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Text of Castro Speech

FL142258 Havana Television Service in Spanish 1300 GMT 13 May 84

[Speech by President Fidel Castro at the National Conference of Medical
Science Students, held in Havana's Palace of Conventions on 5 May 1984

[Text] Dear comrades: It is not easy to make the closing remarks of a
meeting so rich in the discussions which have taken place today. Throughout
the day I took notes of the various topics in a chronological order. I have
taken notes of many of the important ones.

Here someone referred to the final tests and the systematic lack of
evaluation in some classes or by some professors. The extraordinary
importance of Cuban textbooks has been (noted. It was even stated -- with
very sound judgement -- that a new experience is being developed. Also
mentioned were the importance of the work of a group of authors, the idea
of developing contests of knowledge, the need [words indistinct), the
importance of the work at the brigade level, at the rank and file level,
the importance of the bibliography -- not only of Cuban authors, but also
foreign authors, many of whom have recognized and unquestionable authority
in the. subjects. We should try to benefit ourselves not only from our
experience but also from everyone's experience. Of course, the conditions
under which medicine develops in many countries must be taken into
consideration. We should not support the idea that pregnant women may smoke
because it says so in a textbook which is good and famous in other matters.

[Words indistinct] on evaluation, difficulties in the distribution of
books, which I believe also exist in the distribution of magazines.
[laughter] [Passage indistinct] There is a need for a drive in dental
health, the importance of learning, learning to think, learning to study,
the problems dealing with the relationship between professor and student,
demand of the dentists [words indistinct), the need to raise the sector's
[words indistinct]. There is a need to have a number of measures dealing
with fraud, of course, beginning with the idea of the existence of a
fraudulent potential in those who do not attend classes, who are finalists
[study for final exams only] and who become potential perpetrators of
frauds, the need to struggle as a precaution against all those factors
which engender fraud, even though as has been noted here the number of
fraud cases has been small, very small. [Passage indistinct] Whoever has
attended a meeting such as this would have strong reasons to believe that
the battle against fraud is being won, and that it is becoming increasingly
difficult and increasingly morally unacceptable that a student of medical
sciences would perpetrate a fraud.

[Other topics discussed here were] the need to improve the training of
interns, the importance of municipal and rural internships. There were
references to therapeutic procedures. The possible convenience of
initiating therapeutic procedures in the second year was mentioned, but
this has to be given profound thought. This could intensify the problem of
crowding at the hospitals. The number of cases would diminish, and the
student taking basic sciences does not have the basic knowledge and could
not handle this type of study, practical studies in the second year. That
is why this must be given a lot of thought.

The difference between the provincial and municipal hospitals was noted
here. [Passage indistinct] There was enthusiasm in citing the advantages
the municipal hospital has over the provincial because of the amount of
work it has. Matters dealing with treatment and sensibility with the
patients was taken up. Also noted was a very important point; the one
dealing with the need to raise the quality of the paramedics.

[Words indistinct] reviews of their efforts, their achievements, their
difficulties, as well as their importance. It is my understanding that some
people favor making it into a national review. A few other important points
were mentioned. It would not be possible to comment on all of them. [Words
indistinct] but the most important have been mentioned. We should not judge
the results of this meeting by the work done today. [Words indistinct] at
the base, in the brigades, with the almost universal participation of all
the students of medical sciences, the comrades of the FEU [Federation of
University Students] and of the youth [words indistinct] all the problems
formulated. It seems that they take into account not only what has been
said here today but everything that has been said throughout this process
in basic discussions. They collected all the formulations of one kind or
another. They collected [words indistinct]. I believe that material must be
enriched now with the points that have been considered here.

And some of the formulations that do not seem very rational to us should be
excluded. [Passage indistinct] For example, it has been made clear that it
is apparently impossible -- it is neither practical not logical -- to
examine students on a rotational basis at the Piti Fajardo. Because they
already have daily activity [words indistinct] general medicine constantly.
And as a professor has explained to us here, the graduating class was
excellent. [Passage indistinct] They have demonstrated that they
successfully passed the test. Rotation by specialties is not the same in
the provinces, where you go to the maternity hospital and to the children's
hospital, as it is where everything -- the buildings -- is all together. I
believe that a formulation of that kind should not be included in the final

I also read the FEU document that suggested in some province -- I do not
know whether it was in Las Tunas -- the question of whether the tour of
duty of Piti Fajardo graduates in rural communities should be reduced to
only 2 years. This does not seem reasonable to us either because, first of
all, the students of the internationalist contingent that went to Nicaragua
[words indistinct], Western Sahara or Ethiopia, after having graduated.
[Passage indistinct] Some were brought back after finishing their
internship and others the first year. But in principle, 2 years after
graduation was agreed upon. And there are others who should stay 3 years at
Piti Fajardo. And we should also hope that in the future, there are doctors
[words indistinct].

Let us have specialists in the rural communities who remain there and who
can serve as professors of the interns. Because nowadays they have to go
but, in the future, presumably the rotations in those specialties can be
completed in the rural hospitals with the support of professors who are
specialists. This type of formulation should not be included in the final
document, formulations that obviously are illogical or clearly
inappropriate. I believe it would also be inappropriate to propose the idea
that we do with dentists what we are doing with the doctors. [Passage

We suppose that, with the passage of time, medical needs will increase
because average life expectancy is increasing. But dental needs should tend
to decrease if we really apply preventive medicine rigorously. There will
always be dental needs, of course, but they will not be proportional to the
medical needs that we are going to have. Bear in mind that the number of
family doctors is going to increase to at least 20,000. We should be
thinking about 20,000 dentists to put one beside each doctor. And the
problem of the dentist is not the same as the problem of the doctor. [Words
indistinct] serious, fatal if it is not taken care of immediately. Dental
problems can wait for hours, they can wait for a day. They have other
characteristics. [changes thought] It would not be rational. We have
thought a lot about this problem. Perhaps in a community of 1,000 persons
or 1,500 or 2,000, in a rural area, it would be possible to apply the same
concept in order to have the dentist nearby. But it would not be rational
to have him here in the city [words indistinct] where they have the
possibility of going to the polyclinic.

