-DATE-
19910320
-YEAR-
1991
-DOCUMENT_TYPE-
-AUTHOR-
-HEADLINE-
Castro Addresses Close of Health Conference
-PLACE-
CARIBBEAN / Cuba
-SOURCE-
Havana Cubavision Television
-REPORT_NBR-
FBIS-LAT-91-056
-REPORT_DATE-
19910322
-HEADER-
BRS Assigned Document Number:    000004501
Report Type:         Daily Report             AFS Number:     CM2203160091
Report Number:       FBIS-LAT-91-056          Report Date:    22 Mar 91
Report Series:       Daily Report             Start Page:     2
Report Division:     CARIBBEAN                End Page:       14
Report Subdivision:  Cuba                     AG File Flag:   
Classification:      UNCLASSIFIED             Language:       Spanish
Document Date:       20 Mar 91
Report Volume:       Friday Vol VI No 056

Dissemination:  

City/Source of Document:   Havana Cubavision Television

Report Name:   Latin America

Headline:   Castro Addresses Close of Health Conference

Author(s):   Cuban President Fidel Castro Ruz at the closing ceremony of the
Third International Seminar on Primary Health Care at the Havana
Convention Center on 16 March--recorded ; speech includes an
exchange between Castro and unidentified members of the audience]

Source Line:   CM2203160091 Havana Cubavision Television in Spanish 0135 GMT 20
Mar 91

Subslug:   [Speech by Cuban President Fidel Castro Ruz at the closing ceremony
of the Third International Seminar on Primary Health Care at the
Havana Convention Center on 16 March--recorded; speech includes an
exchange between Castro and unidentified members of the audience]

-TEXT-
FULL TEXT OF ARTICLE:
1.  [Speech by Cuban President Fidel Castro Ruz at the closing ceremony of the
Third International Seminar on Primary Health Care at the Havana Convention
Center on 16 March--recorded; speech includes an exchange between Castro and
unidentified members of the audience]

2.  [Text] [Castro] Dear delegates and guests:

3.  I am, undoubtedly, the least appopriate person to close this seminar
because my participation in it has been very limited: first, during the opening
session and later during the debate on the family doctor. Therefore, I have not
had the privilege of hearing everything you have discussed, or the numerous
speeches, and the great exchanges of information, facts, and experiences that
have taken place here.

4.  I really think you have worked very hard. This started on Tuesday, right?
You have worked continuously for five days, and I am not going to make you work
harder. I saw some people dozing off over there. [laughter] I truly do not
intend to put you to sleep [chuckles] at the end of a meeting, particularly
since I said that what I liked best about meetings are the breaks and then the
closing ceremony.

5.  I sincerely believe that this has been very useful. I think that you came
here to work, and that is what you did. I think this was not a pleasure trip, a
tourism trip. I think this seminar became a sort of laboratory or school of
medicine which also viewed many other problems such as social problems which
are closely related to the field of medicine.

6.  I really should also express our great satisfaction over the fact that this
seminar was also attended by outstanding figures, such as the WHO director, the
Pan-American Health Organization [PAHO] director, the Southeast Asia office
director, and many other officials from regional and international health
organizations. The presence of dozens of prominent figures in the health field
is also quite satisfying. I would also like to note the presence of a group of
outstanding U.S. physicians and scientists, whose presence is also quite
gratifying to us, and that of many Latin American professionals. I would also
like to express our happiness that this seminar was attended by large
delegations from several countries, among which is the Uruguayan congressional
health committee. All the members of Uruguayan congressional health committee,
comprising seven deputies from different parties, have attended this seminar.

7.  This shows the special nature of this event and the flourishing of ideas
and interest. This is precisely what we need, because these meetings cannot
continue to be held, as they have been and will probably continue to be for
many years, merely to enumerate our tragedies. The fact that outstanding
politicians are attending an international seminar of this nature is evidence
that there is a slight hope that in the future not just physicians and
scientists will be interested in these issues but also politicians. In the
specific case of Uruguay, this is evidence of how Uruguayan politicians and the
entire country are interested in doing everything possible in the health field.
We are very encouraged by all this.

8.  Many international events are being held in Cuba as well as all over the
world. Some of them are education seminars, others are on health, or law, or
the economy. I have participated in seminars on health and education, and
everything you hear in these meetings is terrible. It is precisely those who
work at the grassroots level, the teachers, who suffer the most from the
limitations in this sector. Physicians are also in constant contact with the
people. This is why they are better informed about all the existing tragedies,
and all the statistics, and all that is invested in the health sector, and all
that is invested in others sectors. They are also aware of the general lack of
support, the lack of resources, the very great lack.

9.  I believe some figures in this regard were mentioned here. I think you
mentioned something about 14 billion [currency unspecified] being invested in
Latin America--in what?

10.  [First speaker] [Response indistinct].

11.  [Castro] Fourteen billion of what?

12.  [First speaker] [Words indistinct].

13.  [Castro] No, you spoke of 14 million children who die; that is, 40,000
children who die every day; but you also mentioned an economic figure at the
very end. You said that about 14 million were squandered.

14.  [First speaker] Fourteen billion.

15.  [Castro] Ah, yes, 14 billion here in Latin America. Is this part of the
budget or is it what Latin America spends on health? It cannot be that; the
figure has to be much larger.

16.  [First speaker] The unnecessary spending.

17.  [Castro] You say unnecessary spending.

18.  [First speaker] Inappropriate.

19.  [Castro] Or inappropriate.

20.  [First speaker] Unnecessary or inappropriate.

21.  [Castro] Grab the microphone, so that you can help me here.

22.  [First speaker] These are figures provided by the PAHO director on what is
considered to be spending that could be done without, unnecessary and
inappropriate spending, superfluous medication, technology that is poorly
applied. This is three times, or a little more than twice....

23.  [Castro, interrupting] Of course. There are no figures on the total health
budget for Latin America and the Caribbean?

24.  [First speaker] This is based on spending throughout Latin America, from
different funds, government budgets....

25.  [Castro, interrupting] As you say, this is where the squandering
occurs....

26.  [First speaker, interrupting] Government and nongovernment budgets.

27.  [Castro] Everything?

28.  [First speaker] Everything.

29.  [Castro] Do we have the figure for the overall Latin American health
budget?

30.  [First speaker] I do not have it with me.

31.  [Castro] This is not known?

32.  [First speaker] I do not have it. I do not have it.

33.  [Castro] In spite of all the information provided here in millions of
brochures?

34.  [Second speaker] [Words indistinct].

35.  [Castro] How much?

36.  [Second speaker] [Words indistinct].

37.  [Castro] Government budgets or total spending, including social security
and private medicine?

38.  [Second speaker] [Words indistinct].

39.  [Castro] That would appear to be the equivalent of $100 per inhabitant. It
appears to be that. Some 400 million inhabitants in Latin America and the
Caribbean, with 40 billion in total spending, would be $100 per inhabitant. 
That is be more or less what we have here.

40.  [Second speaker] [Words indistinct].

