Latin American Network Information Center - LANIC

Castro Speech

FL120053 Havana Domestic Service in Spanish 2349 GMT 11 Nov 84

[Speech by President Fidel Castro at the opening session of the "Cuba-1984
Pediatrics Congresses" begin held at Havana's Karl Marx Theater -- live]

[Text] Distinguished Mr James Grant, executive director of UNICEF,
distinguished Mr (Benjamin Smith), president of the International
Pediatrics Association, distinguished Mr Fernando Olinto, President of the
Latin American Pediatrics Association, esteemed delegates and guests:

Perhaps it would have been much easier for me, and also for the
translators, to bring here a written speech, but more than a formal speech
I prefer to chat with you candidly and openly on these topics of health
which have always been of great interest to me.

I believe that this congress is a good opportunity for exchanging
knowledge, explaining -- modestly -- our experiences, and at the same time
receiving the valuable knowledge that you can contribute. I would like to
explain what we have done, how we have done it, and our goals in the field
of health,

Because this is an event which includes three congresses -- the 7th Latin
American, the 14th Pan American, and the 21st Cuban national -- [applause]
I would begin with the field of pediatrics. I will have to use statistics
on this and other topics. Pediatric attention is gauged by the infant
mortality rate in the first year of life, We have estimated that prior to
the revolution we had more than 60 deaths per 1,000 children born. That is,
if we can trust the statistics that were recorded.

For example, in 1960 the Somoza regime reported that the country had 45
deaths per 1,000 children born. However, when the Sandinist revolution came
to power in 1980, according to accurate statistics and after pediatrics
attention had become available for a large part of the population, the rate
amounted to more than 100.

In the first 10 years we had reduced the rate to 47.6, approximately, in
the year 1969. In 1973 we had already reduced the rate to less than 30; if
my memory serves me correctly, it was 29.6. By 1983, following a reduction
of 20 per year, we had reduced it to 16.8 [as heard]. According to
preliminary reports, this year by the end of September we had reduced it to
14.5. We will have to wait until the end of the year for the final figures.
But we believe that in 1984 we will be below 16. These statistics are
strictly accurate. Any case of a live birth, even though the child may have
a malformation which condemns him or her to death in the first year, is

With these rates, by 1980 when we were below 20, our country was among the
top 25 countries in the world with the lowest infant mortality rate. Today
we are getting close to the United States, which was sixteenth with the
rate of around 12. It is known that children in Hispanic and African
populations have much higher rates.

The effort to reduce the infant mortality rate from 6- to 15 in these 25
years has saved the lives of more than 100,000 children. [applause] In the
ages between 1 and 4, call the preschool age, the rate had been reduced in
1969 to 1.8 per 1,000. Today it is 0.8. Between the ages of 5 and 14 it was
already 0.5 by 1969; in 1983 it was 0.4. It is very easy for us to reduce
these rates, even though we feel it is possible that these are the normal
rates in countries with a much greater development.

The five major causes of death between 1 and 4 years are: First, accidents,
many of which take place at home; second, malignant tumors; third,
congential abnormalities; fourth, influenza and pneumonia; and fifth,
meningeal infections. But of these five, accidents are responsible for
one-third of these deaths.

Between the ages of 5 and 14, the major causes of death are the same. But
in these ages, accidents are responsible for more than 50 percent of the
deaths. This shows the importance of fighting against all factors, and we
do so -- causes of children's accidents and also ignorance. Mr Grant
pointed out the importance of educating mothers and families. Education
plays a very important role.

But is has been awhile since enteritis or acute diarrhea has constituted
the main cause of death as it used to do. It is not even among the first
five causes of death. In 1962, 4,154 children under the age of 15 died.
This is 57.3 per 100,000 children. In 1983, the revolution fortunately
lowered the number of deaths from these causes in these ages to only 385, a
3.9 rate. This is a considerable reduction which clearly demonstrates what
Mr Grant mentioned. It is really impressive when one hears that in this way
the lives of half a million children could be saved in Latin America each

We believe that in this way in those 22 years we have referred to, between
1962 and 1984, we have saved the lives of approximately 70,000 children
under the age of 15. Are you adding? 100,000, 70,000, etc.

Other diseases which resulted in a high incidence of child deaths were
poliomyelitis, in 1970 there was one case, and in 1983 none; diptheria, one
case in 1970 and after 1971 it was eradicated, none in 1983; tetanus, 9
cases in 1970, none in 1983; whooping cough, 28 cases in 1970, and 0.1 in
1983, that is 0.1 per 100,000; measles, 42 cases in 1970 and in 1983, 0.1;
tuberculosis, 5 cases in 1970 and in 1983 none.

There are other statistics which could illustrate the progress in what
refers to, for example, problems of birth weight. At present, the average
weight is 3,181 grams. In 1969, cases which were below normal weight
numbered 11.7; today, 8.5. Regarding nutrition problems, in children in the
first year of life, for underweight problems, there was only a 4.6 percent
rate of mild malnutrition. There were no cases of severe malnutrition. In
children between the ages of I and 15, there was an 0.7 percent rate of
mild malnutrition. There have been no deaths in recent years due to
malnutrition problems.

There are 2,320 doctors working in pediatrics, not counting specialists
such as radiologists and many others in the pediatrics field. We have
specialized hospitals, 27 of them. Before there were three. I think this
has been an important factor, in addition to the pediatrics services that
are given, of course, in mother-infant hospitals, in maternity hospitals,
in general hospitals, in polyclinics, in rural hospitals, and so forth.