It is evident that we will have to give some basic training in general
medicine to the dentists. [Words indistinct] basic training in dentistry to
family doctors and make them into supporters of dentistry and not only of
vaccination campaigns and other problems, and not only of general hygiene,
but also of dental hygiene and preventive dental campaigns. It will be
necessary to think about giving them [words indistinct] in a certain order.

But the formulation of the aspirations of dentists has made us ponder. And
we have been thinking that the number of dental students who have
registered in recent years is too small. We can make certain estimates on
future needs. Perhaps we should double the number of dental students
registering so that, when there is a possibility of providing those
services in areas in which it is rational to provide them because of the
distance to cities -- especially in rural reas - perhaps at a few large
important factories, we can apply that principle. We must ponder the
argument that dentists need dental equipment. I used to tell our comrades
that equipment can be bought but dentists cannot be imported. We have to
develop and train them in our country. It is evident that the number of
students who enter dental school [words indistinct] if we really develop
ideas on a way to expand this service.

The following situation exists with internationalist missions: [words
indistinct] providing medical assistance in Third World countries. They
have very urgent needs. They have assigned priorities to their medical
needs. [Passage indistinct] Today, since they have assigned priorities to
life-and-death health matters -- really, there is a great demand for
medical services in the Third World, and there is no such demand for
dentists -- in practice it is not possible to imagine a large detachment of
dental internationalists. That is, it does not depend on us. But I believe
that the points brought up by the dentists that are applicable [words
indistinct]. Matters related to the specialty of dentistry were brought up.
A medical student said he knew nothing about maxillary surgery [words
indistinct]. Those problems have been brought up and presumably this is a
problem for the dentists to solve, dental specialists. But perhaps it is a
field that can be shared by the two.

It is necessary to stress the importance of dentistry because it is
intimately related to health. Often, when doctors do not find the cause of
an infection (words indistinct] and they cannot detect it, they immediately
look at the mouth to see if it is the origin of a focus of infection,
headaches, and other problems sometimes involving the kidneys. They try to
determine if it has something to do with the mouth and, especially, because
digestion begins in the mouth, mastication, etc, it is very important in
health matters. It is necessary to emphasize the importance of dentistry
and to continue developing ideas on how this activity should evolve in
future years and on what ideas are going to appear [words indistinct)
family doctor can also be applied to dentistry, although I repeat that they
cannot be exactly the same.

It is desirable that the document that records the results of this entire
process and today's meeting be printed -- and not only printed but
delivered and distributed -- [laughter] so that these ideas reach
everywhere. In the first place, [they should go] to professors, university
schools, hospitals; in short, everywhere that these ideas should be
available, because we need the cooperation of many to implement them, (?the
ideas) that have been expressed here.

We have had two meetings of professors recently and now we have this
student meeting. You certainly know of many matters presented to the
professorial meeting. Now the professors should hear about all matters
discussed here, in addition to the Department of Medical Education, the
comrades, the rectors, and all personnel that should study problems related
to evaluations, the need to unify criteria [words indistinct]. Although, as
you have pointed out, many problems do not depend on the institution or on
others but rather on the students themselves -- at work, at the FEU, with
the brigades, with the basic youth organizations -- they depend on you.

[Passage indistinct] This meeting has clarified the need for a greater
effort in the training of students who are going to enter medical school
and universities in general. Because what is fitting for medical school is
absolutely applicable to the school of technology and to any other
university school.

We have made great progress in the field of education, in the quality of
education, the improvement of study programs, but in a meeting like this,
despite the great progress achieved -- and we are aware that we have
achieved much progress in many fields -- it is possible to note that we
still have a very long way to go. For this reason we cannot be conformist;
we still have a world of progress to make in the field of education.

People are unaware of our great achievements, which started about 1970 or
1971 when 70 percent of all teachers still had no degree. The student
population explosion, the need to create a pedagogical detachment which was
to a degree the inspiration for the idea [words indistinct] the detachment
of medical sciences.

Tens of thousands of teachers have been trained. We now have 230,000 [words
indistinct] about 250,000 teachers. We have 250,000. If I am not mistaken,
there were 150,000 student teachers, but I am not sure now whether this
figure includes the students -- not the teachers who are studying -- but
the students who are studying to become teachers. There is an enormous
effort to obtain advanced training. Grade school teachers by the thousands
are working for their masters degrees in primary education. This is
unquestionably an enormous advance if we compare it to those years in which
70 percent had no degree. And this has happened in just a few years.
[Passage indistinct] We have a shortage of 5,000 physics and chemistry
teachers, a deficit of 5,000, and they tell me that we have graduated tens
of thousands.

This is a sympton. [Passage indistinct] Comrade Fernandez has explained to
me that they have a plan for those that graduate (words indistinct) to
continue studying, to provide them with incentives to continue their study
of these subjects. [Words indistinct] history, literature, without
suggesting these subjects at all, in a country that has to develop, that
has to master technology, which is essential for everything else. Because
if we talk about becoming a medical power and a power in education and a
power [words indistinct] means also to become an economic power and have a
material base, with industrial and scientific development and a firm
economy. Each day it is more evident that a complete mastery of exact and
technical sciences is needed to be assured of an adequate economic

It reflects badly on us that our nation's culture, our people, and our
youth still do not appreciate the importance and value of exact sciences
such as physics, mathematics, and chemistry. These are the holes in our
knowledge which still must be filled. We have made great advances in
education and medical fields and we must make the same effort in
technology. We must increase the number of technology students so that in
the future we will have almost double the number of students enrolled in
technology as we do in medicine -- perhaps even more than double because we
have made accurate forecasts of the number of doctors we will need, based
on plans which have been developed.

We continue to need electrical, civil, and industrial engineers, etc. Some
of us have been studying the need to emphasize and make a special effort in
the field of technology, such as the one we made in medicine. We must
examine the equipment, laboratories, present and future resources, and how
to develop this field so that in the future, around the year 1990, we will
have approximately 50,000 technology students. To achieve this, we must
make an effort, like the one we made in the medical field, to advance
brilliantly with visible results. We must do this in the field of
technology because, to reach these goals, we need development in this area,
similar to the one which we will have in the medical field. All engineers
must give support to the production of equipment, the chemists to the area
of pharmaceuticals, and so on.

