Nitheesh Narayanan in conversation with Leima Martínez Freire

Cuba and the socialist model, have once again made headlines across the world with their extraordinary commitment towards humankind. Not only has Cuba been combating the deadly novel coronavirus inside the country and securing its entire population without any bias, Cuba has also provided medical aid to other countries with it’s highly equipped medical team. One must not forget that these are being done by a country that is subject to a criminal blockade by the US-led capitalist, imperialist forces that has been there for decades now.

In this interview with Student Struggle editor Nitheesh Narayanan (NN), the Asia Pacific Director of the Cuban Institute for Friendship with the Peoples, Leima Martínez Freire (LMF), explains the situation in her country since the outbreak of COVID 19, and the steps it has taken both within Cuba as well as on an international level. Read on to know.

NN: What has been the actual extent of the COVID-19 outbreak in Cuba? 

LMF: Like almost all the countries in the world, we have also been affected by the pandemic. We are putting all our efforts to combat it. 1,137 cases were diagnosed positive out of 30,416 test results. This is 3.73%. So far, 309 people have recovered and there are 764 active cases. The total number of deceased so far is 38. Death rate now stands at 3.34%. This was the case till April 21. We hope the number of recovered will increase dramatically in the coming days. About 65% infected people belong to the age group between 20-60. Special measures are being taken by the government to provide extra care to children and the elderly, as their immune system would be weak. All data regarding the cases and statistics are being uploaded publicly, therefore, there will be no confusion or panic.  

NN: The pandemic and the developments that followed must have affected a huge section of people, especially the ordinary people like workers, peasants, students, and people from deprived backgrounds. What are the steps taken by the Cuban government to tackle this situation?

LMF: One principle remains this: “the Cuban Revolution will leave no one unprotected and measures are already being adopted to ensure that no Cuban family is left to their fate”. Based on this premise, many measures have been adopted by the Ministry of Labour and Social Security for the state-owned sector and private entrepreneurs.

The option of distance-work or tele-work has been implemented in work centers that do not require face-to-face service. This group has the same salary; only a supplement in their contract will validate the new conditions.

Another group authorised to stay at home are those who are not directly involved with priority jobs. This includes the high-risk population or the elderly. Those with acute respiratory symptoms will remain at home. These workers will receive a 100% of their salary in the first month of paid-leave, and from the second month on, they will receive 60%. 

Schools are shut, so mothers with children receiving special education are being given protective treatment and salaries, since they need to stay at home to look after their children. The government is receiving significant support from Cuban medical students, who are engaged in door-to-door interviews with families, to gather information about their health conditions. This experience covers all provinces in Cuba. With the world’s highest ratio of physicians to population, Cuba has tens of thousands of doctors, as well as medical students going door-to-door to monitor local communities. All measures have been taken to trace out the affected and also to keep all our people out of panic. 

Sectors such as tourism have been heavily affected by the ban on the entry of tourists into the country, so other options are being promoted to ensure that the sector is not left behind. In this case, in the event of a work stoppage, the relocation of workers is preferred over other options. In this way they will be able to receive a stable salary and contribute to Cuba’s development during this difficult season and to prepare for its recovery. 

In the case of private employers and their employees, there are two situations. For those who are going to continue working, even at lower levels, their salaries will be protected – which cannot be less than the minimum wage established in the country. The employer has to pay them according to the time worked, but never a lower amount than what is established in the country’s Labour Code.

With regard to social security issues, all those family nuclei with insufficient income as a result of this current situation, will be protected through Social Assistance. In turn, mass organizations such as the Committees for the Défense of the Revolution (CDR), the Federation of Cuban Women (FMC), together with the Central of Workers of Cuba (CTC), have been providing support and care for those elderly people who have to remain in their homes and live alone. They are being helped with shopping and other tasks, so that they have to leave their homes only in cases of extreme need.

However, the pandemic has definitely impacted us negatively, which is being reflected on several aspects of the country, mainly the tourism sector, not only because of the income it generates, but also because of its productive chains, since in tourism, other sectors too are involved. In addition, there is restriction on supplies of certain imports. Many countries from which Cuba imports goods have reduced their sales or will stop soon. International trade is not progressing at the usual pace. However, the main obstacle for us to receive the supplies we need is the US blockade.

NN: Cuba’s medical assistance to other countries is being applauded across the world. Can you explain the range of this assistance and where all it has reached so far?

LMF: In the last few weeks, we have responded to cooperation requests without hesitance or thinking of politico-economic advantages. So far, 21 brigades of healthcare professionals have been deployed to join national and local efforts by 20 countries that have strengthened existing medical collaboration brigades in 60 nations to combat the pandemic.