Maybe it would be convenient to explain our experience with the
hemorrhaging dengue epidemic in 1981. The epidemic began in late May in a
section of Havana near the airport. In a few days it had spread throughout
the country and on 16 June there were reports of cases everywhere in the
nation. On 13 July, the epidemic reached its peak. On that day, 11,721
cases were reported. That sudden epidemic here in our country obliged us to
make a great initial effort. Tens of millions of dollars were invested -- I
am talking about dollars, not pesos -- because we had to spend hard
currency to acquire thousands of pieces of fumigation equipment and
hundreds of tons of various kinds of chemicals to attack the adult vector
mosquitoes. It was necessary to mobilize tens of thousands of people,
utilize the support of the entire population to locate and fumigate the
infested areas and clean up the cities. Emergency courses were given for
thousands of workers to enable them to perform basic tasks in this
campaign. Land-based, aerial, and other means were used. It was really a
desperate effort. It was an epidemic that would reach a peak of more than
10,000 cases reported in one day. Essential measures were also taken in
relation to the treatment of the disease: which medication should be used?
Which ones should not be used because they might aggravate the problems?
Intensive care units were set up in all the hospitals. At the end of the
epidemic, it was decided to hospitalize people to isolate the disease. On
10 October, the last case was reported in Santiago de Cuba. Here we had
serotype no 1, dengue, and serotype No 2, which was considered almost

But with this campaign, serotype No 1 and serotype No 2 dengue were
eradicated from our country and the vector mosquito population was reduced
to a minimum. In some regions it disappeared entirely. We have maintained a
constant struggle since then, with about 6,000 health workers dedicated to
this task. Our goal is to totally eradicate vector mosquitoes, which is not
such an easy thing to do because they not only live in the cities, but are
also found in rocky mountains, where there are holes in which a small
quantity of water can accumulate, and so forth. But we are at war with the
vector mosquitoes and we have reduced them to inoffensive levels.

There were 344,203 cases reported during the epidemic. Some 117,000 people
were admitted to hospitals. It was necessary to improvise hospitals. Many
schools -- it was during vacation -- technical schools, sports schools,
preuniversity schools, and so forth, were converted into hospitals. Among
children, 9,128 serious and very serious cases were reported. It had a
greater effect on children. There were 1,097 serious and very serious cases
among adults. Our doctors and nurses throughout the country made an
enormous effort to treat patients, reducing the mortality to 101 children
and 57 adults -- a total of 158 people.

When this epidemic occurred in our country we held an investigation and
found that the disease did not exist anywhere in the world. It appeared in
a very strange manner. We drew the conclusion that the epidemic had been
deliberately introduced. And some time later, not many months ago, work on
biological actions against Cuba was being carried out. And we know
perfectly well who was backing those counterrevolutionaries, who was
supporting them, who was training them in terrorism and all that kind of

Prior to that, we had endured plagues and strange epidemics in plantations
and in animals; plagues in the canefields plagues on the tobacco
plantations; and two outbreaks of swine fever in animals. We were able to
control it both times. I believe we are the only nation in the entire area
which has been able to control that disease. After a long time passed,
there were people, employees of the CIA, who confessed to the crime,
perhaps because they thought it had some historic merit. They claimed they
had introduced those plagues into our country. But never before had we
endured bacteriological actions which would affect the population. That
forced us to make a very big effort. Here, among us, there is no agency for
the prevention of something like this. Not only do we have natural
phenomena, diseases that spread in a natural manner, but we also run the
risk of diseases being deliberately introduced into our country.

The response to that was the multiplication of efforts in the field of
health. An interesting experience was the use of the intensive care unit.
In those days we only had one intensive care unit in a pediatrics hospital.
Our children had intensive care, the serious cases received special care,
but we did not have an intensive care unit in the hospitals. With adequate
equipment a plan was forged to build intensive care units in all pediatrics
hospitals, with separate sections for infectious diseases. Some 93
physicians and more than 300 nurses and technicians were trained. The
equipment was provided. All that was essential, some of it sophisticated,
was provided. Even electronic engineers were assigned to these units.

Today 29 intensive care units are operating. While the epidemic was raging,
the intensive care units were being built. Those units provided an enormous
service. Not all of them are completed, three are unfinished. Some of them
have been in operation 2 years, other 1 year. Some 12,996 cases have been
cared for in those units already. The physicians and technical personnel
assigned to those units are devoted to their job. As you can imagine,
caring for a seriously ill child motivates a health worker to make great

In serious cases the child motality rate has been reduced to 7.9.
Doubtlessly, without that specialized treatment, without that equipment,
without the experience of the personnel working in those units, no one
could estimate if the death rate would have been 20, or 25, or 30 percent,
because the cases were very serious. I believe that with that special care
some of them were saved.

I can say that we responded to the epidemic by multiplying efforts in the
field of health, Just in this age group, the intensive care units must have
saved 15 to 20 times more lives than those lost during the epidemic. That
was a bitter experience, the hemorrhaging dengue epidemic. The efforts of
all our people were intensified in the field of health.

