Latin American Network Information Center - LANIC

-DATE-
19880910
-YEAR-
1988
-DOCUMENT_TYPE-
SPEECH
-AUTHOR-
F.CASTRO
-HEADLINE-
GRADUATING MEDICAL STUDENTS
-PLACE-
KARL MARX THEATER
-SOURCE-
HAVANA TELEVISION CUBANA
-REPORT_NBR-
FBIS
-REPORT_DATE-
19880928
-TEXT-
On Medical Progress, Objectives

FL1209155188 Havana Television Cubana Network in Spanish 0102 GMT 10 Sep 88

[Speech by President Fidel Castro to graduating medical students at the
Karl Marx Theater on 1 September--recorded; monitored in progress]

[Text] ...the contingent or the detachment was formed.  This was the first
contingent.  Perhaps some people thought it would be a long time before you
would graduate, and in fact, time has flown.  It has gone by very quickly.
We meet here again with the satisfaction of being able to say that we have
graduated the first contingent of the detachment.  It was not an easy task.
The creation of the medical sciences detachment was one of several measures
that were taken in the field of health some years ago.  How many measures
were there?  I think we have lost count.  There must have been some 40 or
50 measures, and one of them was the creation of the medical sciences
detachment.

Another measure that was taken concerned the textbooks.  I remember around
that time, in almost all the classes, the students had to take notes
because there were not enough books.  The only books that were not lacking,
to tell you the truth, was one on political economics.... [corrects
himself] some books on political economics, and some on Marxism-Leninism.
I said to myself, well, what kind of doctors are we going to have?  Doctors
who are experts on Marxism-Leninism?  Doctors who are experts on political
economics?  Or doctors who actually know about medicine?  This does not
mean in the least that we are going to underestimate the importance of
Marxism-Leninism.  We consider these books essential and fundamental.

Today more than ever, today, when imperialism and capitalism try and
question the success of socialism [words indistinct].  Why do they have to
give the doctors classes in political economics?  I said to myself, well,
what would (?people) think if in the economics school we began to teach
physiology, anatomy, biochemistry, and that sort of thing?

There were a great many hours dedicated to this subject, and we asked that
all of it be analyzed to change the amount of time that was invested on
the subject, and to limit the classes that were related to Marxism-Leninism
to the essential.  We believe that all doctors should have a proper
understanding of the basic philosophical and political principles of
doctrine.  But there were no textbooks.  It was necessary to make a great
effort, a great effort [word indistinct] in preparing and printing these
texts.  In those days there were also several commissions of professors
established, which visited the best universities of different countries,
where the medical field was most advanced, to then give us the task of
developing a new program.  It is not easy to develop a new program, and
even less easy to introduce it to the classes.  All of you went through the
experience of adapting to the new program.  I remember that when the
congress discussed that theme there were some polemics.  I believe it was
Dionisio [not further identified] who made the mistake and called me "prof"
or professor or something like that, at the youth congress.

It was decided to form the detachment on the basis of the principles of
selection and capacity, as well as the vocation and moral quality of the
student.  And we placed high expectations on this medical science
detachment.  I remember when we were in the phase of tailoring the
uniform--more than tailoring; I think that it was done by specialists in
uniforms.  But when we submitted the uniform for approval, the color, the
gown, all of those things, that famous coat, I don't know what that ended
in [laughs], I don't know how many conscious efforts were made to develop
the uniform, so that you would have all that was necessary.  About that
time, work to create faculties in all the provinces was stepped up.  That
is why we have 21 medical faculties in our country.  We can say that we
were not so lucky in the construction program of those faculties.

That program took too long.  I have seen the difficulties when I visited
some of the sites.  I know that, fortunately, the one in Pinar del Rio is
virtually finished, and it is a great faculty, but, well, you are already
finished.  I remember meeting with the students of Camaguey, where we were
analyzing the construction delays at the Camaguey faculty.  Or the visit to
the faculty in Granma that also had some problems with delays, and not only
with delays but with irrationality, since there were no athletic
installations there and it would not be so difficult, with a bit of good
will, to at least prepare the athletic installations of that faculty.

On one occasion I also visited a small faculty that had been completed.  It
was very well done, and really very pretty.  I'm speaking about the one in
Sancti Spiritus.  That was approximately 2 years ago, but I know that those
in the detachment had to study in faculties that were practically...
[corrects himself] that were under construction, and we know, well, we know
about all of the inconviencies and all of the troubles.  That means....
[changes thought] and I know there are millions of students at this moment
throughout the country, and a significant number of them are not yet
studying in finished faculties.  I think that one of the last ones finished
was the Salvador Allende faculty inaugurated no long ago.

Lately, the business of the medical faculties construction has been stepped
up, but I have always thought, with sadness, of the fact that the first
continents of the detachment were not able to complete their studies in
finished installations.  Anyway, we should not feel unhappy that in our
time we have not had something that, in turn, the younger generations of
students are going to have.  Perhaps someone may ask himself if their is
going to be an excess of medical faculties in our country.  I know, more or
less, about every one of these faculties, and where each is located, and I
know there is not going to be an excess of university faculties.  We have
had to study under difficult circumstances; in the future, students will be
able to study under more comfortable conditions.  If the number of
students now is too high, the number will be lower in the future, but
perhaps I will speak about that a little later on.

The truth is that you, as the vanguard of this movement, had to pass the
test of life, and I believe that you have passed the test of life well.  I
remember when the first contingent, the one graduating now, was in its 1st
year.  They were the only students that had uniforms.  They would
distinguish themselves whenever they went.  During the 1st year they were
in the basic sciences.  Later, when they were in the 2d year, I would
become impatient for the day the detachment would finish all of the courses
in medical school.  That day has arrived.  The day has arrived on which we
have graduated that first contingent, and we know that following you there
are tens of thousands of medical students in six contingents, including the
one that begins its classes today.  You had to go through the whole
experience, from the assemblies in the classes, to have the support and the
approval of the collective of students.

Likewise, I have been thankful during these years, because everyone said
there had been a jump in the quality of the medical students.  That was
said in the capital and everywhere else.  Independently, isolated problems
may have arisen in some cases, but it must be said that from the very
beginning, the detachment had a great deal of prestige and that prestige
grew through the years.  It was their conduct, their behavior, their
devotion to studying, that was.... [changes thought] It was something
acknowledged by everyone.

In addition to these measures decided with regard to the detachment, there
were others.  I remember that in conferences with professors [changes
thought] We had two meetings of professors--a meeting in the west and,
later, a national meeting of professors.  Some of the problems were
discussed there.  Why were there difficulties in some subjects,
biochemistry and others?  Why were the 1st-year medical students
encountering such big problems?  That led us to analyze the pre-university
programs.  It caused me to ponder the issue.  It also led us to take
measures regarding the pre-university programs.  There were meetings of the
directors of the pre-university programs to try to improve the preparation
of the students that were coming to enroll in the university.

