Cuban doctors endure burnout, blackouts as once-vaunted healthcare declines ​

By Daniel Trotta

HAVANA, March 26 (Reuters) - A Cuban doctor with more than 25 years of practicing medicine, like most Cubans drawing a government salary, needs a side hustle to get by.

To avoid regular power blackouts, he wakes at 5 a.m. to cook rice and beans for sale, supplementing his income as his bus and taxi costs outstrip his monthly salary of 8,000 pesos, or roughly $16.

Cuba's healthcare system, long seen as a great achievement of the 1959 revolution and decades of Communist rule, has suffered obvious decline for years as a failing economy and punishing U.S. economic sanctions take their toll.

That decline has accelerated with the oil blockade imposed by the United States this year.

In a country of 10 million people, 96,000 Cubans are on the waiting list for surgery, 11,000 of them children, Cuba's Public Health Ministry said. It projected the waiting list could grow to 160,000 by year-end. More than 300 pediatric operations each week are short of medicine, oxygen or anesthesia and other supplies. Some 32,000 pregnant women may not get their recommended minimum of three ultrasound exams.

Those statistics fail to capture the price exacted on the doctors, nurses and other health professionals, who endure blackouts and water cut-offs at home, only to report to work and face shortages of medicine, unsanitary conditions, and the heartbreak of telling patients they cannot provide the same level of care as before.

The doctor, who asked to remain anonymous for fear of reprisals, said the constant stress of rationing care weighed on him, eliciting memories of the worst days of the coronavirus pandemic.

"Public healthcare has always been promised here. Free. A world-class system," the doctor said. "I don't know how much longer we can endure this. There are fewer and fewer doctors, fewer resources for the patient, but the patients keep coming."

STRETCHING PESOS

While Cuba's economy has its own failings, U.S. sanctions have further dented the armor of the country's doctors, known affectionately as the "Army of White Coats."

Doctors in the state-run medical system say their colleagues are burning out, leaving the country, or forgoing monthly salaries of 7,000 to 8,000 pesos - the equivalent of $14 to $16 under a commonly used unofficial exchange rate - to work in small businesses or wait tables or clean houses.

Those pesos don't stretch far. A carton of 30 eggs costs 3,000 pesos, a liter of cooking oil 1,500, and a kilogram of rice 700.

Reuters interviewed two other doctors who declined to be identified but told similar stories of despair. In addition, while on officially sanctioned visits with government minders nearby, Reuters conducted interviews with three other doctors, four nurses and a senior health ministry official. Those interviews also revealed hardships for the profession, albeit in less dire terms.

The doctors who spoke anonymously say basic supplies are scarce, forcing staff to bring cleaning materials from home or scrub the floors with water alone. Disposable gloves, previously cleaned and reused several times, have disappeared entirely. With urine bags unavailable, doctors have resorted to water or Coca-Cola bottles, one doctor said.

This coincided with an increase in hepatitis and diarrhea cases, two of the doctors said.

Reuters could not verify any link, but a senior health ministry official said there was an increase in infections due to shortages of antibiotics.

The fuel shortage and ensuing power outages stop drinking water from flowing when the pumps are out, shutting some primary care clinics.

"They don't officially close. They can't say that publicly. But they're not holding consultations because there's no water," the second doctor said.

When the power goes out, and before generators kick in, nurses in a hospital neonatal unit rush to hand-pump ventilators for babies, a nurse told Drop Site news.

CANCER CARE SUFFERS

Cuban health officials admit their system is under stress, but insist their doctors have the fortitude to persist.

"The Army of White Coats will not fail the people of Cuba, despite the difficult circumstances we face today," Tania Margarita Cruz, the vice minister for public health, told a press conference last week.

Nonetheless, she said, the energy crisis has resulted in a reduction in patient visits, hospital admissions and basic supplies.

Cuba is treating 117,000 cancer patients, of whom 16,000 require radiation therapy and 12,000 need chemotherapy, while 400 need surgery, Cruz said.

"How difficult it is for a Cuban family with a cancer patient, especially a child with cancer," Cruz said. "We don't have the necessary medications for the world-class protocol that has always been applied in this country."

Cruz would not put a mortality figure on the effects of the U.S. sanctions, nor would other health officials.

But she did acknowledge a "decrease in the average and overall survival rates of Cuban patients and Cuban children" with cancer. Cruz also noted that shortages of antibiotics can "lead to the patient's death."

'I'VE SEEN DOCTORS CRY'

Asked about doctor burnout, Cruz pointed to a recent pay increase and said the ministry had instituted a program to boost morale by improving working conditions, professional opportunities and research.

Last year, the government increased overnight pay to 100 pesos per hour, or $2.40 total for a 12-hour shift. The bonus for high performance in certain specialties amounted to 20 pesos, or 4 cents per hour.

Despite the optimistic official message, doctors on the front line question how much more hardship they can withstand.

All three doctors who spoke to Reuters anonymously have been longtime government loyalists who said their patience has begun to wear thin.

"We all fear speaking out," one of the doctors said, adding that raising objections can derail careers.

"I've seen doctors cry," she said. "With this crisis, they cry. They've stopped working, they've become depressed. You can see it on their faces."