Why is Cuba so concerned about maintaining a reputation of superior health care? For one specific perspective, I again turn to my interview with Carmen. Fortunately, Carmen has also been able to rely on her mother’s older historical perspective to supplement her own memory, offering a survey since the Revolution’s beginnings. Regarding the current status of domestic health care in Cuba, in her opinion, Carmen definitively argues that it has deteriorated, but it is one of the few things Cubans can still be proud of. She attributes the system’s decline to the fall of the Soviet Bloc and the subsequent crisis of the período especial. Cuba abruptly stopped receiving money, medical supplies, technology, and knowledge (through personnel who would travel to Cuba). Even though the embargo has existed since the 1960’s, only until after the
período especial did it become a life-threatening issue. It compounded the crisis by
discouraging countries and companies around the world from selling to Cuba through various trade laws.
According to a joint report from the Washington Office on Latin America and Oxfam America, Cuba’s shortage of biomedical technology was inevitable. Carmen, explains that when Cuba was supported by the Soviet Union, the lack of access to medical supplies was merely a large inconvenience, rarely life-threatening.
Cuba, produce the desired effect (by American officials) of not only applying to
American citizens, but also any foreign national who conducts business with any United States citizen or business. One such example is the instance of a foreign vessel that docks in Cuban waters or ports. Regardless of intent or purpose (such as refueling), that vessel is legally unable to dock in an American port for the purposes of engaging in trade for six months (United States: 17).
Therefore, Cuba’s largest hurdle in preventing it from entering the modern era is the United States’ embargo. Through the complex and well-planned humanitarian-based system (with clear political underpinnings), Cuba has gained overwhelming support in pressuring the United States to lift the embargo across the geopolitical spectrum:
It [Cuba’s recognized success via medical diplomacy] also has contributed to Support for Cuba and rebuke of the United States in the UN General Assembly, where for the past eighteen consecutive years members voted overwhelmingly in favor of lifting the U.S. embargo of Cuba. In fact‚only Israel and Palau have supported the U.S. position, and the Marshall Islands and Micronesia abstained. With equal voting rights for all members of the UN General Assembly, Cuba’s medical diplomacy with such a large number of member states is a rational endeavor, however humanitarian the impetus may be (Feinsilver 2010: 97).
As seen though the UN General Assembly annual vote, Cuba has overwhelming support to lift the embargo. Feinstein emphasizes that without such a monumental expression of goodwill and humanitarianism realized in Cuba’s medical diplomacy, there would be little to no support for lifting the embargo.
The embargo is not simply an inconvenience, but greatly limits what goods and technologies are available on the island. The key role American pharmaceutical and biomedical companies hold within the global biomedical community limits the resources
available in Cuba. Prostaglandin, the preferred drug by obstetricians for inducing labor was previously only produced by Upjohn (no longer in existence), an American
pharmaceutical company, forcing Cuban physicians to rely on other medications which carried higher risks for both the infant and mother (“Myths And Facts” 2). The director of one Cuban maternity hospital explains that the “replacement” drug, an oxytocin, is incredibly inferior compared to the prostaglandin standard. Oxytocins carry greater risk for both mother and child, with risks of uterine rupture, amniotic fluid embolism, and fetal distress or fetal compromise (Reed and Frank 144). Other barriers to modern biomedical care within Cuba include replacing faulty parts to equipment or non-reusable materials (such as X-ray film) (“Myths And Facts” 2). Cuba has little recourse to procure materials it cannot from the United States. One tactic is to produce American owned pharmaceuticals within their own production sites. Unlike other countries, the United States has no leverage to prevent Cuba from breaking American patents. There are simply few remaining sanctions the White House could implement to discourage such actions. Therefore, if the technology exists in Cuba, domestic production is one avenue to acquire goods. The other, more frequent, option is to purchase products from
companies not based in the US who are willing to sell to Cuba. The prices are often higher due to the trade-related repercussions they face from the United States.
Despite the economic barriers the U.S. embargo employs, Cuba has made the best out of the situation, at least in regards to health care. By displaying both its medical skill set and ideology, the world overwhelming approves of the former, creating the perception that the United States refuses to move out of an outdated mindset, regardless of the embargo’s toll upon Cuba’s silent citizens. Another advantage for Cuba is the attraction
of partners in solidarity, such as Ecuador, that view Cuba’s strong stance against the United States as a sign of courage and fortitude. This maneuvering by Cuba is not coincidental but a calculated process in which the Cuban government positions itself as the humble “healer of the world,” but still mistreated by its powerful neighbor to the north.