41.  [Castro] We know how it is distributed. It is very interesting because
there is spending. We should be able to draw a conclusion. We are at about 900,
right, [Public Health Minister Julio] Teja? Of course, one does not know today
what a peso, or a dollar, or anything is equivalent to. There is no way to
measure it. It is a unit of measurement. When we want to have an idea, more or
less, we say peso or dollar. You can buy many more things here with a peso than
with a dollar in the United States, but the dollar has turned into a sort of
universal currency. We try to keep the peso more or less equivalent and use the
dollar in calculations. In Cuba, it would be around 900, right? It reached how
much?

42.  [Teja] One point one billion.

43.  [Castro] Then they say around here that spending is reduced. What is that?
Did you reach 1.1 billion?

44.  [Teja] Yes, 1.1 billion.

45.  [Castro] When? In which year? In 1991?

46.  [Teja] The thing is that it includes the area of social security which
takes care of the homes for the elderly....

47.  [Castro, interrupting] Are you referring to the old people's homes and all
that?

48.  [Teja nods]

49.  [Castro] What else?

50.  [Teja] The area of education.

51.  [Castro] Oh, education is included. Yes. The 22 medical schools.

52.  [Teja] Exactly.

53.  [Castro] Sure, of course. Was this not included before?  This used to be
included before. About three years ago it was around 900 million.

54.  [Teja] Public health alone should be around 900 million.

55.  [Castro] The budget was 900 about three years ago. I believe so. Anyhow,
this means that.... [changes thought] The 14 billion that were mentioned here
now have great meaning because it is unquestionable that there is waste.  It is
unquestionable that if resources were distributed better they could yield
better results. I am not going to say that they are going to yield the results
we get here. Of course, I have no intention of attempting to turn this type of
seminar into a political meeting.

56.  I do not even want to give the slightest impression in that regard. I am
aware that the achievements we have made are related to our system. It is not
really difficult; the achievements, productivity, and the efficiency reached in
relation to health spending are also very much related to the system, but as I
mentioned here the other day, many, many things can be done to have a greater
efficiency in health spending and to improve health levels in our countries. I
am absolutely convinced of that.

57.  I was explaining that in all these meetings on health, education, and
other meetings of a social nature also, what is expressed everywhere is
bitterness, discontent, dissatisfaction, pain, and despair. It has now been
said here that at the rate we are going, by the year 2025 we will reach the
health rates the U.S. had in 1960. It is not so? Well, that is an illusion. At
the rate we are going, I do not know from where they got that or how they
reached these conclusions.

58.  Some indices can be improved, we know that some indices can be improved,
but we do not see any improvements. We really do not see an effort aimed at
improving them. This is the same as the issue of health care for everyone in
the year 2000. In what year 2000 is there going to be health care for everyone?
They will have to change that slogan soon. At the rate we are going, at the
rate we are going [repeats], health care for everyone will be achieved in the
year 3000.

59.  It is not serious; it is a noble and just goal. The intention is right but
reality is turning it more and more into an utopia, into a dream. When will
this happen? No, there are still many problems that need to be analyzed to find
out if human health is going to improve or become worse. Many mysteries still
need to be explained, like the famous hole in the ozone layer and its effect on
health, for example. All the consequences, all the results of the greenhouse
effect, as it is called, are still to be seen in the diet, health, and living
conditions of the population.

60.  The results of the increasing pollution, the poisoning of the seas,
rivers, lakes, and air are still to be seen. Some of these phenomena are a
consequence of the use of fossil fuels, and yet we do not see a reduction in
their use but an increase. Right now, hundreds of oil wells are burning in
Kuwait as a result of the war. The television has shown some pictures of
prominent people who have gone to visit that inferno. It is not known how many
tons those burning wells are releasing into the atmosphere every day.

61.  All the effects of environmental pollution on health and on the dietary
standards of the population are unknown.  The use of pesticides in the
production of food is greater and greater. The number of plant diseases is
increasing as a result of climate changes. I see the amount of spraying that is
necessary for tomatoes, potatoes, or any given crop, and I wonder to what
extent the residual effects of all those chemical products used have been
studied.

62.  In sum, there are still a number of imponderable factors, aside from the
threats of war that may exist. If the problem of hunger is not solved, then the
health indices that are talked about for the year 2000 will be further and
further away. There is really no reason to be pessimistic about this.
Nevertheless, we have a duty to struggle. We have a duty to be optimistic. We
have a duty to think that something can be done and that we need to do
something, even when one wonders how. We know that many political ideas are
going through a crisis, such as socialist ideas themselves, as a result of
mistakes, disasters, and all those things. There has been talk here about
neoconservatism [neoliberalismo]. The consequences already seen in health were
expressed. I believe that you expressed it through the reduction of public
spending, is that not so? Of the share of public spending in health services.
Neoconservatism is in style in everything, the privatization of everything,
even of the streets.

63.  There are countries in Latin America where some streets have been
privatized, as well as parks, in addition to roads. There is a brutal tendency
toward privatization and the seeking of solutions through the market economy.
We have had market economy since the time of Christopher Columbus. We have had
centuries of market economy. What has it solved? What happened to the
inhabitants, with the former inhabitants of this hemisphere? What happened for
centuries? What did colonialism, which is a direct product of capitalism, leave
us? It did not leave us a thing. We know what it left us. It left us 4 billion
hungry people. This is what capitalism, colonialism, and the market economy
have left us. The market economy has been sought as the solution of all
problems such as education, health, and even safety. Many jails have been
privatized.

64.  It is very important to struggle under these circumstances, at this time
of ideological crisis. Will the wave of neoconservatism pass? It will pass. How
could it not pass? [chuckles] The peoples are going to learn through their own
experiences and not through books. They are already learning what
neoconservatism is. What are we going to sanctify now? Debts? Interest rates?
Unequal trade? Plundering? During the discussion the figure $200 billion in
this decade was mentioned.

65.  I started to figure it out at one time. I calculated all the gold and
silver that had been taken out during three centuries of colonialism. I
realized that in one year alone, Latin America is exporting more capital now in
a single year than all the gold and silver extracted during three centuries.
You can imagine [chuckles] the level of plundering to which we are subjected.
The people will experience this firsthand. The wave will pass, but will we have
to wait for the wave to pass to attempt to do something?

66.  During the discussion, the subject of universities was mentioned; that
attempts should be made to train a humane or humanistic physician. But, are the
conditions present so the universities can train that physician in the middle
of the wave of neoconservatism and the exaltation of the capitalist system,
every man for himself, and the law of the jungle? I ask myself if this is truly
possible.  The comrade representing the students said some interesting things. 
I listened to her and I thought they were very interesting, especially when she
said that the humanistic nature is found in a new generation of citizens who
have been educated with different concepts.  This is the case not only of
physicians. One would have to say that that humanistic spirit is generally
found in all the new university graduate professionals and not only in
physicians. Of course, it is especially found in physicians. We have made
efforts so it will be present in physicians.

67.  The struggle is very difficult. The least we can say regarding the
circumstances is that we should all struggle in our countries, in our fields,
to improve medical care and health conditions of the population. We need to
continue to struggle a lot. We need to continue perfecting what we have and
overcoming the deficiencies we still have. They can be other types of battles;
they are no longer technological. They can be social in nature or regarding
education; for example, the battle against smoking that we have to wage. It is
big, simply big. What education measures can we adopt? What type of economic
measures? In spite of the fact that we have never followed the policy of low
prices for alcohol or tobacco.  On the contrary, we have followed the policy of
low prices for milk and foodstuffs but not for these vices.

