Justin Pearce
‘IN Cuba only a few old people have TB,” explained Dr Leandro Ruyz. “In 1959 we had a revolution — and everyone born after that was vaccinated at birth.”
A day after arriving in South Africa from Cuba, Ruyz was sitting in the superintendent’s office at Klerksdorp Hospital, a facebrick pile where the entrance is almost impossible to find. The hospital, built to serve whites of what was then the Western Transvaal, now stands in the middle of a province where it is not uncommon for people to travel all day to find even the most basic medical services, and where 60% of public health posts are filled by foreigners because South African doctors have left for the private sector or overseas.
Ruyz was among 14 doctors assigned to the North West who are currently undergoing a two-week briefing in Klerksdorp, before heading into the remote fragments of what used to be Bophuthatswana.
Some of them are fluent in English, some speak the language only haltingly, and South Africa’s other 10 languages are incomprehensible to them. But as Ruyz’s remarks about TB in Cuba indicate, the doctors who arrived this week are going to have to learn more than languages. They will also have to cross an immense cultural divide.
But many of them have worked in other developing countries, which has prepared them for the challenges they face here. Cuba, whose health care system is rated by the World Health Organisation as among the best in the world, has been exporting doctors for 30 years.
“It was a big shock,” says Dr Amelia Leon of her arrival in Yemen, the first foreign country where she worked. Used to a system where children are vaccinated against every conceivable disease at birth and where doctors are on hand in every community to nip ailments in the bud, the Cubans abroad had to change their perspectives to suit their new surroundings.
“In other developing countries you see lots of things you would never see in Cuba,” says Ruyz ,who spent two years in Zambia. “In Cuba the infant mortality rate is 9,4 per thousand — in some African countries it is 40 per thousand.”
Cubans in Klerksdorp — it sounds like a nightmare sequence from the commie bashing photo-comic, Grensvegter, circa 1979. But the doctors were greeted at the once racially exclusive hospital with no hostility, though much curiosity.
“They must feel as if they’re in a zoo,” the hospital secretary tutted sympathetically. “Whenever anyone sees them, they stare.”
While some medical staff may resent the fact that the Cubans were educated for free, while South African doctors have to repay student loans from their state hospital salaries, on the whole the reception has been welcoming.
“I have been really impressed by their skill and their language capability,” says superintendent Dr Louw du Toit. “And the way they have been accepted by the nursing staff is amazing.”
Cuban doctors were not the first foreign medics to arrive in this region. Many doctors who came independently to fill empty posts in the North West’s hospitals are from Russia, Romania, Poland and other lands seen as the enemy by the white South Africa of old.
What’s more, the province is as badly hit as anywhere else in South Africa by local doctors leaving the public sector. “The interns do their compulsory year, but few stay on — they go into private practice or they emigrate,” laments Du Toit. “There are not enough experienced doctors, and the Cubans will fill the gap.”
It is no coincidence that the Cubans have arrived at a time when health departments in South Africa are trying to transform the health system from one based on centralised specialist hospitals, to a system founded on preventative health care and clinics close to the communities they serve.
After only 24 hours in South Africa, none of the Cuban doctors is venturing to pass judgment on the country or its health system. In their intentions, however, they are single-minded.
Sure, the South African state salaries which the doctors will be earning are many times what they were paid in Cuba, and part of that money will trickle back home to help the ailing Cuban economy. But there is no hint of insincerity when Dr Garcia Sarria says: “I came here to help a population which does not have enough medical services. We are giving our services because we want to help.”