Caring for them from birth to death: The ethics, ideologies, values, and practices of Cuban medicine.

摘要

This study explores how the values and ideology of Cuban socialism are reflected in the practice of Cuban medicine and the health of the Cuban population. How do the at times conflicting needs of the people, goals of the revolution, and economic reality play out in the practice of medicine? I explore the dialectic between the ideologies and values of the revolution and the practice of medicine. I collected the data for this study on and off over a period of three years (2000--2003) as I spent time studying, working, and living in Havana. The data were generated using ethnographic methods including qualitative interviewing and fieldwork.; Cuban medicine is different from conventional biomedical models. Cuban biomedicine rejects the Cartesian mind/body dichotomy, the positivistic etiology of disease, and the individualistic focus of capitalist medicine. The Cuban model of medicine defines health as a state of equilibrium. This is not just a balance of germs and antibodies at a microscopic level within the body---but a balance with all the internal dimensions within the self and all the external factors that shape and impact the self. The Cubans examine how material conditions shape and/or restrict particular decisions and actions. They also consider how culture impacts decision making and how cultural practices emerge out of particular historical, political, and economic moments. Key also, are mind body connections, which are viewed as multiple and dialectical.; This study shows that social stratification and poverty does not have to result in health inequalities. Even in a poor developing country like Cuba, one that is cut off from the largest funders of health care in the world can create healthy bodies when they decide that nothing is more important than the lives of their population. While economic stratification increases every year in Cuba, epidemiological polarization is not developing. The Cubans are able to create policies and programs that promote health precisely because they have a strong state. Their health care policies are decided not by multinational corporations nor by neoliberal interests but by the priorities of the revolution.