Eli Weisel, Holocaust survivor, noble laureate and world-renowned author, passionately proclaimed, “We must always take sides. Neutrality helps the oppressor, never the victim.” I chose Weisel’s words to underscore the continuing philosophical and political debate on Cuba’s commitment to its people. I want to be clear; I do not intend to compare past or present acts in Cuba to the Holocaust. Nevertheless, Weisel’s words are persuasive and relevant.
I speak up, in part, as a promise, which I will explain later.
Since its inception, in 1948, the World Health Organization (WHO) has defined health as the state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. Accordingly, health extends beyond the physical to appropriately consider the mental and social welfare of people.
With this in mind, Cuba is promoted as having one of the world’s best approaches to public health. However, I ask this, “Can protecting public health be evaluated positively without embracing social justice and human rights?” Simply stated, these are core international values. The argument that evidence based research supports good health indicators in Cuba necessarily raises more questions. We know safe water, sewage, housing, waste disposal and good nutrition are all basic building blocks of a sound public health system and essential to positive health outcomes. Yet, Cuba’s failing systems have been widely observed and documented today with corroding and leaking water pipes, lack of garbage collection, spillage of sewage and dilapidated insufficient housing along with growing food insecurity.
During the 1980s, Cuba’s commitment to community-based health became the model for primary health care and was highly regarded by many practitioners, scientists, and leaders throughout the globe. Then I was intrigued by David Werner’s analysis questioning if Cuba’s health care system was a model of service or a form of social control [1]
In the mid-1990s a leader in the Cuban Ministry of Health presented at an international public health meeting in Washington, D.C., and he struck a chord with me. At that point, I asked the speaker and wider audience if they understood the depth of the anger and distrust of Fidel Castro’s regime by many Cuban Americans in Miami. Shortly after, Wayne Smith, former head of the US interests section in Cuba, offered a trip by charter flight to Cuban Americans in South Florida interested in an up close look at the public health situation in Cuba. I reached out to colleagues and others from the community with encouragement and a promise that as a Cuban American their participation would not be disclosed. Despite an Alpha 66 threat prior to departure and an empty promise of anonymity, I had to question both sides of the continuing debate.
The aggressive acts from the anti-Castro paramilitary group in Miami vs. the deception of the Cuban government opened a new window of idealism vs. realism for me. After apologizing to those who did not want their names or faces exposed, I questioned how robust was the health data measures presented when people didn’t have access to sufficient food, reliable potable water, soap, toilet paper, nor adequate garbage collection.
The zenith of Cuba’s “special period,” and the 1991-1993 epidemic of optic neuropathy from lack of sufficient vitamins, revealed a weakening society. How could this support the notion that public health was the government’s priority? More recently, I read with great interest Pedro Coutlin-Churchman’s journal article on Cuban Epidemic Neuropathy: A glimpse from inside a totalitarian disease[2] where he reminds us that even with a universal health care approach, the government controlled all food and markets, contributing to the suffering of its people.
Investment in the health of people includes protecting human rights. This means allowing the health community to speak out and not to be jailed for releasing information about a dengue epidemic considered a state secret, or not sharing timely data on a cholera outbreak until laboratory confirmation of travelers returning from Cuba arrive home with a surprising diagnosis. This causes me to reflect upon my personal interviews where the remaining vigor of public health actions in Cuba exists to fight vector and water borne diseases. Sadly, however, health professionals are directed to euphemistically use the vague terms of febrile illness in place of dengue and gastrointestinal upset for cholera, in contradiction to promoting public health transparency.
For years I have expressed a concern about the Cuban government’s refusal to share official public health data in a timely manner. This epidemiologic silence is most disturbing because Cuba has a robust health surveillance system. As recent as May 2017, Dr. Jason Harris, Associate Professor of Pediatrics at Harvard Medical School in an interview with Drug Development & Discovery Magazine remarked that while the Cuban government may not report cases, “there continue to be sporadic cases of cholera in travelers from Cuba,” further revealing a gap in global health diplomacy and security. This is occurring at the same time Cuba receives a top 2017 WHO recognition [3] for their support to international health emergencies, such as their response to Ebola, and other South – South collaborations.
Nevertheless, at home the Cuban government’s repression of rights continues. According to Human Rights Watch (2017) [4] from January to August 2016 there were 7,900 reports of arbitrary detention in Cuba, showing an increase in such detentions in recent years along with other repressive actions. State sovereignty allows for such internal actions, and yet no national or international state or non-state actors seems to be able to change the conversation.
It may take the graphic depiction of dragging, beating, and jailing members of the women’s human rights group Damas de Blanco, dissidents and independent journalists scrolling across a television, computer, or phone screen to reset the agenda, but soon after, unfortunately, the emotional reaction subsides and indifference sets in.
Is it that we remain silent in a noticeable attention deficient disorder world where one big event dominates the 24- hour news cycle until the next one arrives driving a fickle response? Has this become our twenty-first century style of indifference?
As Weisel so powerfully reminds us, the opposite of love is not hate; it’s indifference. The opposite of beauty isn’t ugliness; its indifference.” I suggest, indifference is a powerful word and exposes the perplexity of problems we face today. Yet, we can no longer be indifferent to the human rights violations 90 miles south, and then step up to revere a country for its promotion of primary health care. This is an inescapable compelling contradiction and we must all take notice.
As I stated earlier, I speak up, in part, because of a promise.
In March 2005, the MTV-University program that substitutes a celebrity for a professor, contacted me to bring Eli Weisel as a surprise guest lecturer to one of my classes. It’s been more than 12 years, and with Weisel’s passing on July 2, 2016 it is more important than ever that we speak up about injustices and refuse to remain indifferent. Weisel recounted the harrowing details of the Holocaust and the genocides in Rwanda and Sudan, and his appeal was for us all to address human rights violations, injustices of pain and suffering and to remain vigilant. Weisel encouraged students and faculty alike to not be spectators to an injustice and to speak out by writing letters to newspapers and leaders. This historical survivor then turned to me to request my promise to keep students engaged with these issues, and emphasized “an ethical person is one who is not indifferent.”
Clearly, Cuba is not the only country with documented continuing human rights violations; however, it seems Cuba is one known violator we are willing to overlook to promote the accolades of a free health care system, whether we question this or not.
I intend to keep the promise to embrace the words of Eli Weisel, may he rest in peace. I/we can no longer be indifferent.
Notes:
[1] David Werner (1979) authored Health Care in Cuba: A Model Service or a Means of Social Control- Or Both? Republished in Practicing Health for All, Morley, et. Al, New York, Oxford, 1983
[2] Pedro Coutlin-Churchman, The “Cuban Epidemic Neuropathy” of the 1990s: A glimpse from inside a totalitarian disease, Surg Neurol Int. 2014; 5:84
[3] World Health Organization, May 26, 2017, announces the Dr. Lee Jong-wook Memorial Prize for Public Health to the Henry Reeve International Medical Brigade (Cuba), http://www.who.int/mediacentre/events/2017/wha70/lee-jong-wook-prize/en/, accessed July 25, 2017
[4] Human Rights Watch Report 2017, https://www.hrw.org/world-report/2017/country-chapters/cuba, accessed July 25, 2017
