``Patria o muerte, Venceremos!````Fatherland or death, we will win!`` (2008)

Cuba's achievements in social development are impressive given the size of its gross domestic product per capita. As the human development index of the United Nations makes clear year after year, Cuba should be the envy of many other nations, ostensibly far richer. Cuba demonstrates how much nations can do with the resources they have if they focus on the right priorities – health, education, and literacy. Kofi Annan, Former Secretary General of the United Nations

Imagine January of 1959. Deep in the hills of the Sierra Maestra, the air is awash with revolution and freedom. In mainland Havana, Batista's forces wage a half-hearted battle in an attempt to repel the rampaging forces of the revolutionaries.

At its head is a dashing young lawyer well known in Cuba for his nationalist views and opposition to Batista culminating in his assault on the Moncada Barracks for which he is earlier tried, imprisoned and later released. He is Fidel Castro or as Cubans will often simply say, Fidel and beside him the iconic Argentine doctor and revolutionary Che Guevara.

Those were some romantic times with politics, change and hope in a curious exciting mix led by the charismatic young Fidel. With their straggly beards, wiry moustaches and stylishly rumpled military fatigues while chomping fat Cuban cigars sticking out of the corners of their mouths, the young revolutionaries were a heady intoxicating sight to behold.

Almost half a century down the line, opinions certainly differ on the successes chalked by the Cuban Revolution and yet in the fields of health and education as amply specified by the former UN boss; even Castro's staunchest critics cannot fail to concede that given the magnitude of the obstacles faced by the Revolution, they have done a marvelous job.

And the obstacles have been many. In fact declassified US Intelligence archives show that as early as October 1959, plans were afoot to overthrow the Castro government culminating in the now famous Bay of Pigs event in 1961 when 1400 CIA-trained Cuban exiles launched an attack on the 2 year old government.

In its aftermath, Cuban armed forces reportedly repelled the invaders, killing many and capturing a thousand. A month later Fidel announced to hundreds of thousands in an audience that “The revolution has no time for elections. There is no more democratic government in Latin America than the revolutionary government…If Mr. Kennedy does not like Socialism, we do not like imperialism. We do not like capitalism.”

These events were to mark the beginnings of what has turned out to be 46 years of an American embargo against Havana outlined in response to growing Soviet influence in Havana and over Fidel's decision to expropriate many US corporations. In addition, Cuba is said to have announced plans to base the compensation of these expropriated property on the artificially low property valuations that the companies themselves had kept to a fraction of their true value in order to play negligible taxes. And still other obstacles persisted. With the collapse of the Soviet Union in 1991 went 85% of Cuba's market. In between Fidel Castro was personally to suffer over 638 assassination attempts leading to the famous quotation that “If surviving an assassination attempt were an Olympic event, I would win gold medal.”

Amidst all these, the spirit of Cuba has soared and in no other area perhaps more than the health sector.

HEALTH

In the pre-Castro era, Cuba reportedly had a little over 6000 doctors over sixty four percent of whom were based in the capital Havana. When Castro moved to have them redistributed, more than half of them fled the island. In response the revolutionary government built three medical schools. By the 25th anniversary of the revolution, Cuba had trained nearly 20 000 doctors with Fidel predicting a further 50 000 to graduate within the next 16 years from that time.

In a speech delivered to thunderous applause in Santiago de Cuba in 1984, Castro declared, “The selection, the training, the work of these doctors, the concept of their utilization, and our health care system will place Cuba in first place in the world in this field in just 15 or 20 more years.”

By this time too, infant mortality had dropped to 15 per 1000 live births, a significant drop from 60 in 1959. This figure was described as the best in the developing world and better than many areas in the US. With a total of 58 hospitals in Cuba in 1959 with 60% of hospital beds being found in Havana, Cuba recorded 256 hospitals by 1984 with hospital beds almost doubling within the same period.

Also, infectious and parasitic diseases dropped from 60 per 100 000 in 1962 to less than 5 per 100 000 in 1984 while acute diarrhoeal diseases dropped from over 90 per 100 000 population to less than 20 per by 1984. Similar significant declines had been recorded in the areas of mortality from newborn tetanus, morbidity and mortality from tuberculosis, poliomyelitis and diphtheria.

