Latin American Network Information Center - LANIC

FL051306 Havana Television Service in Spanish 2222 GMT 3 Jul 85

[Speech by President Fidel Castro at a ceremony held in Havana on 2 July,
during which Bolivian Health Minister Javier Torres Goitia presented him
with the Health Order -- recorded]

[Text] Dear friend Dr Javier Torres Goitia, Bolivian social services and
public health minister, dear Bolivian friends, dear comrades: I deeply
appreciate your touching, generous, and beautiful words. For many years,
almost since the very moment the revolution triumphed, our country has been
in a position to cooperate in the health area with many Third World
countries. At present our doctors work and render their services in over 25
countries. For this reason I am truly moved and surprised that I am
receiving this important decoration, this extraordinary incentive from a
country like Bolivia, with which we have cooperated at a very moderate

You mentioned three things: The delivery of medicine on the occasion of
some natural disasters, the training of medical personnel, and the supply
of intensive therapy equipment for the children's hospital in La Paz with
the cooperation of several Cuban specialists. This is a very small
contribution. We sent several tons of medicine by plane, I do not remember
if at that time we also sent food, but we sent what a plane could carry for
such a long distance as that between Cuba and Bolivia. I wish we could have
been able to contribute more during those difficult times. We also provided
training to some Bolivian doctors and nurses for the operation of equipment
and intensive care techniques, and we furnished the modest intensive care
room in Bolivia.

Of all these activities, I believe the most useful, the one that may turn
out to be most important, is the installation of the intensive care
equipment because its value cannot be measured in terms of the price of the
equipment alone or the magnitude of our small efforts. instead, I think
this must be measured in terms of the value of the idea behind it, to be
able to share the experience with Bolivia.

Four years ago, in 1981, our country only had one intensive care room in a
pediatric hospital. This was the year we had dengue epidemic -- a strange,
mysterious epidemic whose source makes us suspect the worst, because of the
way it appeared, by the fact that it did not exist in the Caribbean area,
and it did not exist in any of the countries with which we had relations.

The fact is that suddenly we were faced with an aggressive, strong, harmful
epidemic. This was when the idea of intensive care units started to
develop because of the fact that pediatric hospitals were full with
children suffering from hemorragic dengue. disease.

The children's mothers -- who in our hospital system participate in the
children's care -- specialists, nurses, hospital technicians, made great
efforts to save the children's lives. I am absolutely convinced that
without that extraordinary effort, that epidemic would have taken
thousands of lives in our country.

I was also noted that not all medicines were appropriate to treat that
illness, which deviated a little from the average, the treatment and
diagnosis had to be accurate. Measures were taken to communicate to the
entire country the right methods of treating the illness. The epidemic was
spreading like wildfire. There were days when around 11,000 cases were
reported in a single day. A case came up in a certain province, and a few
days later there were hundreds of cases in that province. Under those
circumstances, one of the things doctors at hospitals came up with,
considering there were different kinds of cases, some serious, others more
critical, others less, was to group the children who were in more critical
condition in order to provide them with close attention, around the clock.
The high-risk cases received more careful attention in those improvised
rooms. That was the time when, visiting one of the hospitals, we saw the
only intensive care room we had, which did not have individual cubicles for
contagious diseases. Dengue cases, which are transmitted through an insect,
are not the same as cases such as encephalitis or meningococcic meningitis.

I remember that in that intensive care room there were about four beds, and
there was a meningitis case in the same room. We were worried that others
could get infected. In reality, if I am going to be more accurate I have to
say we had already started to build the first intensive care rooms before
we visited that room at the (Borgas) Hospital in Havana. However, we
noticed there were no individual cubicles for those cases. After the visit,
we revised the projects under construction to include individual cubicles
for infectious disease cases. This is how we decided to plan and build
intensive care rooms in every pediatric hospital in the country, even in
hospitals in some regions, which although not pediatric, offered many
services to children, so we also built intensive care rooms, totaling 31
rooms. We began that project with perseverance and urgency. Some of those
rooms were built during the epidemic. We requested the help of a group of
architects we call field architects, and they designed [Unreadable text]
plans at the project sites. We requested the efforts of our laborers, who
worked its great interest and love, to build those intensive care rooms at
maximum speed and some were finished even before the epidemic was over. All
this happened during the battle against dengue, which was eradicated in
record time if one considers it affected around 300,000 persons; I do not
guarantee the amount is correct, but there were around 300,000 persons

