Embargo hits hard at Cuban hospitals

U.S. doctor on crusade to save lives amid lack of supplies

By Mary Murray
NBC News

HAVANA, April 10, 2001 — Carmen Cardenas collapsed one winter night in her brother’s living room. For months, the 48-year-old rural housewife had complained repeatedly of fatigue and abdominal pain. Emergency room doctors at her small community hospital treated her first for dysentery and then menopause. This night, the family rushed her to Havana’s National Hospital. On the way, Carmen began to hemorrhage. Within hours of her arrival, Carmen was diagnosed with one of the most lethal forms of adult leukemia. “It was the longest night of my life,” remembers her older brother Alberto. “The doctor thought she was close to death.”

Carmen needed an emergency blood transfusion. The hospital only had half the amount on hand and it took valuable hours to locate the rest. It was New Year’s Eve weekend and most hospitals were running with reduced staff. From the first, Carmen’s treatment has been plagued with trouble that her family believes would disappear if the hospital had access to American medicines.

Doctors initially missed the leukemia diagnosis because the local hospital had no reagents to test her blood. She waited an extra two weeks to begin chemotherapy while the hospital searched for one of the U.S.-made medications required in the protocol. Her physician stopped her second round of chemotherapy mid-treatment when she began suffering violent bouts of vomiting that provoked internal bleeding. The hospital had run out of Zofran, a drug that inhibits nausea associated with chemotherapy. The country’s meager supply of the costly American drug is strictly reserved for pediatric patients. Carmen resumed her chemotherapy only after an American doctor stepped in and made a personal donation.

Personal Crusade

Dr. Anthony Kirkpatrick, an anesthesiologist and critic of the U.S. trade embargo on Cuba, appears to be on a personal crusade to help save Cuban lives. When Kirkpatrick learned of Carmen’s plight, he not only wrote out a prescription for Zofran but paid for it, too. Last Thanksgiving, the Tampa Florida physician flew his own plane down with the first installment of $1 million in medicines.

“I was a witness to a crime against both Cuban patients and their doctors,” said Kirkpatrick after visiting Havana’s pediatric cancer wards. “I saw doctors confronted with the ethical dilemma of having to administer less than an adequate dose of cancer medicine to an older child so as to have sufficient medicine left over to treat a smaller child. For over 30 years, the U.S. embargo has restricted Cuba’s access to essential medicines.”

Anguish Committees

Unlike 10 years ago when it was taboo to acknowledge shortcomings in public health, doctors on the island today frankly admit the challenges they face daily. Dr. Margo Alvarez an internist at Havana’s leading pediatric hospital says the problems range from broken X-ray machines and neonatal respirators to short supplies of life-saving drugs. “We do our best but you begin to feel like you, as the doctor, are playing God. It’s a moral dilemma to decide which patient gets the treatment.”

In fact, this life-and-death decision-making has become institutionalized. Physicians and hospital administrators convene regularly in “anguish committees,” as they are privately called. These bodies juggle the needs of their critical patients against their inadequate resources. “They decide which patients get the medicines in stock,” explains Dr. Michele Frank, an American physician who makes her home in Cuba.

In addition to not having enough medicines to go around, Cuba is barred under the embargo laws from buying the latest drugs. The U.S. manufactures half of all new global drugs, claims Frank, who researched a 1996 study on the embargo for the American Association for World Health.

According to Kirkpatrick, who conducted his own research into embargo restrictions on American drug companies, “the U.S. monopoly spans almost all therapeutic and diagnostic applications.” International patent regulations keep all new U.S. drugs out of Cuba’s reach for 17 years. Dr. Frank complains this especially “jeopardizes AIDS and cancer patients — patients with no time to waste.”

'Castro, not embargo, is to blame'

Critics of the Cuban government take issue with blaming the embargo for the country’s woes and argue it is a legitimate tool to promote democracy and human rights in Cuba. “It is not U.S. sanctions that have caused Cuba’s economic failure, but Castro’s own insanity,” said Lincoln Diaz Balart, a Cuban-American legislator from Florida. “The embargo as a cause of Cuba’s economic destruction is a persistent myth, promoted by the Castro dictatorship and its international allies.”

Prior to 1990, Cuba’s universal healthcare system benefited from the country’s heavy reliance on Soviet aid. It served as a cushion against the embargo, satisfying 85 percent of Cuba’s trade needs. Public health, along with every other sector of Cuban society, nearly collapsed when Russia cut the purse strings. In the first years following the demise of the Soviet Union, Cuba’s gross national product tumbled 35 percent. This translated into widespread unemployment, lengthy power cuts, reductions in public transportation, food scarcity and empty pharmacy shelves. Now, 90 percent of the island’s trade is subject to the embargo’s restrictions.

In 1992, when the Cuban economy was at its most vulnerable, Washington imposed additional embargo measures that cut off subsidiary trade. At the time, Cuban trade statistics showed 90 percent of this exchange involved food and medicines.

A U.S. State Department fact sheet argues that Cuban medical shortages clearly stem from Castro’s “continued adherence to a discredited communist economic model” and not trade restrictions. The State Department’s Web site claims licenses have been granted authorizing the delivery of some $3 billion in medical donations earmarked for Cuban patients. Cuban health officials refute these statements. Every licensed donation does not necessarily make its way to the island. Cuban officials privately suggest that the pharmaceutical companies sometimes use the donation vehicle to off-load medicines about to expire. As well, donated medicines are not always the drugs most needed at any particular moment.

Buyers for the Cuban health-care sector estimate they would spend at least $50 million annually in the American pharmaceutical market if allowed under U.S. law.

U.S. companies interested in the Cuban market are asking the Bush Administration to open up food and medicine sales. In a letter to the president, the group, Americans for Humanitarian Trade with Cuba, complained that last year’s law to permit some commerce with Cuba is not being implemented.