Those who yearn for a more "egalitarian" and "equitable" system of medical care "like the one in Cuba" are not familiar with the extraordinary saga of Cuban physician Dr. Dessy Mendoza Rivero. But they should be! "¡Dengue! ­ La Epidemia Secreta de Fidel Castro," the title of his book, is one they should read. But they won't!

For one thing, most of the admirers of Cuba's Revolution and her socialized system of medical care don't speak or read Spanish and only know the system from afar ­ either looking down from above in the ivory towers of academia, where Marxism is still in vogue, or learned from the sound bites of liberal journalists or news anchormen, who still glorify Fidel Castro and his socialist Revolution.

Written with a feminist writer and cultural critic, Ileana Fuentes, and published by the Center for a Free Cuba in Washington, D.C., "¡Dengue!" is a must-read. We learn from Dr. Mendoza that Cuba's "free" socialized system of medical care is in shambles, a veritable disaster, a disgraceful tragic regression from the once advanced medical care system of the 1950s in the pre-Castro years.

The Arrest of a Medical Dissident

The book begins with Dr. Mendoza's dramatic arrest at his home in his native city of Santiago de Cuba, the country's second-largest city, located on the easternmost portion of the island and home of the Sierra Maestra mountains.

Dr. Mendoza's crime was that of investigating, revealing and forcing the communist dictatorship to admit the existence of a raging epidemic of dengue fever in the spring and summer of 1997. In fact, Dr. Mendoza was on the telephone with a Miami radio station communicating the details of the epidemic to the outside world when the Cuban State Security political police closed in:

"There are approximately 13 dead, 2,500 hospitalized patients and 30,000 people afflicted!" Mendoza frantically declared, warning the interlocutor on the other side of the telephone line that the communication would be cut at any moment, as State Security had surrounded the house and was knocking on the door.

The Secret Epidemic of Hemorrhagic Dengue Fever

The communist regime did not want to reveal to the world the existence of the epidemic because it was a personal embarrassment to Fidel Castro, who had previously declared that the mosquito responsible for dengue, the Aedes aegypti, had been eradicated long before ­ by the long arm of the Revolution!

More importantly, such a disclosure endangered the burgeoning Cuban tourist industry, which at the time was in high gear preparing for the Santiago Carnival, the Expo Caribe '97 celebration, the World Youth and Students Festival, and "a marathon of cultural and propaganda events planned for Santiago de Cuba that year."

Because the Cuban communist authorities in the public health system kept the epidemic hush-hush, calling the disease "an unspecified virus," the people continued to medicate themselves with aspirin for the prodromal (early flu-like) viral symptoms of the disease, tragically worsening the hemorrhagic manifestations of the disease.

Aspirin, about the only medication available to ordinary Cubans for any disease, aggravates bleeding by impairing the ability of platelets to agglutinate and coagulate bleeding sites. Dr. Mendoza describes some hapless patients who bled from every body orifice and suffocated on their own blood because of the bleeding tendency of the disease, worsened by the anti-platelet effects of aspirin.

And yet Dr. Gustavo Kouri, head of Cuba's Institute of Tropical Medicine, violated Hippocrates' precepts of medical ethics when, in the midst of the epidemic, under the direction of Fidel Castro and to guarantee his own safety, cowardly certified that there was no dengue epidemic and even falsified details about the disease to the media and the public in a campaign of disinformation ­ for example, claiming that the mosquito Aedes aegypti did not breed in dirty, stagnant water or in marshes but rather in clean, potable water!

Be that as it may, Dr. Mendoza was arrested, separated from his wife, Caridad Piñon (also a courageous, dissident physician), and their small children, who, to make matters even more desperate for the valiant physician, were ostracized by their neighbors. Dr. Mendoza was then solemnly condemned to eight years in prison for the crime of "disseminating enemy propaganda." And this, despite the fact that the government less than a week later was forced to admit the existence of the deadly epidemic.

But Dr. Mendoza had succeeded in getting the attention of the foreign press, and Amnesty International declared him a prisoner of conscience. He served 18 months in the horrible Boniato prison under subhuman conditions before he was released in the wake of mounting international pressure. Once free, Dr. Mendoza was then forced into exile by the communist regime.

Socialized Medicine and the Gulag

Besides the trying details of his life in communist Cuba ­ his clamoring for workers' rights, his fight for independent unions for health professionals, and his efforts at founding an independent medical association ­ what Dr. Mendoza tells us about the realities of Cuba's health care system deserves to be told to a wider, English-speaking audience.

Yes, there are still many influential "authorities" in this country who still believe that a universal, "more equitable" system of health care "like the one in Cuba" is worthy of imitation. Dr. Mendoza's testimony should serve as an antidote to those who are peddling the venomous snake oil of socialized medicine ­ like that in socialist Cuba.

