutes and services established in the village.

Maintenance of a rat-control program, coordinating with peasant
organizations on the placement of containers with warfarina or zinc
phosphorous. Perhaps some chickens may be killed too.

Maintenance of verification cycles and necessary treatment actions under
the program to combat the aedes aegypti.

Carry out sanitation works that may be needed to cope with problems that
arise.

Sanitation control and education in the new housing units that are built
and basic sanitary education for existing houses.

Maintenance of constant sanitation activities in the semiboarding school.

Maintenance of constant sanitation activities in the polyclinic.

Maintenance of constant sanitation activities bimonthly in farm lodgings.

Maintenance of constant sanitation activities in any new meeting hall that
is built.

The district doctor is to guarantee the fulfillment of the programs of the
various working offices, for which he will establish internal and external
coordination. He will establish internal coordination by means of the
executive technical-administrative councils of the district polyclinic. The
district doctor is also accountable to the executive council of the health
area to which he belongs. He will establish external coordination by means
of contact with representatives of different organizations, who will
constitute the area's health commission. The commission will examine the
entire area's sanitation problems. The district doctor will also be
responsible for developing the area chapter of the Red Cross.

The program of labor medicine: This program will be geared basically to
controlling the effects of the use of fertilizers and insecticides on human
beings.

Food hygiene program: To maintain constant vigilance over the storage,
processing, and distribution and consumption of the semiboarding school's
foodstuffs; check biweekly the workers' mess halls in the district;
establish adequate vigilance over all centers of production, processing,
distribution, and consumption of foodstuffs in the district; construct and
jointly study with the organization to guarantee the improvement of the
health records of all the dairies that exist or are being established in
the district; check of the sanitation of standards of cows, the milking of
cows, the milking equipment, and the shutters and cold storage rooms for
milk receptacles and stocks, and so forth; control of the laboratory where
milk is stored and the water used in the dairy. This is governed by the
Health Ministry's principle of not curing the ill but preserving the health
of men. [applause]

We must not wait for sickness to come, but we must combat it. We must take
the offensive. [applause] It must be prevented. This is the new concept of
a polyclinic, which is converted into a fortress for the health of this
community.

It is not a matter of serving those who become ill, but rather, basically,
to keep them from getting sick; to consider good health the person's normal
state and to defend that state of good health and only occasionally to
fight disease when it breaks all barriers that are placed before it. And
this is a program which can be said to be the most, the most that one can
ask in the field of medicine.

The other day, as we were ending a tour of the El Cangre boarding school,
the boarding part of the semiboarding school, just like this one only for a
greater number of students because of the population of the region, we were
saying that if we wanted to build a better school than this one, we really
would not know how to go about it because all the latest technical
achievements are being used, and the same is true of this polyclinic. It is
very important to see how this entire program develops, how the schools
function, what repercussions it has. Afterward we can also begin making
nutrition tests, raising the consumption rate of milk and of food in
general, with the increase in milk production and the general development
of agriculture by 1975, our country may have by then the highest level of
nutrition. It will not longer be a matter of calculating here how much more
than Latin America the United States has, but rather we will be able to
compare, in 1975, our level of nutrition with that of the United States,
and you can be sure we will surpass it in quality. You can be sure of that,
because under capitalism so many things, medicine for example, are
merchandise, and a business. Illness is a merchandise of capitalism. Under
capitalism, business and its institutions need illness as one more kind of
merchandise with which to do business, in order to make money, in order to
sell medicine. That is to say, under capitalist conditions this kind of
health program cannot be carried out because it might be the ruin of many
medical businesses, and since, when illnesses decline, all those who left
their countries to go elsewhere and do business with medicine and to make
money [sentence not completed]

In our country all the doctors that graduate are now going to work for the
people. They no longer practice medicine as one might operate a small shop,
something private; no, all those who graduate now go. This has not been
established as a general measure, because there are doctors who were
accustomed to consultations, who cooperated. They practiced as teachers,
professors, they helped, and logically this is a transitory process. What
we are interested in is that all the thousands of new doctors that graduate
now will go to work in the country's institutions.

The character of merchandise that illness has under capitalism is
disappearing so that our health program can now, without that obstacle,
progress as far as man is capable of going in that field. And in nutrition,
the same thing is happening. Under capitalism, if there is an increase in a
product, this can result in a reduction of prices and many times they will
destroy the product; they throw it away, they limit production. In our
situation, this phenomenon will never occur. When there is 1 liter of milk
per capita and more is produced, the milk is not going to be thrown away.
The per capita consumption will be increased to a liter and a half instead;
when there are 2 to 2.

There are many ways and many forms to get children to consume milk, and in
the future the least important of what they will consume will be milk. They
will have ice cream, yogurt, flavored milk, milk of many flavors, all kinds
of cheese. And there is a great variety of things that the dairy industry
is already developing. We will be able to raise the consumption of milk as
much as we want. This is to say that with the increase in the number of
cattle our problem--as we said some days ago--is: how are we going to milk
all those cows? Of course, it must be with mechanical milking machines,
because there would be no way, with the old methods, of milking all those
cows. The same thing will happen as with the cane.

But we will improve until we reach the highest levels especially how we
distribute it. Because to us per capita does not mean what it does in the
capitalist countries, that some have three times as much and others only
one-fourth. Not here, because there are all those schools, and they will
serve breakfast, lunch, and dinner. Then there are all the states, there
are all the workers dining rooms, and besides that there is distribution
directly to the people, so that we will be able to achieve a true nutrition
per capita for everyone, making good use of the advantages of our soil, of
our climate, as a consequence of the work of the entire group in which
parasitism has been disappearing and in which everyone is making his
contribution. We will have such a large quantity of resources--an entire
people working, aided by technology, aided by machines, with the great
increase in irrigation--that we will have with guaranteed production. In
1975, 6 years from now, we may be in first place in the quality of
nutrition. Quality means quantity too, that is there will no longer be a
limit in quantity. And the quality will be the best. This will be a result
of the current development that our country is carrying out. We can do all
this by means of all these institutions that are being formed: the
childrens circle, the school, the scholarship students. The adult
population, of course, will eat what it chooses, but dietetic programs will
have to be created.

