An English translation of the blog Ciudadano Cero from Cuba. "Citizen Zero" features the testimony of two Cuban doctors disqualified for an indefinite period for the practice of medicine in Cuba for having channeled to the Ministry of Public Health the opinions of 300 public health professionals about their salaries. Dr. Jeovany Jimenez Vega, who administers this blog, authorizes and appreciates the dissemination by any means possible, of every one of his opinions or articles published here.

Archive for February, 2013

Peggy Picket: The Pathways of Pain

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At the gates of heaven there is supposed to be the one who separates and in the agony decides who stays, but everyone retraces at the end their own path to the common pain, everyone weaves their own purgatory. “Peggy Picket sees the face of God,” by Roland Schimmelpfenning was the heartrending offering last week by La Compañía del Cuartel  at the Brecht Cultural Center in Vedado. The play leads us to a sensitive and controversial theme: how much frustration or personal fulfillment results for a Cuban doctor from working on a collaborative project abroad, versus submerging himself in the everyday here in Cuba.

A dilemma contained in the compelling performance of the young cast, that managed to address a complex and painful reality, which hit close to home for this viewer because of his own status as a Cuban doctor, and friend to some of those who returned from their own Peggy Picket adventures, and so many others who never returned.

All I wanted to saw was there, everything detailed: peering into the unknown, to another dimension of human tragedy; knowing oneself a vehicle of an alien message, moving the pieces at whim of foreign exchange; the grinding poverty that compels one to leave because no one lives on bread alone, because dreams also count and because love isn’t enough; that tearing sacrifice of a couple or a family destroyed in the making; finding yourself besmirched by someone, they told you, who would be like your brother, finding that “…we are not always welcome here, no”… in short, that Peggy Picket… Shows us the dark and human side of the Cuban medical missions, their unconfessed edge, to those who return with a veil of silence drawn in a look.

It proposes an approach to one of the most controversial nerve centers of the reality in my profession: the way going on one of these work missions can affect the life of a professional Cuban who, at least up to the time this work was written, was not allowed to leave the country except under the conditions demanded by the authorities, and never by choice; that once there had to — and still has to — face living in extreme conditions, exposed to risks in unimaginable countries, that come from nature or the hostilities and ingratitude of men, all knowing that they will receive a tiny percent of the money that will be exchanged between the countries, and meanwhile remaining far from their family and all they left behind.

But today, while I applaud La Compañía del Cuartel, I abstain from making a moral judgment; nothing is further from my mind than to launch attacks capable of hurting feelings. It would be very difficult for me to sincerely say what I think without some colleague thinking I’m referring to them. At my age I have learned to be slow to comment on realities I haven’t experienced; at this point I try, above all, not to judge. For thus reason, I decided to let you draw your own conclusions. And Carol and Martin already know their reasons for leaving; Liz and Frank already know why they chose to stay. Better that everyone be left alone with his own conscience.
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Jeovany Jimenez Vega

February 4 2013

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Rage in the Time of Cholera*

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By Jeovany Jimenez Vega

Cholera – also referred to as Asian morbus because of repeated and deadly worldwide pandemics originating in India and China – is the result of colonization of the digestive tract by the Vibrio cholerae bacillus, “a bacteria of the Spirillaceae family, very sensitive to heat and acids, which quickly kill it.” It was discovered in 1893 by R. Kock, who also discovered the tuberculosis bacillus in 1882. It is treated as a very infectious contagious disease and is transmitted orally through drinking water, foodstuffs contaminated with fecal matter and vomit from an infected person or a carrier. On rare occasions it can be transmitted through urine, as well as through contact with objects such as glasses, dishes or tableware used by an infected person.

The illness has a very short incubation period “that can last between two to three hours, but which generally varies from ten hours to three days” during which time the infected individual shows no symptoms. One should always bear in mind that cholera can be asymptomatic (which is the case in the so-called asymptomatic carriers of the bacteria) as well as the fact that in a significant number of cases – the majority of cases according to some writers – one does not see the typically severe symptoms, but rather a common and easily diagnosed form of diarrhea. After the incubation period comes the stage during with the patient becomes truly ill. A patient can develop one of five different clinical forms of the disease.

It was just a matter of time before cholera reached Cuba. Large numbers of tourists, foreign students and personnel from Cuba’s Medical Mission and other areas of collaboration in countries affected by the epidemic have for years provided a potential gateway for infectious diseases to enter the country. On this occasion it began in Santiago de Cuba and in recent months has spread to the west of the country, including the capital, in the form of outbreaks that have been quickly treated with varying degrees of success, but which for now have not reached epidemic levels.

The epidemiological situation in the Cuban capital is not homogeneous. Some some urban areas are more affected more than others. But it would be extremely irresponsible to speculate here about figures about which I am not completely certain. Similarly, it would not be prudent or ethical to try to minimize the threat facing the country, even if we are not now facing an epidemiological explosive situation. I am certain, however, that health authorities are making great efforts to resolve the situation and do not doubt that the issue is being treated as high priority by governmental officials. Threatening these efforts are irregularities in drinking water supplies, the unfortunate condition of the distribution network, and the deterioration of drainage systems and sewer lines in many locations throughout the country, “whose repair depends on multi-million dollar investments over the medium and long-term.” Further complicating matters is the lack of awareness among certain segments of the population of the risks posed by a disease that has been unknown in Cuba since the end of the 19th century.  

