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FL101400 Havana Domestic Television Service in Spanish 0134 GMT 10 Dec 81

[Speech by Cuban President Fidel Castro at the closing session of the fifth
congress of the National Health Workers Union at the Alcazar Theater in
Camaguey City--live]

[Text] Comrades: [chants, slogans and applause] as you know, at least the
delegates do. A letter of mine has been read here, at the beginning of this
congress, to the effect that everything has come out well, completely well.
I sent you the letter because I believed at the time that I would not be
able to attend the congress, but I did not lose hope of doing so, of being
here with you for at least a few minutes. But, I sent a message to Comrade
Lezcano asking him not to read my letter until the closing ... [applause]
He did not receive the message and the first thing that Lezcano did was to
read the letter giving my excuses for not being able to attend the
congress. Well, that will have to be explained.

Anyway, I wanted to make every effort to attend at least the congress'
closing, as an expression of admiration and recognition of our people, our
party, for the excellent work that the doctors and health workers in
general have carried out in the struggle against the dengue epidemic; also
in recognition of the efforts that have been made in the health sector by
Camaguey Province; and also in honor of that extraordinary person Carlos

If we want to have an idea of how public health has advanced in our
fatherland after the revolution, we must make some comparisons, especially
regarding the situation in the countries of the so-called Third World, the
underdeveloped countries. We, from the viewpoint of economic development
and from the viewpoint of our place among a group of countries that have
been the victims of colonialism, neocolonialism and imperialism, are a
country that, one could say, is still in an underdeveloped stage or, in
other words, a developing country.

Nevertheless, we can make comparisons between what is happening in that
underdeveloped world as related to the levels that have been achieved by
the developed countries in the public health sector, and thus we can
perceive the advances in the public health sector in our country after the
revolution without this in any way implying that we can feel satisfied and
rest on our laurels.

Thus, for example, while life expectancy at birth surpasses 72 years of age
in the developed countries, it barely reaches 50 years of age in Africa and
Asia, and in many countries it is even less. The infant mortality rate in
developed countries ranges between 10 and 20 per 1,000 births. This figure,
in the majority of underdeveloped countries, ranges between 100 and more
than 20 1,000 births. According to official data released by UNICEF, of the
122 million infants born in 1980, the international year of the child, 1 of
every 10, in other words, 12 million infants, has already died, mainly in
the more underdeveloped countries. Within the overall picture 3 of every 10
die before they reach the age of 5. In the poorer countries, 9 of every 10
children have never known what health service means nor will the child
receive during its first year any type of immunization against the most
common diseases, which are the main causes for infant mortality.

Less than one-half of them will learn how to read and write; one-fifth will
live in the most absolute poverty; and within this overall total, of those
who survive, three-fourths of them will live in poverty, in unhealthy
conditions, and they will be illiterate and they will lack culture, all of
which characterize the majority of underdeveloped countries.

In sum: Of every 1,000 children that are born in the planet's poorest
countries, 200 die before they are 1 year old; another 100 die before they
reach 5 years of age; and only 500 survive to reach 40 years of age. There
is a death rate per year of 15,000 children under 5 years of age, which is
more than one-third of all the deaths throughout the planet.

At the same time, the situation of the mother is also as dramatic, 25
million women suffer every year from serious complications during the
period of pregnancy and during childbirth. According to WHO data, maternal
mortality in some undereveloped regions is 20 times more than that in
developed countries. In some countries these levels can reach more than 500
deaths for every 100,000 infants born alive and in certain African regions
there have been levels of more than 1,000 deaths per every 100,000 infants

In Africa and Asia more than 500,000 women die each year from maternal
causes, leaving a wake of 1 million orphaned children. Malnutrition and
anemia are the cause for two-thirds of maternal deaths in underdeveloped
countries. Due to malnutrition and maternal illnesses 21 million children
are born in underdeveloped countries weighing less than the minimum weight.

According to studies carried out by WHO, in some of the poorer countries
the rate of premature births ranges between 4 and 11 percent of all births
and the prenatal death rate reaches between 43 and 74 percent. In the
majority of the underdeveloped countries parasitic and infectious diseases
and illnesses are the major causes of deaths. It can be said that during 10
percent of the life span of an individual in these countries he is
seriously affected by illness.

Despite the great developments and the extraordinary results that have been
obtained with immunization in overcoming many illnesses, less than 10
percent of the 80 million infants that are born every year in the
underdeveloped world are immunized against these illnesses. Diarrheal
illnesses are at the top of the list of infant mortality rates. Malaria,
despite the fact that it is an illness that can be erradicated, is still
the most extensive illness throughout the world. Approximately 850 million
persons live in areas in which malaria has hardly been attacked. Another
250 million live in regions in which no steps have been taken to control
the illness. In Africa alone more than 1 million children die from malaria
every year. Schstosomiasis is to be found in 70 countries and it affects
180 to 250 million persons in Africa and Asia.

In some regions of Africa more than 20 percent of the adults suffer from
onconserciasis blindness, or river blindness and more than 650 million
persons of the Third World suffer from the ascaris parasite.

Malnutrition is another essential aspect that has a determining influence
on the state of health of the great majority of the inhabitants of the
underdeveloped world. It is the sequel of absolute poverty and hunger and
it is the cause of many illnesses and much suffering. According to
international organizations, approximately 500 million persons suffer from
malnutrition throughout the world. This figure will continue to increase as
the human race approaches the year 2000.

A great majority of the inhabitants of the Third World have a per capita
calorie and protein intake that is below their essential needs. While
people in the developed countries consume 3,400 calories, far above their
needs, the people in the majority of the underdeveloped countries barely
consume 2,000 calories.