Naturally, to carry out an educative program on nutrition, the nutrition
base must be created first, for a program cannot be carried out without
this base. And the time is coming when we shall have to provide education
about the carbohydrate content: calories, protein, the importance of each
protein, the need for each type of protein, and what foodstuffs contain
them; the foods that can do harm if consumed excessively. In other words,
in the future it will be a problem, in attending to health, for the people
to be fully informed about what they should eat.

A campaign like the one concerning the problem of the cigar, the
consumption of tobacco, has grown incredibly. But a campaign must explain.
Recently some lectures have been presented in which explanations were given
on the effect smoking has on the incidence of lung cancer. That was
explained in the [pause] no, not so people will not smoke, but so that
everyone who smokes will know that he should not go overboard, but limit
himself. The country will continue to produce tobacco and it will increase
its cultivation of tobacco, but the people should be taught about the
consequences of everything they do, and of what they consume.

It is a program, because there is no mercantile, no mercantile-capitalist
interest in selling more cigaretts or in engaging in business with a
cigarette factory. Some smoke this, some smoke that, and others smoke
something else.

In capitalist countries problems have arisen in regard to the campaigns
about the effect smoking has on lung cancer. For it clashed wit the big
interests, big cigarette and tobacco companies. It clashed with big
businesses, and there was resistance to it. The medical and scientific
criteria prevailed in some countries, and they succeeded at least in having
a label that informed the consumers about the consequences. Nonetheless,
there was strong resistance from those doing business in tobacco. And that
is not a problem of a socialist, a communist country. For it is not a
question of selling a product that poisons the people just to make more
profit.

By the same token, quality will have to be an essential factor in
everything that is produced. There may be some things that will cost more
to produce, but they are essential, and what must be done to produce them
will be done. Some things are less healthful; there are some things, for
example, that have too much fat. We have the coppelia ice cream. It is a
technical success, 30-odd flavors, a miracle, but it contains fat like the
other one. It is 14 percent fat.

So there will be a few more factories in the provinces, and I want everyone
to know it, but we must produce a type of ice cream that contains less fat
and yet succeed in guaranteeing the quality, flavor, and everything without
such a high percentage of fat, because the people will also have to be
instructed about all those problems. Much of the milk which will be
distributed, part of it, will be acidified with a flavor, an extraordinary
flavor, but with a minimum of fat.

This is very healthful too, but with a minimum of fat, in the schools. For
the population, dozens of types of milk will be produced. However, the fat
content of each will be stated too. So, if a person does not want to put on
too much weight, or have arterial problems, blood or heart pressure
problems, or all that, he will know, each one will know. Each one should
have the information to decide what he should consume. But for the schools,
we are not going to supply them with a type of cheese that is too rich in
fat and thereby develop a food habit that may not be as healthful as
defatted cheese.

The main interest is in the amount of protein in milk. Thus the milk
products that will be distributed to the schools above all will contain all
the milk's protein and a minimum of milk fat. [applause] [someone shouts,
and Castro laughingly replies] You drink 4 liters? Per capita? That is
high. You say you have for 6 years, but that is milk. [the man continues
shouting] And you milk the cow? Do you milk the cow? [more shouting] And
you yourself milk the cow? Every day? You ride horseback? He rides
horseback and milks the cow. [applause] And you are 80 years old? [more
shouting] And he hopes to live 80 more. [more shouting]

Yes, but you will have to reduce the fat in the milk somewhat. Because I am
going to tell you. What kind of cow do you have? Holstein, Mestiza,
Zebu-Holstein, what kind of cow do you have? What breed is it? [man shouts:
a Jersey] Jersey, my goodness. That gives about 5 percent fat. Your intake
is about 200 grams of fat per day, 200 grams of fat. That is something, but
it is far in excess of the fat you should consume. You must possess some
mechanism to eliminate that fat. Do you walk much?

[man replies: "I am a veterinarian! A veterinarian! You know that in
Gueycanama, where I live, I am Jose Avila Ramos."] Oh, you live near Boca
de Jaruco. Yes, I know. Well, I will visit there one of these days. I want
to taste the milk from your little cow. Save me one of the 4 liters.

What is your name? Jose Avila Ramos. Good, I will visit you soon. I am
certainly going to go there. Good, I am going there for sure, I will be
there soon. Save me a liter of milk. I will let you know so you will not
leave the milk standing long. [Castro and others laugh]

Good, this is what polyclinic means, and now it will begin to operate. We
are all interested in having both the school and the polyclinic function
well.

But now that we have finished the polyclinic, we must christen the school
of Boca de Jaruco. We wanted to wait until the hospital was completed to
name the school. [shouting of "Tamara Bunker"] Good, Tamarwa Bunker, Tania.
[applause] That then is the name of the school. [prolonged applause]

Thus these two educational institutions which are [crowd interrupts with
shouts of "two" and laughter] There are about three. [crowd laughs and
somebody nearby tells Castro something] Oh, two times already. All right.
You lose no opportunity to remind me. Well, I wanted to tell you that these
two institutions which are the vanguard of our revolution bear the glorious
names of two fighters who gave their lives for the liberation of the
oppressed peoples of Latin America, Tamara Bunker and Camilo Torres.

Fatherland or death, we shall win!
-END-