Oil Wars

A Health System’s ‘Miracles’ Come With Hidden Costs

HAVANA, Nov. 16 — A shiny new tour bus pulled up to the top eye hospital in Cuba on a sunny day this month and disgorged 47 working-class people from El Salvador, many of whom could barely see because they had thick cataracts in their eyes.

Among them were Francisca Antonia Guevara, 74, a homemaker from Ciudad Delgado whose world was a blur. She said she had visited an eye doctor in her home country but could not pay the $200 needed for artificial lens implants, much less pay for the surgery.

“As someone of few resources, I couldn’t afford it,” she said. “With the bad economic situation we have there, how are we going to afford this?”

Cuba’s economy is not exactly booming either, yet within two hours Ms. Guevara’s cataracts were excised and the lenses implanted, with the Cuban government paying for everything — including air transportation, housing, food and even the follow-up care.

The government has dubbed the program Operation Miracle, and for the hundreds of thousands of people from Venezuela, Central America and the Caribbean who have benefited from it since it was started in July 2004, it is aptly named.

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The Cuban authorities say they have treated more than 750,000 people for eye conditions like cataracts and glaucoma since the program started.

At the same time, Cuban doctors have set up 37 small eye hospitals in Latin America, the Caribbean and Mali. Twenty-five of the centers are in Venezuela and Bolivia, whose leaders have close ties to the Castros. The hospitals are staffed with more than 70 top-notch eye surgeons from Cuba and hundreds of other nurses and ophthalmologists.

Dr. Sergio M. Vidal Casali, 84, has worked at the Ramón Pando Ferrer Cuban Institute of Ophthalmology for more than 50 years, specializing in diseases of the retina. He said the heavy flow of foreign patients through the hospital, combined with the exodus of several physicians to other countries, had hurt his department. “I don’t like it, really,” he said. “It’s wonderful for the people, but not for us. It disturbs our work.”

Dr. Reynaldo Rios Casas, the director of the institute, said the first days of the program were hectic. Eye surgeons worked in three shifts, keeping the hospital’s operating rooms going all day and all night. It was not uncommon for a single surgeon to perform 40 operations in a shift.

“It was really heroic,” he said. “We were operating day, afternoon and night.”

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In recent years, the program has allowed Cuba to use its doctors as barter for subsidized Venezuelan oil and to forge closer relations with other countries in the region, including those, like El Salvador, that have not been historically close to the Communist regime here.

Of course, the people who have their sight restored could not care less about the political and economic repercussions of the program. For them, the offer of free surgery was a dream come true.

Mrs. Guevara, whose husband is a retired construction worker from San Salvador, said she had given up hope of seeing again. She heard about the Cuban project on a Mayan radio station. “I never imagined anyone would help me the way they have helped me,” she said as she waited for surgery. “I thought I was going to end up blind.”

Near her in the waiting room was Reina López, 58, of San Vicente, El Salvador, who has not been able to see for 13 years because of cataracts. Her daughter, Adilia Reyes, 33, said she had cared for her mother since she lost her sight. The family, including four children, survives on her father’s salary of $3 a day, plus whatever fruit can be sold at a market on Saturdays.

“For the poor, this is a tremendous benefit,” she said, as she guided her mother to a presurgery test. “If it works, we’ll be so grateful.”

Downstairs in the cafeteria, Manuel Agustín Isasi, 33, a professional fencing coach from Islas Margaritas in Venezuela, was eating a lunch of pork, rice and beans, able for the first time in years to see his food with both eyes. Three years ago, he had been whitewashing his home when he accidentally burned both corneas with a bucket of quicklime. The accident ended his fencing career.

He had been one of the first to receive a cornea transplant in his left eye when the program started, he said. Then, in early November, doctors in Havana replaced the cornea in his right eye. He was unabashed in his praise for the Cuban government and for President Hugo Chávez of Venezuela.

“I would have remained completely blind,” he said, fixing a reporter with a swordsman’s gaze. “Vision is half of one’s life.”