[Marxism] Juventud Rebelde report on problems in Cuban dentistry

["Walter Lippmann" <walterlx@xxxxxxxxxxxxx>]

(This is the amazing, and shocking, JR report on Cuban dentistry, and it's
not the only one. This one was reported by Reuters on Sunday, and another
had preceded it, which CubaNews will also be translating and sharing with
readers of these messages. JUVENTUD REBELDE has a national circulation of
250,000. It's clear that the Cuban government has no intention of trying
to cover up these situations. Indeed, the publication of these articles 
in the Sunday edition, the best-read and most widely-circulated one of the
week - it contains the week's TV schedule, for example, indicates that the
goal is precisely to acknowledge the problems which have long existed here.
Each Sunday seems to bring another report of this nature to public view.)
===========================================================================

JUVENTUD REBELDE

DILEMMAS OF CUBAN STOMATOLOGY
By: Norge Martínez, Osviel Castro, Zenia Regalado, Luis Raúl Vázquez, Nelson
García Santos and Julio Martínez Molina
E-mail: digital@xxxxxxxxxxxxxxx  
October 28, 2007 - 00:50:26 GMT

http://www.walterlippmann.com/docs1612.html 
A CubaNews translation. Edited by Walter Lippmann.

http://www.juventudrebelde.cu/cuba/2007-10-28/
los-dilemas-de-la-estomatologia-en-cuba/ 

Widespread and well-structured, the stomatological service put up by the
Revolution is now suffering from shortages, organizational problems and
attitudes by no means in keeping with the ethical values which govern the
conduct of this profession. 

He can?t stand it any longer. Jumping from bed, he starts walking around the
room, a closed fist firmly pressed against the right side of his face. He
takes a swig of pure alcohol and rinses his mouth as he gets dressed. Never
mind that it?s half past midnight: his toothache won?t let him get a wink of
sleep.

Resolved to find some help, he heads for his polyclinic, less than a mile
away. But the building is so dark that he begins to feel a bit uneasy. Then
someone tells him there are no stomatologists on duty; he should try a
clinic almost six and a half miles away.

His pain grows worse, beating down on him in endless, throbbing waves that
seem to sprout from his brain. He?s been waiting for over an hour, but since
no bus ever shows up, he returns home, whining and in great discomfort, and
once there he replaces alcohol with salt water for his rinses, and soon
starts gulping down as many pills as he can find. At long last, he falls
asleep.

Early the following morning he goes back to his polyclinic, decided to put
an end to his misery. However, much to his surprise, a soft-spoken woman
tells him: «We won?t be seeing anyone today because there?s no running water
in the ward».

He strode toward another clinic, where he has to wait until noon to get a
temporary protective band. «It?s all we can do: there?s neither anesthetics
for extractions nor materials for fillings».

What you read above happened to Gustavo Pedroso, a young man from San Miguel
del Padrón municipality whose pilgrimage to alleviate his toothache brought
him face to face with the problems in our stomatological services.

IN THE CLINICS

Gustavo?s and other people?s complaints were the starting point for JR?s
research on the subject, which included visits to 22 stomatology clinics in
the provinces of Pinar del Río, Ciudad de La Habana, Cienfuegos, Villa
Clara, Ciego de Ávila y Granma where we interviewed dozens of patients and
doctors.



Many stomatologists told us they need better attention and more instruments
to service a higher number of patients.



Our inquiries revealed shortcomings in the provision of material and human
resources as well as organizational problems conducive to incipient
attitudes of a negative nature in a field where ethics should be paramount.

Most of the 22 clinics visited are understaffed, and more than half have
seen hard periods of crisis due to water shortages, insufficient supplies of
dentist?s chairs and resins for dental restoration, major delays both in the
production of prostheses and the system of appointments, lack of proper
garments, improper working conditions, problems with the staff?s meals, and
deficit of bathrooms.

A survey conducted among patients in Havana also confirmed the general
feeling that in certain cases string-pulling and favoritism are just the
ticket to a prompt, efficient service. Several admitted to either having
resorted to those methods or knowing someone who does.

A clinic in Havana?s Vedado district sometimes offers up to seven chairs and
only one specialist, no doubt a reason for overcrowding and the resulting
displeasure for the never-ending holdups.

