Latin American Network Information Center - LANIC


PA232156 Havana International Service in Spanish 1230 GMT 23 Jun 85

[Speech by Fidel Castro, first secretary of the Central Committee of the
Communist party of Cuba and president of the Councils of State and
Ministers, at the closing session of the "Orthopedia-85" conference at
the Havana Palace of Conventions on 22 June -- recorded]

[Text] It says here:  Please, speak slower.  [laughter]

Distinguished guests; dear companeros. You have put me in a fix this
afternoon. It is so for several reasons, not only because it is already
approximately, 1415, and lunch is waiting for you, but also because I
don't like to participate in an event, and much less in the closing of
an event, unless I have somehow participated in the conference, the
meetings, the congress.

This is what I usually do, especially when I am told that I have the
obligation to deliver a brief speech at the end, and a brief speech is
difficult on a day like today because orthopedists characterize
themselves as being really brilliant speakers. You know why? Because you
are very brief. You have spoken very well. Some of your speeches were
even poetic, like that of our colleague -- I was going to say the
Spaniard -- who spoke about poets, thinkers, and philosophers. The
Colombian's speech was that way too.

Generally speaking, I like to be well-informed, as a rule, about what
has happened throughout a congress.

I have participated in many congresses. Some of them have been of a
scientific nature. Others have been political, and others social -- this
means mass organizations. I like to participate in the sessions of a
congress to know what has been discussed and what will be discussed, so
that I can reach some conclusions.

In recent days I have heard much about this event. I have heard
the media, our doctors, various persons. They all said: This congress is
progressing well. This is a good congress. The speeches, the meetings,
and the lectures have been excellent. This is all I knew about this

Today I came to realize that all those who have participated in this
congress have a good impression about the quality of the congress. The
truth of the matter is that in the brief statements that the various
guests made, I was able to note some very interesting things. For
example: Someone said that this type of congress is like a big
specialized course. It was with some sadness that I heard him say that
now, because of economic difficulties, it is difficult to participate in
courses abroad and that these congresses serve as a means to get
up-to-date at a lower cost.

Others spoke about ties and forms of cooperation that are established at
such congresses. Others told us about the work of the Latin American
Association of Orthopedics and Traumatism [Association Latino Americana
de Ortopedia and Traumatologia].

The president of the International Society of Orthopedics and Traumatism
[Sociedad Internacional de Ortopedia y Traumatologia] told me about the
work of association. We have been told about journals. Companero Alvarez
Cambra told me that we finally are going to get an orthopedics journal.

We can say that this is all good news. This is good news mingled with
bad news because it is really bad news to hear again the old news we
have been hearing about for years -- news about the economic
difficulties of the Latin American and Third World countries.

There are economic difficulties that affect the world economy in general.

We understand perfectly the meaning of economic difficulties and the
difficulties that economic crises can bring to the development of
medicine, and especially to the development of this specialty.

We are aware of the problems that the Latin American and Third World
countries are facing in the health sector. We know that the development
of health programs requires economic resources. But it could be said
that one of the best things that could be implemented with few
resources, is a health program. What if we were to compare it (with the
arms race expenditures? Can you imagine investing $1 trillion in
military expenditures? Can you imagine what would be the meaning of
investing these resources on world health?

Let's say that not all of this will be invested on health. Let's say
that only half of that money will be invested on health. Can you imagine
investing $500 billion on health? Let's say that not even half of that
money but one-third of it, $333.3 billion, could be invested on health.
This would be enough, for example, to allot $1 billion to 333 countries
for health purposes. This is just to give you an idea.

