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    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

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