CUBA, Republic of Cuba — the socialist state in West Indies located on the island of the same name and more than 1600 small adjacent islands from group of the Big Antilles. The next boundary with To. the countries are: in the north — the USA, in the West — Mexico, in the east — Haiti, in the south — Jamaica. The territory of the country, including islands of the Cuban archipelago, makes 110 922 km 2 . The population of 9,582 million people (1977), the capital — Havana (apprx. 2 million zhit. in borders of Big Havana). Ofits. language — Spanish. Administrative division — 14 provinces which are divided into 169 municipiums.
The lake of Cuba stretches from the East for the West and represents narrow strips at the earth 1250 km long, up to 191 km wide. The surface is generally flat, the most considerable mountains Sierra-Maestra (height to 1974 m) are located in the south. The rivers are deep, but are short and for navigation are not used. The climate is tropical, passatny, with a pronounced rainy season (May — October). More droughty period from November to May. On 10.-3. there are strong hurricanes in the fall.
On July 26, 1953 the group of young Cuban patriots led by Fidel Castro undertook storm of barracks Moncada in Santiago De Cuba, at the end of 1956 developed the guerrilla war in mountains Sierra-Maestra, and on January 1, 1959 in Cuba the people's democratic agrarian anti-imperialist revolution which opened a new era in the history of the country won.
The constitution approved by a national referendum in February, 1976, the Republic of Cuba is proclaimed the socialist state of workers, peasants and the labor intellectuals. All power in the country belongs to the working people. The supreme body of the government and legislature — the National Assembly of People's Power, edges from among the deputies elects the State Council, the chairman to-rogo is head of state and the governments, and also the commander-in-chief of revolutionary armed forces. The supreme executive and administrative body is the Council of ministers. The leading force of society and state directing to common efforts in construction of socialism is the Communist Party of Cuba.
To. — agrarian-industrial country. On the environment she has great opportunities for cultivation of a sugarcane, rice, a citrus, coffee, tobacco and other tropical cultures, and also for development of livestock production. A subsoil To. are rich with minerals (nickel, cobalt, manganese, iron). There are chromium, copper ores, nonmetallic minerals (rock salt, a kaolin, limestone, alabaster, marble, etc.).
To. received heavy heritage from the past, it developed in an era of colonialism as a raw-material producing appendage at first of Spain, and then the USA. Revolutionary changes led to basic change of social and economic structure. Nowadays socialist sector plays the predominating role in economy, it covers apprx. 60% of page - x. productions, 100% of industrial production, 100% in construction and trade and apprx. 100% on transport. In 5 years (1971 — 1975) annual average gains of gross national product made St.
10% (in 1966-1970 - 3,9%). The full employment of the population is provided. For the end of 1975 in various spheres 647 thousand women worked (in 1958 — 194 thousand women). Considerably the salary and social security payments increased. E.g., in 1958 payments of the salary made 1400 million peso, and in 1973 — 3690 million; social security payments in 1958 made 105 million peso, and in 1973 — 647 million. Expenses of the state on social security and insurance for years of public authority (by 1975) increased by 5 times, on health care — by 20 times.
The leading place in national economy is taken by production of sugar, on export to-rogo To. is on the first place in the world. Main page - x. culture is the sugarcane, it gives 25% of cost of page - x. products. Production of sugar — a fundamental unit, around to-rogo develops a number of industries, agriculture and transport. In a safra of 1975/76 145 sugar plants worked, the St. 6 million t of raw sugar is produced, the level of mechanization of cleaning of a sugarcane reached 35% against 25% in a safra of 1974/75. Production of other traditional cultures extends: tobacco, citrus. From grain major importance has rice; cultivate also batata, to Malang, potatoes and a yam, cultivate coffee, pineapples, bananas, mango, a melon tree, a coconut palm tree and other cultures. Vegetables (hl. obr. tomatoes, cucumbers, pumpkin, onions, pepper) and melon cultures grow up all the year round in the open ground. The livestock production and fishery develops. The large role in development of national economy is played by works on melioration, construction of water reservoirs and involvement in a turn of lands, heathlands and bogs unused earlier. If the total capacity of water reservoirs in 1958 made 29 million m3, then in 1973 it reached 3,5 billion m3, and at the end of 1975 — 4,3 billion m3. The area of the irrigated lands of 662 thousand hectares (1976).