First, we had to struggle against the carrier as a means of controlling
the epidemic. Even before, we had to adequately treat patients, trying to
exterminate the carriers in two ways: killing the adult population and the
larvae. We had to import large amounts of chemical products for fumigation.
We had to buy large amounts of backpack spray units [mochilas]; we had to
bring some from Japan by plane and in adequate amounts. The mosquito
population was considerably reduced, and above all, the isolation of
patients was decisive.

Since that happened during the months of June, July, and August, we were
able to utilize schools, turning them into hospitals. At one point we
hospitalized all patients, not only to control carriers, but to keep anyone
from transmitting the disease. One day, after 3 or 4 months, the epidemic
was eradicated in record time. Type B was eradicated as well as Type A. We
were able to eradicate both, and since then we have maintained control of

A Cuban scientist, Carlos Finlay, was the one who discovered that
that carrier is the same as that of yellow fever. He knew its habits
perfectly well. That scientific discovery was an extraordinary contribution
to the fight against yellow fever. However, efforts were made to deprive
that outstanding Cuban of his glory. Efforts were made to have an American
doctor -- who simply because he was an American and due to the American
intervention in our country was able to learn about Finlay's research --
credit for discovering that carrier. That Cuban scientist's discovery
tremendously helped to improve sanitary conditions in our hemisphere.

Now that I mention Finlay, I think Finlay would have really deserved an
order like this one for his contribution to our country's health and in our

However, as I said, we were able to eradicate the disease in record time. I
think we were able to save the lives of thousands of people with the right
kind of treatment, As a result of that, we got the idea of intensive care
units in pediatric hospitals. This is why today we have 31 intensive care

I remember the latest statistic was received around November when a
pediatric congress was held in our country. I was informed that in less
than 2 years -- because some were finished right away and others after the
epidemic was over, with several million dollars spent to equip them -- up
to last November, around 14,--- children had been at these intensive care
rooms and 93 percent had been able to survive. What would have been the
survival rate without those intensive care rooms? Maybe 85, 80, 75 percent.
But consider that 10 percent of 14,000 is 1,400 children. Only the idea
that we may have saved the lives of 1,400 began to ease the pain of the 100
children and 50 adults who died during the epidemic, especially the lost
lives of those 100 children. We were comforted by the fact that we bad
turned that misfortune around, that probable attack, that probable biologic
aggression against our country into a strengthening of our health system.
This was demonstrated by the fact that maybe before the 2 years of
intensive care programs were started, 10 lives were saved for each of the
ones lost during the epidemic. We have visited the intensive care room in
operation and realize how many of those children would not be saved without
those services, because sometimes a respiratory arrest, if not
interrupted so oxygen can be provided to the child, can kill him in a
matter of minutes.

Neither doctors nor medication can do anything at all. Cardiac arrests,
various problems, and severe traumas, as not only ill children go there but
also those involved in accidents. We realized the importance of those
wards, saw the exquisite and special attention given in these hospitals,
and reached the conclusion that these institutions were very important for
the health area. I have often thought that it is regrettable that the
experience we have accumulated here has not extended throughout Latin
America and other Third World countries where, no doubt, it would help save
many lives. It is more than just saving lives: The idea that those
intensive therapy wards exist give peace of mind to any family, uncle,
grandfather, or brother, knowing that their children -- and each child has
many relatives -- can be rendered services that are just as good as those
of the Mayo Clinic, which I usually cite as an example because I hear it
mentioned often, and it is a famous clinic. However, we are very pleased --
as are Cuban families because this gives them great peace of mind -- to
know that in the event of any grave case of this type anywhere in our
country the children would receive, free of charge, attention similar to
that they would receive in the Mayo Clinic, if not better. Perhaps the
attention received is even better because those clinics are mercantilistic
while our pediatric hospitals are not, and our doctors and nurses dedicate
themselves to this activity with a fervor that no human being is capable of
mustering for any amount of money. As we were saying, it would be truly
beneficial and useful, and it would save many lives, if this experience
could be taken to other places.