Cuba is a small country, but it is not a tiny country. We have 10
million people. We occupy a good place in world health ratings. We are
in first place among the Third World countries. We are ahead of some
developed countries in the health field. There is more: We are at the
same health level as our powerful neighbor to the north. Regarding the
child mortality rate, we are only three points behind of them. They have
12 and we have 15. This is a fact. But it does not explain provincial
figures. We must study differences among provinces. Last year some
provinces had 13, while others had 16, 17. This is pretty much uniform
and there are good explanations for the differences when we understand
that hilly provinces in the country's east, which have poorer
communications, have difficulties in securing immediate attention. It is
more difficult to have there the level of culture and hygiene that
exists, for example, in Camaguey, Matanzas, and the capital.

However, it is interesting to know that the difference between the
country's most developed and most backward provinces is that one could
have a rate of 13 and the other 17 or a maximum of 18. This data helps
us because we can make a big effort in those places where we are behind.
We can see what factors most affect the situation and then struggle
against those factors.

This is not the case in the United States. I am sure that there are
regions in the United States where the child mortality rate is three
times higher than in others. In one area the mortality rate may be 10,
but in others it could be 30. We know of more painful situations. We
know that a particular social sector has a rate of 10, but another
sector may have a rate of 40 or 50. We don't have that kind of problem
here. We know more about more sad things. Sad. We know that in spite of
the fact that the U.S. black population represents 15 percent, perhaps
13 percent, of the U.S. population the number of black children who die
daily in the United States is twice as many as that of white children.
This is so in spite of the fact that the white population represents
more than 80 percent of the total population. This situation does not
exist here. Health services here are distributed justly. Health services
are provided to all the citizens of the country equally.

What this means is that cold statistics are not enough. When one
analyzes cold statistics, when one dissects -- I don't know how medical
professors say it -- when one separates, when one delves deeper, when
one looks at things with a microscope, one begins to see incredible
things in those statistical reports. Those reports alone do not indicate
the advances of a country.

Here when we advance one point in the ratings, this is a point that
applies to everyone. In essence, what I wanted to say is that we are
going to move ahead of the United States. I am not going to speak of an
exact date, but I have no doubt that in the future we are going to be
ahead in the health field. [applause]

I have been referring to infant mortality rate when I mentioned health
rates. We are on equal basis in other health aspects. For example, in
the life expectancy field. We are at their level. If you compare the
gross national product [GNP] of the two,theirs could be this way and
ours this other way, but health is built by man, not money, by the will
of man, by a society decided to solve its problems. The levels of GNP
vary from country to country. It is curious: There are many big Third
World countries. There are oil countries where a few thousand workers
produce much oil with a particular price. And you can find Third World
countries that have a certain GNP that when compared with that of Cuba,
looks this way. But when we look at the health figures, at the infant
mortality rate, the rate of that country is this way, and that of Cuba
is like this. Their statistics cannot be compared with ours.

This means that this is not just a matter of money, and this is not a
capricious statement that I am making as I say that our health rating
will continue to improve.

The important thing is not what we have done, but what we are doing. The
important thing is not what we have now, but what we are going to have
in 10, 12, 15 years as a result of the efforts our country is making
right now in health, education, and in many other fields. But, I was
talking about the things one could do with one-third of what is spent on
military arms, and I said that about $1 billion could be given to
approximately 330 countries. Well, what I wanted to say is that Cuba has
achieved these health statistics with an annual expense of approximately
600 million pesos. This is about half of what over 300 countries would
receive if one-third of what is spent on weapons were to be divided
among them.

Our health budget in 1975 amounted to 701 million [currency not
specified]. No, it is this year -- 1985 -- that is amounts to 700
million [corrects himself], and it increased. It increased by how much?
Well, our budget this year increased by approximately 14 percent. We are
the only country of the hemisphere whose education, health, and other
activities increase.