This is a problem that must be assessed appropriately, one that should not be underestimated “since we are facing a potentially lethal disease that throughout history has amply demonstrated its toll in lives lost.” We should not, however, overestimate it either. I have every confidence in the competence of my colleagues to adequately treat each case. Cuban society should make use of its full organizational capabilities to eradicate this scourge and thus avoid its becoming a full-blown epidemic. The Cuban public health system is prepared to achieve this aim. Without being gratuitously over-confident, I am convinced that within a few months the situation will be under control.

Cuban doctors are quite sensitive to this danger and are trained to deal with it. The fact that our government is in debt to us, that it pays us a “salary” that is laughable, forcing us to live in an absurd state of insolvency, that it still pays scant attention to the medical sector, that the old anger over my pending vindication still persists – all this is, as we say, wheat from another sack. This is not the post that I intended to write, but in spite of everything it seems rage is still my most conspicuous vocation.

*Translator’s note: The title – a reference to the novel Love in the Time of Cholera by Colombian author Gabriel Garcia Marquez – is both a joke and a pun. Also, in Spanish the word cólera can refer either to cholera, or can mean rage or anger, as the word choler does in English.

February 15 2013

Waiting Patiently for What Never Comes

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By  Jeovany Jimenez Vega

The last time I was in the farmers’ market, a couple of days ago, I saw  various things on offer which I don’t recall seeing since I was a kid. It was in the mid-80’s that this market – at least in Artemisa, where I live – had its “golden age”. But the economic strategists disrupted the prosperity of the most entrepreneurial and consistent producers and they stopped right then and there, so that the ability to largely meet public demand which was the case a few years previously, was, at the beginning of the following decade, past history.

During the years following that brief period, the farming sector saw itself, most of the time, prevented from expanding its production as a result of laws which already effectively limited its productivity and threatened the results of its hard work. Up to the present day laws remain in force which give the Prosecutor’s Officethe power to confiscate, without much ado, the estimated gains of a producer who is doing too well – and it is obvious what effect this has had on the enthusiasm of those who find themselves at the wrong end of this process.

Several attempts to sort this out were tried by the state — the “Food Plan” of the ’90’s included — among which the wobbly Credit and Services Cooperatives stood out — including their “stronger” variant — which never managed to guarantee a constant, stable supply for the people, as normally they were unprofitable and unviable, falling most of the time into net losses.

Along with the mismanagement of these organisations throughout the country, there also existed another enormous obstacle to produce arriving on the Cuban table: the proven inefficiency  and irresponsibility of the state supply company.

The Cuban state monopolised the process of supply in a single company, and in its war against intermediaries eliminated the entire chain for transporting the harvest, leaving this activity almost exclusively in the hands of an entity which, citing lack of fuel, tires, transmissions, or whatever consumables, year after year, has left thousands and thousands of tons of food to rot in the fields.

Inevitably this had profound consequences: the markets continued to be without supplies and with prices going through the roof, production was depressed and plates waited anxiously for food which never arrived.

Now it is not about again taking on the intermediary that transports commodities from the field — because that is just one more activity, that all the producers cannot take on because their activities are so time-consuming.

In order to combat speculation they should create mechanisms that regulate, dynamically and realistically, price policies.  But before that the Cuban state has a serious account pending with its people:  first of all it should lead by example and adjust its irrational and hostile pricing policy perpetuated in the retail trade and not empty our pockets on collection days.

I have here an excellent first step to take in order to try to normalize everything!  Only as the prices imposed by the State stop being scandalous will the peasant have an incentive to lower prices, as scandalous as those, at his stand at the market.

But apparently Raul Castro’s policy, slightly more pragmatic, has already yielded some fruit with regard to the food supply, although it has not happened with all due haste.  As I am not an authorized voice, it would be worth listening to the producers’ criteria on this matter, but, judging at first glance, the circumstances today seem different, although the situation is not the same across the country and not all townships have the “privilege” of Artemisa — I have confirmed the great affluence of the regulars from the municipalities surrounding my town’s market.

To the extent that we move away from the capital, the more we look to the east, the more obvious is the deterioration in the quality of life and the greater the decline in agricultural products.

I think everything here is above all a matter of focus, the way to meet our demands could be much shorter than supposed as the example of China demonstrates: from the time Deng Xiaoping determined that the ability to hunt mice was more important than the color of the cat,very few years elapsed before there were tangible results in food production.

The same thing happened in Vietnam — looking at production schemes similar to ours — they substantially increased production when they opened the doors to the small family business.

Ah! But something happens in such cases which is fundamentally different from what happens in ours: Vietnamese producers can go abroad when they need to buy their own supplies and a Chinese businessman may, no one should be shocked by that, amass a personal fortune if he does it by legal means.

And that is what it’s about: it would be much better for the Cuban state, rather than trying to supply all our products, something that has not achieved, so it has had to authorize them to be imported directly as needed, when it has the means to do so, it would be much better to accept that “… to get rich is a duty, whenever it is done by lawful means …” Those are the words of José Julián Martí, not mine, and consistent with his thinking we should reshape our thinking so that we will no longer see all the fruit we cultivated for years with our own hands evaporate overnight.

Translated by GH

January 30 2013

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