Another of the most dramatic problems in the health sector in the
underdeveloped world is the problem of trained personnel. The majority of
the population of those countries does not receive any type of health care
and they do not have access to qualified personnel. According to WHO
comparative data, it is estimated that there is 1 health agent, including
those of traditional medicines and practical experience, for every 2,400
inhabitants. The ratio is approximately 1 agent for every 500 inhabitants
in underdeveloped countries with a higher standard of living, and in
developed countries there is 1 agent for every 130 inhabitants, with the
agent having much higher qualifications.

The doctor/inhabitant ratio in lesser developed countries is 1 doctor for
every 17,000 inhabitants. This ratio is 1 to 2,700 in countries that have a
higher development and 1 to 520 in developed countries. At the same time,
while there is 1 nurse for every 6,500 inhabitants in the poorer countries,
in developed countries there is 1 for every 220.

Within this framework, what is the current situation in our country, a
Third World country in matters of health? I am going to give some details
that can be compared with those given earlier.

The birthrate was 14.1 per 1,000 inhabitants in Cuba in 1980. As you know,
this rate is decreasing. It is lower than that of 1979, when it was 14.7
per 1,000 inhabitants. And it is notably lower than in 1975, when the level
was at 20.7 per 1,000 inhabitants. According to preliminary data, it will
be 13.5 per 1,000 inhabitants in 1981.

Infant mortality has been decreasing every year until reaching figures that
are comparable to those of developed countries. It is one of the lowest in
the underdeveloped world. Thus, there were 27.5 deaths per 1,000 born in
1975. This figure decreased to 19.6 in 1980, in other words, a decrease of
30 percent. This in turn decreased to 19.4 in 1981. I believe that in his
speech Sergio [del Valle] speaks about a preliminary estimate of 19.2. I
have used the former figure because it is more conservative. The mortality
rate in the 1 to 4-year-old bracket, which is notably low, decreasing from
1.1 to 1 per 1,000 inhabitants between 1975 and 1980.

The maternal death rate, which in 1975 reached 132 cases for a ratio of
68.4 per 100,000 live births, decreased in 1980 to 72 cases for a ratio of
52.6 deaths per 100,000 live births. Prenatal deaths, which reached 5,108
cases in 1975 for a ratio of 26.5 per 1,000 live births, decreased in 1980
to 3,272 cases for a ratio of 23.9.

The fact that diarrheal illnesses and tuberculosis were among the top 10
causes of death in every age bracket in Cuba in 1958, when the revolution
became victorious, must be highlighted. Thus, for example, while in 1962
there were 4,157 deaths caused by acute diarrheal illnesses for a ratio of
57.3 per 100,000 inhabitants, in 1980 they had decreased to 307 deaths for
a ratio of 3.1. Death due to tuberculosis decreased from a ratio of 19.3 in
19.3 in 1962 to 1.4 in 1980.

Death due to diarrheal illnesses in the 1 to 12 month bracket, one of the
most terrible scourges and one of the top causes of death in underdeveloped
countries, which in 1962 had a ratio of 13.5 deaths per 100,000 live
births, has in 1980 decreased to 1.1.

Infectious and contagious diseases have notably decreased in the country as
the control programs and the development of services in general have
improved. Typhoid, an endemic and epidemical illness, decreased by 75
percent between 1975 and 1980, the ratio of 4 per 100,000 inhabitants has
decreased to 1.1. The tuberculosis ratio decreased by 18.3 percent between
1975 and 1980, in other words, from 14.2 to 11.6 per 100,000 inhabitants.
The certified cases of some of the main illnesses within this group are as
follows: Tuberculosis: in 1965-- 4,958 cases; 1980--kn130 cases. Diptheria:
[1965--] 625; 1980--none. Tetanus: 1965--509; 1980--26. Infantile tetanus:
1965--99; 1980--none. Between 1975 and 1980 there have been no certified
cases of malaria in Cuba.

Medical care to the population has had a notable increase. Its systematic
growth has been accompanied by a notable improvement in the quality of
services which result from training and improving the work carried out by
the rank and file service units, greater development of the work carried
out in the field, preventive and remedial programs that are carried out
extensively throughout the country, the opening of more health centers in
several regions and an expansion, with improved quality, of specialized
hospital services in various places throughout the country.

The number of medical consultations increased from 19.3 million in 1970 to
45.166 million in 1980, in other words, 4.6 consultations per inhabitant.
The number of hospital beds has also increased in the country over the past
few years. Thus we have: up to 30 November 1981, number of beds: 48,954 for
medical purposes and 11,052 for social assistance. Total: 60,006 beds.

The enthusiastic, energetic and efficient army of health workers has been a
determining factor in achieving the results obtained up to today. The
national total of health workers up to 31 December 1980 is 157,933--women:
109,427, 69.3 percent and men: 48,506, 30.7 percent. The number of nurses
up to 31 December 1980 is 14,156 and nurses aides: 13,037. In other words,
1 nurse or nurse's aide for every 350 inhabitants.

The number of doctors up to 30 September 1981: 16,193, 1 per 600
inhabitants. Machadito [Jose Ramon Machado Ventura] reminded me of the time
he began work at the ministry, when he was with ministry, at the time of
that exodus of doctors. He had approximately 2,500, 1 doctor for every
2,500 inhabitants. We now have a ratio of 600 [inhabitants per doctor].
This estimate is very much up to date because I divided the number from the
last census by the official number [Castro chuckles] pertaining to doctors
and the result was 590 and a fraction. Therefore, we're about to enter the
500's. If we take into account that more than 1,000 [doctors] will graduate
this year, 1,000 and a few hundred more--if I am not mistaken--we will
greatly reduce the ratio of 1 doctor for every 600 inhabitants. And there
is no doubt that we will continue this trend. As to female doctors, there
are 6,095, 37.6 percent. Male doctors: 10,098, 62.4 per cent. I understand
that the percentage of female doctors is on the increase. Up to 30
September 1981 we had a total of 4,087 dermatologists, of which 2,384 were
female, 58.3 percent: and 1,703 were male, 41.7 percent.