We have also shared medicines produced in Cuba, that have been proven effective in the prevention of cure of the disease, for us. In addition, our healthcare personnel have been actively taking part in tele-conferences and discussions on specific treatments for patients in other countries. 

All these actions are being undertaken without neglecting the responsibility of protecting the Cuban population – a duty that is rigorously fulfilled despite huge limitations imposed by the USA’s economic, commercial and financial blockade. Data and statistics that assert this fact are publicly available for anybody to see. Anyone with a shred of decency will understand that the blockade poses remarkable pressure on Cuba to ensure material inputs and equipment need to support the public healthcare system and to control this pandemic.

A recent example was an aid cargo from China that could not be shipped to Cuba because, as the carrier informed, the blockade disallowed it. On this matter, top US State Department officials have had the nerve to claim that the United States does export medicines and medical devices to Cuba. However, they have failed to support these claims with evidence for transactions between the two countries.

We do not, however, deny anyone our assistance – not even to the country that causes so much harm to us, if need be.

NN: This is a great show of solidarity and socialist internationalism. You are fighting the pandemic in your country, as well as sending your medical teams to other nations that are in more severe conditions than you. What is Cuba trying to tell the world through this?

LMF: I will refer to some of the sentences in the statement issued by the Ministry of Foreign Affairs.

Cuba is convinced that these times require cooperation and solidarity. Cuba pursues a politically unbiased international endeavor that seeks to develop and share the scientific research results and experiences of several countries in the prevention of the disease, the protection of the most vulnerable and social behavior practices that will contribute to shorten the duration of the pandemic and slow down the loss of lives. Cuba strongly believes that the role and the leadership of the United Nations (UN) and the World Health Organization (WHO) are indispensable.

The magnitude of the current crisis compels us to cooperate and practice solidarity despite political differences. The virus knows no boundaries or ideologies. It threatens the lives of all and therefore, it is up to all of us to fight against it. No country should assume it is big enough, rich enough or powerful enough to defend itself, isolating itself and ignoring the efforts and needs of others. Sharing and providing valuable and reliable information is urgent. Countries with more available resources should share them with most affected countries that are least prepared to cope with the pandemic. 

This is Cuba’s approach. The humble contribution of a small nation with limited natural resources and submitted to a long and brutal economic blockade. We have decades of experience in the development of international cooperation in health, as generously acknowledged by WHO and our counterparts.

If we act together, the propagation of the virus can be halted in a faster and more cost-effective manner. Then we will also have to deal with the economic and social crises caused by the pandemic – the dimensions of which nobody has dared predict yet. 

If developing countries are not guaranteed access to technologies that are mostly available to highly industrialized nations, especially as far as health care is considered, and if they fail to share scientific developments, discoveries and products in a selfless manner, the vast majority of the world’s population will be as exposed or even more exposed than today in an increasingly interconnected world. If politically motivated, coercive economic measures against developing countries are not lifted, if they are not exempted from the payment of burdensome foreign debt, and freed from the ruthless tutelage of international financial organisations, we cannot delude ourselves into thinking that we will be in a better position to respond to socio-economic disparities that, even without a pandemic, kill millions of people every year, including children, women and the aged. There is still time to act and mobilise the will of those who are responsible. If we leave it for future generations to take up, it might be too late.

NN: Capitalist countries, led by the USA, had already put ample pressure on your economy and now the pandemic has worsened the state of affairs. What is the state of the economy as of now and what are the ways forward?

LMF: There are difficulties in accessing sources of external financing and credit, and the contraction of the world economy is reflected on the condition of Cuba’s domestic economy. As a result, there is a decline in our production levels, in both State and non-State sectors, including foreign investment. In this case, time duration brings about a level of uncertainty, and economics go beyond illnesses. That is, when will the pandemic be brought under control, how it will affect the economy, and how the economy will begin to show signs of recovery?

All resources are going to be distributed in the most equitable way possible. The country’s plan of investments will be adjusted; food and other activities will be prioritised. The centrally planned economy, often questioned and criticised by capitalist countries, is a strength to us, because resources are not allocated by market forces. In a scenario like this, central planning is additional strength because it allows decisions to be made in favor of the people.

Sovereignty in management of budgetary resources, considering the limits established by law; experience in adjustment measures, for being an economy under siege for more than 60 years. Plus, we are not accountable to any international organisation, only to the people in Cuba.

We have to find in our agriculture, the fundamental source of food for the people. It’s no secret that food imports are high. All this does not mean that imports are not going to be made, but we are looking for national solutions, because we do not know what food our supplier-countries are going to stop producing. Priority will be given to urban, suburban and family agriculture, and to short-cycle crops. Maximum use will be made of the national resources available for this purpose. Material and financial resources will be allocated as a priority to the production of rice, banana, bean, corn, egg and pork, which are currently in deficit. This does not mean having abundance or satisfying demand in these areas, but it does mean concentrating our resources on these basic products for feeding our people. Likewise, when it comes to locating resources, producers who obtain the highest yields will be prioritised.