This would benefit not only the medical faculty, but all the other
university faculties.  Today there is a new situation.  Between then and
now the schools, the preuniversity science program, have been created.
That was another very important step.  I believe, In reference to the
quality of mid-level education, that those institutions are, really,
institutions of enormous, of enormous interest, of enorous importance, of
enormous utility to the country.  One of the subjects they study is
biology.  Some are inclined toward electronics, toward computers.  It could
be physics or chemistry, or it could be biology.

In figure years many of the medical students will come from these school of
exact sciences.  So in the future there will be an even better selection.
Ever year students who enroll in the medical schools will be better
prepared.  There's another innovation for next year.  Enrollment will no
longer be based just on one's record, but it will be based on one's record
and ranking--both things.  I believe that will improve even more the
selection of medical students.  What happened with some of the students?
Young ones, some of them almost adolescents, would cheat a little after
being selected for the detachment.  They wouldn't worry very much about
what their grades would be for the second semester of the year because it
wouldn't count on their record, the semester; there was no time.  The
students had to be selected.

Today.... [changes thought] In the future it will not be like that.  This
is the last year in which they are enrolled based on the record.  From the
beginning of the next [words indistinct] more than the exam, the ranking,
the competition to enroll in the detachment.  I believe that because of
that, the preparation of those students will be even better than when the
detachment of medical sciences was formed, which was a considerable step
forward.  I should say, of course, to ease your minds, that the students,
the present students, who are the first ones to go into service for a year,
the ones from last year who had their registration postponed until this
year, will not have to take the exam.  To state it better, the ones who
will do their service this year will have the same requirements as the ones
who enroll now, this year.  They will not have to take the exams.  In the
future they will have to pass the exams first before doing their service.
The ones from Order 18 will not have to do that [word indistinct] because
they have to pass an exam to be able to enroll in the medical school.

There's another factor that is going to be important.  From the beginning
of next year, we will have to reduce the number of students that enroll in
the detachment at the beginning of the year.  That will be around 4,000
students.  I am referring to medical studies.  In these years there were
more [words indistinct] between 5,000 and 6,000 students who enrolled in
the detachment.  There has been a tremendous mass of doctors forming.
We're taking into account all of the contingents.  For the year 1990 it is
possible that the (?situation) will diminish.  [Words indistinct] between
3,000 and 4,000 after we analyze it well and eliminate a few unknowns, we
will be able to determine the date of the ones that will enroll each year
for the next decade.

We should say that this graduation is the largest in the nation's history.
There are 3,440 doctors.  This includes the 147 from other countries.
There are 147 students from 45 different countries who are graduating
today.  We feel a great sense of satisfaction to be able to contribute,
through our universities, not only to the preparation of doctors for our
own country but also for other countries.  This includes 11 that are not of
the detachment, because when we say 3,282 we speak of [words indistinct]
but there are more who graduate now in the country.  It is the largest
graduation.  Next year approximately 3,700 will graduate.

It's the largest commencement.  Next year we will graduate approximately
3,700, and the year after that, more than 4,000.  We will be graduating
4,000 doctors up to 1994, approximately.  Up to the year 1994, we will be
graduating around 4,000.  This is a respectable figure.

With those graduating today, we have 31,000 doctors, a little more than
31,000 Cuban doctors, not counting foreigners.  This is very significant,
very symbolic.  Why?  Those of you graduating today had not even been born.
When the revolution triumphed, there were 6,000 doctors in the country.  Of
the 6,000 doctors, 3,000 left.  A large number of college professors left.
It was the imperialists' policy to deprive the country of its professional
cadres, its higher level cadres.  It opened the doors [words indistinct]
capital.  There were no [word indistinct] or rural medicine.  That did not
exist.  No family doctors--not in the slightest!  Even we ourselves could
not envision that then.  Well, not some of these things.  We did think
about rural medicine then.  We did think of the rural hospitals then.

That was one of the first things the revolution did.  We did think about
taking medical services to the whole population.  It was one of the first
things that the revolution did.  But the present situation never crossed
our minds.  This was the outcome of the revolution's development and of our
own struggle against imperialism, the outcome of our own struggle and
effort to counter that infamous policy of the enemy, of imperialism, of
leaving the country without doctors.

The challenge was taken up.  It was then the Medical Sciences School was
established.  I believe it marked its 25th anniversary last year.  Medical
Sciences was set up a few days before the October crises.  It was part of
our program.  Imperialism was taking doctors away but the revolution was
training doctors.  So, 3,000 doctors remained in Cuba.  See for yourselves:
3,000.  That was the basis for it all, for all the health efforts the
revolution has made, which have led our country to the forefront in this
field among all Third World countries.  [Words indistinct] better situation
[words indistinct].

We started with 3,000 doctors who remained in the country.  Today we
graduate more doctors than the total who stayed in the country following
the triumph of the revolution.  See what symbolism!

We have 31,000 doctors now---10 times more than the number we still had at
the triumph of the revolution.  As I said, we will graduate 1,000 more
doctors in 1994 than the total left at the triumph of the revolution.  I
think it would be hard for any Latin American country to say that it is
graduating 3,000 doctors and that those 3,000 already have a position
waiting for them the next day.  That is not the case in any country, in
almost any country, in the world, to tell you the truth.  I know that there
are 20,000 unemployed doctors in Spain.  That's in Spain, a developed,
industrialized country.  However, Spain has no family doctor program.
Perhaps if Spain thinks about it, they could use many of those unemployed
doctors.

[Words indistinct] one of the unknowns.  One of the remaining unknowns is
that we cannot be sure at this time how many doctors Cuba will be asked to
provide, how much Third World demand there will be for Cuba's cooperation.
I know that one country alone asked us for 500 doctors in a single group.
Well, we couldn't do it.  However, we have come up with estimates as
regards international cooperation in the medical field.  It could amount to
as much as 10,000 doctors.  These are our estimates but no one can be
certain.  It could be a little less or a little more.  Anyway, our
estimates are based on that figure.  They are also based on the notion of
having 10,000 doctors in reserve, a reserve of doctors in order to make it
possible for doctors to spend a whole year studying every 7 years.  That's
one of the ideas in connection with all these programs to train doctors.

We know that 20,000 are going to work as family doctors.  We know that
around 5,000 or 6,000 doctors will be working in factories, schools, ships,
aircraft.  We estimate that around 30,000 doctors will work in the hospital
network.  So, that's the figure.  We can indeed make calculations about the
reserve doctors.  What we can't calculate now with absolute certainty is
the number of doctors that our country can provide to help Third World
countries.

What we do know is that the shortage of doctors in the Third World is
horrifying.  It's truly terrible.  There's a surplus of doctors in other
places but they don't have the budget, the employment, for these doctors.
This happens in both Third World countries and developed countries.
However, the immense majority of Third World countries [world indistinct]
we alone are not going to resolve them.  Of course, we don't expect to, but
we do hope to extend a cooperation proportionate to our medical resources.
Of course, we know that as the country (?gives), the country receives,
because the doctors on internationalist missions, just like those who go to
the mountains, acquire a very valuable, very useful, experience which helps
them a great deal in their medical career.

There are many diseases in the world today that do not exist in Cuba.  Our
doctors have no experience with them.  I don't know what your exact
training may be, but there might be a doctor who finds it difficult to
diagnose malaria because there are not many marlaria cases.  It is vary
rare for a malaria case, and many other kinds of diseases, to occur.