So when Bolivians themselves, their minister, and the Bolivian doctors who
became familiar with this type of experience became interested in it and
told us about their desire to have an intensive therapy ward -- we
ourselves cannot even claim any merit for the initiative, as the idea came
from Balivians themselves -- we immediately approved the idea of helping
them install this facility. From a spiritual standpoint, this was a source
of great satisfaction for us, the fact that that idea could be useful to
other countries.

[Unreadable text], more than our doing something for Bolivia regarding our
intensive therapy experience, it was Bolivia that did something for us when
it allowed us to take our experience there. I can say that those who
planned that small ward did so with great love. Something special motivated
them to carry out that work in Bolivia: perhaps ideas about it being a
Third World country, a Latin American country, a country faced with many
economic difficulties and social problems, a friendly country that had
reestablished relations with our country, a nation whose people have for a
long time been highly esteemed by our people.

I remember, for instance, the sad and painful days when the 10 March coup
was staged. A few days later there was a rebellion, an insurrection in
Bolivia, and a revolution triumphed there. This was in 1952, if I am not
mistaken. The revolution occurred on the same year the coup, it followed
it, and that development, that victory by the people, imbued all of us and
our people with great enthusiasm and with the idea that someday our own
people might also be able to destroy the tyranny. So you transmitted to us
very valuable and decisive ideas, which perhaps can be compared with our
now transmitting to you both in experience and ideas.

As I was saying earlier, those charged with this project worked with
special feelings of affection for Bolivia. Our doctors took great pains in
training the personnel. Our diplomatic representative also took great
interest in that work, constantly sending news about it. I received several
videocassettes on how work was progressing, how bricks were being laid one
by one. We were kept informed as that ward was built. The planners, the
technicians, and the doctors all worked with great affection. Above all, if
there is any merit to this, it is that they worked unselfishly and with
great enthusiasm.

How far it was from our minds in those days to think that we would gather
here tonight for this touching ceremony to receive this decoration that I
accept on behalf of all those who participated in this idea -- planners,
doctors, those who passed on their intensive therapy knowledge to Bolivian
doctors. This decoration is also yours because you were the ones who came
up with the idea that we could cooperate in this manner with the Bolivian

I wish this experience could be taken to other places someday, to other
pediatric hospitals in Bolivia. I assure you we would be willing to train
all the personnel you might need, even though you yourselves can partly
train others with the personnel you already have. However, we would gladly
help train all the personnel you might need for further intensive therapy.
Let us hope that in the future we can also help build a second intensive
therapy ward, as I believe that the importance of that ward is for it to
serve as an example for other Bolivian hospitals. If the capital already
has a ward of this type, it would be advisable, I think, for the second
leading city which surely must have also a public pediatric hospital, to
have one of these wards so the experience can be disseminated. I think this
would also have an influence on other countries. I am sure that many
visitors, many doctors visiting in La Paz will be taken to that ward, and
that will give them ideas. I think it would be ideal if someday all Latin
American pediatric hospitals could have intensive therapy wards like Cuba
has. We are willing to help train personnel for a program of this kind,
perhaps with the cooperation of the various international organizations, as
it must be perfectly understood that our resources are very limited.
Although we would not be able to make too big a financial contribution we
could help train personnel and share our experience. There is nothing we
would like more than to see similar wards someday in other Bolivian
hospitals, and to see Bolivia become, after Cuba, the second country with
an intensive therapy system for children.

You mentioned the efforts, the resources, and the cooperation received. At
a recent orthopedics congress we said that health is one of the most
economically profitable things.

What I meant is that it is an area where much can be done with very few
resources. You can't imagine how incredibly inexpensive health services can
be. For instance, if we make use of Cuba's experience, the cost of
medication in convertible foreign currency could be reduced by 20 percent.