Closely related to the care of the child are mothers' problems. In this
field, the statistics are also very positive. For example, in 1962 for
every 100,000 children born, 118 mothers died, 118 or 130, I am not sure.
Today this has been reduced to 32 deaths for every 100,000 children born.
There are provinces which have reported no deaths of mothers in 2 or 3
consecutive years. It is considered a great honor to achieve these goals.
When there is such a death, it is a tragedy for the entire province. There
is great responsibility in this area. That is why the statistics are very

Recently we read in the newspaper that Matanzas Province, the region of the
Cienaga de Zapata, one of the poorest in the country in the old days --
that is the place where the mercenary invasion took place in 1961 --
reported no infant mortalities for the first year. The health activities
are not centralized. The central unit deals with norms, fundamental
matters, but does not control public health. That is why the municipalities
make a great effort to maintain the best records.

Another rate is the institutional delivery. Prior to the revolution it was
lower than 20 percent; today 98.4 of the deliveries take place in the
hospitals. I have asked what is the reason for the missing 1.6, why is it
not 100 percent? I have been told some of them are born on the way to the
hospital. [applause] This has helped a great deal to reduce the mother
death rate and the child death rate. The number of consultations per
pregnancy is almost 12. They are taken care of from the very beginning.
They also receive special attention in some risky cases.

The rates regarding the weight of mothers or pregnant women are very
positive. About 89 percent are within the normal range. The ones who gain
weight during this time, the ones who should gain weight are also within
the normal range, about 90 percent of them. Those who are not are
considered high-risk cases and receive special care. The ones who have 11
grams per hundred of hemoglobin during the third trimester of pregnancy are
also around 86 or 87 percent.

All these indicators, all these details that can influence the results are
very much taken into account. And speaking of consultations for pregnant
women, I should mention that children now receive during their first year
of life an average of 14.8 consultations. Healthy babies receive an average
of 8.5 consultations. The number of doctors caring for mothers and children
is more than 4,000, many of whom are specialists. They have studied, served
residencies, and been trained in these activities.

What factors have influenced these results? I believe the problems of the
health organizations, such as UNICEF and the other organizations are
important. These organizations already know how, as Mr Grant was saying, to
fight disease with technology, vaccinations, and as he explained, with the
technique of direct oral hydration [of dehydrated patients] in the home.
The problem is how this can be applied. Of course, I am not going to get
involved in political matters during this congress. I am not going to get
involved [applause] but I want to say that it is essential, fundamental
that the states and governments adequately concern themselves and give
priority to public health. I am not going to say anything else about that.

I am going to list a series of factors, the first of which has done much to
raise the general standards of the nation. We had a 30 percent illiteracy
rate. Who knows how many semi-literates there were? Today our workers are
struggling to complete the 9th grade, as a minimum. That helps a great deal
because there is a relation between educational levels and actual
possibilities for the health care programs.

The increase in the nutritional level of the population has also helped us.
Although, of course, we do not consume 100 kg of meat as in Argentina and
Uruguay, countries that have immense herds, our food has improved, our diet
is more balanced, and above all, delegates, it is guaranteed for all.

Each child is assured 1 liter of milk every day in his home until he is 7
years old, and it is furnished at very low prices. No one lacks the
resources to acquire it. [applause] The installations that produce this
milk also have potable water for the cows, although that raises investment
costs. Cows cannot drink water that is not potable, so it is necessary to
build aqueducts not only for the people, but also on dairy farms for the
animals. [applause] Besides, all the milk is pasteurized. Hygienic norms
are carefully observed in the production of all food products so there is
no falsification of products or production of harmful goods. Rigorous norms
are followed in everything connected with the food industry.

The hygienic level of the entire country has increased. The entire country
has potable water, the principal population centers have water purifying
plants. Hundreds of thousands of housing units have been completed.
Unhealthy neighborhoods have been eradicated and in Havana or anywhere in
Cuba you will find that there are no beggars, but there are many children
like these who performed here, in schools in their uniforms, not asking for
handouts. Sometimes they are barefooted, but that is because they want to
be. [laughter] It is not because they do not have shoes.

This factor has helped us. A decisive factor is the participation by the
people in the battle for health, the systematic participation by the mass
organizations in all tasks. The Women's Federation, for example has almost
60,000 centers in the country and in each of them there is a health worker,
a voluntary comrade, a member of the health brigade. She works with all the
mothers trying to teach them, to educate them, cooperating in health plans,
in programs related to cytostatic tests -- not cytostatic, cytological
[laughter], cytostatic is another thing -- for the early detection of
cancer. That is part of the Women's Federation's work with mothers and

The Committees for the Defense of the Revolution, of which there are
850,000, also participate actively in health care efforts with the
organization of blood drives. Half a million people donate blood every year
in the country. This movement is growing. I remember when it was less than
100,000 and we now have half a million. I also remember when, after an
earthquake in Peru, a call was issued to the people to help the Peruvians
and in 10 days 100,000 blood donations were made. [applause] This gives an
idea of the level of education of the population and their concern for
health and the feeling of solidarity; these blood donations and plasma in
transfusions and the many other medicines that we produce show that the
movement is growing.

The trade unions have their health representatives in all the factories,
all the work centers and health centers, who watch for problems in the work
places. The peasant associations also make health efforts; all the mass
organizations have helped a great deal. A factor, an important factor, as
Mr Grant has mentioned, is the specific education of mothers about these
health problems. Other factors are the extension of medical services
throughout the entire country, especially in the rural areas, which is
where the largest number of tragedies, epidemics, occurred in the past;
rigorous and systematic programs of vaccination and prevention; the
training, the technical skill that our workers have been acquiring in this
area; and the high human and moral quality of our pediatricians and
obstetricians and workers in this area. Other measures, for example the
cases, all the cases of diarrhea and respiratory problems, all are cared
for on a priority basis. All the necessary beds are available for these
patients to be admitted and cared for. All the necessary beds are available
for them to be admitted. There are adequate pediatric and obstetric norms
to organize the service; to guarantee diagnosis and correct treatment of
diseases; and to ensure the modernization of the services and techniques.
The maternity homes are another institution which was created to protect
above all mothers who live in the country, in isolated areas, where it can
take hours to get to a doctor or a hospital. There are 85 maternity homes
where mothers spend the last weeks of pregnancy. There they get care, they
are taught what they will have to do with the children if they are working
mothers, and so forth. They are helped a great deal.

