The Doctors' Revolution

Michael Tynan, Emeritus Professor of Paediatric Cardiology, first visited Cuba in 1987 to provide expert advice to a new children's heart unit at the William Soler Hospital in Havana. Over 20 years later and Cuba is the only country in the world to offer foetal heart scanning as a standard part of pre-natal care, infant mortality is one of the lowest in the world and Michael has just finished making a documentary film – The Doctors' Revolution – charting the struggle and success of Cuba's health system.

Cuba first began to focus on pre-natal heart defects in the 1980s when infant mortality had been brought down to Western levels. Maternal obstetric care was sorted and children were no longer dying from curable diseases such as malnutrition and pneumonia. Tynan differentiates Cuba from other developing countries:

In a Third World context, infant deaths resulting from heart disease are almost irrelevant because you’re more concerned with clean water and maternal care. As far as I can interpret, Cuba realised that congenital heart defects were an increasingly important proportion of the now pretty low infant mortality.

The Doctors’ Revolution tells the story of a young boy, Felix, with a congenital narrowing of the aorta. Although it required major and potentially dangerous surgery, a relatively simple piece of equipment could have been used to open up the valve leading to Felix’s heart.

Unfortunately, due to the blockade, and aside from a complicated – and in Tynan’s view overly bureaucratic – procurement system, the hospital was unable to order the equipment internationally because it was manufactured in the United States.

Although there is scope for limited humanitarian medical exchange between the US and Cuba, Tynan explains that Cuba’s internationalism and record of offering healthcare to developing countries is seen by the US as an attempt to profiteer:

Before Felix there seemed to be a tightening of restrictions. The United States government decided that equipment being exported to Cuba was being used by children from other countries and this contravened their rules. They assumed – because this is how healthcare in the West goes – that this was being done for financial gain so they intensified the embargo and wanted details of every child that was using the equipment. What right does the US government have to demand the medical history of a patient in another country? This turn of the screw meant there were long hold-ups and difficulties in getting specific pieces of equipment.

The situation with the US government is further complicated because, if there is an irregularity, then the person liable for prosecution is the person responsible for where it originated in the States. As Tynan notes, this has resulted in medical equipment coming to Cuba from the US in very roundabout ways: “Things from America could go via France or Madagascar and, by the time they got to Cuba, they were more expensive because everybody had had their piece of the action along the way”.

Considering the intensification of the blockade, Cuba’s achievements in the field of healthcare – particularly in the areas of infant mortality, life expectancy and internationalism – are nothing short of miraculous. As far as Tynan is concerned, it is the organisation of the Cuban health system which lies at the heart of this success:

The most impressive thing about the Cuban health service is the organisation of preventative medicine through the family practitioner. If you don’t take your insulin for your diabetes then the GP wants to know why and it’s not left to you to go along and ask for a prescription. That’s the most impressive thing – even more than the high-tech medicine.

After the revolution, public healthcare was based on the Soviet model of the polyclinic and it wasn’t until the late 1970s that they moved to a family-centred model based on preventative and proactive medicine. There are still a high proportion of un-booked new born deliveries in Britain – but that’s very rare in Cuba because GPs live within the community they serve. As Tynan says:

It’s very much a patient-family-community healthcare system. The number of doctors they have – and the number of nurses who are just as important – is amazing. They have as many doctors in Cuba for 11 million people as we have in Britain for 60 million.

Cuba’s commitment to public health has been the heartbeat of their socialist programme – both domestically and internationally – since their struggle against Batista in the 1950s. Following the exodus of significant numbers of doctors after Castro’s victory, Cuba needed to train large numbers of doctors and nurses in a programme Tynan equates in size and significance to the literacy campaigns.

It was central to their ideas when they started and I think it was intensified by their experience during the revolution in the Sierra Maestra. The enemy had cannons and tanks but they had a doctor – and the people had never seen a doctor before. The basic socialist ideas were reinforced by what they saw of the peasant life in rural areas. And of course Che Guevara must have had some input because he’d been through Latin America and seen various levels of healthcare.

The diversity of the medical profession in Cuba testifies to the increased opportunities ushered in by the revolution. On Tynan’s first visit to Cuba he met a young doctor who attributed his success to the victory of the 26th July Movement:

He was the son of a garage mechanic and, although it’s not beyond the realm of possibility that the son of a garage mechanic could become a doctor in England now, it was well beyond the realm of possibility in Cuba before the revolution. The medical school in Havana was dominated by the white middle-class of Spanish decent.

Although called The Doctors’ Revolution – because Tynan himself and many of the people he interviews are doctors – Tynan recognises and praises the work of all health workers in Cuba:

Just like any healthcare system the doctors are just the head on the beer. They have the most glamorous role but plenty of people would die after surgery if they didn’t have physiotherapy. Then there are all the radiology technicians whose expertise is central and the people working in pathology departments, dieticians, dentists and nurses.

Cuba’s commitment to public health and its associated success – at home and around the world in developing countries and disaster zones – is not only remarkable considering the economic and political context in which it exists, but it stands as a shining beacon to the Western world of what is possible if you prioritise public health and international solidarity.