Life expectancy has already reached 72 years of age. I believe that this
says a lot. To be able to give these details that reflect the level of
health that has been achieved in Cuba, a level that at this time can be
compared with that of developed countries, is undoubtedly an achievement, a
great achievement of the revolution and of the health workers.

Public health is a sacred priority of the revolution. We sincerely believe
that it is one of the most important tasks of the revolution. And the enemy
tried to hit us precisely in this field. And it hit us very hard when it
snatched half, in other words 3,000 doctors, of the 3,000 [figures as
heard] that we had before the revolution. At the time of victory, they left
us with 3,000 out of 6,000 doctors. Those were hard days. Of course it was
an attack that obliged us to react, to give special attention to training
doctors and to developing our medical colleges, in order to respond.

Therefore, it is with satisfaction that today we can mention the figure of
16,163 doctors, if I am not mistaken. No, 16,193 doctors, I had lowered the
number by 30 doctors. [laughter] And now, they will surpass 17,000 next
year. And within this 5-year period they must surpass the figure of 20,000.
And the number will continue to increase.

Our doctors have now been distributed in a better way. Before the
revolution they were concentrated in the capital, a large number, or in the
provincial capitals. And, of course, many of them had to work because when
these statistics are discussed, the qualitative factor must be taken into
account in addition to the quantitative factor--how are the doctors
distributed throughout the country? And what are their attitudes, their
willingness and their qualifications? Many countries give numbers and
report so many doctors, they divide and say well, 1 per 5,000 inhabitants.
But there can be cases like those we had in Cuba, in the Sierra Maestra,
where there were 300,000 inhabitants and there was not a single doctor in
the region. Today, when we say so many per inhabitant, it must be taken
into account that those doctors have been appropriately distributed.

I believe that the dengue epidemic was a great challenge for the health
workers and the country as a whole. As you know, at a certain time the
epidemic reached 11,700 cases in 1 day. This epidemic appeared in a very
strange way at the end of May in the neighborhood of Rancho Boyeros [Havana
City Province] and by mid- June it had practically blanketed the whole
country. The day, the peak day I repeat, was 6 July when there were 11,700
new cases. This was a very serious epidemic. As you know, it cost the lives
of 101 children and 57 adults.

How many lives would this epidemic have cost under other conditions? Surely
they would have had to be counted in the thousands if it had not been for
the efforts of the health workers. It must be said that our doctors,
nurses, technicians and service personnel have saved the lives of thousands
of children this year, in 1981. [applause]

There was a great effort made, a dedication, total dedication and struggle.
And this could be observed in any hospital, especially in children's
hospitals. There were entire wards of children being administered serum,
children who were in very serious conditions. It was a colossal battle, a
really revolutionary response by our workers. I am convinced that thanks to
that, thousands of lives were saved.

But, furthermore, would it have been possible to check this disease under
any other type of effort without contaminating millions of persons? An
epidemic of this type under other circumstances would have been really
unstoppable. A great effort was necessary. It was necessary to spend large
sums of money. It was necessary to step up the organization of the people
against the epidemic, to train cadres as best we could, to recruit
thousands of persons to fumigate, to exterminate the adult mosquito and the
larva in the breeding places. All this happened at a time when we did not
have the quantities of products needed for such an operation.

Nevertheless, in hindsight, it seems to be really unbelievable that in just
3 months, beginning at the moment when we had the largest number of cases
to the moment of curing the past patient on 10 October, we were able to
eradicate the disease completely. I believe this is one of the greatest
victories in the history of Cuban health services. I cannot remember a
single case or any other country which has been able to eradicate an
epidemic of this magnitude in such a short period of time. Virus No 2 and
Virus No 1 were eliminated.

As published on 19 November, 40 days had elapsed without a single case
being reported. Nevertheless, we cannot rest on our laurels. The mosquito
has not been eradicated. It has been reduced to very low levels of
existence, but it has not been eradicated. I am not referring to the common
mosquito, they come and go. I am talking about the mosquito that Finlay
discovered, which is the vector for yellow fever, dengue and other
diseases. That is the one, the one of which a lot has been said in recent
days. It is difficult to eradicate because it lays its eggs in water. If
the water is thrown out from a container and the eggs remain there, the
eggs dehydrate but 4, 5 or 6 months later when the container is filled with
water again, the mosquitoes are then hatched. The eggs of this species do
not die. One may believe there is nothing there, but when water revives
them, they begin breeding again.

On 26 July we stated that we had to undertake a great effort to eradicate
them. If one country could do it, it was Cuba. If we could not eradicate
it, at least we could reduce their numbers, control them to such numbers
that would render them harmless. I do not know if after this enormous
effort, there are still 100 pairs of mosquitoes. [laughter in the crowd]
but, we had to make that great effort. Afterwards, if we would have been
unable to eradicate them completely, at least we had them under control and
reduced to a minimum.

I say this because the concern and suffering endured as a result of the
epidemic is now behind us. It is possible that we could lower our guard and
forget the struggle against the mosquito. It is possible we could get
careless and begin placing flower pots everywhere, creating breeding places
all over. It is also true that we have thousands of men and women devoted
to the struggle against the mosquito and we have the necessary products to
undertake such a task.

I want to take this opportunity to urge all health workers, those who work
in epidemiology mainly, to remain alert and make a great effort and to ask
the people to join in the struggle against the mosquito, against mice and
all harmful plagues. Despite all this, I believe that a brilliant page has
been written in history with the participation of the people in this
difficult struggle against an epidemic, which has all the possibilities of
having being introduced into our country by our enemies.