They acquire experience, they learn about the world, and they come into
contact with the underdevelopment and poverty of the Third World.  They
really acquire a very broad experience.  I feel that if has helped our
country a great deal that many doctors [words indistinct]
internationalists.  This has helped to shape the moral, revolutionary, and
political quality of the medical sectors; our doctors, our health
technicians, our dentists, and our nursing personnel.  Therefore, it is one
of the (?revolution's) principles and one of the things in which we can
give cooperation.  We cannot cooperate in other fields, but in the medical
field we can cooperate a great deal with the Third World.  We once said as
much at the United Nations--how the developing countries could cooperate
with others by means of specialists and technicians.  The medical field is
undoubtedly the field in which we can most cooperate [words indistinct]
Third World countries.

However, no one could at this time and on this date say exactly how many.
Therefore, we have to come up with an approximate figure.  From what I know
about the Third World, I feel that thousands of doctors are going to be
needed for internationalist missions.  There are some from this contingent
going to Zambia--80 of those graduating today.  Some of them are from
Santiago, others from Havana.  I understand there are a few dozen from
Villa Clara who are going to Zambia as family doctors.  Well, it's not
exactly as family doctors.  It's going to be hard work.  They are going to
be sent to villages.  There might be 2,000 or 3,000 people in a village.
They might find out that they lack the same resources a family doctor here
has to take care of the population.

Well, we should have more than 55,000 doctors by 1994 or (?1995).  Almost
31,000 new doctors between 1989 and 1995, and that's now counting the ones
here.  We will have between 55,000 and 60,000 doctors.  There are still
jobs for all of them.  However, we will no longer graduate 4,000 doctors in
1996.  In 1996, the graduation figure will have to be between 2,500 and
3,000 doctors.  We will then have to look into the replacement of doctors.
The reality among doctors.... [changes thought] I do not know of a single
retired doctor.  Do you know of any retired doctor?  [crowd stirs] I know
of no one.  They can be 85 years old and no one can argue against their
experience, their knowledge.  [chuckles] There are none.  I don't come
across retired doctors.  If they retire, it's from their jobs as government
officials.  However, as doctors they do not retire.

So, what is the average life of a doctor?  How often will a doctor need to
be replaced?  That is the reason why from 1990 on, the number of
enrollments has to be reduced.  From the moment the enrollment number is
reduced, the selection will be even better.  Look at the factors:  The
number is reduced but a large number comes from the exact sciences schools
and enrolls on the strength of their records and test results.  They will
come to a brand new, completed school of medicine.  These schools will have
all the sports facilities, laboratories, etc--the things you yourselves
have not had during your studies.  They will be more comfortable.  Now....
[changes thought] Well, there will be many more hospitals as well.  Medical
technology will be much more developed.

Now, well, there will also be many more hospitals, medical technology will
be more developed; you will have an even better preparation.  But what will
we do with the faculties?  Well, the faculties will be used for
postgraduate work, from that great mass of doctors that we're going to
have, so that when they have their sabbatical year they can study there.
Additionally, those faculties will also serve to train university level
nurses.  This year we have already started with 250 in the day classes.  We
have to see how much we'll raise it for next year, because 250 still seems
too modest.  [Words indistinct] that started last year, 250 is a very
modest figure.  We have to see how much it will go up next year.  At the
same time that we reduce the number that enroll to study medicine, we must
increase the number that enroll to study nursing.

That... [changes thought] The day must come in which we do not have the
traditional nurse.  Until not long ago they would enroll from 9th grade.
Three years. It was 3.  Later we proposed....[changes thought] Later they
were enrolling from pre-university and they would study 2 and I protested,
really.  I said why does it have to be 3 years [corrects himself] 2 years?
They should study a bit more.  To tell you the truth, comrades, at the time
the detachment was formed, when we also made an analysis of the situation
in the nursing schools, there were many young girls who went to school with
their dolls.  They even went to the hospital with their dolls, those who
enrolled from the 9th grade.  We said, older ones are needed, a little more
mature, to enroll.  Now most are enrolling from the pre-university level,
but they study 3 years.  In the future, that system of creating nurses
should end.  They should all come from the university level, and study for
their bachelors degree directly.

We have to see if there are any other technical specialties [words
indistinct] that are worth taking them to the university level.  That means
giant steps forward, an even greater preparation of our technicians and our
university professionals.  It is not out of the question that we also
increase by 1 more year the [words indistinct] career, also.  What abounds
does not hurt.  And the knowledge of medicine doesn't hurt either, if it
abounds.  I'm saying this to you who are going to begin your medical
studies, [chuckles] not in the faculty, now, but outside of the faculty.  I
know that you're not going to complain because none of this applies to you.

If we have the physical capacity , if we have the physical capacity
[repeats himself], and the number of university students decreases, we will
have the luxury--because it was 6 years, we have to see, we have to see
[repeats himself], if there is sufficient preparation for what medical
science will be in the next 6 years.  A sufficient basic preparation, which
is what you have.  This will not happen immediately, but it must be
considered, and it doesn't have to start simultaneously in all the
provinces.  We can start with a few.  There are some that are going to be
more saturated with doctors than others.  So all of this capacity, all of
this volume, we are going to turn into quality.  This is matter of turning
quantity into [words indistinct] with capacity for so many students--well,
one day, apart from what I explained before, it could be 1 year more of
study.  That has not been discarded but it isn't something immediate.  It
is among the answers that we have been trying to give to the question of
the utilization of all of those colossal capacities to train doctors that
we have created in these years.

As I was saying, you begin now.  You have finished university, in the
university faculty, with basic preparation to do more than practice
medicine--in part, to practice medicine--to (?study medicine).  I have the
firmest hope that you will not think you have finished with your studies in
medicine.  I would rally feel more optimistic if you would realize that it
is just the beginning for you.  For some, it is beginning in a very serious
manner, and with a very great responsibility because I imagine that the
ones going to the mountains will be alone.  There they do not have the
polyclinic close by.  There they do not have anyone at hand to ask, and
must deal with the problems they are faced with now, now in this phase.  I
believe that in the future, the ones who are going to the mountains will be
specialists in integral general medicine because the mountains and the
countryside are the only places where, every 2 years, we change doctors.

In the city we do not change doctors.  The same family doctor stays on, and
when he graduates as a specialist, he will still attend to the population
of the city.  In the mountains, since they can't study there, they must be
sent for a 2-year period.  I know, by the ones who have been there, that it
has been an [word indistinct] experience.  I hope to have the chance to get
together with the almost 140 doctors who are returning from Guantanamo, and
who will soon be part of the capital.  It is possible that I will meet with
them to talk, to find out about everything they have learned.  I promised
them that meeting.  I have a debt.  I told them that at the end of a year I
would meet with them, but I'll have to meet them at the end of 2 years, and
not there but here.  I've heard that they learned a great deal, but the
ones who are going to be here in the cities, to practice as family doctors,
have great responsibilities.  When many people show up, the residents in a
hospital are the ones who make the decisions.  They have many people [words
indistinct] and many people with whom to consult.