68.  What type of arrangement can we have to get better success in this battle?
[Words indistinct] we watch the alcoholism matter quite a bit, and we are
willing to prevent this from being a problem here, of course. We have problems
with early pregnancy. This is a battle we are waging. We have not won it
completely. Progress is being made, according to what family doctors said here.

69.  We have to wage the battle against too many abortions.  This reflects
deficiencies in sexual education or indifference and laziness--still--among
many of our young people. We are waging battles against phenomena such as the
spread of the AIDS virus through various measures including publicity and
public education. We have to see to what extent those instruments produce
efficient results. We have been able to achieve efficiency in halting the
spread of AIDS by testing the blood of each donation, of each blood product.

70.  The fact that the drug problem is virtually nonexistent helps us a lot.
The incidence we have in that area is insignificant. This helps us. I also
observe the way in which sometimes there is a lack of concern among our young
people. I believe there is overconfidence in our country. They have so much
confidence in the health system, in medicine, and the successes of medicine
that they believe any problem--of one kind or another--will be solved for them.

71.  I would say there is a certain overconfidence among our population in the
fight against some of these types of illnesses. I tell you that there is a lot
left for us to fight against. We have a program to continue fighting.

72.  The fight against sedentary lifestyles is one of the battles.  It is an
area in which we have to work. We need to get to the day in which all the
elderly people have their centers and participate in exercise programs. We are
making progress but we are far from having exercise programs everywhere. The
matter of diet and poor eating habits is a large field in which we still have
to fight. Dr. Jordan explained to us very eloquently about everything that can
still be done against accidents. So, there is no country without tasks and big
goals.

73.  Ours is to reach an infant mortality rate lower than 10 [not further
specified]. Will we be able to achieve this under the circumstances of the
special period? Will we be able to achieve it? It is one of the challenges we
have. The special period also places limitations on other resources.  I am not
going to talk about budgets but of resources.

74.  We have had to stop new construction programs, the construction of public
programs, housing programs, programs for new hospitals, programs for new
polyclinics. It is not that we do not have enough polyclinics. We have enough
everywhere but some are located in remodeled buildings. We want them to be in
new buildings with all the facilities such as the new ones we have built. We
had a program we had been carrying out.

75.  We have.... [corrects himself] We used to have special education school
programs. We have continued building the ones that were under construction but
we are not going to begin building new ones. We had ambitious child care center
programs. We completed the ones that were under construction but we are not
beginning a new child care center or hospital program. In sum.... [changes
thought] Of course, we are working with what we have and what was under
construction. We have accumulated a lot. I am not saying that we are going to
go without in this field of health. In the family doctor program, we have had
to reduce the number of consultation offices/ houses. Our program was going
faster, fast as it was mentioned here. We will continue to add thousands of
doctors, but we cannot continue at the same pace for the community doctor
program, which is the one prioritized by us. We are going to continue it. We
are seeing what we can do, because it is very distressing for us to slow down
the pace.

76.  This is something that should have been completed by 1994 or 1995 for 100
percent of the population. Now we have no certainty that it will be completed
by that time.  This program may be delayed two or three years before completing
it 100 percent. All this is a result of the economic situation that has been
created for us because of the disaster in Europe, added to what has existed for
a long time, which is the strict and ever more strict embargo by the United
States.

77.  Therefore, we also have a restriction in terms of facilities of this kind.
Some of these facilities.... [changes thought] What is school for disabled
children? A special education school is a hospital. It is a combination
education and health care installation. When you visit a school for visually
impaired children, children with amblyopia and all those cases, you can see
that the diseases the children have are cured. Many, the vast majority, of the
problems are cured. The school is a hospital. Special education schools are
also hospitals because they deal with people who need special attention,
whether they have a physical defect or a hearing or visual impairment. They
need to be educated and trained, improved, improved [repeats] and taught to
take care of themselves.

78.  In short, we also find ourselves subject to these limitations. They are
making us undergo a difficult test. How can our indices be maintained? Will
they become better?  Will they become worse? Of course, we are making
tremendous efforts so that they do not become worse, and even so that they will
become better. All the available resources that can be found are given as a
priority to health care.

79.  Now we have very good and beautiful health programs, but in a special
situation. We will have more doctors.  Those we have will know more each day,
they will have more knowledge. We will have more specialists in general
medicine, and the organization of work can operate better. That is a subjective
factor; we have the major resources in that subjective factor. We hope we will
not be short of essential medicines. We even hope to have new medicines
produced here. We are in the same boat as you with regard to limited resources,
although at a much more developed level in this field, at a much more advanced
level.

80.  If we can maintain our indices during the special period for a number of
years, it would be a success. We could do it because of what we have built up
during these 30 years.  For a period like this, the family doctors will
undoubtedly play a very important role. This is one of the topics that was
discussed here quite a bit. I myself learned new information in the few hours I
participated in the seminar, because this is a field in which we already have
accumulated some time. It has been about seven years since we began with the
first 10. Right now we have covered entire regions, entire municipalities,
which allows us to do a large number of analyses and draw the right
conclusions.

81.  So the family doctors are something that in their practical application
have given us much more than we ourselves expected. I was convinced of this, of
course: that development, as in everything, would contribute many new things
and many new ideas. The family doctor thing was based on the principle that the
doctors would have to go wherever there were people. If there are people at a
factory, that is where a doctor should be. If there are people at a school,
that is where a doctor should be too. If there are people in a town, that is
where a doctor should be. [chuckles] The family doctors would be for society
what the Committees for the Defense of the Revolution are. They would be the
committees for the defense of the population's health. [chuckles]

82.  This arose at a time when the technocrats wanted us to stop training more
doctors. They said we had too many doctors, there are too many doctors. So
there are too many doctors, or there will be too many doctors?  Because for
them, it was only the hospital network: general hospitals, specialized
hospitals, and polyclinics.  This was explained here with all its drawbacks.
When some people believed we had the last word in health matters, with that
whole network of health care centers, the statistics here reflected quite a few
of the gaps that could occur with that system.

83.  I wonder.... [changes thought] The technocrats wanted to.... [changes
thought] You have to be careful with the technocrats. Sometimes they do a lot
of harm with their ideas and their things, their degrees, even. They will ruin
any country if you let them. It is always difficult to prevent them from
ruining a country, because the technocrats are powerful, sometimes more
powerful, sometimes less powerful. They are all dangerous, and all the more
dangerous the less you know about them. I asked them: If there are too many
doctors, why, each time a high-ranking delegation goes abroad, does one, two,
or three doctors go along? Why? Why does a little group or a cadre or a leader
or somebody need a doctor when they travel and an ordinary citizen does not?

84.  So there were not too many doctors. That was the battle.  The battle was
not, however, waged alone. We continued the battle for health, especially in
the last 10 years, and especially starting with the dengue epidemic in 1981. I
am convinced that it was introduced into the country. I have a lot of facts to
base this judgement on; I am not going to repeat them. Health was also a battle
that began with the embargo. The attempt to take away all our doctors forced us
to fight against the United States in this field. If a doctor leaves, we will
train doctors.