The industry of the country gives St. 40% of all gross output. Much attention is paid to electrification. Rated capacity of power plants in comparison with 1958 increased more than by 3 times and reached 1213 thousand Siberian salmons in 1976, power generation increased more than by 2,5 times, having exceeded 6 billion kWh.
With technical assistance of the USSR expansion of capacities of thermal power plants in Mariela (province Havana) and San Thiago is carried out, construction of the first on is provided To. nuclear power plant. Successfully metallurgical industry develops.
In 1977 smelting of steel reached St. 330 thousand tons, production of hire made 308 thousand tons. Only after the revolution mechanical engineering industry began to be created. By means of the USSR the plant on production of trostnikovouborochny combines is constructed. Mining industry is presented by the enterprises for extraction of nickel-containing, copper and other ores. On extraction of nickel K. is high on the list in the world. The large nikeleobrabatyvayushchy plants reconstructed with assistance of the USSR are in of Nicaro and Moa. With technical assistance of the USSR construction of the 30 thousand tons of nickel new plant in a year is begun, the second same plant is under construction by means of member countries of SEV. Considerable development was gained by the chemical industry on the basis of import raw materials, use of waste and by-products of sugar production, and also petrochemistry. Products of oil processing grew from 3,6 million t in 1958 to 5,9 million t in 1975. The food industry, in addition to sugar, is presented flour-grinding and the bakeries using import grain, meat-processing plants, the maslomolochny and oil milling enterprises. Tobacco products release the 6th large FC.
To. supports commercial relations more than with 80 countries of the world, the share of the socialist countries in its foreign trade turnover makes apprx. 70%, including 55% are the share of the Soviet Union. To. — active member of SEV. The main articles of export — raw sugar, minerals, tobacco; import — food, machines, the equipment, vehicles, oil and oil products, the wood and timber. In development of economy
continuous cooperation with the USSR and other socialist countries, their disinterested aid is important. At the heaviest moment for To. the socialist countries helped it and in the field of health care when the imperialism applied economic blockade, because of a cut import of pharmaceuticals, tools and the equipment, raw materials for pharm stopped. industries.
The national structure is homogeneous, St. 95% of the population — Cubans (1976). There live also natives of the countries of Asia — Chinese and Japanese and immigrants with the lake of Haiti. 51% of the population — men and 49% of the woman, 36% — country people (fluctuates from 7,6% in the province Havana to 61,8% in the province of Pinar del Rio), 38,1% — children up to 15 years, inhabitants at the age of 65 years and are more senior — 6,6% (1976). Average population density — 87,0 people on 1 sq.km (with fluctuations from 291,9 in the province Havana to 37,9 in the province Camaguey, 1977).
The natural movement of the population, on ofitsa. to the data provided in editions of WHO (tab.) it is characterized by noticeable decrease in child mortality. It is supposed that by 1980 the population To. will reach 10 million people, hl. obr. due to decrease in child mortality.
Table. VITAL RATES IN CUBA FROM 1965 for 1977 (on 1000 people)
Steadily maternal mortality decreases. If in 1953, according to not complete data, there were 14,8 cases of a lethal outcome on 10 thousand childbirth, then in 1973 this indicator decreased almost by 3 times and made 5,4 cases. Average life expectancy of men and women by 1976 reached 70 years (men — 68,5 years, women — 71,8 years). On a census of 1953 average life expectancy made 53 years.
For rather small term of revolutionary socialist changes in the state of health of the Cuban people there were considerable changes. Great success is achieved in fight against a row inf. diseases. The program of elimination of malaria (incidence of it in 1953 made 3,6 cases on 100 thousand population, and mortality 0,7 cases) began to be carried out in 1958. According to questioning of 1959 — 1960, the malarial zone covered 32,7% of the territory of the country in which 28, 4% of the population lived. The most active actions are carried out in 1962; pollination of DDT of all houses of a malarial zone was made. By 1966 incidence of malaria sharply decreased, and since June 28, 1967 any local case of malaria is not registered. In 1973. To. received the certificate of WHO on elimination of malaria. Incidence of poliomyelitis decreased from 350 cases a year (1961) to 46 cases in 1962 when vaccination of children to 15-year age was for the first time begun. In 1965 — 1969 any case of poliomyelitis was not registered, in 1970 — 1971 it is registered in one case among not vaccinated children. From 1965 to 1976 incidence decreased by 100 thousand zhit. tuberculosis (all forms) with 63,5 to 13,5; whooping cough with 26,6 to 1,5; tetanus with 6,5 to 0,7. Cases of tetanus among newborns in 1976 were not registered. Incidence of a typhoid and paratyphus in 1965 — 1976 fluctuated from 3,0 to 4,3 on 100 thousand population; leprosy from 4,2 to 4,4; spotted fever from 0,3 to 0,8. As a result of use of preventive inoculations in 1973 — 1976 cases of diphtheria were not registered; in 1965 the number of diseases of diphtheria on 100 thousand population made 8,2.