Unfortunately [as heard], we are not involved in that inferno of crisis,
although we are affected to a certain degree, but we do not sacrifice
health, we do not sacrifice education, we do not sacrifice the
well-being of the people. We try to be more efficient, we try to save
more, and we try to achieve -- even under difficult conditions -- our
economic and social development. But at any rate, the health sector
takes up a lot of resources. Right now, we are allotting to public health
almost 35 times more than what was allotted at the time the revolution
took over. in spite of the fact that the public health sector is the
least expensive sector and that we have shown that we can do much with
relatively little money, the public health sector is very complex. One
has to spend on materials, medicine, and we have found ways to save on
medicines. We know how much it costs to product one aspirin, and how
much the people are charged for that aspirin. It costs a fraction of a
penny to produce one aspirin, and yet it is frequently sold to the
public for 10 cents. We are paying for a lot of advertising, profits,
and many monopolies of prices when we buy medicine.

The same medication is sold under 25 different names, each one with its
own advertising. Due to our circumstances, we have had to make great
efforts to see how we can save, and we have saved a lot. Now, 26 years
after the triumph of the revolution, locally manufactured medicine sells
for half the price it used to cost prior to the revolution. Just imagine
how much such medicine would cost now, and what would be the profits
earned by monopolies in the manufacturing of medicine. Without an
abundance of resources, we are satisfying our needs for medication. I
was meditating about all this as I was listening to some of the guests
who were discussing the problems that I know are very real problems. I
also know there are many countries with unemployed doctors. One of the
presidents of the orthopedics societies told me that in his county 40
percent of the doctors are unemployed. I am not going to mention the
country's name. Naturally, health statistics do not depend only on the
doctor, although the doctor can do a great deal. Health statistics also
depend on living conditions, standards of living, nourishment, and so

For example, we know that in Spain there are 20,000 unemployed doctors.
Now something is wrong in the world, when there are so many unemployed
doctors in so many places. Well, Spain is a country whose health
statistics are those of a developed country. However, I think there can
never be too many doctors. These are very relative concepts. It is even
sadder to know that there are tens of thousands of doctors. [rephrases]
We would have to make an estimate of how many unemployed doctors there
are in Latin America. I wonder what the health statistics would be in a
small municipality in the country's interior, in the countryside.

We have managed to distribute the doctors throughout the entire country
in a very even manner. We have developed the field for medicine
throughout all provinces. We have new schools of medicine; there are
over 20 new ones. There is at least one school of medicine in each of
the 14 provinces, and there are some provinces with two schools of
medicine. In Havana, there are six schools of medicine. We have over 20
schools of medicine.

Therefore, we will have a good distribution of doctors, graduates, and
specialists throughout the country. Despite the economic crisis and the
ensuing difficulties, we have approximately 1,500 doctors and over 2,000
public health workers abroad. We would have to take a poll of the number
of Cuban doctors who have participated in internationalist missions. I
mean to say that the policy we follow is that no matter how serious the
situation may be, a man making the best use of resources can do much for
the health sector.

We all condemn the misuse and waste of resources. If resources are
wasted, the resulting shame is that a factory cannot be built or a
school cannot be built. It is even sadder when resources are wasted and
there is a lack of hospitals. Resources are sometimes wasted on
luxuries, and then there is a lack of medicine to save a life. Those are
facts. Something is wrong.

We do not have one single unemployed doctor. Do you know of any
unemployed doctors? And how many are graduating this year? A total of
2,436 doctors. I do not know if any- one failed his exams in his last
year, but, plus or minus, this is the estimate. How many will be
graduating as of 1988? -- 3,000 per year. How many students are entering
schools of medicine every year? -- 5,500 youths chosen according to
their academic records, vocation, behavior, and character. It is a
select group of 5,500 youths, and this number will grow every year. How
many will be graduating as of 1991? -- 3,500, and these estimates are
conservative. This is based on higher requirements. How many doctors will
be graduating in the next 15 years? -- 50,000. Is there going to be any
surplus doctors? No, there will never be too many: I promise each doctor
a job, wherever a doctor is needed.