85.  We will develop the medical schools, develop medicine, because they wanted
to wipe us out by wiping out our population's health, among other things.
Medicine became a battlefield. Medical schools were developed.  The number of
students was increased, but there came a time when the need for university
graduate professionals in the country was so high that there were not enough
graduates from the preuniversity schools. At one time this limited entries into
the medical schools, but at the time when the dengue epidemic occurred, we had
been taking a lot of measures.

86.  The dengue epidemic reinforced our intention to fight and to strengthen
the mechanisms to defend the country's health.  Although many measures had been
taken-- dozens had been taken--more or less by that time there were many people
in the medical schools who did not come from the preuniversity schools. They
had been health workers who had bettered themselves, who had entered the
medical schools. You could enter up to age 35. It was necessary to rectify many
of these things.

87.  We then had a lot of students in the preuniversity schools. We then had
all the students for the medical schools that we wanted. So we said, well, we
should develop the medical schools as much as possible and put medical schools
in all the provinces. Now all the provinces, all 14 provinces, have their own
medical school.  Havana, of course, has several. We developed this, in many
places with plans to build the medical schools. The medical schools in the
provinces are more complete than those in the capital. The buildings, the
equipment, are newer, more modern. This was a concept, to increase the number
of.... [changes thought] Just the opposite of what the technocrats wanted. They
think there are too many doctors? Well, we are going to bring the doctors to
the community. We are going to bring the doctors to where the people are. So we
began to multiply, multiply [repeats] them.

88.  Added to all this was another factor: a growing demand for doctors in
other countries. So we took measures in this regard, and we had the privilege
of selecting the students better. It was with this in mind that the Carlos J.
Findley Detachment of Medical Students was created, as was mentioned here. Most
of these family doctors, most of these family doctors [repeats], came from the
Carlos J. Findley Detachment. Selection was by vocation and by academic
achievement. Special regulations were issued for university students, even
stricter than for other students in everything to do with academic cheating and
all that kind of thing. Because we cannot allow [chuckles] a doctor to cheat in
school.

89.  Another problem that came up was working out a new medical curriculum,
after sending delegations of professors to the most famous medical schools in
the world to look at teaching methods, bibliography, materials, programs, and
everything. Then all this was processed by all the professors, and based on all
the experiences and specific conditions of our country and the goals we had
set, a new medical curriculum was worked out. It is not easy to bring in all
these things, because there is a curriculum under way and then you begin with
the first- and second-year students and introduce the new curriculum little by
little, everything concerning the medical textbooks, and everything concerning
the textbooks for specialists.

90.  These were all measures that as a whole in one way or another....
[rephrases] Some had to do with medical technologies, the introduction of new
technologies. We worked in a special way in many fields after 1981. Well,
pediatric intensive care began in 1981. In the midst of the dengue epidemic we
began to build the pediatric intensive care units. Now there are these
pediatric intensive care units in some Latin American countries, because we
have transferred to them our experience, and since in this case the costs are
not very high, we were able to donate the equipment for pediatric intensive
care.

91.  We realized that pediatric intensive care was saving many lives that could
not have been saved without the conditions of intensive care. Of all these
measures, the one about the family doctors was, in my opinion, the idea that
will have the most influence on the future of our people's health. Today it is
a reality. It was not an idea about which we said: Let us implement it, because
it is a pretty theory. We began with 10, as was said here, to follow that
example, and we followed that example. That was a demonstration of the quality
of our young doctors.

92.  Of course, the first 10 were outstanding kids. They were not ordinary. We
saw some problems; for example, when a patient had some problem, they would
take him to a hospital. When they had to take a patient to a hospital, they
would go with him, and sometimes, sometimes [repeats], well, they went, they
found a car, they took him to the hospital, and they paid for it out of their
own pockets. Their wages were not very high; they were modest wages, as doctors
have when they start out.  When I saw this problem I was concerned and I tried
to find a solution. I told them: Why do not you keep a log of each case in
which you have to pay and then tell us so that you will not lose and will be
compensated every month for what you have spent for transportation, for taking
patients to the hospital.

93.  Well, they agreed, very unwillingly, but time passed and when I asked
about the logs and expenses, there were no logs or expenses, and they did not
want to keep logs or be compensated one cent. Fortunately.... [rephrases] I
said: How are we going to solve this problem? The residents had such great
respect for the doctors, such esteem, that they were the first ones to try to
keep this from happening by any means. It was gradually resolved that way,
simply, spontaneously, as the residents did not allow it as soon as they
realized what this situation was, this situation we had seen.

94.  This gives an idea of the quality of those doctors. We followed this
experience, and it was developed. There were a lot of ideas. A lot of problems
were discovered which had always been ignored. The number of those who went to
the polyclinics was discovered, and those who did not go, those who went
directly to the hospitals, those who were vaccinated, those who were not
vaccinated, and all those problems that always appear in a society. They
discovered house calls. There were a lot of people who went to the hospital
simply to have their blood pressure taken every three hours or something, every
certain number of hours. They were admitted to the hospital because they had to
have their blood pressure taken.

95.  There were a number of things, and the family doctors discovered that they
could do these things in the homes.  This saved on hospital admittances,
because one of the things we did not know was whether the family doctors would
increase hospital admittances or not. That is, if there was greater care,
greater knowledge, and more things discovered, it could be that hospital
admittances would increase. That was one of the things we did not know. Another
thing was, as I already explained, whether the people would have confidence [in
the doctors] or not.  Would they stop going to the hospitals and overworking
the staff on duty?

96.  So, in time, in practice, especially when we had complete polyclinics and
entire municipalities covered, we could study all this. We began to discover
many beneficial things like this, the idea of house calls, this aspect. We
began to see that the overburdened offices at the hospitals began to become
less crowded. That is, the consultations with the, what do you call them?

97.  [Unidentified speaker] The staff on duty.

98.  [Castro] The staff on duty at the hospitals. We began to see that the
people had confidence [in the doctors]. We began to see they no longer even
went to the polyclinics.  They went to the family doctors. Many of these
practices were developed. Connected with this, many problems had to be solved
involving the professors. One of the problems, and one of the measures, was the
creation of the specialty. Here anyone who was a general practitioner had not
studied anything else, in general.

99.  Some had notable practices, notable experience. There was a tendency for
specialties to increase, which we halted. We said: However many there are now,
stop it there. Not one more specialty. They would end up making all kinds of
specialties, even a specialty in the big toe of the left foot. They said: We
must create a new specialty. We must create a new one, a specialty in
integrated general medicine. I think this was very important, a concept
associated with... [rephrases] because everyone was a specialist in something
and no one was a specialist in general things, exactly.

100.  They did not study methodically and systematically to become specialists
in integrated general medicine. How was all this to be resolved? How can we do
this if they are there in the doctors' offices? That is when the idea arose of
turning the offices into teaching centers, and the specialists with offices
became professors of the integrated general medicine program. Also, we had
previously made all the hospitals teaching hospitals. What is this about having
one teaching hospital, if there are medical schools in all the provinces?