Diseases of cardiovascular system were the main reasons for death in 1977 (161,2 on 100 thousand zhit.), malignant new growths (104,3), diseases of vessels of a brain (55,8), flu and pneumonia (47,9), accidents (38,1), a birth trauma (17,8) etc.
the Organization of health care
Creation of uniform system of national health care on To. is result of political, social and economic transformations which happened in the country after the victory of socialist revolution in 1959.
For the entire period of the Spanish colonial rule (1492 — 1898) any bill in the field of health care was not adopted. Functioned several BCs constructed for service of colonialists and Spanish military personnel who were located in rich districts of Santiago de Cuba, Bayamo and Havana.
In 1871 the Municipal health service was created, a cut was a part apprx. 30 BCs and 16 houses of health and the first «House of assistance», and since 1889 practice of assistance began to be carried out at home.
The most part of the population suffered from epidemics of yellow fever, cholera, smallpox, typhoid, marsh fever, diphtheria and other diseases claiming huge number of the human lives.
At the beginning of 19 century the Cuban doctor Don Thomas Romey introduced in the country vaccination against smallpox for the first time, and at the end of 19 century. K. Finlya proved that the mosquito is a carrier of yellow fever.
In 1909 at the initiative of group of prominent Cuban doctors on To. the Secretariat of health care which was responsible for taking a step in the field of health care of the country, led by To was created. The financial leu which made a big contribution to development of «Health regulations» and «The sanitary code» where the instructions to local bodies of health care directed to improvement of medical providing the population contained.
From 1917 for 1925 in the Secretariat of health care prominent Cuban doctors Menokal, Méndez Capote, Giteras and Agramonte who put into practice a number of actions for improvement of a health system worked. This period is called the gold period of the Cuban medicine.
Since 1925 the period of full decline of the Cuban public health care which proceeded up to a victory of revolution of 1959 began. During this period the number private grew to lay down. institutions. The state budget on health care was is insignificant is small. Lech. institutions, medical offices and laboratories, doctors and nurses lived in the large cities. In Havana the St. 60% of doctors and hospital beds while the country people of the country had no opportunity to receive medical aid were concentrated. There was a medical f-t, releasing in a year apprx. 300 doctors, and 7 schools of training of nurses and nurses who together released apprx. 100 people a year. The foreign enterprises controlled 70% of implementation of medicines in the country. The health care under the influence of the USA developed on private-capitalist bases.
Creation of a national health system on To. began after the revolution. The Ministry of Health was formed, a cut defines policy of health care, develops standards, directs and gives an assessment to activity of subordinate levels of a health system, controls their work. Mines-in of health care directs scientific research institute, training centers and the enterprises for production of pharmaceuticals, medical tools etc. Since 1959 all medical institutions, including and the private, and also industrial and trade enterprises connected with production, distribution and sale of pharmaceuticals, medical tools and the equipment were vlyuchena in a uniform health system. Care of public health care was proclaimed one of the most important obligations of the state, medical aid became free and available to all population. In case of disability the state provides to workers allowances. Lech. the medicine is combined with preventive, much attention is constantly paid to proportional development of network to lay down. - the prof. of institutions, to preparation and distribution of medical shots. The population actively participates in implementation of various programs of health care.
In each province and a municipium there are provincial or regional governments health care which are subordinated to local authorities. The population of the country receives medical aid in city, provincial, regional and rural-tsakh, in scientific research institute, and also in city, provincial, regional policlinics, rural first-aid posts, women's and child care facilities of health care.
