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Castro's exported doctors are human beings whose lives and skills belong to him and are his to barter. They are Castro's slaves.

Ambassador denounces anti-Cuba campaign in Venezuela*** ``Revolutions cannot be exported or imported like merchandise. They are born from the stomach of each country,'' he said in a Friday interview with Caracas daily El Universal. He said the campaign is funded by Miami-based anti-Castro groups. An energy pact signed last year allows Cuba to pay for some of its Venezuelan oil imports with goods and services. The communist island has sent 178 doctors and 323 sports trainers to Venezuela under the pact, and Chavez has sent more than 500 Venezuelans to Cuba for free medical treatment.***

***Thirty Cuban doctors also arrived in Caracas Wednesday to serve the needy in rural Venezuelan provinces. It's part of a deal in which Venezuela sells Cuba oil at preferential rates in exchange for Cuban expertise in tourism, sugar, medicines and other areas. Venezuela provides Cuba 53,000 barrels of oil a day - by some estimates worth $500 million a year. Cuban ambassador German Sanchez Otero said Cuban trainers work at schools and with athletes in 20 of Venezuela's 24 states. He stressed a ``synergy'' between Fidel Castro communist Cuba and Venezuela's leftist government.*** Venezuela barters oil for Cuban doctors

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American students attending medical school in Havana, Cuba are seen Tuesday Aug. 27, 2002. From left: Donniele Marshall, 21 from Delaware, Pierrecharles Serge, 23, from New York, Cuban professor Andres Rodriguez, Sitembile Sales, 22, from New York, Janell Lowe, 23, from New York and Narciso Ortiz, 26, from New Jersey.(AP Photo/Jose Goitia

Cuban Medicine and Foreign Patients

Mark Falcoff

Few political myths in the contemporary world have proven more durable than the notion that medicine in Communist countries is somehow superior in quality and service to that offered in the West, particularly the United States. For some inexplicable reason, the collapse of the Soviet Empire and the embarrassing revelations in its wake have done little to diminish the notion as far as it applies to one of the world's few remaining Communist states: Fidel Castro's Cuba. Establishment figures such as former Defense Secretary and World Bank President Robert McNamara, though gingerly critical of Cuba's political system, go out of their way to praise the island's medical "achievements," and the American press periodically regales its audience with reports on the thousands of foreigners who flock to Cuba for excellent medical treatment, at a fraction of its cost, we are continually reminded, in the United States.

Even now, nearly seven years after the collapse of its Soviet patron and financier, Cuba harbors pretensions of being a "medical superpower." As the author of this document makes clear, this is no accident: rather, it is the product of a conscious political and ideological campaign with important economic implications. Today, Cuban medicine and, particularly, its surgical branches are wholly oriented toward the generation of foreign currency. As a result, ordinary Cubans are shunted aside or made to wait indefinitely while foreigners occupy hospital beds, surgical wards, recovery rooms and rehabilitation facilities.

But this is not all. Even in the privileged precincts where only foreigners are treated, medical care is often substandard or flatly fraudulent. Foreign patients are lured to Cuba with promises of nonexistent treatments or cures for diseases where none exist. The treatment they receive is in no way superior to what they would obtain in their own countries, and, in some cases, it is inferior. Once in Cuba, the foreign patients are subject to robbery, sexual harassment, and extortion by hospital and nursing staff. They are prescribed Cuban drugs they do not need, merely to increase the size of their bill. Most important, many patients do not improve after treatment. Some succumb to opportunistic infections due to unsanitary conditions in kitchens and even operating rooms.

Some of the incidents described here are horrifying: Women seeking abortions are forced to have Cesarean sections when an ordinary vaginal procedure would suffice; fetal tissue is sold outside Cuba; patients are urged to submit to unnecessary surgery so hospitals can fulfill their "quotas;" qualified doctors and staff are often replaced by party hacks and bureaucrats; hospitals are used in narcotics trafficking. All this and more is detailed in the pages that follow. It does not make for appetizing reading. But it provides a devastating corrective to notions all too prevalent in the Western media and in many political and cultural circles in the United States and Western Europe. Perhaps surprisingly, although Cuban hospitals are being pressured to become financially self-sufficient by giving exclusive priority to foreign patients who can pay in US dollars, our author tells us that most medical institutions on the island are starved for resources: What they earn from their foreign patients must be forwarded to a central fund from which they cannot draw at their own discretion. Rather, the state decides funding levels, which, according to the author, almost always fall short of the hospitals' actual needs. She also suggests the possibility that the central fund is used for decidedly nonmedical purposes, namely, to pay for trips abroad for the Cuban chief and his cohorts.