«At the present moment I?m short three stomatologists, and to make things
worse, others here are about to retire», grumbled Odrey Landa Bencomo, head
of the stomatology division of the clinic in California ?a district in San
Miguel del Padrón municipality? where there are no technicians to take care
of the equipment needed in orthodontics.

A similar shortage of professionals is also noticeable in the eastern
province of Granma, whose 241 stomatologists are not enough to service more
than 800,000 inhabitants, the proportion being one to 3,460. «One of our
specialists takes care of at least eight offices», granted Provincial
Stomatology Division head Rolando Morales Soto.

In some places the deficit reaches unimagined limits. Morales Soto says that
the 36.000 people who live in areas like Mabay and its surrounding
neighborhoods have but one stomatologist! And only four of them cover all of
Cauto Cristo municipality (21,320 inhabitants).

However, in many mountainous zones incorporated into the Turquino Plan[1],
where there are 18 dental care posts, «we keep a specialist on a permanent
basis». Therefore, people there tend to complain less.

The lack of specialists in Villa Clara province has led to a shortage of
dental prostheses. According to Cedalys Pérez, head of the Stomatology
Department of Santa Clara city?s Municipal Health Division, there must be
one in every center, but there are only four to cover a population of over
250,000.

PROBLEMS WITH WATER

Judging from what JR saw during its visits, the water shortage has a
considerable impact on stomatology services. For instance, many patients
have to go home unattended every time the water supply system is interrupted
in the polyclinic René Vallejo, one of the biggest healthcare centers in
Bayamo, Granma province?s capital city. This problem happened in 24 days of
the month in February; 11 in June; 21 in August and 19 in September.

«The Hygiene and Epidemiology authorities always warn us that we can?t see
any patients if there?s no running water and make it clear that using water
in buckets, as we sometimes do, is not an option. We often have to call a
bulk liquid carrier, but bear in mind that this polyclinic needs at least 17
of those tanks to be able to work», she points out.

Provincial Stomatology Division data have it that in the first half of 2007
we failed to see 161 patients, mainly because of problems with the water
supply system, or the lack of it.

Most of the 12 clinics in Havana visited by our reporters have suffered from
this inconvenience at any given time, as in the case of those in California,
San Francisco de Paula and Abel Santamaría.

A WAITING CHAIR

Recently remodeled, the stomatology unit of the polyclinic Pedro Borrás in
Pinar del Río province was assigned new chairs. Today, however, only two are
in use. The lamps in all the other chairs are out of order.

Most polyclinics reopened in Granma province have spent months waiting for
the new chairs, months behind schedule for one reason or another. That
explains why the polyclinics Jimmy Hirzel and 13 de Marzo, both in Bayamo,
only have one and three chairs in service, respectively.

Equally affected by the lack of equipment is Villa Clara province, where at
the same time three polyclinics and one clinic were closed for alterations
and the service had to be reduced and/or moved to other facilities that more
often than not were unfit for use, remarks Cedalys.

«There used to be 15 chairs in the polyclinic Celia Sánchez. Now they only
have five. For a year the polyclinics Chiqui Gómez and Marta Abreu have each
worked with 4 of the 11 chairs needed for various specialties and emergency
cases», she added.

WILL vs. WANT

Dr. Ada Machín Martínez loves her job. Since she graduated 37 years ago she
has been the director of the stomatology clinic Enrique Sáenz Casado,
located in Central Havana municipality and popularly known as the San José
clinic.

In her view, the directors of stomatology clinics are to blame if they lack
the working materials they need. «They just have to go through the procedure
and get those materials from the central warehouses in Guanabacoa
municipality. Sometimes those warehouses have the trucks for distribution,
but as a rule you have to get a car in the end and see to it that the
stomatologists have what they need to work», she assures.

«In my case I ask for help among those patients who have a car, and there?s
hardly a day when I don?t have the materials I need. Last week we brought 36
bags of gypsum to make prostheses that I distributed around the
municipality. Chances are I would still be waiting for that material if I
had just sat on my hands. A good amount of willingness is what it takes to
counteract our hardships», she added.

According to the doctor, her clinic never stops working for any reason
whatsoever. They have 13 chairs available not only to regular patients but
also to nearby schools where they apply prophylaxis.