101.  All the provincial hospitals and all the municipal hospitals have to be
teaching hospitals because that is where the interns went, and because, of
course, everyone always had great respect for teaching hospitals. That is where
the professors were, the prominent figures. The medical staff at the teaching
hospitals felt very good. The hospitals, the polyclinics, must also become
teaching hospitals. This would now allow.... [rephrases] That is why we could
not put the doctors there in isolation, but rather associated with a
polyclinic. This is what we did.  There are regions that are saturated and
others where there is not even one, because this cannot be organized any other
way except through the network of polyclinics.

102.  I am talking about the initial ideas, the initial experiences. We heard
the professor when he told us about things that showed great development in the
concepts about educating doctors and continual training. In short, this has
been a breeding ground for new ideas, a laboratory for new ideas. This is what
the family doctor program has become. Then we began to observe the doctors'
social impact, their effect on society, their influence on the social
environment. At the beginning we believed in all these possibilities, but in a
general way.  We had not had a concrete idea of each and every one of the
things that happened later, and each and every one of the fruits the family
doctors brought.

103.  That is why we have a great desire to complete the network. We can still
see the future when there are tens of thousands of specialists in integrated
general medicine. It is a future, a day, in which the doctors direct health.
They will be the ones to direct health, because only they will really have the
greatest knowledge about the society's health problems, and the full importance
of preventive medicine, and the full importance of what happens where they are
and where they live. They are tremendously respected by the population; they
have very high respect in all aspects--to the extreme, even that in any
neighborhood there may be a thief, but would he steal from the family doctor?
Even the criminals respect something; that is, the family doctor, in general.

104.  Now, one may wonder, I wonder, what is a hospital?  What was it in the
old concept? What was a polyclinic? A hospital was where a man or woman came,
as social abstractions. He had never seen that doctor; that doctor had never
seen him. He knew nothing about him. He had no clinical history. So two people
met there. It was a meeting of two people, neither of whom knew anything about
the other. The doctor does not know who he is, how he lives, what problems he
has, nothing.

105.  At the polyclinic, one assumes it is closer and that one may come to know
a doctor, and one out of 32,000 or 30,000 or 25,000 may come to know a
specialist. A patient will not have great confidence in them if he knows that
probably the ones sent there were the ones who did not study, who did not have
the best records, etc. That doctor at the polyclinic may come to know what that
person's name is and what illness he has, but he will not know anything more.
The patient continues to be an abstraction who has come there with a problem,
and the doctor knows nothing about the patient's life.

106.  He has no possibility of influencing the patient's life, the
circumstances that surround the patient's life. It is simply an incomplete
institution. So then, all these things can be seen with great clarity after the
institution of the family doctor was created. Now it has been subjected to the
test of a certain number of years and widespread application, which is very
important, to the extent that it has reached 58, almost 60; we will exceed 60
this year. [number reference unknown] We do not have the resources to say we
are going to continue at the same rate of increase of doctors in the community.

107.  This has taught us a lot. Now we must continue to observe this
laboratory, because I am sure that it will give much more. It can give more,
much more still. I believe that some day we will have a complete health system,
some day, with very close interaction between the work of all the doctors. The
doctors did not know each other, working in the polyclinics. Now the family
doctor goes to the hospital with his patients. Now because of this you do not
have to go to the emergency room, with all the problems this can resolve. The
polyclinics have improved a lot also, because we have put radiology services in
many of them 24 hours a day, for example. There are emergency services there at
the polyclinics. The polyclinics are now open day and night for anything that
must be done there.

108.  Now, this doctor on duty could give some patients poor care in a
hospital, or he might give them deficient care, or he might forget about them.
It is very unlikely today that someone would dare to mistreat the patient of a
family doctor, that someone could forget about the patient of a family doctor,
or do something negligent or careless or any of those things, because the
family doctor is there, and then he follows up. If the patient has a heart
attack, he visits him and he meets with him and checks if he is complying
strictly with all the instructions he was given.

109.  This results in high quality; this has to result in great quality in
health care services, without even mentioning the most important thing the
family doctor has to do, which is to prevent illness, prevent accidents,
prevent early pregnancy, prevent heart attacks, not treat them, prevent
problems or strokes because of hypertension.  This is his number one task. This
is the number one concept, in which there is a world of things to do, of
course. He must organize the elderly, promote exercise, fight smoking, fight
everything. Family doctors must have certain qualities, because they set an
example for their patients.

110.  This is the battle we have been waging. Like all new ideas, it did not
catch on easily. Some things have already been said here about the battles that
had to be fought so that this would be understood among the students
themselves, among the students themselves [repeats], among the professors
themselves, and the specialists. There were many people who understood this and
saw the value and importance of all this. So I do believe it will become a
system.

111.  Now, I will tell the truth. If we had private medicine in our country, we
would not be able to do what we are doing at the level we are doing it. On a
given scale, something can always be done, on a given scale [repeats], in
certain areas more than others. Our doctors have renounced the practice of
private medicine. There is no law in Cuba that prohibits private medicine.
There is a pledge of honor by students, from the first classes, which is to
work in the service of social medicine. There are still a few private doctors
left in Cuba; do not imagine that there are not. There must be 30 or 40, more
or less. They are respected, and they can practice their profession, but it was
by this means, by voluntary means, that we gradually eradicated them.

112.  Now we can make a complete national system. You may ask: Can any other
socialist country do this? There are some that can do it; I do not know them
all. The ones I did know could not, because they had not prepared people for
this task. People must be trained to do this work, from before they enter the
universities. Some turned to specialization from the first year; that is, there
were no doctors in integrated general medicine. Others alienated people one way
or another, by commercializing them, even.

113.  If a professional is commercialized, and only wants to make money....
[changes thought] This was introduced into some of these countries. Some of
these countries, a few that I know of, they did not have the medical personnel
to establish a system like the one we are trying to establish. If you do not
have the people, it is not possible. I am not talking now only about systems.
There may be a system without having suitable doctors to carry out this task or
this work. Fortunately, these two circumstances were present in our case.

114.  We do not claim nor can we claim to be a model in this.  A model is not a
model. It would be an abstract model.  If we get away from the conditions of
the social system, the specific conditions of each country, the most that can
be borrowed in the vast majority of the countries of the world--especially in
the Third World, which is what most concerns us--the most that can be borrowed
are ideas, experiences, possibilities, greater knowledge of what is happening
in society with respect to health. That is why we cannot claim to be a model.

115.  We can point out the successes we have achieved, and the defects, and the
successes we have not yet achieved.  As far as prospects, I am convinced,
absolutely convinced, that for now we do not know, we do not know [repeats],
nor can we imagine a system that shows more promise than the one we are trying
to build and which will take years yet. Now, we can take advantage of the
experience accumulated. You cannot tell how much that is worth, because a good
idea here spreads immediately to everywhere. They do something in one province,
and in another, and there is a creative spirit about all this.