Our possibilities of becoming a medical superpower are weakened if other
fields do not advance evenly with the medical profession. But if advances
are not made in secondary and pre-university education, the bad habits
acquired at this level will weaken us more. These bad habits could
partially be explained during a certain period when we lacked textbooks and
means of evaluating students. What we do not want is students who study
only for exams. This is unacceptable. We must fight against this type of
bad habit. We must get good grades, pay attention, and take notes, but most
importantly we must study and prepare for exams by using our textbooks and
class notes. Textbooks must be used; we do not know of any other way to
study. Lately it is true there have been difficulties with some textbooks.
We must make an effort to resolve this problem, so that the lack of
textbooks does not cover up the bad habit of studying only from classroom
notes. Anyone who has studied can understand that the idea of preparing for
an exam only through class notes is inconceivable; this bad habit must be
eradicated completely.

We must begin a fight in that direction, apart from the effort we must make
to better the quality of teaching, especially in medicine, even though the
situation is more complicated in this field.

Apparently, some pre-university students are better prepared for careers
other than medicine. I understand that some students, who had very serious
problems with pre-university chemistry courses, go and study biology and

We who recognize these problems have offered some ideas. For example, a
pamphlet could be written in a practical and intelligible style for all
pre-university students who could then familiarize themselves with the
subjects that later became major obstacles and stumbling blocks after
entering medical school. We must look for formulas which will help prepare
these students, this new contingent that is being created upon entering
medical school.

This problem came about [passage indistinct due to technical interruption]
primary school, high school, and pre-university schools. I do not expect to
accomplish it in all of them, but we must do it at the pre-universities. It
is very important in all university careers, not only in medical school.
Recently several very important measures have been implemented. The most
important measure is a preparatory course for those leaving the military
service. It is logical to see that, for any person leaving the military --
not having studied in 3 years and without any preparation -- no matter how
much effort is made in the courses, it is impossible to pass the first or
second year. I believe it is a good idea to have a 6-month to 1-year
pre-university course for those who come from the military -- depending on
the case because drafts and discharges from the military occur twice a
year, which is why we have not been able to make it a uniform sequence.
With a good, intensive 6-month course, I think many comrades will be able
to prepare themselves for entering the medical field or another university
career. We are very interested in discipline, political awareness, and
interest in studying which our comrades from military service possess. I
believe an intensive preparatory course is a very good idea, and it
provides a realistic possibility for many young people from the military
service to go into university courses.

As all of you know, entrance into the university for several of you was
dependent on your academic record. Entrance must be controlled by academic
records because we cannot give up the stimulus which it provides. Only a
small percentage of you enrolled directly in the university. I believe that
in the future an increasing number of persons leaving the military -- will
have a deserved opportunity to attend a university.

Another idea, which was put forth by the Ministry of Education and which we
thought was very good, was to convert all vocational schools into
pre-university schools. This would mean that the decision to enroll [in
universities] would not be made at the 6th grade. The student at that age
is still under family pressure to enroll in a vocational school, after
which and during the remaining 6 years the student is assured of university

We have found in our experience with the university school of exact
sciences that it has achieved excellence through competitive entrance
exams. The students get most of the awards in contests and entrance is

We have studied this idea and, beginning in 1985, we will progressively
suspend entrance into pre-universities from 6th grade because we have
excellent facilities for seventh, eighth, and ninth graders that are being
underutilized. Students can then enter prestigious vocational schools,
based on their academic records and competitive test results -- we must
take into account both factors so that students will feel stimulated to
maintain high grades. Therefore, based on academic records, a student will
have the right to take the competitive test. In this way we will convert
excellent vocational schools into pre-university vocational schools -- with
the pre-university exact science schools giving us an applicable
experience. We would then have a large contingent of excellent students
with a rigorous education from vocational schools which would allow us to
increase the quality of pre-university schools. We must not limit ourselves
to carrying out this work only in vocational schools, but in all of Cuba's
pre-university schools.

It is evident that some pre-university schools are different from others,
some have a more vigorous, higher educational level than others. Here, one
student described the difficulties he had in his pre-university courses,
and one of the female students, from Engels, described how her school works
and the resulting confidence and security she obtained from the quality of
teaching at Engels. I believe Engels is one of the best schools, if not the
best vocational school. We must make all vocational schools equal to the
Engels school. [applause] At Engels we have 24,000 prevocational students.
We must continue to raise the standards of the rest of the prevocational
schools in the country because universities feed from Cuba's vocational
schools and pre-universities. In the area of quality, we can obtain a
bigger return from this investment the revolution has made in this type of

Another idea was that of doubling the number of students studying
pre-university courses of exact sciences, and, not having only one
pre-university school of exact science but three schools of this type. One
school would be in the rural western area, one in central Cuba, and the
other in the east, thereby providing three pre-university schools of exact

At present we have one pre-university school with 300 enrolled students.
This number will increase to some 1,800 students with competitive entrance,
if we continue on this road.

These ideas can help us increase the quality of university education and
better prepare students through regular course work for university work.

We must also do battle against what we call conformism, referring to
mediocre grades. We should also wage an energetic war against what someone
here called conformism having a mediocre grade. I cannot imagine this
attitude in a university student -- and, least of all, in a medical
student. As you all know, medical students' rules are stricter than those
of other university schools, and it should be that way because of the
physician's responsibilities and because in his hands rest the health and
lives of the people and citizens. Thus, we are forced to be stricter and
more demanding with students of medicine and dentisty. That is the reason
for more demanding rules.