We are among the countries with a high health index -- we undoubtedly hold
the first place among all Third World countries and rank above several
industrialized countries -- yet health is not one? of our country's
costliest activities. I explained that education costs twice as much as the
health services, and although we are not extremely economy-oriented or too
interested in saving, our country's current health expenditures total the
equivalent of $600 million. We spend pesos, but we speak of dollars so we
can understand each other, as one no longer knows what a peso is in this
hemisphere, but one more or less knows what a dollar is and what it is good
for. Naturally, I am not talking in terms of foreign exchange, as most of
these expenses we pay in our currency, and we use medication manufactured
here in Cubaby Cuban doctors and specialists, and use a minimum of our
convertible foreign exchange.

In the past, these expenses did not exceed $40 million but now we are
spending slightly more. However, I have estimated how much this medicine
would cost at the prices of medicine prior to th(i revolution. To put it
another way: We give our people medicine at half the price it cost 26 years
ago. That medicine must cost much more today. For instance, an aspirin
costs a small fraction of a cent, yet sometimes it was sold for 10 cents to
the people. According to some of my estimates, people today would have to
pay about $1.2 billion for the medication they receive. Some of this
medication we have to buy, some we buy in the socialist bloc, others in the
West, but mostly we bring in raw materials and that way the cost of our
medication is realy inexpensive for our country, if one considers the
health levels achieved. As I was reminding Comrade Machadito [Politburo
Member Jose Ramon Machado Ventura] at a meeting, when this program began in
1959, we spent 20 million; now we are spending 600 million [currency not
specified], that is, 30 times more. Naturally, this includes all our
preventive programs and nursing homes. The expenses mentioned are not just
for medication, but they are still paid for by our country's Public Health

At the same orthopedics meeting, it was mentioned that one-third of what is
currently spent on weapons -- and one-third is equivalent to about $333
billion -- could be distributed among 333 countries so that each one could
receive $1 billion. since there are only about 160 countries in the United
Nations -- I think there are 158 countries, including very small islands --
twice as many countries as currently exist could receive $1 billion per
year or one-third the amount spent on weapons. Therefore, one-third is
twice as much as is needed to resolve all of these Third World problems.
However, if given half, one-third of what is spent in weapons is equivalent
to four times the amount needed for each Third World country, including
India, which is among the largest Third World countries, could have the
health programs and health levels that Cuba has. [sentence as heard]

Now, as you very clearly indicated, it is not merely a matter of economic
resources. No, no, no, human resources are decisive elements, as are the
policies, the willingness to give health to the people, the level of
awareness of the doctors and personnel working in the health area. All of
this is decisive. The people's participation in any health program is
also decisive. This is why I fully agree with the idea of establishing
people's health committees, as this is merely the implementation of the
principle of rank and file participation in the health programs. This is
decisive. We could not have our current health index without very active
participation by the masses and the committee for the Defense of the
Revolution, the latter being the equivalent of the People's Health
Committees, the Federation of Cuban Women, the peasant associations, and
the workers organizations.

All the mass organizations here fight for health and that costs nothing. A
popular and democratic political process can do much in the area of health
without any money. That is a fact: without money. Like we did, for
instance, in the area of education at the beginning of the revolution, when
100,000 students were mobilized to participate in a literacy campaign to
eradicate illiteracy in 1 year. How much did that cost? That cost nothing,
except for the students' uniforms and transportation fees. They went to the
peasants' houses and lived with them.