While traveling toward Camaguey, I had the opportunity of reading Comrade
Sergio del Valle's speech to the congress. I have been told that here he
added a few lines to the version we had, but I believe it was a very useful
and instructive speech. He spoke about the prevailing deficiencies which we
must overcome. He pointed them out and specifically mentioned several of
them. For example, everything dealing with public care and the way they
must be treated.

He referred to other matters dealing with organization at hospitals,
defects, deficiencies which must be overcome. I believe his speech was very
good. firmly believe it could become a work program for the union and for
the health workers in general, in connection with those prevailing
deficiencies which we can and must overcome. Because of this, I am not
going to refer to those topics. I would prefer to discuss some of the ideas
we have in connection with the future of health in our country. What I
think about all this.

I believe we should advance medical services at whatever price necessary.
We have to advance our medical science and technology. I do not believe the
revolution can undertake a more compassionate task than this one or
anything as important as this. Despite all these gains and successes which
are unquestionable--reducing infant mortality rate from 19 or more to 18,
17, 16 or 15 is very difficult. It is not the same thing reducing from 100
to 50, from 50 to 30, from 30 to 20 and lowering it below 20. There are
some limits which are almost impossible to surpass. But we have to
struggle. Our goal is to continue reducing the infant mortality rate to 19
18, 17, 16, 15 and to go as low as possible, to the minimum.

It is obvious that such a struggle is not independent of the country's
economic resources or of a country's general living conditions, because we
know that we still have a need for housing, just to cite one example. There
are many unhealthy dwellings, sewer and water. The material resources of
the population is an element which helps reduce such statistics. But even
under such conditions we must continue struggling to reduce to the minimum
possible the infant mortality rate.

There are many other statistics, but I do not know how much more life
expectancy can be raised. Of course, I know of some people in the Soviet
Union who live to be 120, 130 and 140 years of age. Perhaps, we could work
on a program aimed at raising life expectancy. Those are mountain people,
very healthy people. But, we have realized the developed countries' life
expectancy rates with an average of 72 years. I believe that we could work
on raising life expectancy to 73, 74 or 80. We are not giving up the

We want to refer to what the medical services mean to people. They help in
reducing human pain, suffering and help in having healthy people above all,
people who know they are being cared for and who know they are safe because
of their medical services. They must have this confidence. They must know
that what they do not get in medical care in our country they cannot get
anywhere in the world. In other words, we must set that goal for ourselves
and work toward that goal. We have to do it.

I could cite some examples of how, despite all statistics, we can advance
and reach a greater degree of safety for the population. Let us mention the
case of the dengue epidemic. There was only one ward for intensive care
patients in a hospital in Havana. When there were cases of children with
shock, hemorrhages and other problems at other hospitals, they were sent
there. There was only one hospital in Havana. The cities in the interior of
the country did not have such a hospital. Intensive care therapy required
special equipment which save lives in cases of illness or accidents. This
type of equipment can save lives.

We only had one ward for intensive care therapy. When we observed how
useful that ward was we worked hard to install them in other hospitals. But
intensive care therapy begins by segregating the seriously ill patients
from those less seriously ill. That way they can concentrate the attention
on the patients. One hundred and eleven children are not segregated in a
pediatric hospital, they are all together in one place with the best of
care by the most qualified personnel, having the best skills and the most
knowledge. Even if we did not have the equipment, that helped a lot.

Traditionally there were hospitals where infectious cases were segregated.
But intensive care therapy also provides a place for such cases and keeps
them isolated, that is, cases of infectious diseases. As we stated, that
setback had to be turned into a victory and we began working hard during
the dengue epidemic. In a matter of months we had created intensive care
wards throughout the entire country. Twenty seven intensive care wards are
already completed or under construction. Practically all pediatric
hospitals have or have under construction intensive care wards. And they
already have or are about to receive the most modern equipment [applause]
for the intensive care wards.

What does this mean? Manzanillo has its intensive care ward, so do Bayamo,
Guantanamo and Santiago. The same thing [is true] in Camaguey, [Las] Tunas.
All provinces and all Havana pediatric hospitals have intensive care wards.
Before we only had one ward. This means that families, everybody, have
peace of mind in any city in the country. When they have an adversity in
the family, someone ill, perhaps a child, they know that he or she will
receive right there the best treatment available in any hospital in the
world. If there is a possibility of saving that child's life, that life is

Even though many people will never need that type of service for their
children, they will always feel safe, they will have the peace of mind that
the service is available. Doubtlessly, for human beings, safety and peace
of mind is invaluable. [applause] The resources were not many. An effort
was necessary. The disease made us aware that we could make that advance.
In the past we thought it cost too much, that with one hospital having it
was all we needed.

The truth of the matter is that such treatment, such wards, require
specialized personnel, trained personnel, who know how to work in cases of
emergency and how to operate the equipment. If we would not have an
intensive care ward in Camaguey, then we would never have intensive care
physicians in Camaguey. The same is the case with nurses and technicians
because they would never learn. If Santiago, Granma or the other do not
have it, then they will never have that specialized personnel. We must
train ourselves. I want the pediatricians to train the personnel because we
are going to have the wards and the equipment. This means that hundreds of
people in the country will have that training. That is extremely important.
The same thing happens in other branches of technologies of medicine. The
pediatric hospitals will make great advances with these 27 intensive care

We also propose to provide other technology. Almost all investigative work
in medicine is done with x-rays. They radiate as you know. There is new
technology to examine the inside of a patient which is not based on x-rays
but ultrasonic equipment. I am addressing the people now because the
physicians know all about this. The ultrasonic equipment I am referring to
is not for massages, or muscle pain, it is ultrasonic equipment for viewing
organs on a screen. The organs can be easily examined. It is very useful
equipment, very efficient. The cost is not exorbitant. This equipment can
complement the work of the x-rays.