I cannot imagine that there can be a medical student who only studies for
examinations, someone who only makes the grade. I cannot imagine that. I
cannot imagine a member of the vanguard detachment who does that. In the
case of the detachment, there should be much stricter rules. The rules I am
talking about were implemented when the contingents of medical students
were organized. I cannot imagine a member of the detachment who does that.
What confidence, what reliability in his ability can there be when he cares
for a citizen, children, parents, brothers? What confidence can there be in
one who lacks the will to study when he has such an important, sacred,
vital mission? I cannot imagine a detachment student who settles for a
grade three. I cannot imagine that, someone who is satisfied with a
mediocre grade. I can imagine the detachment students studying constantly
all year long. We must work on methods of evaluation so that the young man
is forced to study all year long.

We should undertake an all-out struggle against that conformism, the case
of the student who is satisfied with the mediocre grade three. Today I said
this meeting is magnificent and these comrades are magnificent. But, I
said, these comrades here represent the best... [changes thought] but do
not represent.... [changes thought] It could be said that they do not have
to represent all medical students, they represent the best, because they
themselves are the best, or are among the best.

It would have been good if today we had here a group of those who are
satisfied with a grade three. We could have selected them and brought them
here to the meeting so that they could speak out and explain their problems
and phenonena. [laughter]

They have not heard what has gone on here. The best students have been
speaking about those problems. We should conduct an energetic battle
against that conformism, against those studying for exams only, against
those settling for a mediocre grade. We must make them understand that such
an attitude cannot be the one of a student or professional we want to
educate in our country.

If we have such a demand, including many people who have th4e aptitude -- I
know of cases of those who did not qualify in experience, are now
practicing as medium-level technicians, and later on will register after
taking examinations.... [leaves thought unfinished] It hurts to know that
just because he only had a grade of 89, he was not able to register and has
to wait 2 or 3 years. There are others who have registered in other schools
and wait for the opportunity that a good university record will give him
the transfer to the School of Medicine. It is painful to see that one of
those cases cannot register in the School of Medicine and, instead, someone
else does and he turns out to be one of those who settles for a grade
three, demonstrating that he does not the aptitude.

The idea that we need physicians, many physicians, should not undermine the
least the principle of strictness. We have mathematical formulas to solve
this problem. It is better to have a high percentage of dropouts than a
high percentage of mediocre physicians. [applause] If we know how many
physicians we need each year, if we know the percentage of those graduating
with high marks, we can solve the problem even if it becomes necessary to
increase the number of those registering -- even though this should not be
the way to solve it. We should create better habits from the secondary and
pre-university levels. We should improve education. We should make a better
selection, much better selection. We should do a better job in stimulating
the individual's aptitude.

That is the first step we should take. In addition, once they have
registered, we should maintain the principle of strictness without being
frightened by the total number of those graduating. It is better, even less
costly, to do the best job registering so that the number of academic
mortalities and dropouts are reduced later on. But, we should not be
afraid. Anything else is better than a graduate a physician who does not
have the quality we seek.

That is what is important. We have the seating capacity and are creating
more, a lot, enough, more than enough to register as many as necessary. But
we must not abandon, under any circumstances, the required principle and
not neglect the selection process at all, and what was pointed out here,
which is to amplify and develop interest in public health.

We also mentioned the need -- very logical -- to improve the training of
medium-level public health technicians. This is very important. We have
worried about this for some time. I know that a number of technological
health institutes have been built and that more are being built, and that
many are registering in them. But we are yearning for the possibility that
nursing schools can register not ninth grade but twelfth grade students.
For example, studies are being conducted to determine how to tackle this
problem and achieve the goals of better training and preparation. We will
have to see what steps can be taken along these lines. But we must do this,
and we know it.

We are also encouraging movement towards a college degree in nursing. This
year about 500 were registered. This movement must incorporate the masses
as they were incorporated into the teachers' movement, and we can see that
we have a large number of teachers. We should have an increasing numbers of
nurses studying for a college degree in nursing. [clears throat] I am not
losing my voice. Although I do not know how it is called, I know in some
places it is called a frog in one's throat. [laughter] My throat is well,
don't worry.

If we are to become a medical power, we must be a nursing power, a health
technicians power, and we should not rest until we achieve these goals. We
have also made that point here.

A great effort has been made in recent years in relation to the development
of our public health and training of physicians and dentists. First, the
detachment was created, and now is an institution the fruits of which are
palpable. It is encouraging to note that each new contingent surpasses the
preceding one. The second surpasses the first, and it is said that the
third is going to surpass the second. Then we have to try to get the fourth
to surpass the third, the fifth and fourth, the sixth and fifth, and so on,
progressing year after year. It should work out this way if we are really
successful in the effort we were talking about, the effort to perfect
training and raise its quality year after year. If quality improves, the
number of students in the detachment will increase.

The third contingent will consist of 5,000 students drawn from the ranks of
pre-university students, to which will be added from 250 to 300 from the
20th Order [1a Orden 20]. So, the number of students registering in the
School of Medicine in the coming school year will be about 5,500. And the
capacity of the schools continues to increase. In 1985, the number will be
greater; in 1986, bigger still. And by 1986 we will have completed all the
schools of medical sciences throughout Cuba. And there will be smaller
schools at new important hospitals that will be built.

The Mario Munoz Advanced Movement [Movimiento de Avanzada] has had very
good results too. As we said on another occasion, we have no complaints
about university students who are in the last years of their studies. Their
conduct has been excellent. They were not selected to enter the university.
They selected themselves after registering. The most studious, the most
disciplined, those with the greatest aptitude remained. This has been
demonstrated in the call-ups we made to resolve, for example, the problems
of internationalist missions and in their total willingness to enter
specialties which were understaffed, etc. Virtually no call has been made
to which they did not fully respond. Those are the students of the advanced
movement, the students in their last years of university studies, who have
had a magnificent attitude.