This article was originally written for CubaSi magazine

Dawkins’ divine intervention challenges faith in his atheist integrity

The creation of the New College of the Humanities (NCoH) – a new private university in London staffed by some of the world’s leading academics and charging fees of £18,000 per year – is a frightening extension of the government’s growing thirst for free-marketisation. The increase of competition within the educational field promises to widen the gap between the richest and poorest in society and has already given birth to an increase in university tuition fees and the growth of free schools. However it is the curious involvement of Professor Richard Dawkins – the eminent biologist and renowned atheist – which seems particularly odd.

Firstly, it is important to recognise that the rise of free schools, the increase in tuition fees and the foundation of NCoH are part of the same cohesive neo-liberal project which believes free-market principles improve educational standards due to increased competition. NCoH is the logical conclusion of the rise of free schools because it comes as a result of the erosion of state authority and the idea that the market can provide for everyone’s needs. The enforced abdication of state authority creates a power vacuum which is filled by other powerful actors – such as private companies or organised religion.

The establishment of NCoH does not in itself contradict Dawkins’ disciplined atheism but – when contextualised within the narrative of educational liberalisation and marketisation – it can be seen to conflict with Dawkins’ rabid religious scepticism because the rise of free schools has fortified the influence of organised religion.

The problem with free schools

There are numerous reasons why free schools reinforce hierarchy and exacerbate social division but – in this case – the most pressing factor is the ascension of faith schools. Free schools in Britain are based on a Swedish model which has been criticised for rapidly increasing the number of religious schools, giving influence to controversial institutions such as the Church of Scientology and the Plymouth Brethren, and empowering fundamentalist Islamic organisations. Indeed, half of Michael Gove’s first round of free schools had a religious ethos.

Gove himself has acknowledged concerns that faith schools may use new legislation to push their own agenda but – unlike in Sweden – no guidance has been issued relating to free school applications. Indeed, David Cameron’s favourite think-tank, the right-wing Policy Exchange, argued in its Faith Schools We Can Believe In paper that free schools are increasingly vulnerable to extremist influences.

Many faith schools have remained within the private sector so as to not compromise their religious beliefs but, under a free school system, they can access state funding without state control. Furthermore, teachers in free schools are not required to hold recognised teaching qualifications.

Dawkins and religious education

According to The God Delusion Professor Dawkins believes:

Children are educated, again often from a very early age, with members of a religious in-group and separately from children whose families adhere to other religions. It is not an exaggeration to say that the troubles in Northern Ireland would disappear in a generation if segregated schooling was abolished.

Dawkins conceptualises religious education and the enforced endowment of religious beliefs onto children as a form of child abuse and lies at the very core of his critique of religion. One facet of this criticism is that segregation and in/out groups creates conflict. Dawkins’ association with NCoH is therefore hypocritical on two levels. Firstly, opportunity to develop the NCoH has only arisen because of the spread of free schools and the inevitable rise of faith schools – something which Dawkins, if he is to remain intellectually consistent, should be opposing. Secondly, both free schools and elitist higher education further encourages segregation on the basis of wealth and class. Dawkins criticises religion for encouraging segregation, so why doesn’t he apply the same analysis to education?

Dawkins’ involvement with the NCoH neo-liberal experiment suggests that he may be more interested in his own wealth and self-interest than academic integrity. According to the Bible, Jesus told his disciples “it is easier for a camel to go through the eye of a needle than for a rich man to enter the kingdom of God”. Fortunately, for Richard Dawkins at least, there’s no such place as the kingdom of God.

This article was originally written for Left Foot Forward and can be read here.

Anger at GMB signing up to Cable

The GMB's decision to invite Vince Cable to speak at their national conference today was a curious one but – considering the media attention given to Cable's appearance – it can be viewed as a tactical masterstroke.

Although Cable regurgitated familiar soundbites about the need for cuts and the economic mess left by Labour, it was the hostile reaction of the GMB delegates which grabbed the headlines. Government stooges usually speak to economic acolytes at business galas in the City to whoops of agreement and media silence, but – because Cable spoke at a trade union conference – it exposed the anger at government cuts and gave a platform to left-wing economic arguments.

I was at GMB conference for the speech and – although many delegates thought Cable shouldn't have been given the platform – his appearance helps send a message to the outside world that there is a hunger for economic alternatives. Furthermore – with palpable anger permeating the conference centre – it will galvanise the trade union movement into action. Many of the delegates were spitting blood – would they have been quite so vitriolic with a leftie keynote speaker? Hopefully their anger will be transformed into workplace organisation and community activism.

In its simplest sense, Cable's appearance acts as a warning to trade unions. It is a threat that co-ordinated strikes will result in a crack-down of anti-union legislation. But what does it matter about legislation when trade unions are too afraid to strike anyway? The sole weapon of trade unions is the power – or threat – of industrial action. Without it they are ineffective and impotent. If the labour movement allows itself to be bullied out of co-ordinated action then it is admitting defeat. Cable's rhetoric shows the government is running scared; now is not the time to concede ground. His appearance at GMB conference is not a concession to neo-liberalism; it is a catalyst for fight-back and a powerful message to the rest of the country.