In 1977 in the country there would be 251, 349 policlinics, 131 rural first-aid posts, 119 stomatol, offices, 38 laboratories of hygiene and microbiology, 21 blood transfusion stations, 63 maternity hospitals and BC for mothers and children, 32 pediatric-tsy and other child care facilities of rehabilitation, etc. 53-tsy and 187 medical centers give help to workers of the village and members of their families. In total in 1977 in the country 1154 medical establishments and institutions of social security in which there were 51 219 hospital beds functioned, or 53 beds on 10 thousand zhit. (in 1958 — 16 beds), and 7214 beds, or 8,0 on 10 thousand zhit., in institutions of social security (the house of mothers, the house on recovery of health of children, nursing homes, disabled people, etc.). In 1974 in the general type there would be 45,6% of beds, in nurseries — 13,0%, in maternity hospitals — 13,0%, in rural — 2,8%, in tubercular — 2,3%, in psychiatric — 14,8%, in oncological — 1,7% and in-tsakh and the centers of other profile — 6,8%. The main medical institutions in the village would be rural and the rural medical center. Rural would have from 10 to 40 beds (generally obstetric and children's), service from 5 to 20 thousand population. The states rural BCs consist of 2 — 4 doctors, the stomatologist, the nurse, 8 — 9 assistants to the nurse and support personnel. The medical center services from 3 to 5 thousand population; in it the doctor, the stomatologist (dentist), the midwife, assistants to the nurse, the laboratory assistant work, sometimes as a part of the medical center there is a hospital on 10 beds, usually obstetric.
The out-patient and polyclinic help in the cities is carried out by policlinics in which doctors of hl work. obr. four specialties: therapists, pediatricians, obstetricians-gynecologists and stomatologists. There are also children's and stomatol, policlinics. Patients receive the specialized extra hospital help in specialized or multi-profile-tsakh. The number of medical visits in 1975 on 1 zhit. made 4,8 (in 1963 — 2,0; in 1970 — 3,9), from them out-patient 2,8, on acute management 1,3, to the stomatologist 0,7. The private practice (1976) is minimized. There is a limited number of the doctors and stomatologists supporting small out-patient clinics.
Broad actions for health protection of mother and the child are held on To. since the beginning of the 60th. Together with social and economic gains they allowed to improve indicators of this service considerably. In 1973 98% of childbirth were accepted in maternity hospitals, also 3,8 surveys of children aged to 15 years are carried out on average on 8,5 prenatal surveys of each woman in labor, 5,0 surveys of the healthy child on the first year of life. In 1977 on 9850 zhit. there was 1 gynecologist and on 5730 zhit. 1 pediatrician. In the country there were 7280 beds of a gynecologic profile (0,7 for 1000 zhit.) and 9706 beds of a pediatric profile (1,0 for 1000 zhit.). The legislation of the country provides paid prenatal (6 weeks) and puerperal (12 weeks) issues to the working women; in a case the pregnant woman and the nursing mother receive benefit of 50% and above from the salary. The law provides release of pregnant women from work for passing of routine maintenances. To pregnant women, women in labor and nursing mothers of medicine are released free of charge.
The sanitary and epidemiologic service in the country developed by 1970. It is Min-va part of health care. The main scientific center studying questions of epidemiology and hygiene is National in-t of hygiene, epidemiology and microbiology. Scientific research and practical work on control of state of environment are carried out in the provincial and regional centers and in a row to lay down. - professional, institutions.
On S. of Cuba, on the bank of the Karnbsky sea, balneological resorts are located: Banyos-de-Elgea with thermal (t ° 38 — 41,2) slabosulfitny, chloride sodium waters with the small content of iodine and bromine; La Payla with hydrocarbonate calcium-magnesium and slabosulfatny hydrocarbonate waters; Santa-Maria-del-Rosario with carbonate sodium and sulphatic calcic waters; on one of islands of the Caribbean Sea San Diego's resort - Los-Banyos with hydrocarbonate calcic, sulphatic, sulphitic and calcium and hloridno-hydrocarbonate sodium waters, and also climatic resorts of San Vicente, Santa Fe, etc.