These are the students who are going to join the ranks of public health
professionals -- physicians and dentists -- in the next 4 years. The next
8,000 or 10,000 medical doctors will come from these students. The
detachment will not begin to produce graduates until the year 1988, the
first of the detachment to graduate. But the 1984-87 graduates will come
from the students who were already in the medical schools before the
detachment was organized, from those students who had selected themselves
and have proven themselves to be of excellent quality. And for this too we
should work so that the students of medical sciences will be better each
successive year. This is asking a lot considering how good you already are.
I do not know whether in some other part of the world -- and I say this
without chauvinism of any kind -- whether in some other part of the world
there is a medical school student body like the ones that our nation now
has. [prolonged applause]

This has been reflected in this meeting. If we had foreign visitors -- from
Latin America, the developed capitalistic countries, from anywhere -- they
would have observed this meeting and possibly they would thought they were
with people from another world. [laughter] What kind of students are these,
speaking of evaluations, graduating classes, studies, discipline,
rigorousness, etc, etc. All this that we have spoken about.

I would say that this reflected spirit places us at the highest level as
regards the quality of our students. It gives us great hope for the future.
Yes, we know that there are difficulties to overcome, that we have to
improve all our courses and teaching methods. Starting last year, we sent
commissions of professors to the best universities of the seven countries
that are the most highly developed in medical sciences to study their study
programs,their methods, their bibliographies, their textbooks. We acquired
mountains of books and materials from the best universities of the nations
most advanced in medicine in the world. We are working with all these in
preparation for drawing up our future curricula because we have to draw up
new programs. It is going to take at least 2 years to assimilate properly,
digest well, tropicalize well, and Cubanize all that experience and then
prepare our programs. It is very important. Yes, we have to perfect all
these things. We are going to have better programs, with students even more
rigorously selected, with even more experienced professors, and with
superior methodology. And with our efforts, our struggle for quality, we
will surpass much of what we have said here. This opens fabulous
perspectives for our country in the field of medicine.

A special effort has been made to provide medical students with books
because we remember the problems we had with textbooks in the medical
schools when the development of the detachment began. There were no books
and the few there were had to be returned. The student was able to only
keep his notes, which were his bibliography. The decision was made to make
a special effort. The Ministry of Culture and the managers of the large
printing shops of this nation were asked to cooperate, to undertake the
noble task of printing books for medical students. We knew, of course, that
the problem existed at all the schools but we said we would at least start
here. And the formula that will make them good and appropriate here will
help us to do the job we have to do at all other universities.

Then they made an effort to have the textbooks by the beginning of the
school term. In addition, the idea of making it possible for the students
to get the textbooks emerged. This was not an economic problem of making a
profit from them, because those textbooks are sold at cost. The idea was to
have better care for that textbook, the best care. It was agreed that the
students could buy the textbooks and keep them. It was even necessary to
bring the problem before the National Assembly in case it would violate a
constitutional rule dealing with free textbooks. In the end, it was
interpreted that it referred to the textbooks' free use, not the property
of the textbooks. Thus, if the textbooks are given to the students and they
are allowed to have ownership of the textbooks, not just the use, so that
they are able to begin their own libraries -- they have to begin their
libraries not only with textbooks, but also with reference books as soon as
they become students. Each of them has to begin a library. Independent of
this, we will have to have a great library of science and technology at the
Academy of Sciences, in addition to the Education Ministry's library.

We have to improve all these information sources. An effort was also made
to provide books not only to students, but also to physicians, who were
lacking many textbooks. Many textbooks were imported and were sold at a
very low cost, in some cases, to just a few individuals. Such was the case
of the books on vascular surgery.

They were so expensive that we decided to give them to the specialists in
vascular surgery, because they would have gone bankrupt if we had charged
what those books cost us. They were just a few, so we decided to give them

These books are very expensive, which is why it is necessary that the
Culture Ministry cooperate with us in the noble task of printing the books
we need. It is not a case of an illegal act but a legitimate case of
internationalization of medical knowledge. If you try to buy them, the
country would not have enough money to buy all those books. For example,
20,000 books were printed of "(Cohn's) Therapy." We did not print more for
fear that many physicians would appear in addition to those we have. They
could buy the book and begin practicing medicine. Well, 20,000 were
printed, and the very minimum cost of the book is $100 and here they were
sold for 20 pesos. Some foreign visitors were here and asked: How can they
be sold for 20 pesos? How is it possible? Yes, it is possible. In socialism
it is possible. Absolutely nothing has been lost. [applause] They were sold
at cost. No one was robbed and no one lost. That book was made accessible
to the doctors. There are tens of titles that are in print for doctors and
at prices practically equal to cost. That is, they are making a series of
editions for doctors.

We have to do this with the other faculties. We have begun with medicine.
It is necessary to continue through the six technologies, learning from
this experience.

Therefore, it is not necessary for a person to become sad if his neighbor
receives something, as long as there is the hope that later, he may receive
it too. There are problems that cannot be solved all at once. It cannot be
done, there are not enough resources. But it is very good when the solution
of a problem begins with the part, because we must apply this experience of
giving books to students in the Faculty of Medicine, in its entirety, to
the other technical faculties. I do not know whether we will give them the
books or not, but the matter of the books is immaterial and we have to
apply the general principles.

Another very important item -- a true revolution in the training of doctors
-- was the conversion of municipal and rural hospitals to teaching
hospitals. It is a true revolution that has expanded the possibilities for
training doctors in our country, but no other country has it. And it was
very satisfying to hear the advantages of that type of education, and it
will have more advantages when, in those municipal and rural hospitals,
there are specialists who have become teachers -- specialist-teachers. That
process will continue with the building of new hospitals so that, in the
future, we will have a hospital in every municipality. There will be over a
hundred municipal hospitals, which will also serve for the training of
medical personnel. And each new hospital that is built, wherever it be,
will be a teaching hospital -- including teaching clinics -- in which these
concepts are progressing with the institution of family practice.

Work has also been done in recent years to solve the problem of the lack of
specialists. Some specialists are scarce everywhere in the world. A strong
program has been undertaken in the training of orthopedists,
surgeons,pediatricians, obstetricians, internists, and so on. We know which
specialties are short of personnel and how great the shortage is. A lot of
work has been done. The policy of vertical internships was continued as a
temporary necessity. In all the specialties in which we are still short of
personnel, persons were incorporated who were studying pediatrics,
microbiology -- in short, all these specialties -- anesthesiology,
radiology, and so on. This is a solution dictated by the circumstances. But
we aspire to a future in which all medical students will do a rotating
internship -- all of them -- so that they will receive better integrated
medical training. All will rotate.