There is no doubt, and someday you'll remember this--after 10 or 20 years,
you will compare what you know about medicine with what you knew when you
had just graduated.  This spirit, this will to improve oneself, must be
kept now more than ever.  I've seen that some have had [corrects himself]
I've heard that 11 students have had a 5 during the entire year.  One
comrade go 5.2.  I said, how can this be?  What kind of mathematics is
this?  It must be a new type of mathematics.  I asked the comrade how he
happened to get a 5.2.  He said, he got a 5 for the whole year, and then
there was a competition, or I don't know what, and they gave him some
points so he went over 5.  I thought, if I get sick I'll find one of these
students with at least a 5.  They could be a guarantee.  They could be
fortune-tellers, because really, because really [repeats himself] to keep
a 5.0 average during their entire career is a true feat.  It is a true
feat, there's no doubt, because I know that the studies are difficult.  One
must study.  The medical student can't be careless even a single day a
year.  That's clear.  I know the studies have been hard, have been
difficult.  They've had to work, they've had to study.  The faculties have
had to demand more.  The demand began here, you will remember, when the
detachment was formed.  It had to be that way.  Some faculties have more
success than others, but we should always concentrate on the best ones, the
more advanced ones, the ones that have more results, to see what new things
we can introduce into medical education.  We will not pause a single moment
to think on what means, what resources, are necessary to have increasingly
better teaching [words indistinct].  That is where [words indistinct] the
advantage that many of our professors are young.  How many professors do we
have?  I think it's more than 5,000.  By chance [Castro addresses person
sitting near him], does the number reach 6,000?  There are about 6,000
professors in different categories.  Somewhere there is a paper with those
facts, but Teja [Julio Teja, minister of public health should know.  After
he sees that paper, he'll know how that attitude [laughter] [word
indistinct].  [crowd murmur] [Words indistinct] of faculties, of hospitals.
There are 6,005.  No, six thousand and.... [addresses person next to him]
What?  Go see.  What--6,003? Among all the [words indistinct] another fact.
We have twice as many, have we?  We have twice as many university
professors as the number of doctors who stayed in Cuba.  Another fact for
those who like to collect facts.  There are 6,000 professors, but they're
young!  With that majority, every passing year they're going to have [words
indistinct].

You tell me, all those comrades that have had a 5 the whole time, when time
goes by and they are all professors, they can be called "prof," like us.
[laughter] Don't they [words indistinct].  [applause] They will have every
right to be called "prof." Me, I consider myself an honorary "prof." [crowd
cheers] Isn't like that?  When they sometimes give a degree like that in
the university, isn't it called honorary?

I want to say that the quality of our education will improve.  Everything
is heading toward an improvement in all areas, just as planned.

Many of you will continue studying, rather than just practicing; 860 of you
are going into direct residency.  I remember that a few years ago we had
what was called vertical internship.  So, when we could, we (?did away)
with vertical internship because that is too much specialization.  The
needs at the time forced us to put someone in their fifth or fourth year
into a specialization; this was vertical internship.

However, in rotational internship, the doctor has to know about everything.
He must have a broad knowledge of medicine, regardless of the
specialization he chooses afterward.  What good does it do us to have a
surgeon who does not have a solid base in general medicine?  Or what good
is a specialist who does not have a solid base, even a stomatologist?
[Words indistinct] something else when one is being examined, or what the
cause of those problems is [words indistinct] The need for a broad base is
what we used as criterion.  Doctors should have a broad base and then
specialize.  Eight hundred and sixty of you are going into direct
residency.  In the future there will not be so many direct residencies.  In
the future, there will basically be direct residency for surgery
specializations, so that those trained in these areas will not lose what
they have learned.  Those who need special manual skills will go into
direct residency.  The rest [words indistinct].

Today there is direct residency for pediatrics, for example, because we
need [words indistinct] in pediatrics for them to teach the clinic family
doctors.  The family doctors study a speciality in the clinics.  There,
they must have good pediatrics, obstectrics, and internal medicine teachers
as well as psychiatry and hygiene teachers, but most importantly they must
have the first three that I mentioned.  Since this is a massive and strong
program, we also need a certain type of massive training for those
specialties.  But in the future, to train in those specialities it will be
necessary to first graduate in comprehensive medicine, (?because) many
family doctors in the future have the option of studying many of these
specialties as a second specialty.  In the future, a pediatrician will
first have to be a doctor like yourselves.  It may even take him 7 years.
He will have to be a specialist in comprehensive medicine and then have a
second specialty in pediatrics.  Were some of you surprised by this?  You
know that this is the way it is.  This is how everything is planned.  Not
at present; today, there are many direct specialties and they will exist
until [words indistinct] of the year.  I am talking about the plans for the
future.  [Words indistinct] surgery and those which require special manual
skills, as defined.  [Words indistinct] specialist in comprehensive
medicine.  It is one of the opportunities that we give the family doctors.
Of course, [words indistinct] the family doctor with his neighbors, to
become a specialist [words indistinct] The family doctor is the ideal.
However, he must have other opportunities.  He must not only be limited to
being a family doctor.  If someone in the future has the desire to become a
pediatrician, it is from among the family doctors that the future residents
for this specialty will (?be chosen).  The family doctor will have that
opportunity.  This makes those who are going as family doctors happy.  I
know that quite often very good professionals have gone to the mountains or
abroad without being asked to do so.  It is only fair for them to have
options open.  In the meantime, they are not wasting time, because I am
sure that the knowledge a family doctor obtains, wherever he is, is the
same in the mountains of Guantanamo, in Baracoa, in Zambia, or any place
here in Havana City.  They obtain, while practicing for 3 years as family
doctors, a world of knowledge that will never be a waste.

He will be a specialist with a secondary specialty, and a doctor with a
very broad base in comprehensive medicine.  He will have studied medicine
for 6 years, spent 3 years in the specialization of comprehensive medicine
and 4 years practicing the profession.  By that time, he may even be a
pediatrics, obstetrics, or internal medicine resident.  He will reach that
point with 4 years of practice and 9 years of study.  [Words indistinct]
from there will come specialists [words indistinct].  When I was talking
about 7 years, back then, [words indistinct] who are now in elementary or
secondary school who may get the 7 years.  There are countries where the
figure is 7 or 6 years.  How long was the training prior to the revolution?
It used to be 7 years, but due to other reasons.  It was not to make them
better doctors; rather, there were no jobs for doctors.  [Words indistinct]
they had little practice. The students are [words indistinct] from the
beginning in the hospitals.  But, what used to be the average life span--50
years, 55 years?  We are now reaching an average life span of 75 years.
this is approximately 15 years longer than [words indistinct] that existed
prior to the triumph of the revolution.  What does [words indistinct] to
which I referred, that doctors never want to retire.  Then, if they
continue to practice until age 90, what does an additional year of training
matter?  We'll see what we (?do).  We have to continue thinking about all
of this.