There is systematic care, systematic medical care for pregnant mothers and
especially for the ones who are high risks; research on infant mortality;
on obstetric risks, on population growth and development and so on;
concrete national programs in these areas; mother-infant care and the
battle to reduce infant mortality; the special care given to diabetic and
asthmatic children which includes vacation periods and recreational camps,
during which they are educated regarding their illness. The asthmatic
children are taught exercises, the diabetic children are taught to
understand their sugar level, even to inject themselves when it is
necessary Those programs show very good results.

Priority attention is given to mothers and children in the dentristry area.
And there are other factors, one which I consider important is the
institution of the accompanying mother. I remember many years ago we were
inaugurating a hospital in the center of the country, and we faced the
problem of mothers whose children were hospitalized. They stood in long
lines, sometimes day and night. It was believed the mother was ignorant,
knew nothing about medicine, and therefore, would be in the way, making
treatment of the child difficult. It was really inhuman. We reached the
conclusion that we should use mothers to support the work done by doctors
and nurses. We did it and the results have been excellent. I remember
during the dengue epidemic, which I mentioned, in the hospitals, whole
wards, in some severe cases, the children on IV's needed to be watched
constantly. The mothers were all there. At that time, in fact, there was a
uniform for accompanying mothers, working clothes. They fed them, took care
of them, stayed next to their children. I asked myself, how could these
mothers be replaced? In an epidemic like this one, with thousands of
patients, all the nurses would not have been enough; it would have been
impossible. The mother understands the problems of the child, his habits,
his psychology; it is much more merciful for them to be there helping, also
for the child who naturally misses her. We have even taken this institution
to the intensive care unit where the technical level is higher. In an
intensive care unit, you will always find the mother. Have these mothers
been an obstacle to medical care, the right application of treatment; have
they given the wrong medicine to the child? I have not heard of a single
case of this happening. To the contrary, they are of extraordinary help to
doctors and nurses. This is why one has to consider this factor.

Another factor which they have contributed and which I have already
mentioned is the intensive care unit, and finally -- I am not going to
mention all of them -- we think school institutions have helped us. We have
835 day care centers. These are the places where the working mother takes
her children when she does not have anyone to take care of them at home.
There they teach them, they feed them, they watch them, they give them
medical care. Not all children of those ages go, of course, but there are
around 100,000 children who go every day. The rest of the children between
the ages of 5 and 14 are either in pre-school, primary, or secondary
school. They are all in school. There are also special schools where
children go who have problems. The entire population, almost 110 percent --
there is always a fraction which is not accounted for -- 99 percent, we can
say that in reality all the children go to school and that helps the
medical care programs.

We have reached these statistics through these routes. I understand that
one cannot do the same thing in all situations; it is not that easy. I
fully understand that for many of you, no matter how much you want to do so
it won't be so easy to make similar efforts.

However, we believe that even in the worst conditions, much can still be
done. We cannot wait for the social regime to change before we try to save
the lives of those half a million children. We cannot do that. We have
changed the social regime and that, I can tell you frankly, has helped us
greatly. [applause]

However, I believe that in many Third World countries, much can still be
done. It can be done, even if with greater difficulty. It is not a matter
of a great amount of resources, of great wealth. Public health is not our
greatest expense. Even education costs three times as much as public
health; it costs approximately three times as much.

Everything depends on certain factors. Some measures that we have taken
have reduced costs, despite the fact that we increased wages quite a bit
from the revolution to date, quite a bit from the level of the first years.
Compared with all the other activities that are carried out, including
education, public health is not very expensive. Some resources are needed
if the lives of those half a million Latin American children are to be
saved. Today, we need a recipe. Unfortunately, while in theory many things
are logical and clear, in practice they turn out to be impossible. However,
with just a little of what is wasted, with just a little of the money that
dribbles away... [changes thought] This morning I read a comment made by a
U.S. professor to the effect that one-third of the present Latin American
debt of $350 billion represents a drain of capital. If that capital had not
been drained, something could have been done. If so much money was not
wasted on luxury, something could be done, If those of us who are
economically poor want to imitate the lifestyle of the consumer societies,
very little will be done, because it will be necessary to buy many luxury
goods. The money is there, Mr Grant, the money is there. And I think that
you, Mr (Smith), Mr Olinto, and the leaders, can persuade them; I am not
going to be able to persuade them, of course. They would not pay any
attention. They would believe that I am going to subvert order. [laughter,

I am going to be sincere. I have even noticed that some governments are
making more of an effort in this area of health and education. Some Latin
American governments are making this effort even during this economic
crisis, Of course, when the crisis occurs, the first advice that the IMF
gives is to close schools, leave teachers and doctors unemployed, close
hospitals, suspend social security benefits, close homes for aged, and so
forth. That is what happens. You know this and we know this, although we do
not want to talk about politics here.

