By JOHN KAMAU
We never thought we would ever tap into the outcome of Cuban Revolution or from the lofty dreams of the late Fidel Castro and Dr Che Guevara — the physician and military theorist who once lived in Dar es Salaam with the likes of Laurent-Désiré Kabila, the Congolese guerrilla leader.
The Cuban doctors, part of this legacy, will this month be in Kenya after President Uhuru Kenyatta and his Health Cabinet Secretary Sicily Kariuki went to Havana to seek their services. Partly, it is a shame, that we are turning to Cuba.
Cuba is the only tropical country that has almost eradicated malaria — and when a case is reported it becomes a national crisis.
How Cuba has managed to have what they call ejercito de batas blancas, which means army in white lab coats, is the best-kept secret of the success of the Cuban Revolution. Why its doctors are upbeat to serve in remote areas and rural villages has always astounded critics of the socialist government of the late Castro.
Before Castro’s revolution, Cuba was known to have a well-trained health workforce which — like ours today — was concentrated in urban areas serving the political honchos, the elites, and the middle class. The Cuban capital, Havana, was home to half the country’s physicians and it also contained more than half its hospital beds.
On health, Kenya is doing badly and we need to reflect on these figures. While the World Health Organisation (WHO) recommends at least 23 doctors, nurses and midwives per 10,000 people, Kenya has only one doctor, 12 nurses and midwives per 10,000 people. The tragic part is that Nairobi, which hosts 13 per cent of Kenya’s population, has more than 50 per cent of the trained health workforce. When you combine the specialist and general practitioner doctors, the national ratio for doctors is 1.5 medics per 10,000 people while that of dentists is 0.2 dentists per 10,000 — a tragedy for healthcare in the country. Nairobi is still way above the national average with 9.5 doctors and 1.1 dentists per 10,000 people.
It was such disparity that Fidel Castro decided to deliberately address after he overthrew the government of the CIA-backed Fulgencio Batista on January 1, 1959 when he landed at the Island whose healthcare system was strangled by corruption, inefficiency and greed; which sounds familiar to us.
When Kenya became independent some four years after the Cuban Revolution, President Jomo Kenyatta had identified three pillars — poverty eradication, healthcare provision, and education — as the bedrock of his legacy.
The independent government had hoped to increase the number of doctors by training its own at the new medical school at the Kenyatta National Hospital which was started by a Makerere don, Prof Joseph Mungai. The story of Prof Mungai and his determination in 1967 was akin to that of the Castro brothers in Cuba as they sought to transform the Cuban healthcare. But we don’t seem to have gone far.
Prof Mungai had left Makerere, the only medical school in East Africa, in June 1967 to become a senior lecturer in human anatomy in Nairobi. But he could not start his job without bodies and he had to get 10 unclaimed bodies from Makerere to Nairobi. It is a story that he has captured aptly in his auto-biography, From Simple to Complex.
It was a personal determination that soon would falter, perhaps due to lack of political support.
“The collection from mortuaries of human unclaimed bodies is controlled by a special anatomy law. Kenya did not have such a law at the time. Makerere agreed to provide Nairobi with 10 properly treated bodies from its medical school (and since) no driver would accept to undertake that kind of journey…I had no choice but to undertake the journey myself,” Prof Mungai would later write.
By then, Kenya had 7.8 doctors per 100,000 people and 22.8 nurses per 100,000 people which would translate to a doctor for every 12,000 individuals. The rural healthcare was still shambolic and a huge part of the population was left at the mercy of religious groups.
When you look at the budget statistics, from 1963, you find education took more than twice the expenditure set aside for health and that explains why the healthcare system in Kenya is still a far cry of the earlier promise.
If you compare with Castro’s Cuba at the same time, we were at independence not even close to its 1959 pre-revolution ratios of a 1 doctor for every 1,000 people which was ahead of many Latin America countries.
The problem with Cuba was that this workforce was residing in the urban areas where it served about 10 per cent of the population. There was no free healthcare before Castro came to power and the country had only 1 rural hospital where the rural infant mortality stood at 100 per 1,000 live births. Only a revolution could have changed a situation where 8.5 million people were only getting service in 46 overcrowded and understaffed government hospitals.
Castro had forged some strong links with the Soviet Union forcing the US Central Intelligence Agency (CIA), and with President J F Kennedy’s approval, to invade Cuba in the failed Bay of Pigs attack; details which had been leaked by Cuban exiles in Miami.
The botched attack saw the arrest of almost all the brigade members and Kennedy’s government had to negotiate their release with Castro demanding for $53 million worth of baby food and medicine in exchange for the prisoners.
A humiliated Kennedy and the CIA lured Cuba’s physicians to defect to the US under Operation Mongoose. But this only saw the emergence of a new solidarity campaign in Cuba with the remaining physicians becoming part of the revolution — what is known as Army of White Lab Coats.
It was Che Guevara, himself a physician, who led this revolution as more than half of the country’s 6,000 doctors leaving for Miami. He had earlier asserted that the work “entrusted to the Ministry of Health and similar organisations is to provide public health services for the greatest possible number of persons, institute a programme of preventive medicine, and orient the public to the performance of hygienic practices”.
With an economic embargo on Cuba in place, the 3,000 doctors who remained became part of a revolution where doctors were dispatched to rural areas to become part of the community vaccinating children against polio and tackling the incessant malaria. At the medical school, only 19 doctors had remained and Castro hired several others to sustain medical training effort.
Students were now attending medical school, not because of the money or desire to defect to Miami, but to go back and serve their community. It was the mark that Che Guevara left for Cuba and soon Castro was sending hundreds of his doctors abroad to serve as part of Cuba’s medical diplomacy.
Today, Cuba has better doctor population ratio that all the western countries and has a better healthcare system. The country’s child mortality rate is today at par with some of the world’s richest countries. The World Bank says Cuba records six deaths for every 1,000 births against the global average of 42.5 deaths for every 1,000 births. And with even half a century of a US economic embargo, Cuba’s average life expectancy matches that of the US.
Fidel Castro’s socialist approach to medicine has paid dividends and when President Kenyatta visited Cuba and opened an embassy in Havana, the first in the Caribbean region, it was not lost to observers that he wanted to tap the Cuban experience in healthcare.
But whether President Kenyatta wants to borrow a leaf from the Cuban Revolution, as he grapples with inbuilt problems and corruption in Kenya’s healthcare, is still not clear but the arrival of Cuban doctors would certainly enable Kenyans to look at doctors differently.
The debate has been on how much we shall pay the Cuban doctors. Mrs Kariuki say it is not the Sh800,000. Back home, the medical profession is not the best paying and doctors make $67 (Sh6700) a month, while nurses earn $40 (Sh4,000).
The reason for this is because the country of 11.2 million people has 90,000 doctors. That is because Castro invested heavily in education and science and trained thousands of doctors, nurses, and scientists. Cuba can still afford to send many of these abroad where they can earn a fortune. It also earns the country $8.2 billion a year in remittances, ahead of tourism.
It is the legacy of Che Guevara and Castro that we are now trying to tap to — after we failed to train our own doctors for 55 years. Instead, the Ministry of Health is the capital centre of corruption. Need I say more?