However, I clearly see a promising future in this field.  Training that...
[changes thought] I can truly say, without chauvinism of any kind, that I
think no country in the world will have the medical personnel Cuba will
have.  I do not have the slightest doubt about that, as long as all these
plans are carried out.  There are all kinds of possibilities everywhere.
Once in a while we receive an application from someone.  [Words indistinct]
know that there still private doctors in Cuba.  Did you know that?  I found
out through those papers.  I knew there were still 40 or so of them.  There
are still 62 private doctors in Cuba.  It is interesting that no law for
this was created, but only moral [words indistinct] of the students.  That
was one of the first and best things that was done in the field of medicine
at the beginning of the revolution--the giving up of private practice.

Therefore, we can see a truly brillant future.  I am sure that a great
number of you will be brilliant [word indistinct].  Some of you will even
be brilliant doctors.  But some of you cannot say [words indistinct] with
regard to personal improvement.  Many of those who are going to become
family doctors, almost all of you, will [passage indistinct] as family
doctors, specialized in comprehensive medicine, another 860 in direct
residency.  Those who are going to Piti Fajardo will be there for a while
and then they will study.  Therefore, all of you will have a specialty in
the future, except for those who do not want to be specialists.  All of you
have proved your willingness, tenacity, perseverance.  The first thing that
one thinks about [passage indistinct] especially in a career such as this
one, this is a young person who has perseverance, willingness, and tenacity
[words indistinct] to get his diploma.  I can imagine how happy and
satisfied you must have been to receive the diplomas you were just given.
That is the reward for perseverance.

Perhaps they were not all good students, but they all persevered and were
capable of [words indistinct] to pass the exams and graduate.  That
perseverance which you demonstrated will continue [words indistinct] and it
is what you must make evident throughout your lives.  Remember that there
is a young generation coming.  Remember that selection will be increasingly
strict in the future.  Remember that our faculties will be finished, that
there will be new hospitals, that the new generation of doctors will have
an increasingly better education.  I hope that you will see [words
indistinct] the facilities [words indistinct] they will have in 1990.
Those who enroll now, those who enroll in 1989, 1990, 1991, 1992--every
year--will find greater possibilities in their studies.  You will have the
opportunities, great opportunities, and they will depend on [words
indistinct] the possibility to go as far in this field as you can go.  You
are the doctors of the year 2000.  Ten or 12 years will have passed by the
time we reach the year 2000.  You will be specialists, almost all of you.
Science advances very rapidly.

It will be the task of the Ministry of Public Health of the socialist state
to put all the knowledge that turns up daily within your reach.  We can't
subscribe for each and every one of you to every magazine that exists in
the world, but we can make it possible for you to have access to any
article, any magazine, any material, any book.  In the Academy of Sciences
we have just inaugurated a science and technology library.  There you can
ask for [word indistinct] from any country of the socialist camp and you
can even ask Western countries.  We conducted a test there; we did the test
and I said [words indistinct] what are they using interferon, a new
product, for?  They asked Switzerland and the answer came back almost
immediately.  Interferon has been used in this, and this, and that--seven
different uses.  We discovered that we have used interferon here in Cuba
in a manner in which they hadn't used it before.  They didn't even know
about it yet, but we got at least a quick response on five or six different
diseases in which it had been used.

That science and technology library is not only for the doctors.  I have
asked the ministry to make special efforts in relation to the science and
medical technology library.  The ministry is also working in that
direction, so that a doctor anywhere in the country can ask for
information, so they have access to the information, so they have access to
the magazines, so they have access to the books.  We'll not only depend on
our experience, the individual experience [words indistinct] a collective
of tens of thousands of doctors in the country.  We should also depend on
the collective experience of millions of doctors in the world.  The world
is full of research centers and laboratories.  Of course not [words
indistinct] developed the old colonial metropolis' that sacked the Third
World.

One must be.... [changes thought] I am in the habit of reading cables.
They assemble a collection of cables and news for me [words indistinct] and
I have seen that every day there's medial news.  [Words indistinct] that
has from 200 to 300 cables [words indistinct] or the state of vaccines or
the difficulties in making a vaccine or new problems related to this or
that disease, but there was news--news of all types, of new techniques, of
new medications.  They would systematically send me a volume of cables, to
the ministry, every month.  Everything was given to the center of genetic
engineering and biotechnology.

Some remain with the team that works with me, and others [words indistinct]
for a collection of [word indistinct].  I don't have much time to review
them but I have [words indistinct] Three or four news items appear every
day in the cables [passage indistinct] This news appears quite often before
[words indistinct] in books and magazines, [word indistinct] because there
is a congress.  There are many congresses being held in the
world--pediatrics, orthopedics, and cardiology congresses--all kinds.
There are also congresses for specific illnesses.  Hundreds and sometimes
thousands of doctors attend them.  Everyone presents a paper [words
indistinct].  Important news about medicine emerges from those congresses.
We may need to increase the number of recipients of these cables, and we
may need to send them to the science and technology library and to the
ministry [passage indistinct].

Our research centers must be up to date.  As much as we may be able to
create, experiment, research [words indistinct] our own country, this does
not compare with the [word indistinct] of researchers and doctors in other
countries.  This is a very important (?principle).  For us to know that
there is technology for any type of illness, [words indistinct].  This is
how we have been introducing [passage indistinct] in the field of medicine.
I think that if we want to reach a high level, and (?become) a (?leader) in
medicine, we must be current, and we must be flexible and quick in the
methods we use to receive information and build on it.

We must introduce new techniques in the treatment of illnesses.  To cite an
example, [passage indistinct] in transplants.  That is very new, extremely
new, and very recent.  Already, our country is quickly progressing in that
area.  I will also cite the example of interferon [words indistinct] for
the first time we heard talk about it.  Between the time we heard about it
and [words indistinct] a treatment which could fight cancer, or at least a
certain type of cancer.  From the time we heard the news to the time our
country produced interferon, only a few weeks had passed.  It is possible
we would not find out about the existence of something, an innovation or
discovery [words indistinct] if we don't adopt methods to be up to date on
scientific developments.  That is why [passage indistinct] that is not
enough.  Doctors  are sometimes unpredictable, dogmatic, [words indistinct]
enough, they think they know it all [passage indistinct].  If something
new is done or discovered in the country, they have the tendency to
(?believe) what they see in a Parisian magazine more, [words indistinct]
than what has happened in (?their) country.  There are even some
tendencies to underestimate, to discriminate against, the achievements of
their own country.  I know; I have examples of this.  [Words indistinct] a
product in the country successfully, it is necessary to quickly disseminate
it to all the other doctors.  There could be a group of doctors in a
hospital who know about it, but the rest of the doctors in other hospitals
do not know about it.  I think one of the important roles the Hermanos
Ameijeiras Hospital must play [passage indistinct] the immediate
dissemination to the rest of the country.

