Socialized Medicine in Cuba (Part II): "Doctor Diplomacy," Sex Tourism, and Medical Apartheid

Surgical Neurology
Article Type: 
Published Date: 
Wednesday, September 1, 2004

In Part I of this essay, we discussed the secret epidemic of dengue fever, the Cuban gulag, and other aspects of Cuban medicine leading to a poor state of health in that Caribbean island, based on Dr. Dessy Mendoza Rivero's book ¡Dengue!-La Epidemia Secreta de Fidel Castro (Dengue! The Secret Epidemic of Fidel Castro).

Cuba's health care system is a disaster for both patients and physicians. Because of the meager salaries paid Cuban physicians, on the average 400 pesos per month (equivalent to $20 U.S.!), many doctors quit the profession and seek jobs in the only industry that offers any chance for economic opportunity and access to dollars---the Cuban tourism industry. Doctors can be found driving dilapidated taxis, acting as tour guides, or even working in the paladares (family inns) as meseros (waiters) or cooks.

Those who choose to remain in the medical profession suffer long hours of work and lamentable working conditions. This is particularly true for female physicians who, despite the "liberation" of the Revolution, are not only working mothers but also the spouses who shoulder the lion's share of domestic chores in a persistently machismo-oriented society.

Dr. Dessy Mendoza writes, "When a woman physician, one of the thousands in the island, ends her 24-hour duty in the hospital where she is assigned, she must get home and then as if by magic find food (if she can find any available) to feed her family."

Dr. Mendoza's revelations are in accord with my own research in this area. In Cuba in Revolution, I commented:

Fidel, in fact, proudly counts the number of physicians and professors in Cuba as another great achievement of the Revolution. But of what good are these highly educated and trained professionals to the nation when the country remains drawn into a perpetual economic black hole? There are no incentives for these professionals to work hard and be productive because individual initiative is not rewarded. Citizens are not entitled to the fruits of their labors because communism does not take into account enlightened self-interest. Neither professionals nor workers are allowed to accumulate wealth or to own private property for the betterment of self and family. Consequently, the Cubans in the island do not strive to succeed or even to be productive. They play the game, but do not produce. Marxist theoreticians do not understand that when individuals are materially rewarded for their work in a free market society, the community and society also benefit, because there is a beneficial exchange of goods and services guided by Adam Smith's classic concept of the invisible hand of supply and demand of the free market and laissez-faire economics.

In Cuba, science and medicine remain subordinated to the state and political considerations---that is, the whims of Fidel Castro. Even the doctors serving in the government health agencies or ministering to patients in clinics and hospitals are not informed about new technology or medical breakthroughs, except for the privileged few---the Communist Party members, the privileged mayimbe class, who are allowed to travel abroad or employed in the clinics serving the tourist industry---"sociolismo," the Cubans call it.

Moreover, specialized diagnostic studies (e.g., CT scans, endoscopies, ultrasound, etc.) and treatments (e.g., chemotherapy, radiation therapy, surgery, etc.) must be approved by medical bureaucrats with political connections, another example of "sociolismo."

Castro's 'Doctor Diplomacy'

Cuba's young physicians must serve in international missions to assist Third World nations for propaganda purposes. Presently, Dr. Mendoza estimates that close to 1,500 Cuban physicians are employed in what many of us in the U.S. have characterized as Castro's "Doctor Diplomacy."

A Cuban physician in one such "humanitarian mission" found to his dismay that in Guatemala, where he had been sent, common laborers and unskilled workers were paid between $100 to $300 monthly. Guatemalan physicians earned well over $1,000 monthly, while he, a Cuban surgeon, was paid less than $25! While in Guatemala, the Cuban surgeon found himself relying on the good will and the financial aid of his humble Guatemalan patients.

Cuban physicians in Nicaragua are paid the equivalent of $50 per month by the Cuban government. The Nicaraguan government has been forced to supplement the income of their intended benefactors with a subsidy of $40 to $70 per month, depending on the specialty, just to make ends meet for the Cuban physicians!

It is no wonder that many physicians in such missions defect to freedom. The reader may remember the saga of two Cuban physicians, Drs. Leonel Córdova and Noris Peña, who defected two years ago in Zimbabwe. They were imprisoned for two months in that African country ruled by dictator Robert Mugabe. After finally reaching freedom, the two Cuban physicians reported that during their mission they did not render medical care to the people as propagandized. According to Dr. Córdova, they "did not even touch a single patient." Their purpose in that mission was solely to support the embattled regime of the Marxist dictator, on behalf of Fidel Castro.

The vast majority of physicians, though, submit to the Cuban government because their families are held as hostages in the communist (fascist) island, at the mercy and reprisals of Fidel Castro. So the doctors comply with their internationalist mission and return to Cuba to continue their professional enslavement and to submit to the will of Fidel Castro.

Sex Tourism and Medical Apartheid

According to dissident physician Dr. Hilda Molina Morejón, a Havana neurosurgeon and founder of the Colegio Medico Independiente de Cuba (Independent Medical Association of Cuba), "the main purpose of many hospitals in Cuba is to generate foreign capital, one way or the other ...thegovernment assigns special budgets to those hospitals that serve foreign patients."

