Cuba’s Secretive Public Health Policies Criticized in Medical Journal

Cuba's Secretive Public Health Policies Criticized in Medical Journal
July 8, 2013 | Print |
Rogelio M. Díaz Moreno

HAVANA TIMES — An article titled "Secret Epidemics: Cuba's Public Health
Ethics" ("El silencio epidemiológico y la ética de la Salud Pública
cubana") appears in the most recent issue of Cuba's quarterly Public
Health Journal (Revista Cubana de Salud Publica). Written by National
School of Medicine physician Luis Suarez Rosas, the work criticizes the
Cuban government's information policies in the area of public health.

As almost everyone knows, official Cuban newspapers showed themselves
immensely reluctant to publicly acknowledge the different epidemics that
broke out around the country in recent years. Whenever there is an
outbreak of dengue, for instance, major and local papers seem to turn
their backs on the problem or show more interest in the misfortunes of
distant nations. The massive campaigns launched by the country's public
health system are evident for most citizens, save government journalists.

Unsatisfied with this state of affairs (as many of us are), Dr. Suarez
Rosas elucidates the disadvantages inherent to such secretive practices.
In his article, he points out that there is no shortage of scientific
knowledge about and experience in the management of epidemics, in Cuba
and abroad. This, which should help reduce the number of such outbreaks
and their impact on the population, is only undermined by concealing
information from the public, a practice which encourages the spread of
every imaginable rumor.

Cloaking the reality of an epidemic with a veil of silence, Suarez
argues, in no way contributes to reducing the incidence of the disease,
for an uninformed population can never attain a realistic perception of
the risk of contagion or the gravity of an illness. It isn't hard to see
how such questionable practices hinder the social mobilization needed to
combat such means of disease transfer as the Aedes aegypti mosquito,
which is a carrier of dengue. Suarez asks:

"Does the fact that doubt exists as to whether a dengue epidemic is
currently being concealed from the public in Cuba in keeping with the
ethical standards reached by Cuba's public health system?"

According to the author, the common strain of dengue was first
introduced into Cuba in 1977. Despite concerted efforts to eradicate the
carrier of this disease, a considerable part of the island's population
was infected. As of the tragic epidemic of 1981, this insidious virus
would become one of Cuba's most persistent epidemiological problems.

In the 80s, Cuba's national public health system was given considerable
financial impetus and sought to become an internationally renowned
healthcare model. Deprived of East European subsidies starting the 90s,
the system invariably deteriorated, despite different government plans
and initiatives of varying success.

New dengue epidemics have since broken out across Cuba's public health
panorama, most intensely between 2000 and 2002 and in 2006. Suarez was
unable to find official mention of the dengue cases reported in 2012,
though less secrecy surrounds the cholera outbreak experienced this
year. In this connection, the author explains that "in the Pan-American
Health Organization report on dengue cases in Latin America, submitted
on epidemiological week 36 (last updated on September 25, 2012), we find
no reports from Cuba. In the row for the country, what you read is:
'Without reports'."

As for me, I don't need an official report to know there's dengue in
Cuba. My two parents caught the infection and had to be admitted,
simultaneously. I can therefore echo the author's opinions when he
writes that:

"Whether cases of a particular disease have been detected, or not, is
the kind of public health information and issue that demands a very
thorough ethical consideration, and which requires a responsibly
transparent means of informing individuals and population groups that
does not distort, conceal or hijack any information. In many cases, such
practices are a matter of life and death."

In the author's opinion, secretive practices, and the questionable
ethics behind them, are totally at odds with a legacy of Cuban health
professionals which spans hundreds of years. Cuba's health system, he
adds, constitutes one of the country's treasures and an immensely
valuable resource for the island and other countries around the world.

In view of this, he argues that re-establishing health practices that
are more in keeping with the humanistic principles and the respect for
truth shown by earlier generations of Cuban health workers must become a
priority in the process of addressing the sector's problems.

Most articles published by Cuba's Public Health Journal are
characterized by unconditional praise of the government. It is also
evident the journal has a limited readership, confined to small,
professional circles. It is therefore encouraging to see that
individuals calling for greater respect towards citizens begin to be
published in the journal, and that more and more voices are demanding
the right to access accurate information about vital issues, through the
newspapers that supposedly belong to the people.

According the Royal Spanish Language Academy, "Ethics is the branch of
philosophy concerned with morality and the obligations of human beings"
and "the set of moral norms that govern human conduct." From this
definition, we can say that Ethics constitutes a reflection on morality
which delves into that which is specific to human behavior and
enunciates general, universal principles that are to govern all conduct,
in order to establish norms and codes that determine what is considered
a good practice and the prohibitions that beset it.

No ethical code exists in the abstract, isolated from specific
circumstances. The ethical legacy of Cuban health workers, whose work
over hundreds of years underpins Cuba's public health system, from that
of Tomas Romay (responsible for the island's smallpox vaccine) and
Finlay (head of the School of Cuban Hygienists in the late 19th and
early 20th century) to those of exceptional men and women of our times,
devoted to the creation and consolidation of a nationwide public health
system sustained by solid ethical foundations, can guide us in our
reflections and actions today, when ethics is the only thing that can
afford us a feasible and sustainable solution to the problems we face.

On July 26, 1981, in the city of Las Tunas, during his address for the
main function held to commemorate the 1953 attack on the Moncada
garrison, Fidel Castro declared:

"I believe that, if any country is capable of eradicating this mosquito,
it is Cuba, and this because of its organization, the educational level
of its people, the discipline and work ethic of our people. Because of
these things, I believe our people can take on the aim of eradicating
this mosquito."

Three decades after these words were spoken, the main carrier of dengue,
the Aedes aegypti mosquito, has not been eradicated in Cuba and the
disease continues to affect its population.

Source: "Cuba's Secretive Public Health Policies Criticized" -
http://www.havanatimes.org/?p=96055