Women's Healthcare in Cuba: Observation of
Medical Facilities in Cerro, Havana
Stephanie Bernal
California State
University, San Bernardino
This project was based on interviews and observations related to health care services available to women in Cuba. These observations included a tour of medical facilities in Cerro—a municipality located in Havana, Cuba. Interviews with Havana physicians and patients, as well as observations of patients, show some of the successes and limitations of Cuba’s health care system. This firsthand observation is then compared with other research. The negative effects of the economic crisis and embargo on the health of Cuban women are illustrated.
In 1960, Che
Guevara, a medical professional himself, stated in his speech “On Revolutionary
Medicine” that above all else, doctors should work to provide health care
services to all people. One of the
beliefs of socialism is that providing free health care to all citizens is the
government’s responsibility. The Cuban
government considers its health care system to be one of the revolution’s
greatest successes. In the 40 years
following the Cuban revolution, life expectancies have increased, and maternal
and infant mortality rates have decreased substantially. In spite of severe economic setbacks, Cuba
has managed not only to continue its commitment to the public health sector,
but also to make improvements through educational campaigns, improved
communication systems, and data collection.
In keeping with the
concept of socialized medicine, the Cuban government offers a range of
health-related services and programs to its citizens free of charge, with a
special emphasis on maternal and infant health. My research focuses on women’s
health care issues; my objective was to observe what types of medical and
health-related services are available to women. Statistics from the World Health Organization and the Pan
American Health Organization (the Latin American regional office of the World
Health Organization also known as PAHO), helped to put into perspective some of
the successes and limitations of women’s health care in Cuba. In addition, I obtained from the Cuban
Ministry of Health some literature that defines Cuba’s health care strategies
for combating specific health problems.
I wanted to discuss with Cuban women and healthcare professionals the
quality and availability of services to women.
My research
centered on the central metropolitan section of Havana called Cerro, which has
a population of about 600,000 (“Havana City,” 1997). While there, I observed different levels of Cuba’s highly
structured healthcare system from the neighborhood family doctor’s office, to a
special maternity home for pregnant women. My research sources included
interviews with five Havana-area doctors: two doctors of obstetrics and
gynecology, one resident physician, and two general practitioners, one of whom
is the director of a Havana clinic in Cerro.
Dr. Jorge Puentes-Corral, an obstetrician/gynecologist, acted as my host
as he led me on a tour of different medical facilities where I met and spoke
with patients and three of the other doctors.
I observed twelve patients in the maternity home and spoke with two of
the women who were resting in their beds when I arrived.
“Total
biological, physical, and mental well-being” of the Cuban population is the
goal of health care providers, said Dr. Jorge Puentes-Corral (personal
communication, July 3, 2000). They
achieve this through what they call community-based programs, which carry out
health care strategies and educational campaigns that the Ministry of Public
Health (MINSAP) directs. The health
care structure in Cuba begins at the national level with the Ministry of Public
Health, and “extends through the provincial level, the municipal level, and to
the local community” (Davis, 1998).
This structure is intended to guarantee that all citizens, even those
living in remote locations, benefit from the health care system, a benefit that
was not possible in the private medical system that existed before the
Revolution.
In 1960, Che Guevara
gave his famous speech “On Revolutionary Medicine,” which described the ideological
differences between socialist medicine and private medical practice. Cuba’s health care system was completely
overhauled after the revolution when it changed from a privatized to a
socialized structure. While creating a
new policy on health care in 1960, Cuba’s national health system declared that
health is the state’s responsibility and that everyone has the right to health
(Davis, 1998), a point that was reiterated during my interviews with Cuban
physicians. Dr. Puentes-Corral emphasized that not a single doctor practices
private medicine in Cuba today (personal communication, July 3, 2000).
Following the revolution, Cuba suffered what Dr. Puentes-Corral called “a profound loss of medical professionals” (personal communication, July 3, 2000). Fifty percent of its 6,000 physicians had left the island by 1962. As a temporary remedy, the government sought help from doctors in Mexico and other parts of Latin America (Davis, 1998). In 1961, the government prepared to educate future doctors by converting a large, spacious nuns’ convent into a teaching hospital as part of the University of Havana (J. Puentes-Corral, personal communication, July 3, 2000). Medical students attended school free of charge, but in exchange, they agreed to serve for one year in remote, rural areas that had the greatest needs. Che Guevara spoke of the need for doctors to serve in rural areas and also to “be a farmer” in order to help the poor (Guevara, 1960).
