In Cuba, bartering eye care to regional neighbors strains health system
By James C. McKinley Jr.
Tuesday, November 20, 2007
A spiffy new tour bus pulled up to the top eye hospital in Cuba on a
sunny day this month and disgorged 47 working-class people from El
Salvador, many of whom could barely see because they had thick cataracts
in their eyes.
Among them were Francisca Antonia Guevara, a 74-year-old homemaker from
Ciudad Delgado whose world was a blur. She said she had visited an eye
doctor in her home country but could not even pay the $200 needed for
artificial lens implants, much less for the surgery.
"As someone of few resources, I couldn't afford it," she said. "With the
bad economic situation we have there, how are we going to afford this?"
Cuba's economy is not exactly booming either, yet within two hours
Guevara's cataracts were excised and the lenses implanted, with the
Cuban government paying for everything – including air transportation,
housing, food and even the follow-up care.
The government has dubbed the program Operation Miracle, and for the
hundreds of thousands of people from Venezuela, Central America and the
Caribbean who have benefited from it since it was started in July 2004,
it is aptly named.
Yet the program is no simple humanitarian effort, and it has not come
without a cost. The campaign against blindness serves as a poignant
advertisement for the benefits of Cuban socialism, as well as a way to
export one of the few things the Cuban state-run economy produces in
Cuban doctors abroad receive much better pay than those who remain in
Cuba, along with other benefits from the state, like the right to buy a
car and get a relatively luxurious house when they return.
As a result, many of the finest physicians have taken posts abroad.
The corps of doctors and nurses left in Cuba are stretched thin and
overworked, resulting in a decline in the quality of care for Cubans,
some doctors and patients said.
The Cuban authorities say they have treated more than 750,000 people for
eye problems like cataracts and glaucoma since the program started.
At the same time, Cuban doctors have set up 37 small eye hospitals in
Central and South America, the Caribbean and Mali. Twenty-five of the
centers are in Venezuela and Bolivia, whose leaders have close ties to
the Castro regime in Cuba. The hospitals are manned with more than 70
top-notch eye surgeons from Cuba and hundreds of other nurses and
Dr. Sergio Vidal Casali, 84, has been at the Ramón Pando Ferrer Cuban
Institute of Ophthalmology for more than 50 years, specializing in
diseases of the retina.
He said the heavy flow of foreign patients through the hospital combined
with the exodus of several physicians to other countries had hurt his
department. "I don't like it, really," he said. "It's wonderful for the
people, but not for us. It disturbs our work."
Dr. Reynaldo Rios Casas, director of the Pando Ferrer hospital, said the
first days of the operation were hectic. Eye surgeons worked in three
shifts, keeping the hospital's operating rooms going all day and all
night. It was not uncommon for a single surgeon to do 40 operations in a
"It was really heroic," he said. "We were operating day, afternoon and
night." Since then, Rios says his hospital has been training new eye
doctors at an astounding rate of 2,100 this year, half of them surgeons.
The hospital budget has been increased tenfold and its equipment
upgraded. It now has 34 operating theaters with state of the art
equipment, including two equipped for advanced laser surgery.
One advantage of the program is that it has given young surgeons a
steady flow of patients on whom to hone their skills. Just this year,
they have performed 394 cornea transplants at the hospital, he noted.
"Our specialists have an incredible amount of experience," he said.
"What specialist in the world can do dozens of cornea transplants a year?"
In recent years, the program has allowed Cuba to use its doctors as
barter for subsidized Venezuelan oil and to forge closer relations with
other countries in the region, including those, like El Salvador, that
have not been historically close to the Communist regime here.
Of course, the people who have their sight restored couldn't care less
about the political and economic repercussions of the program. For them,
the offer of free surgery was a dream come true.
Guevara, whose husband is a retired construction worker from San
Salvador, said she had given up hope of seeing again. She heard about
the Cuban project on a Mayan radio station. "I never imagined anyone
would help me they way they have helped me," she said as she waited for
surgery. "I thought I was going to end up blind."
Near her in the waiting room was Reina López, a 58-year-old woman from
San Vicente, El Salvador, who has not been able to see for 13 years
because of cataracts. Her daughter, Adilia Reyes, 33, said she had cared
for her mother since she lost her sight. The family, including four
children, survives on her father's salary of $3 a day, plus whatever
money they can make from selling fruit at a market on Saturdays.
"For the poor, this is a tremendous benefit," she said as she guided her
mother to a pre-surgery test. "If it works, we'll be so grateful."
Downstairs in the cafeteria, Manuel Agustín Isasi, a 33-year-old
professional fencing coach from Isla de Margarita in Venezuela, was
eating a lunch of pork, rice and beans, able for the first time in years
to see his food with both eyes. Three years ago, he had been
whitewashing his home when he accidentally burned both corneas with a
bucket of quicklime. The accident ended his fencing career.
He had been one of the first to receive a cornea transplant in his left
eye when the program started up, he said. Then, in early November,
doctors in Havana replaced the cornea in his right eye. He was unabashed
in his praise for both the Cuban government and President Hugo Chávez.
"I would have remained completely blind," he said, fixing a reporter
with a swordsman's gaze. "Vision is half of one's life."