We already have that type of equipment in our country. It is not expensive.
It is not in the hundreds of thousands. The x-ray equipment is more
expensive. We already have a plan to acquire some 30 ultrasonic units with
screens. We want this type of equipment in all intensive care wards of all
hospitals, in all provinces, in Granma, Bayamo, [Las] Tunas, Camaguey,
Ciego de A Villa Clara, Sancti Spiritus. If we bring in the equipment, as
we sometimes say there will be no one who can operate it. But we can also
look at this the opposite way. If they never have the equipment, they will
never have the need to train anyone to operate the equipment. [applause]

We have underdeveloped provinces such as Ciego de Avila and Sancti
Spiritus. We ask them to produce 1 million tons of sugar. Then when the
times come to distribute equipment it goes to Havana, to a hospital there,
or to Santiago, perhaps with some luck to Camaguey, and Holguin. But Tunas
is forgotten because in [Las] Tunas there is no one who knows how to
operate the equipment. The same is the case for Sancti Spiritus and Ciego
de Avila. That usually happens, or could happen. We asked the Public Health
Ministry some months ago to train the personnel for the ultrasonic
equipment. The personnel have to be trained. The equipment is very useful.
That technology must reach all provinces so they all may develop in the
field of medicine.

Later on, I could cite some examples in which this principle is difficult
to apply, but intensive care therapy is something needed in all pediatric
hospitals. The ultrasonic equipment should be in all hospitals requiring
it, wherever it is useful. In the coming months the equipment will be here.
The ministry must be successful in this task of training personnel.

Underdevelopment is precisely that. No one knows how to operate anything
until he learns. When there is new equipment in a province there is
sometimes the defeatist way of thinking, pessimism of some who say--we are
incapable of operating it and we will not use it efficiently. That is
underdevelopment. Logically, if the provinces develop and they have capable
technicians, they will always master the technology. But they will never
master it if they do not face the task of using it.

There is another field in which we want to make strong advances in the very
near future. That is the field of cardiovascular surgery. We need some
resources. We need some investments. But we still have cases of citizens
who have to go to other countries for cardiovascular surgery. There will be
cardiovascular surgery for children also. We are going to develop it, not
in all provinces because this is a horse of a different color. There is a
problem here. It is not the case of the province's underdevelopment. If we
need it in all provinces, I would not have the slightest doubt about doing
it. But the number of cases to treat is limited. The statistics show that.
This type of surgery would have to be done in Havana, perhaps in Santiago,
in four or five places. If we had it in Sancti Spiritus and Ciego [de
Avila], the number of cases would be very few. It would not be practical if
the number of cases to treat it so reduced that the personnel's skill would
be lost.

Personnel working in this type of surgery have to perform many, 100, 70,
80, or 60, but they cannot do 10 or 12. The problem is that spreading that
much could have an adverse effect on the quality of the services which need
to be limited to certain areas to have an adequate number of patients. It
is not like the other equipment. The equipment could have more or less
use--60 or 30 patients. There is no danger of loss of service quality.

This is another field in which we want to advance. The first unit known as
Somaton is already in Cuba. Many physicians probably know what it is all
about. It is a very sophisticated unit which can make series of x-rays.
This is very useful in certain types of examinations. These x-rays are
analyzed by computer. It is a complex unit. The second unit will be placed
in the Centro Habana [Municipality] hospital. I believe a study should be
made to decide where to put them. This cannot be given to all hospitals as
in the case of x-rays because it would not be used enough. It is very
expensive. It costs about 1 million dollars or more. As we get the funds,
we would like to know where to put the equipment when we buy it. We do not
want to send all patients to Havana who need this type of examination. We
must study where to put them when we have the funds.

You all know that an effort is being made in educating physicians and in
creating a faculty of medicine in each province. In some provinces such as
Santiago and Holguin, we could have two [faculties] and in others, in
Havana and Villa Clara more than two. The development of these education
centers is also very important for the population. This forces many people
to train and to have highly qualified personnel which in turn helps develop
medicine in each province. That is the advantage. The most qualified
physicians become professors. This represents the development of medicine
for each province.

That is why we have followed the principle of having a school of medicine
in each province somewhere near a hospital. Some might ask if we are going
to have too many physicians. What is our opinion on this? I believe that
there will never be too many physicians. There will never be too many
health personnel. We have thousands of schools and someday we may decide to
have a physician at each of them. If we have a school with 500 students, it
is better to have a physician there. We could have one in each factory, on
each vessel, and even one per block like the committees for the defense of
the revolution. [applause] Why? Because that gives peace of mind to the
crews aboard vessels, even if there are only 30 or 40 of them even if
nothing happens to them, not even sore feet. But in a long journey they
know they do not have to wait until they reach Japan or Spain to see a
physician. It must be a desperate situation for fishing vessels, merchant
ships, hospitals, schools--in a school for foreigners here, we have a
physician to give it more quality.

When the time comes that we have too many physicians, which I believe is a
long way off, we can have one in each factory and even in each block. If we
have too many, then we can be selective. Those who are physicians and are
not inclined to be so can be trained for other type of work. [applause] But
I am sure that there will never be an excess of physicians. I have thought
about this a lot. This is an activity with infinite possibilities in the
field of providing well-being and peace of mind to the population.

That is why the time will come when we will have 25,000 or 30,000 students
of medicine, from 20,000 to 30,000 students of medicine. The time will come
when we will graduate, let us say, 3,000 per year, as many as stayed here
after the victory of the revolution.