116.  In economic aspects, we should not forget that we base ourselves on a
different theory, not that of costs, but rather that a given social system,
whatever you want to call it, has to try to optimize the use of human
resources.  We start from the premise that socialism makes no sense if it is
not capable of optimizing human efforts and resources. If it leaves this to
spontaneity, to crazy, blind market laws or whatever, these laws will never be
able to create an ideal conception, or allow the development of something that
is absolutely rational.

117.  What happens? Tremendous underutilization of human resources. Capitalism
is concerned with whether economic resources are underutilized, with whether it
achieves maximum efficiency or not, but it is not concerned with whether it
underutilizes human resources, which are the most important thing. I say that
if there is a system, when human beings consider themselves civilized and are
almost exploring space, the most important thing is that it is able to make
optimum use of human resources. For whose benefit? For the benefit of society. 
If it does not achieve this, well, it may be that human beings are not
civilized enough yet; they have not yet advanced far enough in social matters
to be able to set up a rational society.

118.  A rational society has to try to use human resources optimally to meet a
maximum of society's needs of all kinds--material needs, health, education, or
cultural needs, or whatever. This is the aspiration to seek a society....
[rephrases] Throughout history there have been a lot of people and a lot of
philosophers who have tried to imagine a perfect society. Of course, when a
society can have 25, 30, 35, 40 percent of its resources, of its human
resources, not being used, this is a terrible thing. The idea is catastrophic.
Even in the most developed capitalist countries there is great underutilization
of human resources.

119.  There is also a lot of bureaucracy. Do not imagine that bureaucracy is
the exclusive heritage of socialism. There is a lot, for different reasons,
including pressure from the people themselves. If a problem in one place can be
solved by hiring 50 people, they demand... [rephrases] the union demands 300.
Now, we also have a lot of people who are being underused. We have not
succeeded in optimizing. It should be that the day there are too many people,
work hours will be reduced. Many things can be done.

120.  It makes no sense to have a man doing nothing, and a man doing nothing is
an expense. He eats, he travels, he needs shoes. Often he has one relative or
another who helps him, and he is a cost to society. Based on this idea, we say:
Instead of having people on inflated payrolls at work centers, factories, and
all that--and there are a lot--or in offices, it is better for us to train
those young people as doctors, nurses, teachers, give them training and use
them in an optimal way.

121.  That is, if we are going to have a surplus of people, we are going to
train them and have them work at least in providing services for the entire
society. This is our aspiration, that those 40,000.... [changes thought] By the
end there are going to be about 52,000, because I calculate that between
communities, factories, schools, etc., and child care centers there will be
about 26,000 people, count in replacements for them and there will be about
60,000 in all, which are 60,000 people to provide this service.

122.  I am not talking about health, because hospital services are more
expensive. It was well said here that there was a time when for every 15 people
who went to a polyclinic, one went to the hospital. Now it is that of every 240
people, one goes. How much do hospitals cost, and how many staff members does a
hospital have? So the hospital system is unquestionably much more expensive. 
If you have put 60,000 people in, the day this network is completed, you will
have less than 1 percent of the country's inhabitants. Possibly it may be
around 1 percent of the economically active population. In any country, you
will find.... [rephrases] In a country with 10 million people you will find 1
million unemployed. Any country like ours with 10 million inhabitants has 1
million unemployed now.

123.  Is it not better for us to have these people providing these services?
Which is even more--not more useful, which no one doubts, but which is more
economical? That is our aspiration as a society, to optimize human resources. 
Now I am talking about this field, but I could say the same thing about the
teachers. I could say the same thing about the scientists. I could say the same
thing about many areas. They said there were too many, that suddenly there was
a surplus of doctors? Why not send other doctors to study and put these to
work? Why not give them a free year so they can study for the famous sabbatical
year, to continue that concept of continual training for professionals? Why not
take a professional who spent seven years working and give a year of study to a
specialist, a specialist in integral general medicine?

124.  There have to be more. There have to be too many teachers and professors
if this goes along with a little technological development of production. The
tendency is for there to be too many. What is the big problem with industrial
reconversion in the developed capitalist countries? The people who are surplus,
and they cannot find anything to do with them. If there is automation,
robotization, and productivity is raised.... [changes thought] For example, we
used 350,000 workers to cut cane in 1970. Today about 50,000 are used, 50,000
or 60,000. We have saved 300,000 workers thanks to machines. Machines free the
labor force and allows us to have more human resources available.

125.  It is a disaster if we do not know what to do with the human resources.
For example, a man and a woman come into the world without knowing why, and
they have no chance. They are merchandise waiting for someone to buy them as
labor force. They are fourth-rate merchandise, or who knows what rate. These
are the concepts we base ourselves on, and we must keep all this very much in
mind.  We will continue accumulating all our experiences and transmitting them,
and we will continue organizing the seminars because they can be useful for
other countries, but the model cannot be made just like that. No one can
imagine that, and I do not believe that none of you imagine that, of course.
These are ideas that have to be associated with the analysis we make, but we
are making it.

126.  I am sure that this laboratory will give many more experiences and will
enrich the arsenal of knowledge and information of all those who, like
yourselves, are concerned about these matters.

127.  I should add something, another idea that I believe it is appropriate to
note. I believe--and I said it during that meeting--that a lot can be done in
spite of all the problems. We have to fight to do what can be done within the
system. I have no doubts about this, no doubts. I believe that the [infant
mortality] rates in Latin America can be reduced from 60 or 65 or 70 [not
further specified], which is the average they have now, to 30. It would not
even be expensive. With what is available now, with a little effort, with a
little will, a little will [repeats] to reduce the infant mortality rate, it
can be reduced to 30. I am going to say more: I believe it could even be
reduced to 25. The ability to do this is available now.

128.  The regional and world health organizations know this.  They know how
much the oral rehydration envelope costs.  Oral rehydration saves many people
even in the case of cholera epidemics. Those envelopes cost centavos. Who knows
about those 14 million children who die....  [rephrases] Would this not bring
up another issue? How are the 14 million going to eat if 12 million could be
possibly saved? The other problem comes up. What are they going to eat? What is
going to happen when they reach their first birthday? What is their life
expectancy? What kind of life are they going to have? How is the matter of
weight in relation to age going? All those rates need to be considered.

129.  Many problems could be solved. Of course, physicians are not going to
solve them. They could advocate the need for improvements, changes, but they
are not going to solve the social problem. The social problem is the tragedy of
today's world. It is something that has no answer. The problem of poverty,
hunger, and all of those phenomena have no answers. The world does not have an
answer to those problems. I do not know that someone is going to believe that
they are going to be solved with neoconservatism.

130.  All the housing problems, cases in which the cities are surrounded by
millions of people living under the worst imaginable conditions, the migration
from the countryside to the city, the increase in unemployment, all those
problems cannot be solved by physicians. This cannot be expected of them.
Physicians can cooperate with many things but they will not be able to solve
the social problem. I believe that in their area.... [changes thought] They can
have an influence in all areas but, in my opinion, the area in which they
should [corrects himself] they could have more influence is the health area.