We hope that the Hermoanos Ameijeiras Hospital will be a hospital among
hospitals.  There are no interns there, in the hospital.  There are
residents, but there's also an entire program so that doctors from Baracoa
[words indistinct] from anywhere in the country, in specific subjects, can
come to take courses in that hospital, to be informed on everything that
has to do with their specialty.  However, Ameijeiras shouldn't be the only
hospital.  It's true that it has excellent things.  We began testing the
extracorporeal litholapaxy unit there, in Ameijeiras.  However, now we have
just acquired one for Santiago de Cuba.  It's much more modern.  It doesn't
have that tub it used to have.  In 2 years, barely 2 and 1/2 years, the
equipment has been revolutionized.  That equipment was excellent and solved
important problems.  It avoided complicated surgery, traumatic surgery,
destroying the stone by a very simple procedure.  The machine that's 2 and
1/2 years old does not compare with the new one.

This past 26 July, Santiago de Cuba received an extracorporeal litholapaxy
unit.  Santiago de Cuba also received a computerized axial scanner from the
same factory, of the same brand, but cheaper and much more modern.  This in
a matter of 2 or 3 years.  Of course, though, the first one came here to
the Ameijeiras Hospital.  Soon several hospitals in the country will
have.... [changes thought] Villa Clara will have its own.  There are, or
will be, computerized axial scanners in Santiago; that is to say, in the
eastern part of the country, in the central region, and in the western part
of the country.  In the western part, there's more than one.  The new
hospital that we plan to build to the east and west of the capital should
be the same or better than Ameijeiras Hospital, and they should have the
same role.  Or any hospital that we build in Santiago de Cuba, like the new
one that we're building.  Construction will be resumed in Santiago de Cuba.

This technology, when it is tested in the capital or some hospital in the
country, must be passed on to other hospitals.  [Words indistinct] not to
create new research institutes in the field of medicine.  We have several:
metrology, cardiology, cardiovascular surgery.  We have.... [changes
thought] There are 12 or 13.  The principle that we've proposed is that all
hospitals of certain level [words indistinct] raise the level of the
medical sciences.  One of the things that helped a great deal, and it was
one of the measures taken when the detachment was created, was to extend
teaching to all the hospitals of the country.  Before, to be a teaching
hospital, it had to be a super hospital with I don't know how many
specialities.  At the time, it was the Calixto Garcia.

[Words indistinct] and in those times a new measure, which was
revolutionary, was introduced [words indistinct] even the municipal
hospitals.  They couldn't be teaching hospitals for neurosurgery but they
could be for pediatrics.  A hospital in Mayari or [words indistinct] in
pediatrics, or they could be in obstetrics or two or three other
specialties.  It was taken.... [changes thought] They turned into the
(?polyclinical) teaching centers of the country.

Today there are many teaching polyclinics.  Today those dozens of
polyclinics where the family doctors work are teaching polyclinics for
training in determined specialities, those that belong to integral general
medicine.  In the same way, we plan to move research away from the cloister
of research centers and take it to all the high-level hospitals, which will
make a great advance in terms of quality.  That is the concept we must
apply.  No hospital in the country must feel inferior to another!  The
nation will do all that's possible so that all the hospitals have the
necessary technology and resources.  I'm not going to say that we're going
to commit the stupidity of [words indistinct] there will be a million or a
million and a half in all the municipalities.  We can't do that.

We can't even say in all the hospitals because there would be things left
over; it would be squandering of resources, and our resources must be used
carefully.  A nuclearmagnetic resonance unit is a superior piece of
equipment which is capable of detecting an ant in the brain.  You can see
it there by methods that are simple, don't cause any effects, and are
non-traumatic.  However, you can't buy one for every hospital.  They are
[words indistinct] pieces of equipment.  They must be [words indistinct] at
a given moment to have one per province, and they would be underused.  One
starts with the capital, then the central part of the country, the eastern
part, and so on.

It wouldn't make sense to build an infant cardiovascular surgery center in
every province.  With this one that we have, we will have 100 beds
[corrects himself] 104 beds.  It started with 50; a little motel was set up
for the postoperative children so that they wouldn't be in the hospital.
We are going to build the intensive therapy unit at the William Soler
Hospital--that's the one in the hospital itself, the cardiocenter--in
another area.  That way, we will free all those beds, and our infant
cardiovascular surgery center will have 100 beds, or slightly more than 100
beds.

It's not only the problem.... [changes thought] Children from Latin
American countries are constantly coming and asking, begging, for medical
care.  Sometimes a child may [word indistinct] from another country, from
any country in Latin America.  We receive between [words indistinct]
applications, and they ask us [words indistinct] that they don't have the
resources and we [words indistinct] problem.  We think that in the future
there should be an infant cardiovascular surgery center [words indistinct]
that already has one, but it's not for children a few months old.  It's for
older children.  This is a very [words indistinct] specialty.

However, no hospital anywhere should feel inferior to another.  I'm talking
about [passage indistinct] what I call the necessity of being informed, of
all the [words indistinct] that must be transmitted to the rest of the
country, that knowledge and those experiences.  Any time we have the
resources, we'll do it, and I can assure you that medicine is a priority
with the revolution.  Medicine has the resources [words indistinct] with
priority, over any other [words indistinct].  Examples we have, with the
pediatric intensive therapy wing in the country.  Something else--We are
now doing the same thing in the surgery centers, and we already have about
40 intensive therapy wings for adults.  The same principle, taken to the
surgery centers.  All of that needs resources, and sufficient resources.

The (?means) are expensive.  The means are expensive, and the country is
not used to having those resources for medicine.  We are going to take this
intensive therapy to all the surgery centers in the country.  There's an
entire program for that, with specialized personnel, which logically saves
many lives.  To the maternity wards, we are taking the intensive services
[words indistinct] perinatal intensive services.  Millions are needed.
Several millions were needed for the maternity wards in the capital of the
Republic alone.  It is going to be extended to the whole country.  It's
being done in Santiago de Cuba.  That helps reduce infant mortality
because, really, we who have such excellent [words indistinct] and we are
not satisfied with it.  Last year it was reduced to 13.3.  [words
indistinct] per thousand.  For every thousand born [passage indistinct].
Perhaps this year we'll be able to go lower than 13.

Perhaps we'll be able to (?go lower than 13) this year, but some year we'll
go lower than 10.  [Passage indistinct] 30 and from 30 to 25 and from 25 to
20, but [passage indistinct].  There are countries that have a figure lower
than 10.  [Words indistinct] where very few children are born.  [Passage
indistinct] Here we have to see if there are climactic factors, if there
are [words indistinct] factors.  Besides [words indistinct] of infant
mortality.  I have thought about that.  When I see mountain municipalities
where they have family doctors, and the mortality rate is less than 10, I
have no doubt that the country's infant mortality rate can be lower than
10.

Although we are an island, and an island generally speaking is (?humid),
[passage indistinct] respiratory, asthma, for example.  In all islands,
[words indistinct] the rate of asthma.  The humidity and head are
appropriate for [words indistinct] of what could be a drier climate.  All
the countries [passage indistinct] lower than 10, (?with) some of the
measures we are taking I think we can lower the rate [words indistinct].

Now, look here (at)[speaking to another person], if you'll do me the favor,
there is a file and a small white card which had [word indistinct] to talk
about the subject of infant mortality.  No, no, mine.  I know mine, and
that of others.  This one [passage indistinct] Well, look at Pinar del
Rio's rate which is presently at 10.5, Sancti Spiritu at 10.6, Cienfuegos
10.7, these provinces have a lower infant mortality rate than Washington.
Cienfuego's is 10.7, Holguin 11.8, and Villa Clara 8.  These are the
lowest.  The highest presently is still in Las Tunas with a rate of 16.2
and Guantanamo has 16.7.

