A Caution [to U S Citizens no OFAC License with Health Issues] re Traveling To Cuba
Feb 5, 2014, 10:27 am
#46
Join Date: May 2013
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Ofac doesn't care anymore about the "fully hosted" category as far as I know. If you want to go independently you can use the General License that allows for research related to your full time career, but of course there is a lot of wiggle room with that -- and as far as I know there is little to no enforcement of the Cuba travel restrictions for US citizens at this point.
As far as medical emergencies, I think we cannot realistically expect Cuba to be up to first world standards. When I was there once it was impossible to purchase Cipro anywhere, even in the pharmacies for foreigners, a shipment was due in "next week". This was maybe 10 years ago so things may be better with the increase in tourism. We finally got some under the table from doctors at a hospital. I don't know what the Cuban health insurance is like but I think it can be purchased at the airport. It might be useful for a US Citizen who likely will not be covered under their US insurance if one is extremely unlucky and needs a major procedure, they probably will not allow you to leave unless the bill is paid.
Feb 5, 2014, 1:31 pm
#47
Moderator: American AAdvantage
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Whilst the OFAC regulations are not being currently enforced, until this dragon is bleeding out and slain it is still there to be fired up by politics, or possibly even a USCBP agent who feels s/he should make life difficult for a returning US non-licensed passport holder.
Ciprofloxacin (in one of its many guises) is available - but one still may have to go on a hunt for it. The farmacia internacional near Cira García Hospital is probably the best for those with CUCs, but one can certainly hunt nearly anything down - as long as they have patience and CUCs.
(Whilst the farmacias internacionales on Ave. 3a didn't have Cipro, the one within the centro comercial Comodoro near the infamous Comodoro Hotel did, for example - but I speak Castilian / Spanish fluently and know "la movida", making it easier for me than for some visitors.)
Ciprofloxacin (in one of its many guises) is available - but one still may have to go on a hunt for it. The farmacia internacional near Cira García Hospital is probably the best for those with CUCs, but one can certainly hunt nearly anything down - as long as they have patience and CUCs.
(Whilst the farmacias internacionales on Ave. 3a didn't have Cipro, the one within the centro comercial Comodoro near the infamous Comodoro Hotel did, for example - but I speak Castilian / Spanish fluently and know "la movida", making it easier for me than for some visitors.)
Ofac doesn't care anymore about the "fully hosted" category as far as I know. If you want to go independently you can use the General License that allows for research related to your full time career, but of course there is a lot of wiggle room with that -- and as far as I know there is little to no enforcement of the Cuba travel restrictions for US citizens at this point.
As far as medical emergencies, I think we cannot realistically expect Cuba to be up to first world standards. When I was there once it was impossible to purchase Cipro anywhere, even in the pharmacies for foreigners, a shipment was due in "next week". This was maybe 10 years ago so things may be better with the increase in tourism. We finally got some under the table from doctors at a hospital. I don't know what the Cuban health insurance is like but I think it can be purchased at the airport. It might be useful for a US Citizen who likely will not be covered under their US insurance if one is extremely unlucky and needs a major procedure, they probably will not allow you to leave unless the bill is paid.
As far as medical emergencies, I think we cannot realistically expect Cuba to be up to first world standards. When I was there once it was impossible to purchase Cipro anywhere, even in the pharmacies for foreigners, a shipment was due in "next week". This was maybe 10 years ago so things may be better with the increase in tourism. We finally got some under the table from doctors at a hospital. I don't know what the Cuban health insurance is like but I think it can be purchased at the airport. It might be useful for a US Citizen who likely will not be covered under their US insurance if one is extremely unlucky and needs a major procedure, they probably will not allow you to leave unless the bill is paid.
Feb 5, 2014, 4:21 pm
#48
Join Date: May 2013
Programs: Hyatt Platinum, IHG Platinum, Aadvantage Platinum
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I went to the pharmacy in Miramar and called all over but nada. This was a while ago as I said but it was something that made me realize I couldn't ever live there. I had to go through Cubans to the Hospital and could get it with a bribe "al nivel del hospital" was the term used - as in they always will have things for emergencies and bribes will work if you go through a Cuban. Hopefully things have improved. Also, the care given to Cubans is nothing like it is for foreigners. At the time there was only one ambulance for Central Havana and the line was very long - to see Chilean medical students. I think the Cubans can get good care but they have to work for it depending on their connections and their ability to bribe. You mileage may vary but this is what I observed as the person who paid to jump the line for the Chilean doctor.