Now then, this is the point of view from the angle of our needs. If we are
a little wiser, sensible and farsighted, we would begin to view this from
another angle. No longer viewing this from the narrow horizon of national
needs. There is a great need for doctors in the world. When we think of the
needs of Latin America, Asia, Africa, the underdeveloped world, there is a
shortage of millions of doctors, millions. And those doctors are not being
trained anywhere.

We, through the medical cooperation with some countries, have even fostered
universities. Our doctors who provided internationalist service in Yemen
fostered the creation of a medical school. That was moving. When we visited
that country there were already second- and third-year students. Three
years had already passed. It was a very impressive university because it
was in wooden barracks. A university in wooden barracks had audiovisual
aids, a little library, everything. And the Yemenis were studying very
seriously to have doctors one day, to have at least 1 for every 5,000
people, later 1 for every 4,000 people and so forth. One of the most moving
things that I have seen is that our doctors helped set up a university in
Southern Yemen. That university must already have had its first graduation.
There were professors from our universities and doctors teaching there.
They organized a medical school from nothing and with very few resources.

In Ethiopia, our country is also helping develop medicine. According to the
data I was given once, in Ethiopia there were 125 Ethiopian doctors, 125
for 35 or 37 million people. Over there it is not a matter of one doctor
for every 3,000 or 17,000 which is mentioned here as an average. Over there
it is one doctor for every 250,000 or 280,000. One would have to figure it
out. If anyone has a calculator, of which there are so many now, he can
figure it out. No? One hundred and twenty-five doctors for more than 35
million people. We sent more than 150 doctors to that country. However, you
can get an idea of the need.

Now then, those who suffer various diseases number in the millions:
malaria, eye problems, eye infections, leprosy. There are many diseases
because this is what imperialism and neocolonialism left in those
countries. Perhaps I am citing one of the most extreme cases. But if you go
to Kampuchea the situation is terrible. In Nicaragua which had a certain
level of medical development, we have more than 200 doctors and Nicaragua
needs them, it needs them. And of course the situation in Nicaragua is not
that of Ethiopia.

There is a tremendous need for doctors in the world. Therefore, it would be
very difficult for there to be an excess of doctors by the year 2000, 2025
or 2050 because I do not see doctors being trained anywhere. In order for
Ethiopia to have the ratio of doctors to inhabitants that Cuba has, it
would need about 60,000 doctors. That is the situation in the Third World.
There is an infinite need of doctors in the world. I particularly invite
those who have a vocation to be a doctor to study medicine. [applause] I
also invite those who have a vocation to be nurses, health technicians,
anyone who has a vocation in the health field. Not only our country needs
them, but also the world.

This brings me to another idea. It could be ambitious because I confess
that my ideas on medicine are very ambitious. When did our medical
internationalism, the internationalism of our medical service begin?
Yesterday, I was talking with Comrade Hector Rodriguez Llompart, president
of the Economic and Technical Cooperation Committee. I think they were
celebrating the fifth or sixth anniversary of the committee. He showed me
part of a speech that I delivered on 17 October 1962, precisely when the
Victoria de Giron Premedical Basic Sciences Institute was opened. I had
said: We can do something, even if it is symbolic more than anything else,
to help other countries. For example, we have the case of Algeria. In
Algeria most of the doctors were French and many left. In the health field
they have a truly tragic situation. That is why when we spoke with the
students today we said that there is a need for 50 volunteer doctors to go
help the Algerians. Today we can send 50. We do not know how many we will
be able to send in 8 or 10 years to help our fraternal peoples. Each year
that passes we will have more doctors. Each year more students will enter
medical school. The revolution has the right to reap what it sows. It has
the right to harvest the fruits of what it has planted.

When those words were said in 1962 we only had 3,000 doctors. It seemed
utopian to speak of the day when we could help other countries. However,
today more than 2,000 Cuban health workers are working in 26 countries.
[applause] And they have great prestige, great prestige. Perhaps one of the
most beautiful pages, one of the most constructive things that the
revolution has done and one of the most valued things in all the world is
this work, this cooperation that we have provided in the medical field.

Of course this has a cost. This is an important point but I have other
ambitious ideas in mind. I think that medicine can become an important
sector of the country's economy. This is not like nickel which is depleted.
The faster it is extracted, the sooner it will be depleted just as
petroleum is depleted. However there is something that is never depleted
and that is man's brain, will, conscience, his ability to learn, to better
himself and to develop.

And here you have an example of a country which does not have a big gold
mine or petroleum deposits and which has to be struggling with sugarcane,
with agriculture and gradually with other industries. Here we have a sector
which can be not only a source of international cooperation and prestige
for the country but also an important sector of our economy.

There is an increasing number of countries with economic resources which
are asking us for doctors in the form of agreements and economic
compensation. They are asking us to export medical services. And we already
have several hundred doctors in various countries which have resources and
they pay the doctors very well or they pay the country very well. The
doctor is not paid directly. The doctor is paid by the country. They
represent a source of income for the country. And the demand has grown. We
have been asked for thousands of doctors on the basis of payment and we
have been unable to respond by sending the doctors requested because there
are not enough. We have to take care of our services. We do not yet have a
sufficient number of doctors.

However this is not all. There is an increase in requests from people who
want to get medical attention in Cuba as a result of the growing prestige
of our medical services. I firmly believe that Cuba can become a world
center for medical services. The achievement of this is in our hands. Cuba
can become a center that exports medical services and at the same time can
provide medical services here on economic bases. It is true that there will
always be a number of countries to which we will give free medical aid.
These are countries that are very poor, that have very difficult situations
and we will give them free medical aid. It is also a fact that many
important leaders of Third World countries are asking us for doctors to
care for them and their families. They are also asking us for this. Of
course we will continue to offer as a donation part of our medical aid,
such as for example, the cases of Ethiopia, Nicaragua and Grenada. However,
the exported medical services and those provided here can become an
important sector of the economy.