Prevention and the right medicines make it possible for children to grow
with good teeth and be protected from diseases of the mouth. Photo: Calixto
N. Llanes

 «We service 12 primary schools, 5 secondary schools and 8 day-care centers,
where we give all children several stomatological products designed to keep
their mouth in good condition and instill in them the importance of oral
hygiene for good measure, so that they grow to have healthy and nice-looking
teeth», points out Dr. Ada Machín.

URGENT SOLUTIONS

In order to lessen the current deficit a plan has been implemented across
the country ?under the motto Everything for Health? to make sure the service
be provided in the areas most distant from the city clinics. It involves
creating brigades of stomatology students who spend their weekends seeing
patients around those places, taking portable chairs with them and
accompanied by instructors.

JR confirmed in the field the effectiveness of this initiative. In just one
weekend, almost a hundred of these teenagers saw hundreds of people in the
said neighborhoods.

The future stomatologists pulled out and filled teeth, diagnosed, updated
case histories and worked in prevention, telltale signs of their good
qualification level.

«This is quite an effective movement in that it serves a twofold purpose:
resolve many people?s stomatological problems and provide an unparalleled
opportunity to practice that these students have jumped at with joy as a
chance to show what skills they have learned in their respective years at
school», remarked Dr. Jeydel Abull, an official with Havana?s Provincial
Stomatology Division.

?NEVERTHELESS, IT DOES MOVE?

The National Division at the Ministry of Public Health is aware of these
dilemmas. «We know about them. It?s true that at times our centers have less
than they need to offer a good service, but it?s also true that most of our
professionals do their best to take care of every patient?s problem», holds
Division director Dr. Armando Mojaiber de la Peña, who was kind enough to
devote a few hours to answer JR?s questions.

For all the flaws still found throughout the system, he believes Cuba boasts
better indicators than in previous years of stomatological work.

«Before the special period we used to be assigned up to 12 million pesos a
year for development, but the figure went down to 300,000 pesos when the
economy reached crisis point.

«Nonetheless, last year we filled over 6 million teeth, a first since the
1980s. Besides, our indicators today are on a par with developed countries:
68% of our children between the ages of zero and five have no cavities, and
90% of people under 18 still have all their own teeth.

«Another example to illustrate how much the stomatology service has improved
is that Cubans in the 35-44 age bracket lose 5.4 teeth on average, as
opposed to 12 in the 1980s».

Regardless, he admits there are flaws in this vital service. «We have
serious difficulties with the gloves, an item whose availability depends on
a number of entities and how well they do their job. Sometimes the suppliers
take too long; other times we have no vehicles to distribute the product in
due time, among other shortcomings.

«Concerning water, we have advised each clinic to create their own reserve
so that they can remain active even if the water supply system is off. If
the service is interrupted somewhere, it?s the director?s fault».

Q: Having fewer specialists than required is a major problem in some
clinics. Why the shortage?

«The stomatologists are not evenly distributed over some regions. Were they
properly appointed in every municipality, I?m sure everything would be very
different.

«Right this minute we are qualifying thousands of professionals, enough to
fill all positions in Cuba and fulfill our cooperation agreements with other
countries.

«This year we have 2,439 new stomatology students, for a total of 6,100 when
we add the rest of the years, a noteworthy achievement if we keep in mind
that only 410 students entered our schools in 1986».

Q: Several people have told us that sometimes they have paid for your
services...

«We know that a few workers devote themselves to charging for a service that
the Revolution decreed it must be offered free of charge. In the last few
years we have expelled eight of these individuals from the national
healthcare system because of such practices».

Q: There has been talk lately of private clinics...

«Not long ago we inspected the stomatology service all over Cuba and found a
number of private clinics working with neither permission nor the required
sanitary conditions. We?re already enforcing the relevant provisions to
eliminate those cases.

«Insofar as our service becomes more efficient, people won?t have to go to
those clandestine places. It?s an immediate goal we must meet as soon as
possible, and to that end we are working as best we can».

Q: Are all those private clinics illegal?

«No. Some of them ?very few? have a practice permit, in all cases run by
specialists who graduated before 1965. The rest are illegal, and many of
them the service has been found to be in violation of the main hygienic and
sanitary standards governing this profession.

«We recently had to close five private offices in Havana which had a permit
but failed to pass the health inspection».