Dr. Mendoza reminds us that for more than 30 years, even during the alleged "golden years of the Revolution," milk has been distributed by the ration book only to children up to seven years of age and to the elderly. Everyone else wanting milk must obtain it on the black market and risk imprisonment.

With such privations, it is not surprising that malnutrition, including vitamin deficiencies, such as lack of thiamine causing peripheral neuropathies and blindness (beriberi), is rampant. We also learn that in order to feed their families, a vast proportion of the estimated 180,000 to 200,000 "common criminals" confined to Cuba's 500 prisons are people who have violated the law by killing their own pigs, cattle and even horses, and selling the excess meat on the black market.

The Boniato prison, where Dr. Mendoza was held, was built in the 1940s to contain no more than 720 prisoners. Yet, while he was confined there in 1998, there were 2,200 men serving long, harsh sentences for such crimes. Nor should we neglect to state that with such a humongous penal colony, Cuba has become a veritable gulag where, Dr. Mendoza informs us, "acute diarrhea, parasitic infestations, amebas, gastritis and gastric ulcers, etc., are rampant due to the dire conditions of hygiene and sanitation, the meager allotment of clean water, and the horrible, rotten food rations distributed to the prisoners."

Hygiene and Sanitation in a Workers' Paradise

"The Cuban people suffer in silence," writes Dr. Mendoza, "assailed by successive infestations and epidemic diseases due to the deteriorated conditions of the public health infrastructure, the contamination of rivers, streams, and Cuba's once beautiful bays and coastline." One reason for so many outbreaks of pestilential diseases, such as acute diarrhea, leptospirosis (from the vast rat population), hepatitis (fecal-oral contamination), typhoid fever, etc., is because of the poor state of hygiene and sanitation on the island.

Sources of potable water are frequently contaminated by runoff from old, leaky pipes (plumbing that preceded the 1959 Revolution) and potable water coming in contact with raw sewage. It is not unusual to see fecal material seeping from the ground and floating in stagnant water in the streets!

Hospitals are not exempt to the deplorable, unsanitary conditions. Cockroaches and mice roam the hospital wards. Floors are dirty because of lack of cleaning material, detergents, and the overall lamentable unhygienic milieu of the Cuban health care system. Hospital gowns, linen and towels must be brought to the hospital and cleaned by the patients' families.

Poor sanitation is extended to medical instruments handled by doctors and nurses; these are not properly sterilized and frequently remain dirty with the remains of tissue and blood after their use. Syringes are frequently used to inject different patients without any sterilization, and "disposable" gloves are used and reused on different patients. Not surprisingly, infectious diseases such an impetigo and hepatitis, and infestations such as scabies, lice and fungal diseases are also commonplace in the population.

Predictably, hospitals for ordinary Cubans have a dearth of the most basic medicines and medical equipment to care for patients. Doctors have no sphygmomanometers to measure blood pressure, sterile gloves, sterile water for diluting injections, syringes, soap, disinfectants, and the most basic items that one would expect in hospitals and clinics.

Dr. Mendoza points out the most essential medical equipment is not available, not because of the embargo but because of the misallocation of priorities and a perverse system of tourism and health apartheid that has developed in Cuba under the auspices of the communist (fascist) regime. As we shall see in Part II of this essay, clinics that cater to tourists and the privileged mayimbe class have the latest medical technology.

And yet, Dr. Mendoza reminds us, in the pre-Castro years of the1950s, Cubans had excellent access to medical care through association clinics (clinicas mutualistas), which predated the American concept of health maintenance organizations (HMOs) by decades, as well as through private clinics. Notwithstanding the regime's published statistics, according to Dr. Mendoza, the standard of living and the state of health of the Cuban people were far better in 1958 than they are today, making evident the direful state of medical care regression since Castro's communist takeover.

It is no wonder that one of the goals of the Colegio Médico Independiente de Santiago de Cuba, founded by Dr. Mendoza, is to at least return the Oriente district to the state of salubrious health that prevailed in the 1950s!

In the concluding Part II of this essay, we will have a few words to say about Castro's "doctor diplomacy" as well as reveal other aspects of the hidden face of Cuba's socialized ("free") system of medical care, such as apartheid tourism and health.

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 spouse who shoulders 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 classical 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-$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.

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 the government 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 U.S. 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 9-11 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 percent 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 due to 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."

Amen!

Miguel A. Faria Jr., M.D., is Editor-in-Chief of the Medical Sentinel (www.haciendapub.com) 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). All three books are available from www.haciendapub.com.