Over the years, Cuba not only realized
Guevara’s vision of socialized medicine, but also provided new opportunities to
future aspiring doctors. With over 60,000 trained physicians, 54.6 per 10,000
people, (PAHO, 1998), Cuba has the highest doctor-patient ratio in the world,
according to Randal (2000). By 1995, the number of doctors in Cuba grew to 20
times what was available in 1959 (Davis, 1998). In addition, Cuba recruits medical students from various regions,
social classes, and racial backgrounds (Waitzgen, Wald, et al., 1997).
Cuba
continues to evaluate and make improvements to its health care system. The Family Doctor Plan is one of these
improvements. Until 1984, the levels of
community-based medical care included polyclinics and hospitals (J.
Puentes-Corral, personal communication, July 3, 2000). In 1984, the Program of Integral Community
Attention, better known as the Family Doctor y 3, 2000). Plan, Los médicos de
las 120 familias, was initiated,
adding an extra level of community care to the system.
Under this plan, an assigned family
doctor attends 120 families in a given neighborhood block. The family doctor lives in the community
that he serves, providing primary and preventative care to the 700-800 people
in his assigned area. The family doctor carries out any special
health-awareness programs that the national level directs. In addition to seeing each patient twice a
year, the family doctor is also responsible for maintaining health records and
seeing that his patients receive vaccinations and health screenings. Patients
usually
Photo 1. The district of Cerro in greater Havana
see
their assigned family doctor first and, if needed, receive a referral to the
hospital for specialized care, except in emergencies when patients can opt to
go directly to the hospital emergency room (Waitzkin, Wald, et al., 1997).
Che
Guevara believed that doctors should be humble in their practice of medicine,
with the primary motivation being the pride of serving their neighbors
(Guevara, 1960). Keeping true to that belief, family doctors live in the
same neighborhoods in which they are assigned to serve, and the doctor-patient
relationship is a close and personal one.
“In Cuba, doctors are like friends; [patients] tell you their problem,”
said Dr. Melba-Sosa Leyva (personal communication, June 27, 2000), a resident
physician who is completing the three years of family medicine training
required of all residents (Waitzkin, Wald, et al., 1997). This arrangement between doctor and patient
can break down the barriers that are often present in a privatized structure
where doctors live in one, usually wealthier section, and the patients live in
another. In addition, the income that a Cuban doctor makes is extremely modest
compared to privatized standards; Dr. Sosa-Leyva told me that she makes the
equivalent of twenty-five U.S. dollars per month (personal communication, June
27, 2000).
Photo
2. The neighborhood clinic in Cerro
As was stated earlier, under
the socialist system providing health care is the state’s responsibility. The doctors I spoke with emphatically stated
that they take personal responsibility for their patients’ care. According to Dr. Florángel
Urrusuno-Carbajal, it is the doctor’s, not the patient’s obligation to see that
patients get the care that they need (personal communication, July 6,
2000). In fact, when a pregnant woman
does not show up for her pre-natal visits, one doctor said that she makes a
house call to provide the services in the patient’s home (M. Sosa-Leyva,
personal communication, June 27, 2000).
The main objective at the primary care level is counseling and prevention. As an example of preventative care measures, women between the ages of 25 and 65 receive Pap tests every three years. Family doctors counsel patients in order to eliminate risk factors such as smoking, obesity and lack of exercise (M. Sosa-Leyva, personal communication, June 27, 2000).
The doctors
listed some of the common health problems in women. Obesity is a frequent health problem among women in Cuba (J.
Puentes-Corral, personal communication, July 3, 2000). Obesity is more common in female patients
than males and tends to increase with age.
Other health problems which exist among women include hypertension,
anemia and diabetes. In Cuba, 26.3
percent of women aged 15 and over use tobacco, according to PAHO (1998).
The web site for the Hospital Clínico Quirúgico Hermanos Ameijeiras,
located in Havana, lists dates for educational programs that help patients
manage these common health problems (Hospital
Clínico, 2001). Cuba commonly uses mass communication in the
form of public service announcements on the airwaves as a way to educate the
public about prevention and control of health problems (PAHO, 1998).
The family
doctor practices medicine in the neighborhood doctor’s office called a consultorio. The consultorio is open
24 hours a day, since the doctor’s home usually sits above his office. J. Puentes-Corral (personal communication,
July 6, 2000) stated that patients rarely have to wait long in the consultorio in order to see their
doctor, a common complaint among patients prior to the implementation of the
Family Doctor Plan (PAHO, 1998).
Photo 3. A doctor explains the health bulletins
While not working in the consultorio, the doctor is out making house calls to one of the 120
families assigned to him. He or she may
also rotate shifts at the local polyclinic, which offers more specialized
community health care services.