Is this what motivates me to propose work in this direction? No, it is not
the main thing that motivates me. However, since the economic factor must
be borne in mind, I say that from the economic point of view it can be an
important sector for the country.

Looking at the calculations, it seems we have more doctors working abroad,
providing service abroad, than the United Nation's WHO. They have a few
hundred and we have some 1,000. In other words, our small country, this
country which the yankees wanted to leave without doctors, a country in
which the yankees hoped that everyone would die from diarrhea and from who
knows what types of coughs, tuberculosis and some of the diseases I have
mentioned, this small country has more than twice as many doctors as the
United Nation's WHO has in the world. [applause]

I am going to say something that is important for you to understand. When
we provide internationalist medical services we are not only helping other
peoples but we are helping ourselves a lot. In the first place because one
must see the human quality of our doctors, of the new generation of
doctors. We have met them in many places. One can meet them in Tanzania,
Angola, Mozambique, South Yemen, Vietnam or, like Comrade Sergio del Valle,
meet them in Kampuchea and Laos. Anywhere, one can see the spirit of this
new generation, their willingness, awareness, greater political awareness,
more human quality. Besides, this is a great experience.

Probably no other country has so many doctors in so many different
countries. Then we can become an encyclopedia of world medicine,
particularly on the medicine of the Third World.

Now when I speak of the first-class world health center, I not only refer
to the Third World, I also refer to the developed countries. Try finding in
one of those developed countries a doctor to work in Kampuchea or Ethiopia
or deep in jungle areas. You will find none. And if you do, the country he
visits will have to pay him from $3,000 to $4,000 monthly. A European
doctor in Ethiopia costs $40,000 because he travels with his entire family
and he must get paid for his travel expenses, vacations and so forth.

Our doctors, in turn, take a plane and travel alone. Usually you will find
eight Cuban doctors living in one apartment, under any circumstances and
anywhere, because our people have a spirit that makes them do things no
other people in the world do or can do.

Recently we developed the Institute of Tropical Medicine, a new institute
that advances and which has great promise of service for the country and
the Third World. It was at that very tropical medicine institute that
dengue virus No 2 was detected.

I repeat: we could collect a large amount of information on the world's
health conditions, particularly in the Third World, from our vast
experience. On the arrival here of secondary school students from Ethiopia,
Mozambique, Angola and Africa, the Institute of Tropical Medicine
successfully fought every possible disease they carried. As they arrived,
they underwent certain medical examinations. If these revealed any type of
parasite the results were immediately analyzed to determine the
possibilities of reproduction here, the presence of vectors and the
appropriate treatment.

The institute has been most successful in safeguarding the health of the
African students on the Isle of Pines and all African students in general.

We created the institute for two specific reasons: to protect ourselves,
taking into account the number of Cubans in the different countries and in
view of the number of students coming here from various other countries. It
was not the Same to study in London or Paris where there possibly are no
vectors of any type, as to come to a tropical zone such as ours. We then
had to investigate everything related to the types of diseases in other
countries and the types of vectors that could exist there. This was the
reason for the creation of the Institute of Tropical Medicine. This
institution, however, can play a very important role in Third World

Therefore, if we want to have men of great human and revolutionary quality,
if we can acquire the necessary technical ability, and if we want to take
advantage of the opportunity which fate has bestowed on us to become
doctors for the Third World, then I believe we must establish such
objectives for our selves. Now, these are not the only objectives of the
revolution. There are many more and in many spheres, including those
related to scientific research. Our country has already made some progress
in this area.

Since we are now talking about medicine, however, I insist that our country
can become a world center of medicine capable of exporting its services to
many countries and capable of receiving many people here to care for their
health, even to the point of making this activity an important factor of
our economy and, at the same time, one of the greatest contributions our
small country can make to other countries in one of the most humane,
valuable and constructive areas in which our country can be active.
Although we have made no profit from it, our country has not been boastful
about our export of medical services.

This is not, of course, the only field in which we could develop the
qualities which the revolution has created in our country. We are no longer
a country of illiterates, of 30-percent illiteracy and of 60- to 70-percent
semi-illiteracy. Now we are a country with a minimum sixth grade
educational level, with over 1 million young people at the secondary level.
We are acquiring an excellent level of cultural training, and I say with
great satisfaction and tranquillity, that we have a population with
extraordinary revolutionary awareness, a population capable of tackling any
task. [applause]

I say this in relation to something that I had said previously. If we do
not develop technology and medical sciences in the provinces, then how can
we meet the demand for doctors and technicians?

Sometimes they ask us for dozens of orthopedists and if we have not
developed the orthopedics branch to the utmost, we cannot respond to the
requests. If any country asks us for specialists in intensive [care]
therapy and is prepared to pay us and pay us well, or if a country needs
them even if it cannot pay for them, we cannot supply specialists, nurses
and doctors whose specialty is intensive [care] therapy if we do not have
intensive [care] therapy services throughout the country.

This means that in order to be able to respond to requests like the ones we
have listed we must greatly develop medicine in our country. We must
greatly develop all the possible specialties in medical technology and
science in our country.

Do not tell me we should become specialists in space diseases because we
have no experience in space. But we can be prepared to treat terrestrial
diseases, especially diseases of the Third World, better than any other
country in the world. The most important factor to do this is man and his
scientific and human qualifications.

I was telling you that we are creating a school of medicine in each
province. To this we must add that we are making a study. We have called
for a group of responsible and competent comrades to make a study to
determine the quality of medical education.

