[Marxism] Cuba's cure for health worker ills should add to the debate in SA

Walter Lippmann walterlx at earthlink.net
Fri Aug 24 10:45:52 MDT 2007

Cuba's cure for health worker ills should add to the debate in SA

August 24, 2007

By Terry Bell - Business Report, South Africa

Health is going to top the trade union agenda over coming months -
and not because of anything to do with the travails of health
minister Manto Tshabalala-Msimang.

But there will be echoes of the statement by recently sacked deputy
health minister Nozizwe Madlala-Routledge that a national emergency
exists. (Only the term generally favoured is "crisis".)

One of the root causes of this crisis is the admitted chronic
shortage of healthcare workers, from technicians to nurses and
doctors. Next Friday in Johannesburg, trade unionists and
representatives of a range of non-governmental organisations will
discuss this staffing crisis.

In the wake of the recent public sector strike, which highlighted the
massive staff shortages, the government stressed that it had a human
resources plan, designed to deal with the situation - which
government spokespersons prefer not to refer to as a crisis.

But a crisis it certainly is, and today it will be discussed as such.

Cosatu president Willie Madisha will give the opening address at the
conference, organised under the auspices of the Joint Civil Society
Monitoring Forum.

By the end of the day, there may at least be some clarity about the
extent of the problem and the potential of the government's human
resources plan to deal with it.

Like so many issues debated, often vociferously, there is little
wholly reliable data available.

However, it is generally recognised that there are nearly 30 000
vacant posts in the public health service; that most doctors
graduating from medical schools leave the country; and that many
resent the required year of community service after graduation. There
are also some reasonable estimates of the extent of the problem in
specific areas.

For example, Itumeleng Molatlhegi, the media officer for the
Democratic Organisation of Nurses (Denosa), notes: "To bring the
nurse-patient ratio up to acceptable levels, we probably need 80 000
or more additional nurses."

Denosa estimates that as many as 40 000 nurses may have become
migrant workers abroad. Of the 191 000 nurses registered in this
country, fewer than 120 000 are currently working in the profession.

Proportionately, the situation regarding doctors is probably worse.

The healthcare staffing crisis applies in many countries. It is the
focus of Salud, a new documentary film about the Cuban healthcare
system and its international outreach programme. Salud will be
screened in Johannesburg, Cape Town and Durban next month as part of
the annual TriContinental Film Festival

Festival organisers also plan to screen the film for health sector
unions and healthcare workers, as well as communities in townships
and informal settlements.

South Africa, Venezuela, Honduras, Gambia and Cuba feature in the
film in a way that should add useful fuel to current debates about
the state and orientation of the local health system.

Venezuela did not have sufficient health workers to staff its
ambitious new community clinic-based health system. Venezuelan
doctors, by and large, refused to work in the shanty towns - called
barrios - and remote rural areas.

The solution: Cuban doctors. Venezuela now has about 20 000 Cuban
doctors working in the field.

They are also training more than 17 000 students drawn from these
areas to become "community doctors", complete with medical degrees.

The film reveals something of the contribution Cuban doctors have
also made to South Africa's health service. Several who are
interviewed tell how shocked they were at the levels of poverty,
malnourishment and illness in our rural areas. It is from these very
areas that students are now being recruited to train in Cuba as
community doctors. They will attend what is probably the world's
biggest medical school, in Havana.

The film reveals that among the students from mainly disadvantaged
communities and regions in 27 countries are Hispanic Americans and
African Americans. They are given full scholarships on the
understanding that they will return to serve their communities in the

The stress of the Cuban system, which has also been introduced to
Gambia, is on health rather than illness; on prevention, rather than

As Dr Paul Farmer of the Harvard Medical School in the US points out
in the film, prevention is better - and much less expensive - than
any attempted cure once a medical problem is diagnosed.

But to operate in this way, as Farmer, other medical specialists and
former US president Jimmy Carter acknowledge, healthcare must be
regarded as a human right and not a commodity. Which, in turn, means
an equitable public health system.

For South African trade unions, this remains a remote goal.

However, the message of Salud may stiffen the resolve to fight harder
to achieve it.

More information about the Marxism mailing list