In the area of health, and health now encompasses children, mothers, and
everyone in the population, we were guided from the beginning by a number
of basic criteria. The first, was to give priority to public health, as one
of the basic services to the population and to society. Moreover, the
service that the people most appreciate is the public health service. It is
number one everywhere. Number two is education. These are two things that
the family, the people, appreciate greatly. So we began by giving priority
to public health services. Second, we extended it to the entire country and
within this extension, we created the rural medical service from the first
years of the revolution. Third, we gave free health services to all the
people, including the medication dispensed in hospitals. This gave all
people, from the very start, the opportunity to receive health services.
Since then we have fought to defend the quality of those medical services.

Fourth, among the factors that I mentioned as influencing our mortality
rates for infants and mothers is the participation of the masses. Yes, the
concept of the importance of preventive medicine is another of the basic
criteria. We can see the results in the statistics I mentioned, in the
development of our public health network. For example, in the past there
was not a single polyclinic; today we have 396 polyclinics. It is the basic
unit of primary medical attention. We had 97 hospitals; today we have 273
hospitals. There was not a single rural hospital; today we have 54. There
were 3 pediatric hospitals; today we have 27. There were no homes for
mothers; today we have 85. There were no stomatological clinics; today we
have 143, stomatological clinics. There has been an increase in medical
services, clinical services, stomatological services -- dentists do not
like to be called dentists or odon... [does not complete word] but
stomatologists. Stomatological services were extended to the people free of
charge. Moreover, there used to be 1 blood bank; now there are 24.

In addition, there are hygienic and epidemiological laboratories, many
dental prosthesis laboratories, orthopedic laboratories and a total of over
1,500 health units. Formerly there was 1 school of medicine; now there are
18. Every province has its school of medicine; some have two, and Havana
has five. There was one school of stomatology; now there are four. There
were 6 middle-level nurses' schools; now there are 64. There were 4
training hospitals; now there are 99. Formerly 63 percent of the doctors
and 62 percent of the beds were in the capital of the Republic; now it is
the opposite. We did not reduce the beds or doctors in Havana; on the
contrary, we increased them, but we have developed public health in the
rest of the country. Over 60 percent of the doctors and beds are now in the
interior of the country. It is a notable jump, a notable change. I imagine
that this problem of the concentration of doctors and beds in the capital
exists in many of the world's countries.

Health budgets that were... [changes thought] Well, at the time of the
victory of the revolution, 21 million pesos were allocated for health, for
public health. In 40 years, following the emergence of the puppet republic,
public health expenditures had increased by 3.5 million pesos. Between 1942
and 1958, the public health budget was decreased. At the time of the
triumph of the revolution, it was 21 million pesos. It was not quite 21
million; it was a fraction less. Today, 668 million pesos is invested in
public health. Formerly 3.3 pesos per capita were invested; and this was
only in theory because a part of it was lost on the way. [laughter] Today
66 pesos per capita are invested. Actually, it is not a lot; no, it is not
much. I believe that a human life is worth a lot more than 66 pesos a year.
It is sad that in a world where $900 billion is invested in weapons,
children are dying in a large part of the world that does not have the $5
for the vaccination plan mentioned by Mr Grant.

Well, in our territory, poliomyelitis was eradicated in 1963, malaria in
1967, diptheria in 1971, and in that same year, neonatal tetanus was
practically wiped out. Many diseases were problems that were gradually
resolved. For example, we can mention that cases of tetanus declined from
509 in 1962 to 24 in 1983. In the case of tuberculosis, for example, we
used to have 13.6 fatalities out of every 100,000 cases; now we have 0.9,
that is, less than 1. Leprosy has been reduced to a minimum and is in the
process of being eliminated. We have the means to combat it efficiently.

It has been a long time since we had an outbreak of typhoid fever in our
country. We have epidemiological control of diseases of that type and now,
in our country, people are dying from the same causes as people in highly
developed countries, despite the fact that we are not in the same category
as those countries. This proves that we can do things, that it is not just
a matter of wealth, of abundant resources. We are far from being able to
compete with highly developed countries.

We have achieved these results by putting forth great efforts and by using
our resources rationally. People here die, unfortunately one has to die of
something, [laughter] of cardiac problems, malignant tumors, and
circulatory problems. These are the three main reasons for death in this
country. Today we are fighting against the diseases of civilization;
fighting against sedentariness, obesity, against all of those factors that
fall under these diseases. We are also fighting against accidents, which
are the leading cause of death not only among children but among the
population in general. We have begun to fight against a low-fiber diet. The
super rich and the developed countries have discovered that eating only
flour, animal proteins, and other low-fiber substances causes a series of
illnesses that were practically unknown early in this century. We are
working toward the early detection of cancer. It has been proven that early
detection is the best weapon to fight this disease. We have practically
fulfilled the goal of the World Health Organization, which is: Health for
all in the year 2000. We have already reached our goals. [applause]

Our life expectancy is currently at 73.5 years, similar to that of the
United States. Of those who die, 72.5 percent are over 55 years of age; 15
percent are over the age of 85; and a noteworthy fact is that 1 percent of
those who die in our country are over 100 years of age. We have improved.
However, all scientists say that man has the genetic potential to reach 120
years of age. There are some who live beyond this age; those who live in
the mountains of Europe, in the Caucasus, live to be 140 years, but it is
said that the genetic potential is 120. We still have a long way to go.