The international scenario is not predictable and we must respond with an organised strategy – a set of measures and decisions that will allow us to face the pandemic with the least economic cost possible and to recover as soon as possible.

The economic, commercial and financial blockade imposed on Cuba by the United States – whose government has tightened measures this year with the aim of stifling the national economy – has intensified. There is no flexibility – the pressure is maintained to prevent the country from accessing finances, besides the persecution of companies and tankers in order to cut off the supply of fuel to Cuba.

Cuba is fighting SARS-CoV-2, one of the biggest challenges that humankind has faced over the past decade, amid relentless harassment, financial persecution and smear campaigns by the US government.

NN: Can you tell us about the health system Cuba has developed over the years?

LMF: Health is a universal human right, which should be safeguarded by responsible governments. Only by doing this will it be possible to ensure effective responses to the health needs of an entire population. The Cuban Constitution recognises the right to health, and the country’s single, free, universal public health system. High-level political commitment promotes inter-sectorality as a strategy to address health problems.

Inter-sectorality is reflected in national regulations that encourage participation by all social sectors in health promotion/disease prevention, treatment, rehabilitation policies and programs. The strategy has increased the response capacity of Cuba’s health system to face challenges in both national and international socioe-conomic contexts, and has helped improve our main health indicators. 

Newer challenges – sociocultural, economic, and environmental – on the population’s health, well-being, and quality of life, will now require improved inter-sectoral coordination in the primary health care framework in order to sustain the achievements made so far.

The damage caused to the Cuban healthcare system by the US blockade is incalculable, but the island’s government is committed to finding solutions to any medical emergency, despite the expenses. 

Cuba’s national health system is made up of multiple tiers:
1) the community, containing individuals and families
2) family doctor-and-nurse teams
3) basic work teams
4) community polyclinics
5) hospitals
6) medical institutes

Municipal authorities oversee community-based primary care levels consisting of consultorios (first-level clinics for consultation with doctors and nurses)and regional polyclinics. This level is famously characterised by a general family-doctor-and-nurse model (MEF, for its acronym in Spanish), which is tasked with the lofty goal of improving the base level health of the entire nation. Under the MEF model, every neighborhood is assigned a family doctor. These doctors are responsible for keeping track of every patient in the area; they determine who is healthy, who is sick, and who is at risk, as well as make rounds to ensure that everyone receives vaccines, prenatal care and other attention at the proper times. Consultorios serve as decentralised, front-line points of healthcare administration and they strive to resolve around 80 percent of cases.

When patients require a higher degree of care or attention, they move up to the second level of healthcare – provincially managed hospitals and centres of specialisation to treat sick patients, handle complications, and encourage rehabilitation. Although patients are free to directly go to these institutions, the system works most smoothly when family doctors refer them and work in partnership with specialists. Approximately 15 percent of cases reach this level.

Finally, the third level of healthcare includes nationally-administered, specialised hospitals, and centres for the treatment and study of particular diseases. This level is the most curative of the three, and deals with patients who have complications from serious illnesses. 

In addition to the three-tiered model of doctor-patient care, the SNS oversees a set of policies and practices geared toward prevention and public health. The Ministry of Public Health (MINSAP) oversees epidemiological control; regulation of sanitation; promotion of hygienic norms in the population; care for the elderly and disabled; and regulation, evaluation, and control of both imported and domestically produced medicines.

MINSAP also oversees institutes and state-enterprises that investigate and fabricate vaccines and pharmaceuticals. Largely because the trade blockade has limited Cuba’s access to many imported medicines, Cuba has developed an innovative domestic bio-pharmaceutical and bio-technological sector. Cuba’s domestic production of medicines reduces the cost of importing the medicines from other countries.

NN: Have you heard about the work being done by the Indian state of Kerala, against the novel coronavirus? The communist government in the state has also made headlines globally because of their remarkable fight against the pandemic.

LMF: Yes, we have been trying to follow the news and it seems that Kerala´s authorities and people have worked together and have been able to flatten the curve. Community work and support of local governments with a plan has been recognised. We are absolutely curious to read about the developments in Kerala.

Leima Martínez Freire is the Asia-Pacific Director of the Cuban Institute for Friendship with the Peoples (ICAP). She is based in Havana.
Nitheesh Narayanan is the editor of Student Struggle, a Central Secretariat member of SFI, and a PhD scholar at the Jawaharlal Nehru University’s Centre for the Study of Social Exclusion and Inclusive Policy.