We also considered those specialties that require special skills, above all
special manual skills. I hope that those who are going to be surgeons begin
operating at the pre-university level or in the secondary schools, even if
it has to be on rabbits, because there are specialties that require special
manual skills. Even these students, when they reach the sixth year, will
have to do their internship because surgeons must know medicine.

And later, with all the specialties that require special skills, we will
follow the path of the direct residency -- ophthalmologists, surgeons -- as
with those that are in some way a little distant from general medicine,
such as radiologists, anesthesiologists. We are classifying those that in
the future will have to be studied in direct residency. The other
specialties will not be studied this way.

Regarding the different specialties, we should bear in mind the fact that
accumulated demand has required a great effort in the training of
specialists. In the future we will not have such a great need for
specialists -- for the training of specialists. It will become necessary to
reduce the number of students studying these traditional specialties. The
number of surgeons is limited by the demand for surgeons. The possibilities
of working at their profession [changes thought], if there are twice as
many surgeons, they will work half as much. They will lose their skills.

What our country needs is what international cooperation requires. But
there will be limits. We have to start getting used to this idea now. It
will be necessary to make a more rigorous selection of the students
entering those specialties. And their academic records will have to be
considered. Because if there are 15 openings and 100 applicants, the best
students of all must be selected. Nevertheless, and fortunately, there will
be a very valuable, very important, very prestigious specialty that we can
open to masses of students because it is for the type of doctor that ( is
needed everywhere: the integral general physician [medico general
integral]. One of the ideas that was developed with regard to this medical
revolution was the idea of the specialist in integrated general medicine.
Why use the general practitioner to refer to the doctor who did not study
anything else and who is differentiated from the specialist? Of course,
there are internists. But if you are going to send a physician to a
factory, to a rural farming community, what kind of physician will you
send? Will you send an anesthesiologist? Will you send a surgeon who will
not even have a place to operate? Will you send a radiologist? No. You have
to send a specialist in integrated general medicine who is familiar with
obstetrics, gynecology, pediatrics, hygiene, psychology, and from what I
can see, he will have to learn a little about dentistry also, a little bit
anyway. [laughter and applause]

The program for integrated general medicine was drawn up. We have 30
studying in different provinces, and the program is difficult. I do not
want to discourage anyone. To the contrary, I want to encourage you. But I
am warning you that the program for specialists in integrated general
medicine is difficult. If we send a physician to a youth camp, whom do we
send? If we send a physician to a pre-university institute, whom do we
send? On internationalist missions -- although they need specialists,
surgeons, pediatricians, orthopedists, and so on -- fundamentally, they
need the integral general physician. Without any doubt, in the future there
will be an evolution towards this type of physician, whom we are going to
call family doctors. At the present time he is known as the 120-family
doctor and we calculate five persons to a family. Families in Havana
average fewer than five members. The families are smaller. We calculate one
physician for every 600 citizens. But we are not going to call him the
600-person doctor. We can call him the 120-family doctor or we can call him
family doctor.

This type of physician is the most commonly known. The idea of this
specialty makes it possible for all physicians in the country to be
specialists, and to have the designation, the social prestige that goes
with the classification of specialist, as well as the importance that being
a specialist implies. Thus, those who are not surgeon, pediatrician,
orthopedic, etc, could be specialists in general medicine [medicina general
integral]. In my judgment, this is the type of physician that will play a
fundamental role in the health of our people.

As this was a new idea, it had to be put to the test, even though we were
sure of the results. However, the results have been much better than
expected. For this purpose, the first 10 physicians were selected. The
truth of the matter is that it was a good selection because that is a very
good group of comrades. They were not mediocre students, or anything like
it. They are comrades having a great spirit and a great talent. They began
the program. They were guinea pigs, the first family doctors. It has turned
out to be a real revolution -- the admiration felt by the people; the
security felt by the people because they are there; the services the people
receive; the problems those physicians are solving. This is not only
happening in rural medicine. It is not necessary to go to the Sierra
Maestra or the Turquino mountainside to find people with problems who do
not go to the hospital or polyclinic.

They have found many people who were not going to the hospitals or
polyclinics, persons who did not observe vaccination programs, persons who
would go to see about one problem and another more serious would be found.
For example, they would go to see about coughing and a tumor would be
found, or any other problem. Some of the comrades told me that some persons
were afraid of the doctor because they would go for one thing and another
would be found. Well, all people in the country have that type of fear,
including doctors themselves who do not want to see a doctor, generally.
They have made it possible for many old people to go out and walk, people
who would not leave their homes. Following a policy aimed at ending
sedentariness, obesity, they have made it possible for many persons with
those conditions to run. They have created a real revolution which has
developed enormous interest among the rest of the people who are waiting
for their doctors.

They receive the neighbors at their offices and, in addition, visit them at
home. They even take them to the polyclinic or the hospital, according to
the seriousness of the illness. When we asked who paid for those taxi or
bus fares, they would say it was paid by them out of their salaries. This
problem will have to be solved. They will have to carry a notebook to keep
track of their expenses. We trust them, we do not need anyone to keep track
of that. The physician will keep track of the expenses. He becomes an
accountant and will be fully trusted. [applause]

They follow the cases when they are in the hospital, how long they stay in
the hospital, when they are discharged from the hospital. They have
uncovered numerous problems. They were able to make diagnoses of the cases,
keep records on cardiac problems, diabetes, asthma, hypertension, etc. They
have a clinical report on each area resident, including neighbors not
residing in their area. This occurs because someone in his area wants to
bring his mother from another area. They told me that a girl wanted to
bring her boyfriend. But, you know there are only 10 of them.

But next year, in that same area of Lawton, all the area of the local
polyclinic will be covered, and 39 family doctors will be assigned there.
In addition, there will be a doctor for the school and another for the
hospital. In the future, we hope to have doctors in work centers and
schools with 500 or 600 students.