FOREIGN PATIENTS ARE LURED TO CUBA WITH PROMISES OF NONEXISTENT TREATMENTS OR CURES FOR DISEASES WHERE NONE EXIST... THEY ARE PRESCRIBED CUBAN DRUGS THEY DO NOT NEED, MERELY TO INCREASE THE SIZE OF THEIR BILL.

The author of this document is no run-of-the-mill Cuban physician. A distinguished neurosurgeon of international reputation, she is the founder of Cuba's International Center for Neurological Reconstruction and a pioneer in the treatment of Parkinson's disease. Until recently, she was a member in good standing of the Communist Party and the Cuban Federation of Women. Her relatively high standing in the medical establishment is attested to by the fact that she occupied a seat in the National Assembly, Castro's puppet parliament. Her difficulties with the regime began in 1989, after the Soviet subsidy ended and Cuban hospitals were pressured to follow the regime's new economic logic. But there were other problems as well. She refused to engage in political propaganda on her foreign trips, which she regarded as wholly of a scientific nature. She refused to participate in Cuban efforts to recruit foreign scientists for tasks of an (undisclosed) "nonmedical nature." She resisted attempts to divert her staff from their duties to attend sessions in political indoctrination. Her efforts to enforce high ethical and professional standards among subordinates backfired politically, causing her serious problems with the provincial authorities of the Communist Party.

But her chief difficulty with the authorities was her refusal to convert her Center into a cash cow for Castro's regime: She would not prescribe therapy or drugs that her patients did not need. In retaliation, the authorities forbade her from traveling abroad. They organized a whispering campaign against her and her Center. They even introduced political provocateurs to sow dissent between the hospital management and its workers. Eventually, the Cuban government and the Communist Party demanded that she share administrative authority in the hospital with a "political commissariat." Instead, she resigned. At that moment she also rescinded her party membership and her seat in the National Assembly.

Thereafter, the Cuban regime blocked all her communications with professional colleagues abroad, intercepted and read all her personal correspondence, tapped her telephone and put her under surveillance. She even received anonymous phone threats. The regime attempted to undermine her reputation in Cuba and "to create confusion and disinformation abroad about [her] work,'' happily without much success. Most recently, she was refused an exit permit to visit her son, also a physician, who lives in Buenos Aires with his Argentine wife. From a woman deeply involved in the revolutionary process, she has suddenly become a non-person.

Since her departure, the International Center for Neurological Reconstruction has completely lost contact with the international scientific community. The foreign contacts it maintains are driven strictly by the need to generate money from abroad. Servimed, the Cuban government agency in charge of recruiting foreign patients, now works hand in glove with unscrupulous tour operators and foreign physicians (many trained in Cuba) to funnel unsuspecting patients to the island. Close by are a gaggle of foreign politicians, businessmen and diplomats who skim off resources in their role as Servimed's advance men and propagandists. Let those who contemplate medical treatment in Cuba, the author seems to say, beware.

The document which follows begins with a general survey of medical conditions in Cuba since the Soviet Union's collapse. From there, it turns to an extensive discussion of the conditions in the author's hospital and the difficulties that eventually led to her resignation. Finally, it concludes with a brief survey of other Cuban hospitals, about which the author has some professional knowledge, presumably through her still wide network of professional contacts in Cuba .

This testimony does not make for light reading. More than just a report on a medical crisis, this is a remarkable exercise in self-revelation. A woman fully committed to Communist ideals came to see over time that "the problems which, in [her] naiveté, [she] had attributed for years to individual errors, were part and parcel of a larger system, one with neither scruples nor any sense of ethics." She continues, "Let those who read these pages do with the information what they consider best. I am not moved by any personal interest, much less desire for revenge. But I do consider it my obligation as a physician to defend both ethics and truth." Both are well-served by this timely, courageous and revealing document.

Mark Falcoff is Resident Scholar in Foreign Policy at the American Enterprise Institute in Washington, DC. He was a professional staff member with responsibility for Latin America of the Senate Foreign Relations Committee in the Ninety-ninth congress, and has taught at the universities of Illinois, Oregon, and California (Los Angeles). He is the author of Small Countries, Large Issues, A Tale of Two Policies, and Modern Chile: A Critical History.