131.  Every time one of these seminars is held, not only do all of us learn new
things, not only do we all receive new information, but I believe our
consciences also need to be strengthened. After certain rates are reached--I
believe it is fair to say--when you reach 25, 20--to speak of an rate--if one
wants to go lower than this, expensive and sophisticated medicine is needed.
Medicine could improve many other things, even reduce the number of accidents.
For example, we have attempted--especially during the last 10 years--to acquire
and introduce new technology in medicine. We attempt to acquire and introduce
each new thing that comes up anywhere in the world. When [computerized] axial
tomography became available, we got [computerized] axial tomography.  Nuclear
magnetic resonance appeared and we said: Let us get nuclear magnetic resonance
and let us see what it can do. When the extracorporeal lithotriptcy came, we
said: Let us get the lithotriptcy here to begin reducing traumatic surgeries.
When the linear accelerator became available, we welcomed it. We welcome any
new things, in addition to the new medical equipment we build.

132.  This is a field which has developed quite a bit. We have laboratory
analysis equipment such as the SUMA [Ultra Micro Analytic System] which uses
very small amounts, it makes 90 simultaneous analyses repeatedly. It is very
new equipment which is being improved every year. It is extremely valuable in
examining blood donations to see if there is hepatitis or other viruses. This
type of analysis prevents the spread of viruses. It also helps to reach
diagnoses. We have a few dozen new sets of equipment.  How valuable could they
be? I will give an example.  Something called (dirinamica)--that is the name
given it here--already exists in the world. It is used to shorten the time of
a....

133.  [Speaker, interrupting] An antibiogram.

134.  [Castro] What was that? It is an antibiogram, yes, of an antibiogram. In
the natural way, through cultures, it takes 48 hours or more to find out which
antibiotic should be administered. Imagine what it is to lose 48 hours or more
with a patient in serious condition.

135.  We already have a machine that in four hours, in less than what it takes
other machines on the world market-- I understand that there are machines that
take up to 12 hours--we have machines that make the analysis in four hours and
indicate which antibiotic should be used. How many lives can a machine like
that one save?

136.  We are developing machines but we do not believe we are going to develop
all the machines that are needed in medicine. We are fighting to be up to date
in any technique. I mentioned mammography here. We did not invent that machine.
Others invented it and we acquired it. We have made advancements in surgery, in
many transplants, kidney and heart transplants. Coinciding with this
seminar--it was an absolutely coincidental thing--we implanted an artificial
heart for the first time. The idea of attempting to make the artificial heart
was pretty audacious but it was done. It was implanted a few days ago. I ask
the hospital's director every day how the case is progressing. Well, I know
that at least four days had passed. A heart was made available. The patient
had-- because of the group he falls in--an 80-percent chance of being able to
get the first one that became available, but it could not be used because it
did not match the group. Four days had passed--which was supposed to be enough
time to do the [word indistinct] I do not know if they have more recent news
about that. Gomez Cabrera should be around there. I saw him somewhere. Nobody
knows?

137.  The case was going well last evening when I asked him. I believe four
days had passed. That is a more expensive type of medicine. Did I mention the
linear accelerator?  Yes, I did. This is also combined with radiology. We have
a lot of hopes of the linear accelerator regarding the possibility of
noninvasive brain surgery. With this, I want to tell you that we have tried to
begin acquiring, begin mastering all the new technologies that are appearing. 
Once we get the news.... [changes thought] Many times we do not wait for the
conferences. Many times we learn about developments in newspapers, in news
dispatches, and we are immediately interested in the technology. This is in
addition to the ones we develop.

138.  There are things that if we did not do them, we would have not reached
the 10.7 [infant mortality rate]. I am going to cite some. First, there is
pediatric intensive care. This helps to save lives. Second, there is early
detection of congenital malformations of the neural system or heart, all of
those that can be detected through analyses, through reagents, or other methods
such as radiology. In this case, through ultrasound, the equipment available to
detect, not to detect, [corrects himself] to examine pregnant women.  The rate
of heart defects is not very low, for example. A third factor is the Children's
Cardiovascular Surgery Center. Even premature babies are operated on there. 
They are also learning the techniques for intrauterine surgery there. I have
mentioned three. [Fourth] we have to include--I mentioned cardiovascular
surgery--perinatal intensive care services. This is a service that we have been
extending to all maternity hospitals in the last two or three years, taking
into account the number of those who die in those first weeks. Fifth, there is
the family doctor.

139.  I understand that these five factors play a very important role because
there are birth defects that are incompatible with life. If they are detected
in time, at the right time, the pregnancy can be interrupted. All these factors
help to reduce the rates. Nevertheless, there is a curious thing that catches
our attention. Several provinces have a rate lower than 10. There are
municipalities with 0. Sometimes they have had a rate of 0 for two years. There
are provinces with seven or eight. It is a curious thing. The capital has a
rate of 10. Several provinces have an rate greater than the one the capital
has. Sometimes it is seen that there are regions with greater rates of birth
defects.  Sometimes there are even municipalities with greater rates of birth
defects. Another curious thing: There are regions with greater rates of mental
retardation.

140.  Studies need to be conducted of all those things that are being
discovered. Studies need to be conducted to find out the reasons. When you ask
how many died at the polyclinic, two, three, all of them, most of them are
because of unsolvable problems. There is a large number of unsolvable problems.
There is, however, room [for improvement]. We do not have the lowest rate in
the capital now. It has a rate of 10. There are several provinces that have
rates that are lower than 10. This shows one thing: that health care is
generalized and that it reaches all the corners of the country.

141.  It also shows the possibilities of reducing the rate below 10.  I already
said the other day that we do not know if we have the best conditions to reach
that goal genetically or weather-wise. It is lower than 10 wherever there is a
family doctor. I believe that is evidence of the effect the family doctor has
had in reducing the infant mortality rate. I say this because it is a reality.
There are rates that can be reached with relatively inexpensive medicine. I
believe those are the rates we have to go after. It is an illusion to attempt
or advocate a general type of medicine like the type of medicine we are
practicing because this is more expensive. It is more expensive. [repeats]

142.  There is another field that is very promising in our country, and that is
the field of research, the task of the research centers in the area of
biotechnology, medicine, medical equipment, everything related to human health. 
I already mentioned the health of plants and animals. We have a group of
research centers working on this. All the medical schools are doing research.
All the universities are doing research nowadays. Research is prioritized in
this field. Results such as the meningitis vaccine have come from this, the
vaccine against meningitis B. This one does not exist in other countries yet.
The vaccine against hepatitis B exists in some. We also have the vaccine
against hepatitis B. We have the skin growth factor used for burns and ulcers.
We have the skin growth factor. Recombinant streptokinase: We are the first
country to have recombinant streptokinase. It is much more economical than ATP
[adenosine triphosphate] because this is a natural product and is extremely
expensive.

143.  We are working on finding the nerve growth factor. We are working very
hard. This is related to all nerve transplants and rehabilitation programs.
This is to give you some examples. We are working on other types of vaccines.
We are working in all fields. We are working with new products, and also with
the universal pharmaceutical formulary. We are developing a strong medical
industry. We are producing medicines and equipment, not just new ones. It is a
broad and very important field. An example of this is the study of natural
products, botanical medicine. We intend to boost this area. We will study the
effect of natural products on the human organism. We are going to create a new
research center for natural products alone using groups who have been working
in this area.