The consultorio in Cerro is relatively small
and has only the most basic equipment.
The consultorio contains a
waiting room where patients can read some health care pamphlets from a small
bookcase. An exam room around the
corner contains a few medical supplies.
The only air that circulates within
Photo 4. Women patients in the maternity ward
the rooms comes from open doors and windows. A lamp located next to the exam room
provides artificial light, but sunlight comes in through the high, frosted windows
located near the ceiling to provide additional lighting. The exam table is a metal table with no
additional padding other than a cloth.
Medical equipment is laid out in the open on a metal tray. One tool, a cone-shaped object, is used as a
stethoscope. Since paper is in short
supply, the waiting room bulletin board is decorated with neatly placed cutouts
and drawings against brown paper backgrounds, a huge difference from the slick,
commercially-produced color charts and graphics that are common in U.S.
hospital marketing pieces.
In spite of the
lack of high-technology equipment, Cuba has managed to make remarkable strides
in the quality of health care that it provides to its citizens. Today, the major health problems and causes
of death in Cuba are similar to those of developed countries, including heart
disease, cancer, and diabetes (Davis, 1998).
This is markedly different from the main causes of death, infectious and
parasitic diseases of 30 years ago (PAHO, 1998).
Like the rest of
Cuba’s population, women’s life expectancy is high and comparable or even
superior to that of more developed countries.
The average life expectancy of women is 74.3 years (PAHO, 1998).
The polyclinic consists
of a group of medical specialties that exist under one roof. The polyclinic offers social services,
emergency services, pediatrics, gynecology, diagnostic ultrasound, dermatology,
psychiatry, radiology, and statistics, said Dr. Urrusuno-Carbajal (personal
communication, July 3, 2000), director of the polyclinic in Cerro. The
polyclinics are structured so that patients may visit with specialists from
8AM-12PM, and for emergencies from 8AM-4PM.
After hours, two family doctors are available all night. Like the consultorio,
the polyclinic in Cerro operates on relatively low-tech equipment; for example,
the building relies mainly on light coming from the windows, and air circulates
through windows and rotating fans. Four
polyclinics, approximately 200 consultorios,
and a total of 280 family doctors exist within Cerro.
Due to the
chain of command required to gain permission, getting access to some of the
healthcare facilities depended on the connections and influence of the doctor I
was with. I was unable to visit a
hospital. In total, 281 hospitals exist throughout Cuba (PAHO, 1998). Dr.
Puentes-Corral, however, convinced the guard to let us through as he led me and
another student on a brief tour through the corridors of the University of Havana’s
medical school site, the same one that was converted from a nun’s convent in
the early years of the revolution.
PAMI (The Mother
and Child Plan)
“All [national
health care programs] are important, but the most important is the Mother and
Child program,” said Dr. Florángel Urrusuno-Carbajal (personal communication,
July 3, 2000). This program places a
special emphasis on the needs of pregnant women, newborns, and children. Infant mortality decreased from 62 per 1,000
live births in 1959, to 7.2 per 1,000 live births in 1998. Some of the special needs addressed in this
program include attention to breast exams, cervical cancer screenings, genetic
testing, pre-conception risk, low birth weight, and family planning, said Dr.
Carbajal. Educational campaigns, such
as breastfeeding campaigns that lowered the infant death rate from acute
gastroenteritis, have increased the quality of life for Cuban women and their
infants (Davis, 1998). The efforts to
carry out the objectives of these educational campaigns are evident during
tours of the consultorio and
polyclinic: cutouts and hand-drawn signs taped against bulletin boards
emphasize the importance of breastfeeding and good nutrition.
Better data collection
methods and research into causes of death make it possible to provide even
better medical attention to women and their newborns. Prior to 1969, the causes of prenatal death were not even
investigated, but today, all prenatal deaths are recorded in hospitals, (J.
Puentes-Corral, personal communication, July 3, 2000). Committees at the provincial and national
level analyze every maternal death.
Since this maternal death analysis was initiated in 1970, the maternal
death rate has decreased by more than half, from 70.5 per 100,000 in 1970, to
32.6 in 1995 (Davis, 1998).
In 1996, improvements
were made to the first Infant and Maternal Mortality Program, first implemented
in 1995 (J. Puentes-Corral, personal communication, July 3, 2000). The Ministry of Health designed strategies
for dealing with maternal mortality factors, including complications from
caesarian sections, pregnancy risks, toxemia, and abortions (Davis, 1998). Other statistics provided by PAHO (1998)
showed a decline between 1992 and 1996 in maternal death from 3.3 per 10,000
live births to 2.4.