The citizens will be cared for by a network of polyclinics, hospitals,
specialized centers, medical research institutes, and in addition will be
cared for at work centers, schools, factories, and place of residence. This
not only solves many problems and contributes to healthy conditions, but
also gives a feeling of security to the citizen. The importance that the
people attribute to this is demonstrated by the love, respect, cooperation
they offer to family doctors.

We estimate that in the next 15 years, some 20,000 doctors will be active
in this type of service. We estimate that in the next 15 years, there will
be some 30,000 in the network, some 20,000 as family doctors, some 4,000 or
5,000 in work centers, schools, aboard ships, some 8,000 or 10,000 -- these
are estimates which could change -- in international cooperation. Not only
this, when we have 65,000 we will need 10,000 more, what for? We will need
them so that all physicians will have 1 year for studying and further
training every 7 years at least. [applause]

That includes 1 year of sabbatical leave for each doctor. We will have to
wait, though, because we do not have 10,000 doctors. Before we have that
many doctors, we must first satisfy other demands, but at least that is the
goal. In Cuba there will be 75,000 positions open for doctors. What if the
future demands more positions? These figures are only calculations. It is
possible that by the year 2000 or before, the number of medical students
will decrease. But, at that point, universities that are presently used as
medical schools will be used for providing additional medical training.
Some 3,000 doctors must graduate annually in the future to reach 75,000.
And, if this number is too great, we will enjoy students who are qualified
as teachers in the medical profession and provide them with additional
training. Therefore, the road to follow is very clear -- to teach or work
in the medical field.

What do we aspire to? We want family practitioners to be specialists in
general medicine. At the start of their university studies, several medical
students had planned to study other specialties. We told them to study the
specialty of their choice, and these doctors were the first ones to
participate in the experiment. Next year, we hope to have 228 doctors in
this experiment -- it continues to be experimental, although we are
absolutely convinced of the results. General practitioners will go to rural
areas, factories, schools, and in every province there will be a family
practitioner. Some 500 medical students from the 1985 graduating class will
be included in this program, and we will try to send doctors who want to
study general medicine. The number of students who are interested in this
field is increasing. We hope that these family practitioners, after the
first year, will be able to begin their specialty courses -- as specialists
in general medicine after their first year.

Sometime around the year 1977 or 1978 [as heard], no later than this time,
the possibility of studying other specialties will decrease, as I have
explained. The need for specialists will decrease. What have we planned for
1978 [as heard]? First, when the first contingent of medical doctors
graduates, a selection will be made of those who will go to the Piti Fajar
Rural Medicine Detail. Second, all those who will do their specialty
internship at once must be selected, and everyone will be on a rotating
basis. Under this system, the students will come out with a more complete
medical background.

A number of students will go directly to their specialty's internship. The
rest of the students, we believe, can gain experience in family practice.
Everyone, including the person who will go on to study obstetrics, internal
medicine, or pediatrics, will first be a general practitioner, for at least
3 years. Why should you do this? Because, comrades, this experience is

Even rural hospital doctors do not have this experience. Rural hospitals
have doctors with much experience, specialists, and so on, so the doctor
does not face problems alone. One of the most interesting aspects of this
experience is that the doctor faces the patient and the problem, alone.
Today, the student is a recent graduate, but tomorrow he will be a
specialist in general medicine, although this is in the future. This
experience will be of extraordinary value to the doctor.

Several subjects should be strengthened at the university level. There is a
need to know more about angiology, because there are many angiology
problems among the population. Students have said that they studied this
course for only 2 weeks or something like that in their entire time at the
university. This then becomes a problem. It is logical that those who will
become pediatricians -- not only those who will specialize in general
medicine but those who will specialize in many other branches -- go through
the experience of being a family practitioner. This experience will prepare
them for the future, when they become specialists in obstetrics,
pediatrics, internal medicine, etc.

These are some of the subjects that have been under discussion. Without a
doubt, the experience of being a general practitioner is rich in results
and in perspective. I believe that we are the only nation in the world that
is carrying out this concept in medicine. I have no doubt that in the
future other nations will adopt this practice, because it constitutes the
most perfect network for keeping people healthy.

But, it must be added that these family doctors observe a special and
rigorous code of ethics. Why? Because of the access they have to the family
circle, the confidence the family has in them. This is so to such a degree
that they will have to have some knowledge of psychology and psychiatry. In
a certain way, many families ask them for advice on problems. In reality,
they become professionals with great influence, great prestige, and they
make a great contribution to the health and well-being of the people.
Undoubtedly, I believe that this will contribute to prolonging the people's
life-span, and we will be among the first in the world in that field. In
this task, the family doctors will play a fundamental role.

In recent years, there have been some activities and efforts in the field
of health which are of great importance. For example, we now have intensive
care units for children. This emerged after the dengue epidemic. There was
only one pediatric intensive care unit in a pediatric hospital, the
(Borras) Hospital. From that moment on, a program was organized to develop
intensive care units superior to the one at the (Borras). The one at the
(Borras) had to be redone so that it would have cubicles for cases of
infectious diseases. We now have 29 in operation and 2 under construction,
a total of 31 intensive care units.

But, the most important thing of all is the results we have obtained. Since
their creation, those intensive care units have taken care of 13,328
children. The morality rate recorded by those units is 7.9. It is
impossible to estimate how many children would have died without these
units, but it could be 25 or 30, no one knows. These intensive care units
have already saved thousands of lives. It could be said that for each child
who unfortunately died because of the dengue epidemic, the intensive care
units have already saved at least 20 of them, This is also something which
gives peace of mind to all families in the country,

Recently, delegates representing all intensive care units met to examine
their experiences and they are greatly encouraged and excited about the
work they are doing and the results.

This has contributed to improved medical services and has helped to reduce
the child mortality rate, children less than 1 year old, as well as
children of preschool and school age. Those mortality rates were
considerably lower in 1983.