Health care workforce
In 1977 in the country functioned 10 medical f-tov, 2 stomatol, and 1 f-t on training of nurses of the top skills with the contingent of 7,5 thousand students, and 58 medical schools at which studied apprx. 12 thousand nurses and medical technicians. Annual release in 1970 — 1975 apprx. 1000 doctors and apprx. 5000 average medics on 9 specialties. The term of training of the doctor — 6 years, and the last year is allotted for passing of an internship on therapy, pediatrics, obstetrics and gynecology and surgery. After an internship each doctor shall work 2 — 3 years in rural areas, only after that it can start preparation on narrower specialty. The term of training of nurses — 2 — 3 years, assistants to the nurse and support personnel — 1 year, druggists — 5 years and technicians of drugstores, laboratory assistants, X-ray technicians, midwifes — 2 years. Training of doctors and paramedical staff takes the important place in work of health care.
Special attention is paid to ideological education, instilling of materialistic outlook, mastering methods of Marxist-Leninist philosophy, studying of social hygiene and the organization of health care. The principle «is widely realized to study and work». A half of operating time students are busy with the work connected with future profession (e.g., students of medical in-t carry out duties of nurses, laboratory assistants), in the rest of the time study.
In 1976 in the country there were apprx. 10 thousand doctors (13 on 10 thousand population whereas in 1958 there were 6 doctors on 10 thousand population) also 31 618 average medics (33,4 on 10 thousand zhit.). In 1960 — 1961 1360 doctors (21,5% of total number of the doctors working in the country in 1959), having come under influence of imperialistic promotion, left the country. During this period the big help To. physicians from other countries, in particular from socialist rendered. By 1976 the number of doctors not only reached the level of 1959, but also considerably exceeded it.
The medical industry
In Cuba 53 pharm, the enterprises producing pharmaceuticals from plants, vitamins, hormonal drugs in quantity apprx. 660 names. In a decade from 1965 to 1974 the output of pharmaceuticals increased more than by 3 times.
However large amount of medicines K. imports. Main suppliers: NRB — 32,6% of the general import; The USSR — 27,7%; GDR - 9,5%; VNR - 8,6%. The help of the countries of SEV with development of own medical industry allowed To. to reduce import of pharmaceuticals to one and a half times after the introduction in SEV.
Production of the medical equipment is concentrated on f-ke on production of medical tools, f-ke-point frames, orthopedic f-ke and in 10 workshops at large orthopedic and traumatologic-tsakh. There are 28 bases on repair of the medical equipment. Gross output of the medical industry apprx. 250 — 270 million peso a year.
Production of pharmaceuticals and the medical equipment is under authority of Management of tools, the equipment and Min-va medicines of health care of the republic. The Republic of Cuba conducts active cooperation with the Soviet Union. By means of the Soviet specialists it was reconstructed f-@ medical tools. In 1973 with the assistance of the Soviet specialists the experimental station of medicinal plants was organized and the collection experienced nursery by 13 types of medicinal plants is put.
The revolutionary government of the Republic of Cuba pays exclusive attention and gives full support to development of medical science. In the country 10 scientific research institutes function: cardiology and cordial surgery; oncology and radiobiology; gastroenterologies; neuropathology and neurosurgery; nephrology; endocrinology and metabolism; hygiene, epidemiology and microbiology; angiology; hematology and immunology; in-t of development of health care. Besides, a scientific medical research is conducted also in the National center of scientific research and in Academy of Sciences of the Republic of Cuba, in structure the cut functions one medical scientific research institute. The management and coordination of researches exercises Control on scientific research as a part of Min-va of health care. An important role in development of medical science is played by 37 science medical foundations. They work under the leadership of the Academic council of Min-va of health care. On To. the medical magazine, magazines of surgery, pediatrics, tropical medicine, pharmacology, stomatology, hygiene and epidemiology, etc. are issued Cuban. The Cuban scientists study questions of prevention of diseases and environmental control.
Thanks to successful development of a national health system and holding preventive actions To. achieved great success and on many indicators advances other countries of Latin America.
Expenses on health care in 1976 exceeded expenses of 1959 by 20 times.
Bibliography: Gorbachev In, and Darusenkov O. Cuba at a new stage of socialist construction, the Communist, No. 2, page 81, 1973; Zhilinskas Yu. Yu. Health care of the Republic of Cuba, Owls. zdravookhr., No. 9, page 52, 1978; Tarasov V. V. Health care in the countries of Latin America, page 149, M., 1976.
X. Gutierrez Muñis, V. B. Tsybulsky.