For instance, if it were possible to mobilize Bolivian students, those
thousands of students you have in the schools of medicine, they, too, could
help. I am sure they would be enthusiastic about these health programs and
might help greatly, dedicating part of their vacations to this project. If
there are many doctors, they could be used part of the year or as part of
their training they could be asked to participate in health programs. You
told me that you have about 4,000 doctors and that you graduate about 700
doctors every year. That is a treasure, a big treasure. We had 6,000
doctors, but the Yankees took 3,000 away. We accepted the challenge and now
have 20,500 until July or August, when we will graduate over 2,400 new
doctors. After 1988, we will graduate 3,000 per year, and after 1990 3,500
per year. A few minutes ago, while chatting before this ceremony began, I
told you that the family doctors' institution, in which you expressed great
interest, is another idea with a great future. We will employ 20,000
doctors in this area during the next 15 years. Within the next i4 years, or
perhaps sooner, every family in this country will have its own doctor in
addition to the entire hospital network and the special hospitals like the
clinical-surgical centers, etc. I think this is another idea that will
prevail in the future: the idea of a family doctor, not like those in a
capitalist society, but a family doctor practicing socialist medicine.

[Unreadable text] the satisfaction of hearing you express an interest in
this contribution by our country to the medical field. We are working in
many fields, We are conducting medical research, and have a group at a
medical research center. We have also prepared programs to develop 35
special surgical clinics. They will advance quickly, with each of them
receiving special attention so the ones most advanced and those lagging
behind will move ahead evenly toward higher levels in each of their special
fields. We have completed a new program for the schools of medicine and to
that end have gathered the best experiences from the most advanced
countries in the medical area. We have gathered all that experience, have
summed it up and in September we will begin implementing the new program.
We are also conducting research in connection with audiovisual and other
methods and resources that might help train medical students more

So we will graduate thousands of doctors in the next few years, doctors
with increasingly better preparation. We select them among students with
vocation, with good records, the ones who truly have the souls of doctors.
We select them among our many youths. (?Those selected) have been organized
into a special detachment, where they even have a special code of conduct.
We are more demanding with the discipline and conduct of medical students
than with those in any other professional field. They are imbued with that
spirit, with that desire to cooperate.

You mentioned vaccines, and it was very interesting for me to hear about
your efforts in the struggle against malaria. Perhaps some efficient
vaccine against malaria will be manufactured in the future, as sometimes it
is not easy to eliminate the mosquito. We hope that through genetic
engineering it will be possible to prepare a vaccine against malaria, an
inexpensive vaccine against viral hepatitis, which causes so many problems,
and several other vaccines. We hope it will also be possible to manufacture
vaccine against meningococcic meningitis. We think that through genetic
engineering many new vaccines will be made against those strains for which
no vaccines presently exist.

We are already working in the area of genetic engineering. We are building
a new research plant, which will be very well equipped, and we are already
training personnel. That genetic engineering and biotechnology research
center will help us not only manufacture medicine, but will help us in many
other areas, like increasing agricultural yields and producing food. These
are essential areas if one wants the people to have good health, as it is a
known fact that lack of food causes malnutrition. An individual cannot even
develop normally, either physically or mentally, under such circumstances.
Genetic engineering will contribute to this field. In the future we will be
able to increase our vaccine production with the new factory we are
currently constructing, and with new methods and technology for the
manufacture of vaccines based on genetic engineering. I think that in this
field, which is also related to medicine, we can cooperate with the Third
World countries. The foreign students in that genetic engineering center
can help in the medical field.

We are also trying to develop the field of biochemistry and the
pharmaceutical industry. Today there are procedures for developing new
molecules, not only the ones already in existence in nature, but new ones,
suitable for blocking the effects of a virus or a given toxin. There are
many possibilities in this area and medicine is being revolutionized at a
quick pace, faster than ever before.

I have told you that we are trying to remain up to date as regards new
medical equipment and technology. We are, however, aware of the fact that
man was, is, and will continue to be the fundamental element. I would
recommend that special attention be given to medical students and that
efforts be made to instill into them an awareness of the importance of
their activities.