So in contrast to the deplorable state of medical services provided to ordinary Cubans, there exists in Cuba special hospitals and clinics with the latest medical technology that cater to two types of patients---foreign tourists with hard cash and the privileged mayimbe class of the communist (fascist) hierarchy.

In Cuba in Revolution, I mentioned the documented case of an ordinary Cuban citizen who was denied medical care at the Cira García clinic for foreign tourists. We learn from Dr. Dessy Mendoza that such cases are the rule rather than the exception. Furthermore, Dr. Mendoza recounts the difficulties of obtaining even those medications and treatments prescribed for ordinary Cubans.

He cites cases of patients with cancer who cannot get treatment because the medications have to be bought with dollars and not Cuban pesos! Yes, some pharmacies, like the specialized clinics, are authorized by the government to accept only dollars and are almost exclusively patronized by foreign tourists and the mayimbe class with access to dollars. So much for Cuba's revolutionary ideals of social justice and egalitarianism!

Cuban communism looks more like fascism as the years pass, but what is the difference between the two iniquities? They are kindred spirits of the same evil totalitarianism/collectivism!

Foreign tourism has brought much needed hard currency to the dictatorship of Fidel Castro, but it has increasingly alienated the Cuban people, who continue to suffer in silence. Cuba has more problems. Another problem is one of the highest suicide rates in the world, much higher than that of other Latin American nations or the United States. That notwithstanding, the government agency SERVIMED, founded in 1989, is in charge of promoting tourism and medical apartheid. Cuban physicians are paid in pesos while Castro's government keeps the dollars. Be that as it may, doctors employed in these facilities are the privileged few, part of the "sociolismo" network.

Slogans used to attract foreign tourists include "Cuba: An Ideal Destination for Your Health" and "Cuba: Tourism and Health." The most deceiving slogan, according to Dr. Mendoza, is "Cuba: The Most Salutary Health." While SERVIMED does provide high technological medicine in modern centers throughout the island, it is patently false when it claims in the advertisement underneath the aforementioned slogan: "Health can be recuperated in Cuba because the island is free of contagious diseases."

Deceitful ads such as this can be promulgated with some success not only because of the state-controlled press as well as the complicity of the U.S. media but also because "access to medical statistics and scientific information is restricted to the high-ranking public health, bureaucratic hierarchy," which, of course, is only possible in a totalitarian, fascist state.

In addition to such diseases as dengue fever, typhoid fever, leptospirosis, and hepatitis that we discussed in Part I of this report, other diseases have become resurgent in the island because of increased sexual promiscuity, prostitution and, increasingly, tourism. (Tourism in Cuba, though, has taken a dive since the 9­11 tragedy, severely hurting Cuba's flow of hard cash.)

Tourists are not being informed about these diseases in tourist pamphlets or promotional material. For example, they are not told that AIDS increased 150% between 1990 and 1995. Moreover, gynecological infectious diseases are rampant, particularly in the young jineteras (prostitutes), including vaginal monilia (yeast), trichomoniasis, bacterial leukorrheas, and other sexually transmitted diseases. Syphilis and gonorrhea, in fact, have increased dramatically in direct correlation with the tourism industry. Dr. Mendoza relates that in the native female population these types of infections are widespread, in part because of the lack of antibiotics and medications necessary for treatment.

Perhaps the most choking admission for Dr. Mendoza was not what he experienced in communist Cuba---after all, he was born in 1954 and thus grew up with the Revolution---but what he experienced when he reached freedom: "What I could never imagine from my neighborhood in Santiago is that I would come abroad and have to educate and inform first the Europeans and then the Americans, still fascinated with the Revolution and Castro, about the horrors of Cuban socialism."

Read Part 1

Miguel A. Faria, Jr., M.D.
Macon, Georgia

Miguel A. Faria Jr., M.D., is a retired neurosurgeon and editor emeritus of the Medical Sentinel and author of "Vandals at the Gates of Medicine" (1995); "Medical Warrior: Fighting Corporate Socialized Medicine" (1997); and "Cuba in Revolution: Escape From a Lost Paradise" (2002). His books are available from This article first appeared in, August 26, 2002.

(This article was published in Surgical Neurology 2004;62(3):275-277.)

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Comments on this post

Therapeutic Apartheid

Medicinal protection in China is an extremely muddled low level framework. "Free" of charge is just for a couple of high positioning frameworks. The vast majority ought to pay and pay 10-80% of their hospitalization costs. Surgical nurture patients with epilepsy typically need to pay 50-90% of their hospitalization costs. Most new procedures, for example, intracranial cathodes, long haul 128 channel EEG checking and profound mind incitement are excluded in restorative protection framework. Patients need to pay independent from anyone else. Families with epilepsy patients typically were low pay families. Viagra is not free in China!

Epilepsy surgery in China

We thought this informative scientific dialogue that appeared recently in Surgical Neurology International (SNI), a leading, free access, online major neuroscience and neurosurgery journal would be of interest to readers of It deals with very specialized neurosurgical care in China and general medical care in Cuba.

