-DATE- 19811210 -YEAR- 1981 -DOCUMENT_TYPE- SPEECH -AUTHOR- F. CASTRO -HEADLINE- 5TH CONGRESS OF THE NATIONAL HEALTH WORKERS -PLACE- ALCAZAR THEATER IN CAMAGUEY CITY -SOURCE- HAVANA DOMESTIC TV -REPORT_NBR- FBIS -REPORT_DATE- 19811210 -TEXT- FIDEL CASTRO ADDRESSES NATIONAL HEALTH CONGRESS 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 Finlay. 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 born. 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 struggle. 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 saved. 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 wards. 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 nations. 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 future? 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 technology. 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 themselves? 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] -END-