A Cuba Policy Driven by Sadistic Zeal : The U.S. embargo hobbles lifesaving medical care. Why don’t U.S. doctors protest?

The United States is killing Cubans every day. The victims are mostly over 65, and they are dying from such diseases as TB, influenza and pneumonia. It’s the kind of carnage registered in small upticks on a mortality graph, not as easy to focus on as, say, a pile of bodies dismembered by U.S.-trained troops in El Salvador in the early 1980s. But the killing, engineered by the U.S. government, is just as relentless.

Cuba’s crisis began with the collapse of the Soviet Bloc in the late 1980s, but real devastation commenced with the Cuban Democracy Act of 1992, reluctantly signed into law by President Bush in order to head off candidate Clinton, who had been eagerly promoting the bill in Florida. The new law severely tightened the 33-year U.S. embargo on trade with Cuba, banning shipments to Cuba from any subsidiaries of U.S. firms. Foreign ships visiting Cuba are banned from docking at U.S. ports for six months.

U.S. government officials have been enforcing the 1992 law with sadistic zeal. They once banned a shipment of Colombian chickens to Cuba because their diet consisted of American-made chicken feed. Goods produced outside the United States containing less than 10% U.S.-origin components aren’t banned under the act. But the United States determined that by the time of shipment, the American feed was reckoned to make up more than one-tenth of the chicken. It would take the pen of Jonathan Swift to address this level of bureaucratic madness. Would a Somalian kid fed on humanitarian shipments be able to claim U.S. citizenship because he had been raised on corn from the Midwest?

The policy is sadistic and deadly. Cuba was able to import a European-made water-purification system that contained filters made in the United States. But the sale of replacement filters was prohibited. So now the whole system is useless. Deaths in Cuba from diseases such as diarrhea, associated with unsafe drinking water, have been rising since 1992.

Medical donations are sometimes permitted from private U.S. organizations, but only under maniacally tortuous on-site supervision.

Cuba can buy food and medical supplies from other countries, but pays about 30% more than U.S. prices; shipping costs are anywhere from 50% to 4,000% higher.

Under such duress, imports of medicines and medical supplies have declined by about 40%. Substitution of some American products is impossible: X-ray film for breast-cancer detection; replacement parts for respirators, Spanish-language medical books from a firm bought by a U.S. conglomerate. Bibliographic searches are impossible for Cuban doctors, since they can’t use the National Library of Medicine’s MEDLAR indexing system.

Between 1989 and 1993, Cuba’s overall mortality rate rose 15%, with a 79% increase from flu and pneumonia attributed to lack of antibiotics. Since the Cuban medical system gives priority to women and children, the elderly and men are bearing the brunt of the shortage.

Rationing protects the weak. Nonetheless, even though overall infant mortality continues to decline, babies with birth weights under 5 1/2 pounds rose by nearly 2% from 1989 to 1993, wiping out 10 years of progress.

Cuba’s health system has always been one of the great achievements of the Castro years. Childhood malnutrition disappeared. Immunization coverage for those under 2 is still higher than 90%. The population over 65 increased from 4.8% to 8.9% in 20 years and life expectancy at birth is 75 years, the highest in Latin America.

There’s one physician to every 214 residents and the number of physicians continues to rise.

This public-health system is resilient, and shows no sign of the sort of collapse suffered by nations in the former Soviet Union. When a shortage of B vitamins caused 50,662 Cubans to go temporarily (and 200 permanently) blind back in 1993, health workers were quick in distributing the necessary supplements to every household.

But Cuban people are dying because of the U.S. siege, and one question is: What is the American medical community going to do about it? Almost all the major associations have kept their mouths obediently shut. The only one that fought the 1992 bill publicly was the American Public Health Assn. When its own material interests are threatened, no group is more tigerish in self-defense than American physicians. Is it beyond the powers of one of the most powerful U.S. lobbies to urge its government to drop this barbaric siege?