I can say that we have put forth many efforts, we have achieved many
successes, and for our country we have achieved these rates, but we have
not been selfish and we have not denied help to other countries since 1963,
when the first medical brigade was sent to newly independent Algeria. Since
then, and for the past 20 years, we have collaborated with many countries.
We have cooperated with some 2,000 health workers, some 1,200 doctors, 600
male nurses and medical technicians, who are working in 25 developing, or
Third World, countries. Thousands upon thousands of Cuban doctors have
performed this type of internationalist mission. Our country has graduated
776 doctors and stomatologists from Third World countries. More than 1,800
students from 77 Third World countries have received scholarships to
specialize in the area of health. They are studying to become technicians,
some are doing their residency, and others are doing postgraduate work.

How did we achieve this? It was not easy: it was actually difficult. When
the revolution triumphed there were some 6,300 doctors in Cuba. To be
exact, there were 6,278 doctors in Cuba when the revolution triumphed. Then
the exodus began; the economic blockade began. Offers and promises to the
doctors began to pour in and 3,000 doctors left the country. Almost all of
them went to the United States. Then came the economic blockade, a harsh,
bitter, even strangulating measure. I mean it is an unprecedented blockade
that has gone on for 20 years. It is a blockade that strictly forbids the
United States to export a single medicine, piece of medical equipment, or
part, to Cuba. However, the country did achieve its technological
development in this area. Therefore, we had to carry out this program
despite this blockade and begin the program with half the number of doctors
because we did not stop them from leaving. We just wished them good luck
and accepted the challenge. Some 3,000 doctors remained in the country and
they were the spinal column of this masterpiece; they became the professors
at the universities and hospitals. We did not forbid private practice, we
never issued a law against private practice. We worked with the new
generation of doctors; we worked with the students from their first year.
The conditions helped us; there was a great patriotic effervescence. We
persuaded them and got them to commit themselves, not by issuing a law
forcing them to renounce private practice, to give all their time to public
health. We never forbade any of the 3,000 doctors to continue their private
practice. However, many of them decided to go into public health full time,
while some continued with their private practice and I can add that today,
there are still 53 doctors who have a private practice. And if these
doctors live long and fall into the 1 percent of those who live to be 100
years of age, then we may even have doctors with a private practice for the
next 40 or 50 years. [applause] No one bothers them; they work and are
respected. We made our laws and we adopted political measures, not coercive

We started that way and accepted the challenge. We began to improve and
enlarge our universities. Today we have 20,545 physicians, and over the
next 15 years we will graduate 50,000 more. I realize that this may seem
like too many to you. [applause] It is not too many because we know what we
will do with those physicians; we know what they will be doing and what
they mean to us. We plan to continue to progress because there is still
much to do in this field. We must not be content with what we have achieved
thus far; we have the basic duty to continue to struggle because other
conditions exist today. Thousands of specialists have been trained in the
past few years. There were 828 nurses in the field of public health,
perhaps a few more, but today we have 35,0000 nurses; there were 478
middle-level technicians; we have 34,000 today. We have 29,000 youths
training in nursing and middle-technician schools.

Moreover, we have established a university program to graduate nurses. Our
goal is to train nurses at the university level. Currently, there are 1,600
of them studying. They are working, too. In the past, only a ninth grade
education was required to begin nursing school. After we overcame the
backwardness of our schools, ninth grade graduates were too young for
nursing training and now we are trying to have the students begin nursing
school after preuniversity school. Many of those now enrolling in nursing
school are at a preuniversity level.

The schools of medical sciences currently have an enrollment of 25,000
students. Of those, more than 21,000 are in medicine, 2,000 are in
stomatology and 1,600 are in the nursing bachelors degree program.
[sentence as heard]

We have established what we call the medical sciences group. It is a group
of youths selected each year on the basis of their records and proven
medical inclination, a group of carefully selected students out of a group
including the best students. First, second, and third year students are
already members of a group bearing the glorious name of Carlos Finlay, the
famous discoverer of Aedes egypti, the transmitter of yellow fever and
dengue. [applause] Others have tried to besmirch his achievement but it has
been proven. We are putting together a publication of students which will
include all of Finlay's works. Finlay's discovery was incredible as was the
way in which it was made. The group I mentioned bears his name.

This means that we demand more of them than of any other university
student. They have stricter rules to abide by. If the architect or engineer
makes a mistake, it is bad, but if a physician makes a mistake, if he fails
to strictly fulfill his duty, it is worse. The demands on medical students
are considerably greater.

We sent missions of university professors to the seven countries with the
highest development in the medical field. We sent them to the best
universities in those countries. They gathered information, bibliographies,
programs, and so on. This material is being used in our new medical
program. We are aiming to improve by learning from the experiences gleaned
in all those countries.

The development programs in 36 clinical and surgical specialties are being
established. They will be ready by the end of this month. They involve the
planned development of all essential specialties including, among others,
programs on anemia and anesthesiology.

A new specialty has been created within which it is necessary to struggle
against many tendencies. It is a specialty, an idea that is shaping up in
our country. A new program, a very important specialty. It involves the
idea of integral general medicine. Thus far, in our country those
physicians who did not further their studies were called general
physicians; that is, they did not pursue any other specialty; they did not
become pediatricians, orthopedists, and so on. Well, we think that general
medicine should become a specialty; that is should require more study. Each
physician must undergo a residency period. We have established a rigorous
program demanding broad knowledge about pediatrics, obstetrics, internal
medicine, psychology, and sanitation problems. A group of physicians is
already involved in such a residency program. The program requiring all
physicians to be specialists, including general physicians, is accompanied
by social acknowledgment and the reward of their knowledge. Therefore, 6
years of medical study will not suffice. Physicians will have to undergo a
3-month residency in addition to that.