144.  I believe that we should study anticarcinogenic products.  In the same
way that everything that has a carcinogenic effect is studied, everything that
stops the mutation of cancer should be studied. A number of products that have
those qualities are known. We have to study them systematically and thoroughly.
This involves serious work.

145.  Yesterday I was talking with a group of delegates. I was telling them
that we are going to throughly study the problems of nutrition, especially a
theory based on research conducted in other countries comparing the recommended
diet and other types of diets. Research shows that many of the worst diseases
are started pretty early--at least in animals--with the American diet, with
that diet. This diet is called an undernutrition diet and not a malnutrition
diet, as a concept that is the opposite of the super diet. It has been shown in
animals that those diseases take almost twice a long to appear.

146.  See, this would be the only good news the Third World could receive
[chuckles] that with the so-called undernutrition diet --that is, based on
concepts other that those of the diet recommended in the developed world--human
life expectancy is considerably increased. We know this through what it has
been published as a result of the research conducted in Europe and the United
States.

147.  I say, we have to do all this research very thoroughly to see if there is
some truth to it. In the case of cancer, there is the study of anticarcinogenic
products, all the problems related to early detection. [Words indistinct]
mentioned machines but monoclonal antibodies could be mentioned. They could be
used for diagnosis at a very early stage. We are also working with monoclonal
antibodies with the idea of fighting cancer, not just diagnosing it but
fighting it. We have also conducted experiments with natural products such as
interferon obtained from blood. A lot of progress is being made.

148.  It is incalculable what can be achieved in the fight against cancer with
early detection alone. I also trust that we can do all the necessary research
in order to use those natural products that fight cancer. Natural products
fight cancer in the same way that tobacco promotes it.

149.  What results can be obtained? In addition to working intensely, we are
working and will work more intensely in everything concerning cures, cures
also, not just diagnosis but also curing cancer. This is one field. We are
working a lot with everything that has to do with circulation. We are working
on all the fundamental problems affecting health. I do not think there is
anything more important that we could be doing right now.

150.  Our young people and our scientists have demonstrated their abilities in
this research, in this kind of work. I can tell you that there are thousands of
scientists working right now on these tasks. We are building numerous research
facilities. This is an abosolutely prioritized activity in this field. We are
bringing biological and biotechnological research in general to all places. I
will say that what we have accomplished to date may be 10 percent, one-tenth,
of the effort we are going to make in this field in coming years. We have some
medications that show a lot of promise. They are in the testing phase, the
phase of research of all kinds, and medical protocols, and we do not want to
say too much right now, but there are some medications that show extraordinary
promise.

151.  So this can be our country's contribution to the health problems of the
Third World and the entire world, because some of these medications are in
universal demand. How much progress will we make? We do not have a lot of
resources, but some of the few resources we have are being invested in this. I
think this is part of this whole struggle.  I have said this about the field of
medicine and the field of medical equipment. We are developing a research
center for electronics and computers which will be entirely devoted to
supporting the scientific research centers and will also produce equipment for
the research centers and medical equipment. This is because we are building the
factories around the research centers and subordinate to the research centers.
That is the reverse of what happens in other countries.

152.  All this facilitates the process of immediately applying any innovation,
any result of research. I can assure you that in our country today, we do not
lose even 24 hours from the time we know of a scientific result to the time we
begin to design a pilot plant or whatever connected with it. We will try, on
some occasion, especially at the next seminar--for those who come--to make time
to visit the scientific research centers. I think this would encourage you a
lot. Then you would have a clear idea of the solidity our medical programs have
today, based not only on the systems and concepts that are applied but also
based on the training of the specialists, based on the production of medicines,
and based on scientific research.

153.  Of course, scientific research in this field goes beyond our borders. The
number of people who want to come to receive some medical service in Cuba is
growing. Really, it is growing, and people come from all over, not only from
our brother countries in Latin America but even from industrialized countries.
We hope that the progress we will make will be useful not only for our country.
So I say that already many of the things we are doing and the things we are
producing go beyond our borders.

154.  It is almost a rule that every time a dengue epidemic occurs in Latin
America they immediately ask us for information because of the experience we
have accumlated with this.  Also when the cholera epidemic began they
immediately asked us for cooperation, for the information we have. Because we
have doctors working in more than 30 countries and there are diseases in those
countries that do not exist in Cuba or in Latin America, this has allowed us to
gain a lot of experience.

155.  We have an institute for tropical medicine, which will soon move into its
new buildings, magnificent buildings, and I think this institute can also be of
great use in general to Third World countries, and it is a very important point
of support for research. We have followed this path; it is one of the
prioritized activities. We are working on the food program. We are working on
tourism. We have economic needs. We are working in general in the economic
field, but this activity I am referring to has very high priority.

156.  There are many very valuable scientists devoted to these tasks. I was
saying that I wished you could visit some of these places. The organizers
should include a program of visits. They are close to here; the centers are
close to each other. They should be included in this program, because I know
this will interest you and will encourage you, the fact that a Latin American
country, and a Third World country, can do these things. I can say that many
visitors express their admiration, and on many occasions, on not a few
occasions, their surprise at what they see.

157.  Naturally, this encourages us, but events like this one, meetings like
this one, seminars like this one, especially encourage us. Perhaps you think
that you are going back with some encouragement from the exchanges of views
among all of you, the experiences shared among all of you, and the part that
corresponds to Cuba's experiences. I can assure you that we are the ones who
feel very encouraged to continue with our efforts, redouble our efforts,
multiply our efforts.

158.  You also make us feel part of one family. You make us feel part of one
world. You make us feel part of your sufferings, and we share them. You make us
feel that we are in solidarity with those sufferings, and it multiplies our
desires to join together, work together, and participate in this struggle. I
want to tell you--to close now; good news for those who are about to fall
asleep--that you can consider our people's efforts, you can consider all these
things I have been talking about--our experiences, our advances, our
research--you can consider them not as Cuba's property, but as the property of
all of Latin America and the Third World.

159.  When I speak of Latin America, naturally I give it special emphasis,
since here, with the exception of some delegates who speak other languages,
here we speak a single language. We have something that others do not have. 
They are saying that Europe is coming together, and in fact it is coming
together. They say they are uniting, and in fact they are uniting, but they
speak something like 15 different languages. Europeans cannot meet together as
we do and speak a single language.

160.  We who speak a single language and do not need translators can ask: Who
has more ties and more things in common than our nations? How much time have we
lost? Our destiny and our future cannot be otherwise. We cannot be a Balkanized
set of countries, incapable of confronting the great challenges of the colossal
economic and scientific powers of this age. This is a long road, but we must
move forward step by step.

161.  These seminars, these meetings, this cooperation in the field of
medicine, as in the field of health and other fields, unite us a lot. We do not
know how many friends are appearing, how many values are being discovered, and
how many possibilities are opening up. This is why we are not saying farewell
as a group of guests, and it is forbidden to say the word ``foreigner.'' We are
saying farewell as a group from a great family, as a group of brothers from the
great nation of Latin America. Thank you very much. [applause] In our farewell
we should include our Iberian brothers who are present here.  [applause] We
should include our English-speaking brothers who have also accompanied us.
[applause]
-END-