However, there are three (?paragraphs) here which say that the main causes
of infant mortality are:  1) perinatal disease, hypoxia, trauma during
labor, and other perinatal death causes.  This accounts for 5.2 of the
cases.  See how important special perinatal care services will be.  We
already know about all the cases of [word indistinct].  Out of the 13 per
1,000 cases, 5.2 are perinatal.  the cases of perinatal deaths can be
reduced, and they will be [passage indistinct] congenital defects.  You
know the problems we have with [word indistinct].  It is precisely to
detect congenital defects which [word indistinct] which could interrupt the
pregnancy.  There are some which are cardiac and some [words indistinct].
We already have equipment and procedures to detect congenital defects
[words indistinct] at 3 and 4 months.  We already have the equipment and
doctors.  There are a certain number which are already born condemned to
die, and others are congenital anomalies [word indistinct] by life.
However, there are other types of congenital anomalies [passage
indistinct].  The national network which is being created around the center
of [word indistinct] is already detecting many of those [passage
indistinct] not only do they influence the mortality rate but they also
influence the welfare of the family.  It is a terrible tragedy for a family
to have a deformed child.  We know of many cases where they take them to
the hospital and don't want to take them back home so that they don't have
them with [words indistinct] or any type of problem.  The ability of a
family to have up to [passage indistinct] is tremendous.  [Words
indistinct] the assurance to any mother that her child [passage indistinct]
a (?contribution) of good health to over 150,000 women.  Now it will be
between 170,000 [words indistinct] family, in these times.  We are [passage
indistinct] phenomenon of population.  There fertile generations, [passage
indistinct] the majority are women who are in the age range of [passage
indistinct].  To assure a mother that her child will be born in perfect
condition is in itself one of the greatest gifts.  [passage indistinct]

Because of these two factors, congenital defects and perinatal disease, 8.4
for every 1,000 die.  The third cause includes things like influenza and
pneumonia, with 0.8.  The fourth an fifth causes account for 0.6 deaths.
These are diarrhea and sepsis.

I speak to you about this, about the problems, the perinatal services I was
referring to in the maternity hospitals because these services should be
provided early [words indistinct] family doctor [words indistinct] the care
that must be observed to prevent accidents with children.  All these
factors [words indistinct] infant mortality rate considerably.  If it goes
from 13 to 8, (?it is) still a high rate.  I feel that with all these
technical services in play--perinatal care, the detection of congenital
malformations--as we extend the family doctor program, I have no doubt that
we are going to cut the infant mortality rate to less than 10.  We might
get to 9 or 8 one day.

[Words indistinct] but all that our life potential can provide--the life
potential of the Cuban people.  All that our scientific potential and our
geographical potential can provide.  It is a fact that though we are a hot
and humid island, we can go under 10.  It is demonstrated by the results in
some municipalities and in whole provinces.  Look at Pinar del Rio Province
with 10.5.  A whole province.  And this a province that has a large number
of rural families.  There's also Sancti Spiritus with 10.6.  [passage
indistinct] infant mortality rate will go below 10.  I feel that the time
is not far off when we will be able to announce this type of success in one
of them and someday in the whole country as well.

Many of you are going to be family doctors.  I believe it's around 1,088.
The figures are here somewhere.  I believe this figure includes the 80 who
are going to Zambia.  There are always some from the Piti Fajardo Hospital.
They say (?they want to be) family doctors.  There are some who have been
with the Minfar [Ministry of the FAR] as doctors who selected this
speciality.  So the number will always be larger.  Around 2,000 will join
the workforce around the country.  With them, we will have 6,000 family
doctors.

When the members of this continent [words indistinct] I recall we were
involved in the experiment with the first 10 doctors.  I don't even
remember if we were actually conducting the experiment.  In fact, I think
it was a year after the detachment was organized.  Well, we now have
(?6,000) family doctors and 2,000 more will join the workforce each year.
It could be that when we are graduating 4,000, the number will be at least
2,500 each year.  [Words indistinct] by the middle of the next because
[words indistinct] the whole country will have family doctors.  We have
whole mountainous areas with family doctors.  That's the case in Granma,
Santiago de Cuba, Guantanamo.  I understand that Holguin will be almost
complete this year with the group of family doctors going over there.

Six thousand--that's considerable step forward. A true revolution in
primary health care.  Every single visitor to this country admires our
health system.  Every doctor coming to this country yearns for the day when
the same thing  can be accomplished in his country.  In this area, we are
ahead of all other countries in the world, with such a considerable
advantage that having these medical contingents guaranteed [words
indistinct] with the spirit of new doctors [words indistinct].  I estimate
that by 1995 more or less, we will have the 20,000 family doctors.  That's
around 1995.  That's not such a long way off.  It's as much time as it took
you [chuckles] to study medicine.

Some provinces will come first.  I think Santiago de Cuba will be there
shortly.

I believe that in 1992 the capital will be saturated with family doctors.
This is also why we need to restrict admissions.  It is not going to be a
general action.  We are not going to reduce admissions across the board by
10 percent.  In some areas we will not have to reduce anything, and in
others [words indistinct] because it is not the same situation [words
indistinct].  the situation is not the same in every province.

Two thousand eighty eight doctors have to care for citizens all by
themselves.  I believe that with the detachment the family doctor has
started to have a great reputation among the population.  People ask for
doctor services.  They want to have a family doctor.  They ask when they
are going to have a family doctor.  Not only this, they want the doctor to
live in their community.  They complain quite a bit at district meetings
when the doctor does not live in their community.  They are concerned about
this.  In the mountains--sometimes they are married and it is obvious that
the couple has to see each other sometime.  I do not know how many times a
week, but they have to get together at least 1 or 2 days a week.  It
depends on how far each office is from the other.

Some residents complained that the doctor was away for a night.  They are
told that this is not reasonable, that it is unfair.  They are asked to
understand the problem.  People do not want to go without a family doctor
for even a night.  One doctor has problems [words indistinct] has to have a
reserve of doctors.  This is why we were (?talking) about birth rates, etc.
They are in reserve.