These physicians will play a very important role in primary medicine in the
field of community medicine. That means that everything having to do with
the training of medicine personnel is part of an ambitious and rigorous
program that in my opinion promises much better results in the future.

Advanced techniques such as prenatal genetics are used to diagnose
malformation of the central nervous system. They also serve to diagnose
Down's Syndrome, and also sickle-cell anemia. I have mentioned three
illnesses. I must say that in our country 270 babies are born every year
with open malformations of the central nervous system, neural canal
defects. [applause] Two hundred and fifty babies are born with Down's
Syndrome and 100 with sickle-cell anemia, in other words, around 600
babies. This is not only important because of the large number and the
tragedy to the families but it is also important to more than 150,000 women
giving birth every year who would like to be sure that their children will
not be affected by one of these problems. Any mother faced by such a case
would be able to end her pregnancy at a specific period. We are speaking of
early diagnosis. [applause] I do not wish to discuss religious dogmas. I
believe that this has nothing to do with religion. It has to do with basic
common sense and with humane piety. [applause]

We have seen the tragedy this entails. We have the genetic exams of the
couple. The situation is explained to them, along with the risks, if there
have been cases in the family, as in the case of Down's Syndrome due to the
age of the mother. Hundreds of tragedies can be prevented, and this also
contributes to giving the potential mothers a feeling of security, if we
can tell them where they stand. I have forgotten the medical term.
[laughter] With so many doctors here I should not have any problem getting
help. What is the name of the new-born baby disease caused by a protein?
[Words indistinct] There are also a number of cases. We are planning to
install a laboratory to use this technology. That is very important because
diagnosed in time it can be cured. Also in neurophysiology, work is being
done for the early detection of bearing problems, abnormalities in the
central nervous system, slow learning capacity, and neuropsychiatric

Modern technology and equipment are used in general medicine in rural areas
here. We are organizing nephrology units for children in certain age ranges
because treatment with the famous intraperitoneal catheter -- I think that
is what doctors call it -- is too painful and traumatic. We are
establishing these centers. We are installing six cardiovascular surgery
centers. One is in the center of the island and another in the eastern part
of the country. There is also a cardiovascular surgical center for
children. We are preparing the personnel for this job. This activity has
been increased. We are using the computerized sonography technology. many
cases have been solved and thanks to this, our country will soon have the
first nuclear magnetic resonance equipment, which does not work with
x-rays, but with the rays of the body instead. From our resources, we can
keep a little and try to learn, understand, and master technology. A
scanner, recently developed in Great Britain for treatment of
cardiovascular diseases, has also been purported to even prevent attacks.
If it is true that some medicines are being developed which can stop
attacks, then the possibility of living to be 120 will increase.

We have already ordered a machine that has interested us a great deal. It
has a technical name also. It is a machine for an (?elitotricia extra
corporis). Gentlemen, I had to explain it to myself to try to understand
better [laughter], but it has no other name. It is a highly sophisticated
machine, but it is very important, because with the use of sound, it
destroys kidney stones, which cannot be expelled in any other way and which
can result in extremely traumatic surgery. In our country, approximately
3,000 of these operations are carried out every year.

The machine is relatively expensive. Whenever a new machine comes on the
market for the first time it is more expensive. If we can prevent doing
3,000 surgical operations of that kind, fine. There are persons who have to
undergo frequent surgery for this same problem.

We are trying to gather all available information on medicine and equipment
development. The ultrasound diagnosis has been rapidly established
throughout the country. It is being used in 60 hospitals. It detects things
that normal X-rays cannot show. Some mothers already know if they are going
to have a boy or a girl. There is no longer room to make bets on this.
[laughter] Many problems can be detected by the ultrasound apparatus. It
saves money and it is economical.

We are trying to develop and implement all these technical discoveries.
Fortunately, not all are made in the United States. They are also made in
Japan and in Western European countries, where we have been able to buy
them. But we are also developing the production of medical equipment. We
are building two new factories for medical equipment because if we produce
equipment here, it costs 20 percent of what it costs us to import it. The
same is true for medicines. One of the reasons we have been able to carry
out this program at a low cost is because our foreign exchange expenditures
are very low. We produce many medicines and raw material and we import and
refine raw materials. Others, which because it is not feasible or the
quantity is not large enough [to produce], we acquire in western countries
or in the socialist area.

This is important, because the prices of the transnationals are acceptible.
Here, the truth is that an aspirin, which costs a fraction of a cent to
produce, is sold for five cents. This is the case with all medicines. If we
were to buy all the medication that we use on the world market, it would
involve some $150 million to $200 million. With a fifth of this amount we
can purchase the medicine or raw materials we need. Some of these are
purchased in socialist countries. These two problems are very important for
the Third World countries: the development of the production of equipment
and the development of the pharmaceutical industry research is also an
important area. The Public Health Ministry has 13 research centers and
includes a tropical medicine research center, which is under construction.
The research center is involved in the study of diseases of the Third
World. They are very experienced in this area and this experience leads us
to believe that almost all these diseases can be cured today.