The article refers to the difficulties of evaluating and ministering surgical care to patients with intractable temporal lobe epilepsy in a major seizure center and hospital in Beijing, China. The abstract preceding the full text of the peer reviewed scientific contains statements of interest to the general reader:

"In China, decisions about how to treat BMTLE (Bilateral mesial temporal lobe epilepsy) patients can occasionally be challenging. Patients and their families spend a great deal of time and money on the surgery to implant the intracranial electrodes, and most patients cannot afford bilateral hippocampus electric stimulation. These challenges raise several questions..."(1)


(1) Guangming Z, Wenjing Z, Jiuluan L, Zhaohui S, Bingqing Z, Gaoxiang S, Huancong Z. Long-term therapeutic effects of corticoamygdalohippocampectomy for bilateral mesial temporal lobe epilepsy. Surg Neurol Int 2013;4:147

Dr Miguel Faria (11/15/2013) comments:

This is a very interesting report about a very difficult problem. This paper from neurosurgeons in China is particularly of interest to me. I have three questions for these authors.

Recently, as a result of my papers, "Violence, mental illness, and the brain – A brief history of psychosurgery," particularly "Part 3 – From deep brain stimulation to amygdalotomy for violent behavior, seizures, and pathological aggression in humans," published here in SNI,(1) I received several letters from laymen, including the mother of a child with clinical psychomotor seizures and erratic behavior but negative EEG. Neurologists were conflicted in how to proceed in management. I referred her to a functional neurosurgeon, a member of the Editorial Board of SNI in her own hometown of Chicago, for advice in conjunction with his working neurologist.

The authors write in the abstract: "In China, decisions about how to treat BMTLE [Bilateral Mesial temporal lobe epilepsy] patients can occasionally be challenging. Patients and their families spend a great deal of time and money on the surgery to implant the intracranial electrodes, and most patients cannot afford bilateral hippocampus electric stimulation."

So first, I am surprised at this statement, as I imagine that medical and surgical care are "free" of charge in socialist and nominally communist countries. I would like the authors to expound on this and the issue of payment for medical care in China for my edification. Is health care not "free" in China? Is there a two tiered system of medical and surgical care?

Second, I also would like to ask: Did any of the patients present to them with seizures associated with violent behavior or "pathological aggression?

Thirdly, is functional neurosurgery, either brain stimulation or ablation, carried out in China for violent behavior in association with seizures, as described in part 3 of my article (1)?

Thanks again to the authors for a very interesting paper.


1. Faria MA. Violence, mental illness, and the brain - A brief history of psychosurgery: Part 3 - From deep brain stimulation to amygdalotomy for violent behavior, seizures, and pathological aggression in humans. Surg Neurol Int. 2013;4:91. Available from:

Miguel A. Faria Jr., M.D. is World Affairs Editor of Surgical Neurology International (SNI)

Dr. Zhang Guangming (11/16/20) responds:

Medical insurance in China is a very complicated low level system. "Free" of charge is only for a few high ranking cadres. Most people should pay 10-80% of their hospitalization costs. Surgical care for patients with epilepsy usually need to pay 50-90% of their hospitalization costs. Most new techniques, such as intracranial electrodes, long-term 128 channel EEG monitoring and deep brain stimulation are not included in medical insurance system. Patients have to pay by themselves. Families with epilepsy patients usually were low income families.

2. Deep brain stimulation for epilepsy was applied for few peoples (<20 patients in different epilepsy centers in China). Surgical care for mental diseases is forbidden in China.

3. We had some patients with seizures associated with violent behavior or "pathological aggression." If these patient were not suitable for resection operation, they had to turn to psychiatrists.

Dr. Zhang Guangming
Neurosurgeon, Epilepsy Center, Neurosurgery Department of Yuquan Hospital Tsinghua University, Beijing, China

"Free" health care for the Party only!

Dr. Miguel Faria (11/16/20) replies:

Dr. Zhang Guangming, thank you for your informative and fascinating responses. It will help us in the West to understand your medical care system. China's medical care has come a long way but then it still has a two-tiered system of medical care as in Cuba:

One system for the "high ranking cadres" and another for the mass of the people.

Cuba, which has touted her free, universal health care to the world, has also one system for the privileged high functionaries of the communist party ("free" and high level care) and for the foreign tourists (who pay with Euros and high level care). Whereas the people do have "free" medical and surgical care but it is very primitive and inadequate health care.(1)(2)

Thank you for answering. We hope China will continue to progress and increase the standard of living for all her citizens.


1) Faria, MA. Surgical Neurology 2004;62(2):183-185 Available free access from

2) Faria, MA. Surgical Neurology 2004;62(3):275-277. Available free access from

November 18, 2013


Great comment! I guess we all knew that under Marxist collectivism some are more equal than others — the "high ranking cadres" always seem to reap the benefits — just as with "ObamaCare." Congress excludes itself from most collectivists programs as does our commandant dictator. When will the "masses" learn that the socialists/communists only use the poor, they never really care about them. They are always the first to be mass executed--either by hunger, lack of care or outright murder.

Russell L. Blaylock, M.D.
Theoretical Neurosciences Research, LLC