The technology of diagnostic ultrasonics has been introduced in all of the
countries' main hospitals. This represents a great advance. All optical
facilities have been improved; they are practically new. A shop producing
lenses from the raw material has been acquired which represents great
savings for the country. It has been acquired and is under construction at
a cost of several millions. This makes it possible for us to save 80
percent of the expenses in foreign currency. The cost of the raw material
is 20 percent of the finished lens at the spectacle frame shop. The waiting
time for the finished product has been considerably reduced, and we expect
it will be further reduced.

The operating rooms for cardiovascular surgery are being developed at the
Hermanos Ameijeiras and Carlos J Finlay Hospitals as well as at the William
Soler Hospital for children's cardiovascular surgery. There will be
operating rooms for cardiovascular surgery at hospitals in the central and
eastern parts of the country. We will have five hospitals equipped for
cardiovascular surgery. The allocations have been approved, the equipment
has been purchased, the personnel are in training, and the units are being

Considerable progress has been made in prenatal genetics. Several books
have been published and further progress is under way.

Large investments are being made in the field of public health. A large
part of those investments have been assigned to the Schools of Medical
Sciences. Construction projects are under way in the country's 14
provinces, not counting Havana Province. [as heard] The School of Medicine
is opening extension campuses in all provinces, some have one, others two,
Santiago de Cuba Province will have two, Holguin two, Villa Clara two. This
year's investments in health projects -- equipment not included -- amounts
to 80 million pesos. This is considerably more than in 1983.

All health projects are closely followed; we know where there are
deficiencies and where there is progress. We know that the people in
Matanzas Province will have water supply and other types of problems during
the next school term, and ways to remedy the problems will have to be
found. Nevertheless, many provinces will have new facilities next term.

Four new pediatric hospitals are under construction in the cities of
Marianao, Sancti Spiritus, Ciego de Avila, and Bayamo, The Hermanos
Ameijeiras Hospital is each day gaining more world prestige. The Calixto
Garcia Hospital, as was mentioned before, will be remodeled and will become
another Hermanos Ameijeiras Hospital. A medical school with a capacity for
1,500 students will be built at the Claixto Garcia Hospital, this old
school where so many doctors have been trained and where a large number of
the Ameijeiras personnel worked. Construction of many hospital clinics with
surgical facilities continues around the nation and more are planned. In
the next 5 years, a new hospital will be built in the eastern part of
Havana and a new hospital clinic with surgical facilities will be built in
Marianao. We hope that both facilities will be similar in nature to the
Hermanos Ameijeiras Hospital.

Studies are under way on medical research facilities and plans are being
made so that these facilities be devoted entirely to research. Currently,
researchers are working in several hospitals, many of which do not provide
the research facilities. We are looking for ways to assemble a large number
of research facilities in one place. We are looking at these problems and
some of the possible solutions.

In research, as all of you know, we are producing new medicines such as
interferon. The facility producing interferon was built rapidly and the
research in this area is developing; it has a high production rate. Many
types of diseases have been cured with interferon. Acute hepatitis is
practically cured within 48 hours as well as other types of viral diseases.
Interferon has also been shown to help alleviate certain types of cancer,
especially those which seem to be viral in origin.

A world class research facility is under construction for the study of
genetic engineering and biotechnology. Construction began the beginning of
January and it will go into operation on 30 June 1986, at the latest. The
personnel are being trained. Research into these areas has good prospects
for the future as a science that is truly revolutionary. Needless to say,
many medicines such as insulin will be able to be produced by people using
bacteria and not through beeg as we do at present. Construction has begun
on the Tropical Medical Institute and on the National Microbiology
Laboratory. Also under construction is a laboratory for pathogen-free
animals. These animals are used for experiments and for producing vaccines
and so on.

A new vaccine plant is under construction and will be capable of producing
14 types of vaccines. Two new factories for building new medical equipment
are under construction. With the building of this plant, Cuba will be able
to produce ultrasound and X-ray equipment and so on. This is why I said
that electric, machine, industrial, and other types of engineers are so
important. By building this equipment, Cuba will be able to save 80 percent
of what it would cost in foreign currency. This is the difference between
building equipment and importing it, Plants for producing this equipment
are being built in Havana and Santiago de Cuba. Some new types of valuable
equipment have also been developed. We have the potential capability of
developing in the medical industry to build medical equipment for our
necessities as well as for export. Work is also going on in the
pharmaceutical industry.

A special project is currently under way in dentistry. Some 500 dental
facilities in Cuba were visited and all problems in this area were studied,
whether related to materials, equipment, aerators [aerotores], and so on.
Right now it is possible that all of us know a little bit about dentistry.
A plant for making false teeth is projected. Studies on the problems in
prosthetics are under way because there are many cases of people in many
areas having to wait a long time. The same thing that was done with optics
will be done with dentistry, equipment, new technologies, and so on.

Studies are also under way on all specialities to try and find areas of
strength, and make them stronger, and our weak points, and what to do to
strengthen these areas. An earnest study is being conducted in each

All these factors, which certainly cannot move forward isolated from the
rest of the country and cannot be separated from the improvement of
education, development of schools of technology, an development of the
country, contribute to the possibility of making our country what has been
called a medical superpower; that is, occupying one of the highest
pinnacles in the world on health matters, This is one of the things our
people most appreciate. What place will we occupy? We must not resign
ourselves to occupying only a fifth or sixth place, we must move to the
first place in the world in the public health field. [applause]

We congratulate our comrade youths and comrades from the Federation of
University Students [FEU] for the excellent work they have done and the
process undertaken by medical students.

I believe this experience can be useful in other university careers and in
other areas, too. What has been discussed here today confirms, strengthens,
consolidates our conviction that all just, noble, and humane goals
established in the medical field for the happiness and well-being of our
people will be achieved. After this meeting, you will surely go back,
filled with satisfaction, to meet with your colleagues throughout the
country, to talk with them, give them an account of this meeting, and
convey the impressions of the importance of the quality of this meeting and
all activities in which you have participated during these days.

We, for our part, will leave this meeting feeling very encouraged, highly
satisfied, and very optimistic on the quality you have, the extraordinary
doctors who will come out of our medical schools, and about the future of
our nation in the medical field.

Fatherland or death, we shall win! [applause]