TODAY

In grudging acknowledgment of the significant gains of the revolution and as if in confirmation of Castro's predictions 24 years ago, the immediate past President of the World Bank, American James Wolfensohn would say, “Cuba has done a great job on education and health and it does not embarrass me to admit it.”

Also in a letter from Cuba written by one Hans Veerken and published in the British Medical Journal, the following observations on the Cuban Health system will surface, “The health system in Cuba guarantees accessibility to the entire population, is free of charge, and covers the spectrum from vaccinations to sophisticated interventions.

The results are impressive: Cuba's health figures are on a par with developed countries that have 20 times the budget. The country is experiencing a difficult period because of the collapse and loss of support from the Soviet Union; over 30 years' trade embargo by the United States; and the gradual change from a centrally planned economy towards more of a free market system. Shortages are experienced in every sector, and maintaining health care services at the current level is too expensive.

Doctors and nurses continue to work towards the goal of health for all Cubans, even though their salaries are minimal. Signs of negligence or corruption, often seen in other socialist countries where incentives for output are lacking, are unknown. Topics such as family planning and AIDS deserve immediate attention.”

HIV/AIDS

Talking of HIV/AIDS raises Cuba's astonishing record in managing this scourge that has proved daunting to many developing countries. Specifically although the rate of HIV infection in the Caribbean is second only to rates in Sub-Saharan Africa, Cuba is an outstanding exception with an infection rate of 0.07 %.

Cuba is on record as having launched an initiative to assist the other 15 nation Carribean Community (Caricom) to fight HIV/AIDS by providing them with antiretroviral drugs at below market prices, as well as doctors and instruction in public health methods for combating the AIDS pandemic.

It must be recalled that as far back as 1993, 10 years after Fidel Castro had described the “mysterious illness” as the “disease of the century” Cuban Scientists were reported to have placed heavy emphasis on developing anti-retrovirals to combat HIV/AIDS leading to the situation where by 2001, according to the Monthly Review, “Cuban medical research had on its own devised five different varieties of antiretroviral drugs.

Every Cuban who is HIV positive has been put on therapeutic regimes utilizing these drugs. Cuba is now offering these antiretroviral drugs to all other Caribbean nations at affordable prices.”

HEALTH SYSTEM

Cuba's health system is under-pinned by a community-oriented primary health care with doctors following morning polyclinic care with afternoon field visits. The aim reportedly is to have a family doctor per 120 families, vaccination is also universal, and everybody above 45 has his Blood Pressure checked every two years. In addition there is a comprehensive program of care for pregnant women and children under one while women are encouraged to have cervical smears every two years. More specialized care is offered in secondary and tertiary facilities.

Also in what has been referred to in certain quarters as Castro's Doctor Diplomacy, Cuba has been known to send out thousands of doctors to support the health systems of many developing countries including Ghana in addition to numerous scholarships offered to many foreign students.

In fact as a follow up to the Vice President's recent visit to Cuba, Cuba is reported to have offered 20 scholarships to Ghana for medical training in Cuba. Interestingly, at a time when economic conditions were harshest following from the US Trade Sanctions inter alia, Cuba is again reported to have sent 9000 doctors to Venezuela in exchange for oil.

CONCLUSION

I conclude by drawing attention to Cuba's role in bolstering the fight for independence in colonial Africa. Indeed as World leader Nelson Mandela would point out, “Cuban internationalists have done so much for African independence, freedom, and justice.”

Today, according to the United Nations Development Programme's Human Development Index (2007), Cuba at number 51 in the World and 9 in the Americas and with a score above 0.8 is a high human development country.

On February 19, 2008 five days before President Fidel Castro's 49 year tenure came to an end, Fidel announced that “he would neither seek nor accept a new term as either president or commander-in-chief”. His younger brother Raul, has since been sworn in as President.

Cuba is a lesson in many respects but perhaps in no area more than in having a leadership whose heart beat is the people's welfare and who are both willing and able through inspired leadership to explore alternate means of addressing pressing threats and challenges.

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