Feb 9, 2014, 5:32 pm
#49
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Cubans have access to a three-tiered medical system, which begins with neighborhood medical clinics - usually, the second floor of the "clinic" is the doctor's home. These in turn relate to a more centralized clinic medical center (several neighborhood clinics to one center), and these in turn to hospitals. The medical centers have urgent care beds, which in theory should not be occupied for longer than several hours as part of observation, treatment and triage before someone is sent on to a hospital or specialized medical center.
The specialized centers include a large new children's hospital, oncology centers, etc. etc. as one would expect in more developed countries. Cuba produces perhaps 80% of the medications it uses, and actually exports some medications. It has an active research branch (one result of the "special period" was a major reshuffling to find low-cost and locally produced pharmaceuticals, as much as bioresearch into agrochemistry, more organic products in the markets - saving the importation of manufactured fertilizers and biocides).
The doctors are usually physicians how have served their servicio social - Cuban doctors get free education, but are expected to provide a certain period of social service, including rural clinics and often, time abroad - the physicians I met had sent time in various African and Latin American countries. Other medical staff include nurses, aids, etc. The Cuban medical system has about 175 per physician, the UK 600 - but I suspect this includes physicians sent abroad in schemes such as "doctors for oil" to Venezuela.
Foreigners generally are referred to the Cira García Hospital, which is a fairly modern clinic originally opened to diplomats. The pertinent pharmacy has probably the best variety of medicines available in the capital district. Cuba has a very active "medical tourism" activity, and visitors travel to Cuba for a variety of surgical and medical interventions of reasonably high quality (and relatively low cost, given the system is a strict monopoly of the government).
This hard currency medical tourism helps pay for many improvements to Cuban healthcare system. But some facilities still seem quite dilapidated, outdated and in need of modern equipment and training.
Some healthcare is dedicated to curing and preventing issues not seen frequently in developed nations (like amoebiasis), but others are more common - escalating rates of diabetes, hypertension and the like point out Cubans too are perhaps way beyond the time of eating the island's cats for protein, as occurred in the 1990s.
For ~2010, rates are interesting:
Probability of dying between 15 and 60 years m/f (per 1 000 population, 2011):
USA: 131 M / 77 F
Cuba: 119 M /75 F
Life expectancy at birth:
US: 78.7 years (76 M, 81 F)
Cuba: 77.9 (76 M, 80 F)
Probability of dying under five (per 1 000 live births, 2012):
US: 7
Cuba: 6
Infant Mortality rate: 6.15 deaths per 1,000 live births
Infant, Cuba: 4.8 / 100.000 per year
(World Health Organisation: link)
Much of this is probably the result of placing an emphasis on, and dedicating resources to, healthcare to improve the situation since "the special time" in the late 1990s when the Cuban economy went into the wastebasket.
The dual currency issue has changed the problem a bit - people with CUCs may have much easier and speedier access to medical care, and to better levels of care, than Cubans living on the non-CUC / CUP economy; the Cuban government is considering how to create a single-currency economy, given there are even "CUC millionaires" now - who can access a variety of better services, including housing, medicine, etc.
Nonetheless, my spontaneous interviews with Cuban healthcare workers - nurses, doctors - as well as visits to healthcare facilities and interviews of everyday Cubans indicate most Cubans do have access to a multi-tiered care system, though it is not what people expect when they come from developed nations. For example, mercury-filled thermometers is the level of technology, and only the most advanced centers and hospitals have the latest equipment.
For example, one taxi driver told me he went to his neighborhood doctor with gastrointestinal symptoms, was diagnosed tentatively, sent on to his medical center for tests, and it was verified he had a case of Entamoeba histolytica. He was educated and treated properly - and today insists on drinking purified and bottled water (he showed me the two liter bottle of water he carries in his vehicle).
There are good points and bad points to the system, as I saw them. The system is evolving, I received attentive treatment and had some tricky times searching for simple Cipro - though I knew how to find it, and did within four hours. Another issue is that in some sectors, I do believe one can "incentive" the system with bribes; I had no experience with this, but I did hear a few stories.
I would not recommend medical tourism to Cuba, myself, and if I determined I had a special need I think I'd follow the dictum "when in pain, take the plane" - but for many conditions, I know how the system works, speak the language and know "la movida" and would be as willing to use the health care system as in some second-tier European countries, and many Latin or African or Asian countries.
I would not recommend people with special needs who may have emergent issues travel to Cuba; but if you have controlled medical conditions and your medications with you, you might do just fine with the usual care and attention to what you consume and managing your risks.
And for people with disabilities and mobility impairments, Cuba is working on it, but is not what you would be used to in the most aware and concerned countries. Resources are scarce enough housing and medical systems are not universally advanced and very much a work in progress with stops and starts and a problem of "socialismo", a highly centralized control system, and "sociolismo", where who you know or can influence makes a huge difference.