Q: Where do private dentists find the materials they need?

«Those who have a permit can buy them from the State. As to the others, they
get them illegally, usually from people who stole them from our clinics,
warehouses or during transportation. Others receive those materials from
family and friends in other countries.

Q: The repair work in some clinics is a long way behind schedule, which
gives rise to long lines wherever one is in operation...

«Now we are deeply engaged in the work to recondition dozens of stomatology
centers across Cuba to restore them to their former glory, but we know the
program is delayed and many patients have to go to other clinics as a
result, which leads to further delays in those places.

«So far we have repaired and retrofitted a total of 108 units, and we expect
to have finished nearly 200 of them before the end of 2008, which will
redound to the benefit of our service in every way». 



JR identified the delays in the manufacture of prostheses as one big problem
in this sphere. Photo: Heriberto González Brito

Q: People complain about delays in the manufacture of prostheses...

«That?s one big difficulty facing our service. We must make around 180,000
of them this year; however, it?s not enough for a product in great demand.
Things will change as soon as we repair all the polyclinics, since by then
there will be more laboratories to make them and we?ll be able to attain the
300,000 items that people need.

«It?s important to bear in mind that taking care of our teeth is the best
way to avoid the need to wear a prosthesis, and for that we have in place a
promotion and prevention program that includes common salt fluoridation to
attain in five years a sixty percent reduction in the incidence of
cavities».

Q: Some stomatologists say that working without air conditioning is a
violation of the current technical standards...

«Wrong. Ideally, they would all have air conditioners, but they can work
without them. We have approval to deal with that problem little by little,
at least in the polyclinics already repaired and those still in the process.

«We have given priority to operation rooms, the clinics for the disabled and
X-ray departments, in addition to some other facilities».

Q: In your opinion, is prevention properly conducted?

«It?s essential that we insist on the adequate way to brush our teeth and
gums at least four times a day and replace the toothbrush every three months
if possible. In the case of children, we must do it as soon as they start
teething. Mothers are recommended to keep their children from sucking their
thumb, give them milk in a feeding bottle, avoid blending their foods and
have them sleep without pillows.

«Prevention is the best way to deal with stomatological problems, and we can
make it by assuring first of all a proper oral hygiene and paying regular
visits to a specialist, not only when pain appears».

OUT OF THIN AIR

Stomatology services were all but nonexistent before the Revolution, as is
evident from figures and records consulted as part of this study. There was
only one school, located in the University of Havana, where a few
professionals were qualified. The number of clinics was very low too.

Following the revolutionary triumph the country began to do something about
such a harsh reality, achieving successes step by step and making a
healthcare system available to the Cuban population that has become a
touchstone for many countries.

Stomatology is now a field taught in all Cuban provinces nowadays, even in
many municipalities, so that every territory can qualify as many
professionals as it needs. Today we have almost 500 polyclinics ?most of
them with stomatology services? and 156 stomatology clinics, not to mention
nearly a thousand additional units in schools, hospitals, military units and
other places. All in all, Cuba has approximately 1,700 stomatology
departments. And not only have we set in motion a big stomatology network in
almost 50 years; we also cooperate with other nations and provide dental
care free of charge to thousands of people around the world.

YEAR 2006?S FIGURES:
Stomatology consultations: 17,623,000
Consultations per inhabitant: 1,6
Inhabitants per stomatologist: 1,049
Source: Anuario Estadístico de Cuba 2006


[1] Christened Turquino Plan when it began in 1987, the basis of this
integral program for economic and social development in mountainous areas
includes steps towards food sustainability, nature conservation, enhanced
defense capabilities, and measures to stop a continuous emigration and
attract (mainly young) workers instead by assuring better standards of
living.

It covers about 18% of the national territory (49 municipalities in 8
provinces) with a total population of 700,000 (6% of the Cuban inhabitants)
in 977 settlements. 

According to the Food and Agriculture Organization (FAO) authorities, the
Turquino Plan is the only one of its kind in the world, given its
meticulousness and the extensiveness of its projects. (T.N.).


________________________________________________
YOU MUST clip all extraneous text before replying to a message.
Send list submissions to: Marxism@xxxxxxxxxxxxxxxxxxx
Set your options at: http://lists.econ.utah.edu/mailman/listinfo/marxism