We have not asked the Public Health Ministry to implement this study so
that it will not have to judge its own work. We have asked the educational
sector to do it. We asked the vice presidency in charge of education,
culture and science to do it. That is a group of professors. They must
gather this information. It is there where the concern, great concern, must
be. This is very important. It is decisive. Otherwise, nothing of what we
are saying would make any sense. How are our doctors being trained? What is
the quality of the training of our doctors? And what has to be done to
overcome any deficiency existing now, or any that may come up in the

The rigor involved in the training of our medical personnel is of the
greatest importance. In a few weeks we will have something on this. We have
talked with hundreds, with more than 1,000 people including professors and
doctors, to discover what the difficulties are and what factors can further
contribute to better doctor training. We will have to see what scientific
and general background our doctors are to have. And also, what their
medical preparation as well as their general education will be. We will
have to study many things. We will have to decide if it is good or not to
give up the rotational system-- if the so-called vertical
residency...right?...vertical, yes--is good or not. We must decide if we
must train extremely specialized doctors who would know only about the
little finger of the left hand, for example, and about nothing else,
nothing about the knee, the elbow or anything else.

To what extent should we have specialization? A doctor, well, he must know
about childbirth, for example. However, if he becomes a specialist in
something else and does not know how to help deliver a child and finds
himself in any of these countries we have mentioned in the situation where
a woman is giving birth to a child, and the doctor does not even know how
to take the child, this doctor, even if he is very good in treating ear,
nose and throat problems, well....

I think all this must be analyzed in an unhurried and careful way. What
general background must a doctor have? How much knowledge on important
areas? And then, what is our concept of specialization? And what
specialties do we need? Of course, we must accept that specialization is a
must, very important.

We must also do a study to determine how many specialties we need. If we
take the example of the little finger as a basis for specialization then we
will need 300 different specialties. I think we must have only the
specialties that we need and we must give priority attention to the most
important ones. We must determine which are less developed in our country,
which ones have a lower level. We must continue developing those at a
higher level to the highest degree. We must make a special effort with
those at a lower level. We must know what specialties we must develop and
do whatever has to be done to develop them.

But at the same time that we satisfy our need for specialists, we must not
narrow the training and knowledge of our doctors. We want to respond to all
these matters, to the needs of the schools. What organizational problems
are there in medical schools? What limitations in resources? What if they
do not have a certain book? And what if they lack some materials?

There are hospital-schools that have no classrooms or insufficient
classrooms. I am sure the country can solve all these problems. But first
we must determine what the problems are, what work has to be done to favor
the training of our doctors and what kind of doctors we want to train. But
we must do this with a realistic frame of mind, with much common sense,
with wisdom and taking into consideration our needs and also the needs of
the world, especially the needs of the Third World.

I think that if we are making a big effort to create universities, the
material bases, we must pay special attention to the quality of the
training of our doctors. I think we must have an open mind and have
up-to-date knowledge about medical findings in the world. We must establish
contact with the countries that are more advanced in this or that branch of
medicine. We are not going to try to reinvent something that has already
been invented. Whatever has been invented, and is within reach of the
countries of the world, must be known by us and we must master it.

We must dedicate our research efforts to matters that have not been
discovered. I think that if we want to achieve what we are proposing, we
have to do it with up-to-date information, with a broad frame of mind and
with much contact with classrooms and [word indistinct]--wherever they may
be--marching at the vanguard in any field of medical science and

Is the economic aspect what most interests us? No. Our greatest interest is
that, as we become a medical power, the first to benefit will be our
people. [applause] Our people will be able to say: The Cubans are among the
best of the world's specialists in this and that branch. The Cubans are in
the vanguard of medicine, there is the Cuban medicine. The people who are
best cared for from a scientific and technical point of view--and this must
also be true from the human point of view, which is what has been
emphasized during this congress-- could be the Cuban people. [applause]
They will be the most important beneficiaries of our becoming prestigious
exporters of medical services and the providers to citizens of other
countries of the same services which we have in our own country. This would
leave us this fundamental byproduct which is what most attracts us.

All the knowledge, science, technology and skills will be at the service of
our people first of all. In the past, our country had no laboratories or
research centers but produced eminent men.

We are commemorating the 100th anniversary of Finlay's discovery. Finlay
was a son of this city of Camaguey. He was a glory of our country.
[applause] And what service Finlay gave the world! Finlay's discovery
permitted the eradication of yellow fever from this hemisphere and from
many other parts of the world. That Cuban scientist's discovery was
extraordinarily valuable.

I think this is a good example, good evidence, of how a small country and a
humble people can make great contributions to mankind. When we were
struggling against dengue I remembered Finlay because dengue was carried by
the same mosquito that he discovered. It has the same characteristics he
discovered and many of the eradication measures used had been recommended
by Finlay.

I think that with this example we can see the importance of man's work,
will and intelligence. It is incredible that the yankee imperialists tried
to snatch Finlay's glory away from him. Of course, an attempt was made to
pretend that it was a yankee doctor who discovered the transmitter of the
yellow fever, who discovered the facts and theories, that it was a yankee
and not a Cuban. That yankee came around here 20 years after Finlay had
made his discovery and had presented it before scientific institutions.
Most historians of the medical science have already acknowledged this. No
serious person in the world is denying it now.

I think that men like Finlay can be an inspiration and a model for Cuban
researchers and doctors. And if it is true that by the end of last century
there were already men capable of serving mankind as Finlay did, at a time
when they had no resources, no laboratories, nothing, what can our
revolution not do? What goals can our scientists and doctors not set for

I think that on a day like today, on this anniversary of Finlay, in this
city where he was born, in the closing of this great congress of our health
workers who have earned so much respect, acknowledgement and gratitude from
our people. I think this was the most appropriate place to present these
viewpoints, ideas and opinions.

Fatherland or death! We will win! [applause]