We have promoted biological research. We have produced interferon from
white blood cells and this was done in a relatively short time. Probably no
country has tested the use of this product and its efficiency against
viruses as much as Cuba has. It is the first antiviral weapon that medicine
has. During the outbreak of dengue fever this drug was tested on serious
cases. It was tested on a group of children, of Pioneers, who were
vacationing at a camp. We had to decide whether to close the camp or not
and we decided that it was best if they stayed at the camp because they
could receive better treatment from the moment the first symptoms appeared.
The drug was given when the first symptoms appeared and no serious case
developed among the hundreds of children at this camp. The product was
successful in the treatment of viral hepatitis, plantar warts, pharyngeal
papilomatosis -- I do not think I made a mistake with this name, pharyngeal
papilomatosis -- which otherwise would have to be treated surgically.
Unfortunately, this drug does not cure all the cases of pharyngeal
papilomatosis; it seems that this condition must be approached in a variety
of ways but the results are encouraging.

This product will soon be produced through genetic engineering, A new
genetic engineering research center is being built as well as one for
biotechnology. These centers should be completed in the next 20 months. It
will be a very important achievement because it will allow us to produce
and to reduce the cost of interferon and insulin. It will also allow us to
produce vaccines and medicines used in the area of agriculture and
industry. There are great possibilities in this area of research but what
is most important is that it does not require large investments or funds.
What it needs is personnel with talent. If we have this human talent we can
work and achieve a great deal in this area.

Before concluding I wish to mention some of the ideas we are introducing
and developing, such as the idea of a community doctor or a family doctor.
However, the meaning of community or family doctor here is not the same as
in the western world. He is a family doctor because he is assigned to a
number of families, 120 or 130 families. He would complement the primary
network of public health. This doctor works and lives in the community.
This community could be a school, a factory, or an area where people live.
This doctor would keep the health files of these 500, 600, or 650 persons.
He would treat and follow up on cases of diabetes or asthma, cardiac
problems, or any other type of problem. He would visit the patients. He
would be the guardian of the health of the community. Not too long ago the
first group of doctors began to work under this plan. The results are truly
impressive. There are some of them here with you and I believe they will
speak to you about this program.

This year there are 230 doctors involved in this program. It includes
mountain areas, rural areas, urban areas, factories, and schools. The idea
of this program is that in the future the person will be taken care of not
only by the network of polyclinics, general hospitals, or specialized
hospitals, but in the area where he lives he will also have a doctor; where
he works he will have a doctor; where he studies he will have a doctor.
These doctors will be specialized in the area of general integral medicine.

Of the 65,000 doctors we will have within 15 or 16 years, by the year 2000,
which is not too far away, 25,000 will be involved in this activity. This
means that we will have some 30,000 working within the hospitals network
and 25,000 within the communities. We estimate that some 10,000 will be
working abroad, which means that we will need 10,000 more to be able to
fulfill our goal of giving each doctor a 1-year leave every 7 years so that
he may dedicate himself to study. [applause]

We have work plans for the 75,000 doctors, which we are working on now.
Some 5,000 selected students are registering in the medical science school
every year. In the past few years some 2,000 have graduated annually. By
next year some 2,500 will graduate from that school. By 1988 there will be
3,000 new graduates. By 1991 there will be 3,500 new graduates every year.
And they will be really well-qualified doctors.

We are working on publishing textbooks for specialists; we are obtaining
whatever books doctors need to obtain information. This is very important.
There have to be true information centers that should contain whatever
information is required.

To summarize, in my opinion the experiences of Cuba, of the Cuban
revolution, have contributed to finding solutions to health problems. In my
opinion this contribution has been important. One contribution has been
rural medical services. Then there are the strict measures applied to
select medical personnel. I don't think that medical personnel anywhere in
the world have go go through selection processes as rigorous as those in
effect here. This is another contribution. Another contribution has been
the idea of teaching in all the hospitals in the country. Before, this was
done in only one, or two, or three hospitals. We have found out that when
hospitals become schools, assistance to the classes improves and the
doctors prepare themselves, study better, and become experts. We have
extended this program to municipal hospitals and it will be put in effect
in rural hospitals.

The fourth contribution is the participation of all the people in health
promotion work. Fifth, I believe that the concept of general integral
medicine as a specialty will be successful. Sixth, we have systematic
development of all the specialties. And seventh, we have the community
doctor. These are seven aspects in which our country has, in our opinion,
made contributions. We are confident. I believe the future will prove us

We are willing to share our knowledge with Latin American physicians and
the entire hemisphere, including Canada, the United States, and the highly
industrialized countries. Some U.S. physicians are among us; I believe
there are 31 of them, and we are glad to have them with us. I believe that
Canadian physicians are scheduled to arrive on a later flight. There are
more than 1,000 pediatricians attending.

Our achievements and modest discoveries are at your disposition. In return,
we hope to receive from you experiences and valuable knowledge. We hope
that these congresses will serve to strengthen ties and that we will unite
in helping each other greatly and generously. Some leaders of international
health-organizations have said very encouraging things here. They spoke of
very crude realities that I did not want to mention. They spoke of what is
happening, about those who are dying. They said something that is hard to
forget: that the million babies who die could be reduced to 260,000 at
Cuba's current [infant mortality] rate. I myself marvel at those figures
that are encouraging to us; we are glad to have decreased the number of
children deaths by hundreds of thousands. However, we must admit that it
saddens us to think that 740,000 children dying in Latin America could be
saved. I believe that this speaks for itself. These are 740,000 lives that
are lost as a result of irresponsibility, insensibility, negligence, and
ignorance. I think that the statement made the UNICEF director shows the
extent of the importance of the topics to be discussed and the work that
will be carried out during these congresses. I have spoken at length and
have also perhaps taken advantage of you, but I hope that you will have the
opportunity to confirm what I have said here during the upcoming days.
Thank you very much. [applause]