Here, at this convention, a doctor is needed, and right now we have a
lot of doctors around. [laughter] I do not know how well you know
internal medicine, you are all orthopedic doctors. If someone breaks a
bone right now, I am sure he will not have any problems. [applause]

Companeros, something is wrong. There are never too many doctors. You
say that so many doctors are needed for so many people. Those statistics
do not tell me anything. Some say, well, 1 doctor for every 700 people;
that is nice. But where are these doctors? Well, in the capital city
there is 1 doctor for so many people, while in the countryside, there is
1 doctor for every 10,000. Something is wrong there. That is not good.
Statistics do not tell the story for they are only figures.

We have 1 doctor for approximately every 488, more or less. Maybe some
doctors have died during the year, but surely new doctors have been born
[as heard], so we estimate that by September we will have 1 doctor for
every 445 persons. But that does not is everything. The doctor should be
where the citizen is. And we have already increased our population. That
is the concept we are developing. I think one of the newest, most
revolutionary things that we now have is the fact that the citizen
should be taken care of not only in hospitals, clinics, specialized
hospitals, and surgical hospitals; the citizen should also be taken care
of in the factories, if he is employed in a factory.

We are developing the concept of a doctor in each factory, in each work
center. The citizen should be taken care of in a school, and we are
developing the concept of a doctor in each school. The citizen such as
the housewife or retired person should be taken care of in his own home,
and that is why we have developed the great concept of the community
doctor, what we call the family doctor. This is a new concept, which we
began 2 years ago. We are the first country in the world to use this
concept. We already have 230 doctors in this group. We began with 10,
and now we have over 230.

In the next course, we will have 500 more doctors assigned to this
specialty. Then we will increase it to approximately 1,500 per year. In
the next 15 years we will have 20,000 family doctors. There will be 1
family doctor for every 500 persons. In addition, these persons will
have their hospitals and clinics. I do not know if our guests have been
told this. Cubans, of course, are aware of this. I do not know if (Abel
Bardito) spoke on this when he talked about public health in Cuba and
explained the concept of the family doctor. We will have thousands of
doctors in the schools and factories. We already know where we are going
to employ the 50,000 doctors who will graduate in the next 15 years. We
also know more or less how many we will have abroad, cooperating with
other countries. They will be approximately 10,000.

And when we have 65,000 doctors we will be graduating another 10,000
doctors so that they can have a free year every 7 years, with full pay,
to study and improve their knowledge. This will be their sabbatical
year. [applause]

I see no reason for a surplus of doctors, if the work is properly
distributed. We are determined to develop the medical field. I can note
with great satisfaction that the new program for the medical school will
be implemented next year. This program has been prepared by eminent
professors and is the result of the work of commissions that visited the
best universities in the countries with the most advanced medical
technology. Our new program is based on the information they gathered,
which could fill a whole room, including the text books for each subject
in each university. This program is already under way. We have prepared
a plan for the development of 35 clinical surgical specialties
starting at our current level in each particular field -- taking into
consideration that the level might be good in some cases, bad in others,
and high in others -- in order to develop each of them, of course
including orthopedics. We cannot overlook any specialty, as they are all
important in one way or another.

We are also developing medical research. Next year we will have a new
center for genetic engineering and biotechnology which will not only
be of great benefit to the medical field but also for the production
of new medicine. This new technology has started a real revolution in
preventive medicine, vaccines, and so on, as well as in therapeutics.

We are also developing the production of medical equipment. In other
words, we are building solid foundations to continue the progressive
development of our public health.

I mention this to our dear, distinguished, and friendly guests not to
brag about what we are doing here in Cuba; I mention these things simply
to show that there is much that can be done in the health field based on
rational effort and that progress in this field greatly depends on man
and his efforts. Even in Third World countries-- it does not apply only
to developed countries -- much progress can be made in public health. I
say this because, motivated by the words expressed here, we believe that
our desire for exchange and cooperation in the health field with other
countries in the world, particularly with the Latin American
countries, has increased. We are not saying that we know everything, not
even that we know a whole lot; on the contrary, we are aware of our
limitations. We know that even the countries most advanced in any
specialty can always learn something from others, because there are
always new experiences, even new diseases, new situations. I think that
we should always learn from each other. No matter how advanced a
country may be in the orthopedics and trauma fields, there still is a
lot to learn from all of the other countries, from the experience of
professors and eminent doctors in other countries. There might be a
Third World country facing great difficulties in the medical field,
but which has a group of eminent men in a certain specialty who can
contribute with new knowledge, new experiences, and new advancements.