Efforts need to be made so that as many family doctors live in the doctor's
house to avoid peoples' dissatisfactions and complaints.  Family doctors
have a great reputation.  To the extent that we have reached--not though
law--an agreement [words indistinct] for district delegate.  If [words
indistinct] family doctor should not be nominated and if he is nominated
the family doctor should not agree to be a district delegate.  If we do not
take this precaustion, half of the family doctors will be district
delegates within the next few years because they are very popular, well
respected, and loved.  [passage indistinct] They can be nominated [words
indistinct] they can be nominated to the Provincial Assembly.  District
delegates make a solemn commitment, which is unwritten but [words
indistinct] it is something that is established by habit and we have
already made this a habit.  Up to now, we have not had any case of a doctor
as a nominee unless the moral commitment has been broken by nominating a
doctor.  [Words indistinct] certain limitations to the constitutional
rights [words indistinct] but it is necessary in the special field of
medicine and family doctors.  As I said, they can be nominated to anything
else but not for district delegate.  Is this clear?  [passage indistinct]

You are going to carry out a very important job and a very revolutionary
one.  At the beginning some were traumatized [words indistinct] because
they had the idea that the only way to be a doctor was working in a
hospital or a polyclinic.  You cannot imagine how the work of polyclinics
has improved because of the family doctor.  You cannot imagine.  I have
given certain information to some foreign visitors which attracts their
attention.  Lawton, where the program began first with 10 doctors and later
with 40, has a polyclinic for 25,000 people.  I asked how many used to go
to the polyclinic each day and I was told some 500 went each day.  Since
the polyclinic was saturated with family doctors some 100 people were
going.  Those were the ones who had to go because they had to have X-days
taken, laboratory tests done, or had to see a specialist.  The number of
people who went to the polyclinic was reduced by 20 percent.

Some interesting cases came up.  The family doctor was still not a
specialist.  When the patient had to see a specialist he later went to see
the family doctor [words indistinct] the opinion of the specialist.  he
showed a great deal of confidence in the family doctor.  Above all, there
was not a single case of a citizen who went to a polyclinic before going to
see the family doctor.  The prestige of polyclinics has increase and--I am
going to tell the truth--the polyclinic used to be the last card on the
deck.

In our country [words indistinct] did not have all the confidence it should
in polyclinics.  People went to hospitals' emergency rooms.  So [Second
speaker] they saturated emergency rooms.  They went through agony.  Today
when a citizen goes to the hospital he is usually taken by his own doctor.

His doctor and his lawyer in the hospital, who checks and sees how he's
being attended.  [sentence as heard]

The family doctor has pushed forward raising the quality of service
rendered by the polyclinics and [words indistinct].  I can assure you that
the medical institution was the most revolutionary.... [corrects himself]
is one of the most revolutionary measures ever taken in Cuban medical
history.  Some day it must also be acknowledged, that in the history of
[words indistinct] but you have to be ambitious to do that.  You have to
have a program of [words indistinct] of people who don't do anything.  Even
the labor centers and factories, with their excess personnel, [words
indistinct] service was better [Second speaker] for its personnel to render
new services to the population, and what better service than what a
millionaire in the United States doesn't have.  The millionaire may [words
indistinct] but he doesn't live next to it.  The residents of this country
have, today, what a millionaire in the United States doesn't have:  the
doctor [words indistinct].

I (?believe) this institution is going to be studied and observed (?more
and more).  Our country can do it, because [words indistinct] the people
[words indistinct] we still have offices that are full and other things,
but we are heading towards the more rational use of human resources.  We
also have about 270,000 professors and teachers, and we have more than
15,000 reserve teachers.  This is what allows our bachelors program to
[words indistinct].  We don't close the schools for teachers.  We have kept
training teachers, and we're going to [words indistinct] sabbatical, too.
That is one truly revolutionary, common socialist--to my thinking--way of
using human resources.  I believe we can do all of this for socialism.  We
can have 270,000 professors and teachers.  We have 18,000 [as heard]
reserve teachers.  One day we'll have reserve doctors so that the others
study and make themselves better.  (?This is) what socialism will do.  No
one ever dreamed that [words indistinct] with our very eyes of what it can
do.  I really believe that [words indistinct] in a revolutionary process in
a socialist revolution.

I believe that the fruits of that process are marvelous and impressive, and
you are products of that process!  We see you today with joy,
satisfactions, sympathy, and admiration.  It makes us happy to be able to
say that we have graduated so many doctors, and good doctors, who have been
in contact with hospitals since they began.  If we graduated as many as
were left, more than were left, it is precisely because these miracles are
only possible in the revolution.  Imperialism thought it was crushing us,
leaving us without doctors.  It thought that here everyone would die
without a doctor!  If you do not want soup, you get three cups, goes the
saying.  Today we are giving imperialism a cup of 3,440 doctors graduating
in only one class!  [applause]

[Words indistinct] to graduate the first contingent of the Carlos J.
Finlay medical detachment.  Recently you've seen some episodes that were
shown on television.  Every time I could I saw them.  Not on the hour, but
they had the kindness to send me a collection, a videocassette, and in the
early hours of the day I saw the series on Finlay's life.  I remembered
just now, when I was talking about imperialism, because with that
historical figure a great injustice was committed, the injustice of taking
away the merit, the glory, of having made a great contribution to humanity
and to science.  It was ripped away from him in a shameless way.  I believe
that history has vindicated Finlay.  I believe those historical episodes,
in my judgement--I'm not an expert in that subject--were very well done.

They have helped our people to understand Finlay better.  We asked the
Institutes of Culture to publish Finlay's biography.  A few thousand were
published.  I don't know how many of you may have received Finlay's
biography, how many of you have it.  No one is saying anything.  Those of
you who have Finlay's biography raise your hands.  [crowd murmurs] The one
that was published about Finlay's life.  Teja [Julio Teja, minister of
public health], what happened to prevent these people of the first
contingent from getting one?  Why is this?  Could it be that they received
it and haven't read it?  [crowd answers in unison:  "No!"] Or could it be
that they don't remember?

What we wanted, Teja, the idea behind sending those biographies to be
published, was for every one of the students of the contingent to have a
copy of Finlay's biography.  What happened?  Didn't they print enough?
Did they run out of paper?  Did they sell them at the corner market?  What
happened with Finlay's biographies?  [laughter, applause]

Look, Teja, I'll tell you the truth.  I think the book should be a gift
from the ministry to every member of the detachment who graduates.  We're
not going to sell it to them.  The textbooks, yes.  We had to make an
interpretation of the Constitution to do it, but it's so they could keep
them.  I believe a book is something very personal in which one takes
notes, like me with these papers I have here.  For the students to be able
to keep the book, we had to sell it to them.  We have to look into this
thing about the biographies.  It's a very nice story of a man of very great
perseverance and tenacity.  So that you can have it.  I believe (?it is) a
historical vindication that these 3,000 or 4,000... [corrects himself]
3,282 students that are graduating; 3,282 of them are from the Carlos J.
Finlay detachment.  It's very important.

We must think about something more important, such as how, the future
graduations are projected, as they are projected.  In the year 2000--and
the year 2000 is just around the corner; don't think it's too far away--in
the year 200 two out of every three doctors will come from the Carlos J.
Finlay detachment.  Out of every three, two.  And that in a very few years.
You should always honor that very worthy name which the detachment bears.
The prestige which medicine has attained in our country, you should honor,
always.  The prestige which you have attained in these years, you should
always preserve. We expect that from you.

To conclude--perhaps I have gone on too much on a day in which you want to
go and celebrate the degree which you have received, or go to work--I want
to tell you that we have infinite hopes placed in you.  From the very
bottom of our hearts, in the name of all of us here on this tribune, we
congratulate you.  We wish you great success in your careers and hope that
you reach high peaks.  Fatherland or death, we shall win.  [applause]
-END-


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