And In Cuba...Quarantine

By CATHY BOOTH/PINAR DEL RIO

THE MAN WAITS ANXIOUSLY AT HAVANA'S JOSE MARTI International Airport, scanning the arriving passengers for the courier from Miami. The life of his nine-year-old daughter, deathly ill with a cancerous tumor, hangs in the balance: the doctors have prescribed chemotherapy, but two of the five drugs needed for treatment are unobtainable in Cuba. Both medications are readily available in Miami, only a 30-minute flight away, but the 32-year-old U.S. trade embargo bars the unlicensed sale of medicine to Cuba. The father's last hope lies with an old woman who has agreed to smuggle $10,000 worth of chemotherapy drugs from Miami to Havana. When he spots her at last, he bursts into tears. Four hours later, his daughter is undergoing her first treatment session.

The long-respected health-care system in Cuba is faltering under the combined impact of the U.S. embargo and the loss of the East bloc as a reliable trading partner. While Cuba can still boast of having 51,000 doctors -- 1 for every 231 inhabitants -- it suffers from a critical shortage of medications and medical supplies. Last year's mysterious neuropathy epidemic, which affected more than 50,000 people and was apparently linked to nutritional deficiencies, has run its course with no deaths, but critical shortages are threatening to unravel a health system once described by the Pan-American Health Organization (PAHO), a branch of the World Health Organization, as "better than that provided by the rest of the Americas.

Pharmacy shelves are bare, even of common-cold remedies. Doctors complain about shortages of antibiotics and approximately 200 other medications, ranging from simple Mercurochrome to sophisticated cancer and heart drugs. Aspirin has been rationed to 20 pills per person per year (40 pills for Havana residents, no doubt because of urban stress). About 10% of Cuba's 10.7 million people suffer from asthma, but asthma inhalers are almost impossible to obtain. Even such rudimentary supplies as sutures, syringes and surgical gloves are scarce, as are anesthetics. "We haven't had a simple cotton bandage to put under children's plaster casts for three or four years," says Dr. Julio Gomez, a pediatric surgeon at the Enrique Cabrera National Hospital, outside Havana.

The government once tried to gloss over the shortages, but not any longer. The money is simply not there: budget allocations for health care in 1993 were one-third the $300 million spent in 1989, a gap that will hardly be bridged by an expected $30 million worth of humanitarian donations from abroad. "If you go to a medical center, you will see how conditions have deteriorated," says Public Health Vice Minister Ramon Diaz Vallina. In many cases, diagnostic equipment stands idle for lack of spare parts and readout paper. Mammograms were cut back last year because of chronic X-ray-film shortages.

The American Public Health Association, a U.S. research and professional organization, reported last year that health standards in Cuba have "declined dramatically" over the past two to three years. Physicians fear that deteriorating sanitary conditions will bring back dysentery and typhoid, since soap and detergents are in short supply, as is chlorine to treat the water supply. The incidence of hepatitis A and diarrhea is on the rise, and infant tuberculosis is a growing problem in poor sections of Havana.

As the U.S. embargo has tightened, Cuba has had to import more drugs from Europe, Japan and Canada, tripling costs of the medications needed to treat and prevent, for example, typhoid and whooping cough. A 1992 U.S. law forbids foreign subsidiaries of U.S. companies to sell to Cuba; Dutch and Swedish firms report that they too are being pressured by Washington to stop providing such items as catheters and sutures. A Canadian firm was even barred from selling Cuba a U.S.-made steel pin to repair a broken operating table. Medical journals are included under the embargo.

Despite the difficulties, however, Cuba's mortality rate for infants and children under five continues to improve. At 9.4 deaths per 1,000 infants last year, Cuba's rate is surpassed only by Canada's (7 per 1,000 in 1992) and the U.S.'s (9 per 1,000) in the western hemisphere, according to PAHO. Though hard-pressed for basic supplies, Cuban biotech labs still produce the world's only meningitis B vaccine, as well as 39 monoclonal antibodies for treating cancer. The Neurotransplant Center in Havana is rated the best in the world for fetal-tissue transplants to treat Parkinson's disease, a degenerative brain disorder that causes muscle tremors and weakness. One of Cuba's most popular new over-the-counter drugs is PPG, a sugar cane-based medication developed to lower cholesterol; reputedly it also boosts sexual potency.

With the shortage of modern drugs, herbal medicines -- Cuba produces 300 different types -- are making a vigorous comeback. "People used to say only witches and the uneducated used herbs, but as times and politics have changed, we have turned to medicina verde," says Dr. Majmud Gomez, a family doctor in Pinar del Rio. He uses herbal preparations to treat a variety of conditions, from parasites to a problem caused by the soap shortage, an itch for which he prescribes a pomade made from the majagua tree.

The embargo's impact on health care has become an issue for U.S. groups like Pastors for Peace, which feels morally obliged to circumvent the ban by sending humanitarian aid to Cuba. Some of the aid may not reach those who need it most: there are complaints in Havana that donated medicines are being diverted to the government's dollar-only stores. As the medical scarcities multiply, discontent over the pride of the revolution is bound to increase.