Thus, we see the importance of these conventions. In some cases it is
said that the crisis prevents these meetings, and thus the importance of
these courses. [sentence as heard] Therefore, we were very pleased to
learn that although this was a national congress, more than 50 Mexican
orthopedic doctors, some of whom are accompanied, making a total of
approximately 70 Mexicans, and a large number of Columbians,
Venezuelans, and so on, came to participate. We were pleased, because we
are convinced that this is a useful convention, that the meeting is not
merely a social event, to greet friends, or to have a good time.
Although it is true that a congress includes recreational and social
programs, the essential part of a congress is what can be learned in
that rich exchange of experiences.

What we have heard here has heightened our concept of the importance of
these conventions, now more than ever, because if dozens and dozens of
professors cannot go to another country for 5, 6, or 12 months, they can
still attend a congress here and in a few days gather information and
acquire much experience.

This is essential, because medicine is constantly changing, and we can
see that in recent times changes are taking place faster than ever
before, perhaps not at the same pace in all specialties, but quite
rapidly in many fields. We know, for example, that significant progress
has been made in a short time in the treatment of heart problems, in the
cardiovascular field, in pediatrics, in the methods for early diagnosis
of cancer, and in the struggle against cancer. There are reports every
day in international dispatches about new developments, new drugs under
study or which are already being used experimentally which have good
prospects, and new equipment. Therefore, doctors -- general and
specialized -- must continuously acquire new medical knowledge.

By the way, regarding general practitioners, I do not know if the guests
have been informed that we have a new specialty in our country:
integral general medicine. We are also the first country to implement
this concept, because in the past general practitioners were those who
did not study any specialty. However, in the future all our doctors
will be specialists, because they are family doctors, and after the
first year they will begin to study their specialty in integral general
medicine. They do not go to a hospital, they are assigned to a
polyclinic where they are trained by specialists in pediatrics,
obstetrics, and internal medicine, which is also a new concept in the
training of specialists.

Good pamphlets and the 20,000 community doctors we will have in the
future will be enough to enable early, easy detection of any problem.
These doctors will also have knowledge in orthopedics because they must
know about a lot things, although they will know more about some things
than others, in order to provide guidance and recommend a specialist
whenever necessary.

I am not going to discuss specific cases, because it would take too
long. However am aware of cases in which lives would have been saved if
there had been a specialist in general medicine available. Sometimes an
individual may have a problem that looks simple, and he goes to see a
doctor at the hospital, or a doctor sees him at home. I know of people
who have visited several doctors. However, follow-up is very important.
If a symptom appears, persists, and the patient changes from one doctor
to another, the follow-up will not be the same. Family doctors follow up
on their cases. They know the health risks faced by the 550 patients
they attend in the polyclinic. If someone needs to see a pediatrician,
the family doctor refers that person to the polyclinic. He does this
whenever he feels that a person should be seen by a specialist. If
X-rays or laboratory tests must be taken, he refers the person requiring
this service to the polyclinic.