The specialized centers include a large new children's hospital, oncology centers, etc. etc. as one would expect in more developed countries. Cuba produces perhaps 80% of the medications it uses, and actually exports some medications. It has an active research branch (one result of the "special period" was a major reshuffling to find low-cost and locally produced pharmaceuticals, as much as bioresearch into agrochemistry, more organic products in the markets - saving the importation of manufactured fertilizers and biocides).
The doctors are usually physicians how have served their servicio social - Cuban doctors get free education, but are expected to provide a certain period of social service, including rural clinics and often, time abroad - the physicians I met had sent time in various African and Latin American countries. Other medical staff include nurses, aids, etc. The Cuban medical system has about 175 per physician, the UK 600 - but I suspect this includes physicians sent abroad in schemes such as "doctors for oil" to Venezuela.
Foreigners generally are referred to the Cira García Hospital, which is a fairly modern clinic originally opened to diplomats. The pertinent pharmacy has probably the best variety of medicines available in the capital district. Cuba has a very active "medical tourism" activity, and visitors travel to Cuba for a variety of surgical and medical interventions of reasonably high quality (and relatively low cost, given the system is a strict monopoly of the government).
This hard currency medical tourism helps pay for many improvements to Cuban healthcare system. But some facilities still seem quite dilapidated, outdated and in need of modern equipment and training.
Some healthcare is dedicated to curing and preventing issues not seen frequently in developed nations (like amoebiasis), but others are more common - escalating rates of diabetes, hypertension and the like point out Cubans too are perhaps way beyond the time of eating the island's cats for protein, as occurred in the 1990s.
For ~2010, rates are interesting:
Probability of dying between 15 and 60 years m/f (per 1 000 population, 2011):
USA: 131 M / 77 F
Cuba: 119 M /75 F
Life expectancy at birth:
US: 78.7 years (76 M, 81 F)
Cuba: 77.9 (76 M, 80 F)
Probability of dying under five (per 1 000 live births, 2012):
US: 7
Cuba: 6
Infant Mortality rate: 6.15 deaths per 1,000 live births
Infant, Cuba: 4.8 / 100.000 per year
(World Health Organisation: link)
Much of this is probably the result of placing an emphasis on, and dedicating resources to, healthcare to improve the situation since "the special time" in the late 1990s when the Cuban economy went into the wastebasket.
Originally Posted by wikipedia
A Canadian Medical Association Journal paper states that "The famine in Cuba during the Special Period was caused by political and economic factors similar to the ones that caused a famine in North Korea in the mid-1990s. Both countries were run by authoritarian regimes that denied ordinary people the food to which they were entitled when the public food distribution collapsed; priority was given to the elite classes and the military."[18] The regime did not accept donations of food, medicines and money from the US until 1993.[18]
Nonetheless, my spontaneous interviews with Cuban healthcare workers - nurses, doctors - as well as visits to healthcare facilities and interviews of everyday Cubans indicate most Cubans do have access to a multi-tiered care system, though it is not what people expect when they come from developed nations. For example, mercury-filled thermometers is the level of technology, and only the most advanced centers and hospitals have the latest equipment.
For example, one taxi driver told me he went to his neighborhood doctor with gastrointestinal symptoms, was diagnosed tentatively, sent on to his medical center for tests, and it was verified he had a case of Entamoeba histolytica. He was educated and treated properly - and today insists on drinking purified and bottled water (he showed me the two liter bottle of water he carries in his vehicle).
There are good points and bad points to the system, as I saw them. The system is evolving, I received attentive treatment and had some tricky times searching for simple Cipro - though I knew how to find it, and did within four hours. Another issue is that in some sectors, I do believe one can "incentive" the system with bribes; I had no experience with this, but I did hear a few stories.
I would not recommend medical tourism to Cuba, myself, and if I determined I had a special need I think I'd follow the dictum "when in pain, take the plane" - but for many conditions, I know how the system works, speak the language and know "la movida" and would be as willing to use the health care system as in some second-tier European countries, and many Latin or African or Asian countries.
I would not recommend people with special needs who may have emergent issues travel to Cuba; but if you have controlled medical conditions and your medications with you, you might do just fine with the usual care and attention to what you consume and managing your risks.
And for people with disabilities and mobility impairments, Cuba is working on it, but is not what you would be used to in the most aware and concerned countries. Resources are scarce enough housing and medical systems are not universally advanced and very much a work in progress with stops and starts and a problem of "socialismo", a highly centralized control system, and "sociolismo", where who you know or can influence makes a huge difference.