In all these fields we have mentioned we are willing to share our knowledge
and experience with the Bolivian or any other Latin American or Third World
peoples, by training their doctors and using our experience with
audiovisual methods because the Third World must really train millions of

Of course, our Latin American universities have graduated many doctors,
most of whom are concentrated in the capitals. They are human resources,
but are not being well used. Unfortunately, many migrate, and many of the
best ones are lured away by the wealthy and industrialized societies,
especially the United States. If you have about 4,000 graduated doctors,
you have about 1 doctor per 1,500 or 1,600 doctors [as heard]. This average
is not the important thing, but how these doctors are distributed. That is
the fundamental thing. There is a similar situation with health figures and
averages, how they are distributed among cities and rural areas. Figures
alone do not indicate everything. We now have schools of medicine in all
the provinces, including the smaller ones. We have taken medical teaching
to all hospitals. I believe this is another new step. For instance, a rural
hospital may train obstetrics, pediatrics, and internal medicine
specialists, which are the areas most needed there. A good specialist may
be the professor of those doctors, as we have turned many specialists into
professors. So, a set of measures has been implemented in this area, which
for our country represent a revolution. Results will be viewed in the
future rather than at present.

All our advances in the medical field may be very useful for Latin America,
with whose sanitary conditions we are already familiar. We.know of zones in
certain countries, where 200 children die in their first year for every
1,000 born alive. We know of countries [words indistinct] about 100 for
every 1,000 that records of all who die under these conditions are really
kept in places where there are no communications, births are not even
recorded. Latin America's sanitary situation is truly horrible as a rule,
except for certain exceptions that are slightly better. However, hundreds
of millions of people live under terrible sanitary conditions. There are
hundreds more living under terrible conditions of malnutrition.

The numbers are simply frightening, considering that in addition we are
asked to pay 60 billion in debt, and interests alone total $400 billion
over a period of 10 years. Really, this looks like a contradiction, a
paradox, an absurdity.

We have been talking about all these problems, the economic problems, the
sanitary problems. We know that these circumstances are very tragic and we
really harbor the hope that someday our peoples, the Latin American
peoples, will be able to do what we are doing in the health area, just as
we hope that they will also be able to do it in the educational area.

The possibilities do exist, and I think that the most elemental duty of any
politician -- be he right, left, or center -- is to take care of the public
health, because otherwise he is not even a politician. He would not be
realizing that this is what people appreciate the most. A good politician,
regardless of his ideology, should concern himself with public health and
do something about it. However, a right-wing politician with caveman like
ideas, would not try to do for the public health what we are doing. He
probably thinks that business and industry must prosper even if people die.
We always prefer to save people, and treat them well, rather than to have
business prosper.

We do try to have prosperous businesses but, above all, we seek to place
business at the people's service and make them benefit the people. However,
even a right-wing politician, areactionary, if he is a good politician and
wants to obtain votes in an election, should concern himself with the
people's health. I am truly amazed, and I say this frankly, at how little
Latin American politicians usually concern themselves with the public

This is why at today's event, the thing I have appreciated the most is the
love, interest, and awareness that you, as Bolivia's minister of social
services and public health, have demonstrated and expressed through your
words. This can be expressed only by someone who truly feels deep vocation
and love, someone deeply aware of the existing sanitary problems, the good
that can be done through health programs, the mourning that the community
can avoid, the happiness and well being that can be guaranteed to the
people and, above all, the security they can be given. The most important
thing about a health program is that it gives security to families and
mothers, to all without exception. One may be an uncle, a father, brother,
grandfather, or grandmother, but they all have to do with a child's health.
It is even better if total security is granted to the entire family, which
then knows that any of its members can receive the best health service and
their health is guaranteed. This is what we have fought for, what we have
to a great extent achieved. We are sure we will continue to achieve this in
increasing levels in the coming years.

Believe me, this simple tribute, and I say simple because of the way in
which this ceremony has been held; this great honor moves me, and I am
absolutely sure our entire people will he moved by this action over the
simple things we have done for Bolivian health. Let us hope that in the
future we will have the chance to do much more. Let us hope that in the
future we will be able to say that with time, with the passing years, and
with our cooperation, our people have earned this tribute.

In the meantime, I reiterate to you our solidarity and our willingness to
cooperate with Bolivia's health programs as much as possible. I express my
deepest gratitude and beg you to convey this gratitude to our dear and
distinguished friend, President Siles Zuazo and especially to the Bolivian
people. [applause]