Nevertheless, there are still cases. [sentence as heard] There are
people with diabetes, with heart problems, and with respiratory
problems. The family doctor is aware of all of the illnesses of the
people in his community, and he checks on them. Some patients suffer
from two or three diseases, and they are the individuals who deserve
special attention. When someone has a grave problem, the family doctor
will visit him in the hospital. He will also do this if the individual
undergoes surgery or is being treated for heart problems. When that
person is released from the hospital, the family doctor with visit his
place of work to check if he is doing exercises or following the program
set up for him. I am sure that these doctors are going to save many
lives. Based on these efforts, we expect to surpass other countries,
especially the United States, in the health field. [applause]

We are developing new medical concepts. I believe one of the most
important is this so-called family doctor. We call him that because he
is really a family doctor, but the concept is not the traditional one.
It is possible that we should have a specialist in general medicine
right here because if any of our distinguished visitors developed a
problem not related to bones, like a chest pain or something similar, we
would have to look for a general practitioner to give him an

There are not too many doctors and there are not too many specialists,
especially those who specialize in integral general medicine.

Some day we may have so many orthopedists that we many have to say that
the limit for the population has been reached. We may have a certain
number of surgeons and decide, after estimating our needs and those
abroad, that there should not be more since these doctors must keep
active to remain good surgeons. However, this new specialty gives us
great possibilities because it is massive, universal, and vigorous. If
we must send a doctor to a work center, a hotel, or a campaign center,
which doctor should we send? We would send a specialist in integral
general medicine.

Companeros, you forced me to come to this podium, and I have been taking
advantage of this time to comment on the efforts we are making in the
field of medicine. These comments are especially aimed at our foreign
guests since our fellow countrymen are pretty well informed on this
situation. I have observed a very particular situation. I remember
that as a result of the convention on pediatrics that took place a few
months ago, more than 1,000 pediatricians attended, and hundreds of them
were Cubans. Now we are holding a national congress, and we have
hundreds of Cubans here again, but there are also hundreds of foreign
guests. This means that our congresses are mixed. International
congresses are turned into national congresses and national congresses
are turned into international ones. You fellow countrymen can understand
that my statements are aimed at our guests.

In spite of the fact that today you gave me a great honor, I am not an
orthopedist, as in the case of Rodrigo who spoke to you about the
magazines, the prosthesis laboratories, and so on. At that moment I said
to myself, Sergio is a doctor, and he can be given this honor, but am I?
But, ah, then I remembered that I am also a doctor, a doctor in law.
[laughter, applause]

I am truly interested in public health. I believe that health is an
obligation of every true revolutionary, of every true politician. Very
often I wonder why politicians in other places don't take care of the
health problem. Those are bad politicians. If they were good politicians
[applause], if they were good politicians, they would realize how much
the people appreciate health services. They would discover that.
Unfortunately, many politicians in our hemisphere don't worry about
health problems, not even for the sake of securing votes at election

I believe, that working for health is not a political matter, but an
elemental obligation of every responsible politician, of every
politician capable of understanding what his functions, obligation, and
responsibilities toward the people are. This includes education,
health, and every other aspect that involves the material and moral
well-being of the population. That is why I say that public health is
one of the most sacred duties and should be one of the priority tasks of
any responsible official, of any responsible politician. That is why I
have given special attention to health and why keep in touch with
doctors. Logically, I learn something from them: a phrase, a word, a
specific concept, book references, certain scientific principles. In
sum, perhaps I was supposed to have a medical vocation, but did not know
it. [laughter] Perhaps someone heard me talking or arguing, and
thought: This boy is going to be a lawyer; he would make a good lawyer.
I think I was told this before I even knew what a lawyer was. However,
the fact is that I was pushed to study law. Fortunately, I rectified
this in time and...[applause] I changed my path and dedicated myself to
other objectives, to what I considered a good cause and the road to
justice, to politics in the good sense of the word, and to the
revolution, a field where I have had the great privilege of struggling
and working for the people's health. This would really be the only
justification for this great distinction that you and your guests have
bestowed on me today.

I congratulate you for this congress.  I thank all of you,  particularly
our foreign quests, for the knowledge you have left here in our country,
for the encouragement we have received through the hundreds of works
presented and defended by our doctors in the orthopedic and trauma
specialties.  I also want to tell you that today I have once again
confirmed how useful, healthy, and inspiring it is to meet with doctors.
Thank you. [applause]