Since Cuba
places special emphasis on maternity and infant care, expectant mothers with
high-risk pregnancies or other special needs can visit the maternity home where
an on-duty nurse lives and is available 24-hours. A total of 209 maternity homes exist throughout Cuba (PAHO,
1998). This particular house in Cerro
offers 12 beds, with the majority of women arriving on an out-patient
basis. One maternity home exists per
municipality, said Dr. Juan Casellanos (personal communication, July 3, 2000),
director of Cerro’s maternity house. The common reasons for going to the
maternity home are the need for additional nutritional supplements, the risk of
carrying a low-weight baby and carrying twins which is also considered a
high-risk pregnancy. Cerro is one of
the lower-income areas within Havana and frequently a high number of
adolescents and single mothers visit its maternity homes. Depending on how
critical her needs are, a mother-to-be can visit the home during the day, or
she can be admitted by doctor referral, usually at 22 weeks, until the end of
her pregnancy. In-patient services are
provided to the patients who are at greatest risk.
“Obtaining
vitamins for pregnant women in the maternity homes is not a problem [because]
in Cuba it is considered a priority,” said Dr. Juan Casellanos (personal
communication, July 3, 2000). The
supply of iron salts and folic acid in the prenatal period has reduced the
incidence of underweight infants (Davis, 1998). Iron deficiency anemia is the most common nutritional problem in
Cuba since 40 percent of women in the third trimester of pregnancy, 25-30
percent of women of childbearing age, and around 50 percent of children up to
age three, all suffer from it (PAHO, 1998).
Cuba makes pre-natal
care efforts to guarantee a diet of 2800 calories per day (Davis, 1998). The in-house nurse cooks and provides
balanced daily meals to residents in their beds, all free of charge. One of the
women I spoke with there told me that as the mother of a small boy, she stops
by in the afternoon in order to have a place to rest, and then she leaves in
the evening. She said that she found
the home to be very calm and tranquil (personal communication, July 6, 2000).
Two of the women I
observed in the maternity home were suffering from iron deficiency and possibly
malnutrition and were sleeping when I arrived.
They risked delivering low birth weight infants. Both of these women seemed a little younger
than the rest of the other women since they appeared to be in their late teens
or early 20s. This age group is the
most likely to experience these difficulties during their pregnancies, the
doctors explained to me.
Not all the women in
this home necessarily suffered from pregnancy difficulties or from problems
with dietary deficiency. One woman was
an English instructor who was pregnant with her babies, a set of twins. With the exception of two patients whose
pregnancy difficulties I mentioned earlier, the patients I spoke with expressed
their contentment with the healthcare they received. They appeared happy and pleased with their services that the
maternity home provided. One of the
things that struck me was their eagerness to make me feel welcome. For instance, in spite of my protests, they
sat up out of bed, put the fan towards me, and accompanied me downstairs when I
left.
When I visited this
summer, this maternity home was two stories high, with patients of the higher
risk pregnancies located downstairs.
Their beds were metal-framed twin beds with a mattress and pillow and no
bedding or sheets. There was a
television in the room of the women with the low birth weight pregnancies. A rotating electric fan cooled the
room. A tray next to their beds held
their belongings.
Pregnant women receive
a number of tests in order to ensure that no complications exist. The average
number of prenatal visits per woman increased from 17.2 in 1992, to 23.6 in
1996 (PAHO, 1998). Prenatal screenings are
free of charge and include glycemia, urine, vaginal, and ultrasound tests (M.
Sosa-Leyva, personal communication, June 27, 2000). As early as 1987, Cuba had
included HIV testing for pregnant women (Keys & DeNoon, 1997). During a typical 37-40 week pregnancy, a
woman sees her doctor once a month until week 30; from weeks 30-35, she sees
the doctor every 15 days. At week 36,
she sees the doctor once a week (M.
Sosa-Leyva, personal communication, June 27, 2000).
The
doctors’ goal is for at least 99 percent of all births to take place in the
hospital, said Dr. Elena Martinez, a doctor at the Antonio Maceo
polyclinic. Home birthing is not
permitted (personal communication, July 6, 2000). In fact, Cuban doctors have been so successful at this goal that
PAHO lists their percentage of deliveries by trained professionals at one
hundred percent (1998).
By U.S.
standards, Cuban women appear to have fewer choices in their healthcare
decisions as far as where they can give birth, who can be present at the time
of delivery, and whether or not an episiotomy can be performed. Some of the
reasons appear to be due to lack of supplies, lack of space, and in some cases,
value judgements about what is best for the patient. During labor, for example, the doctors give local anesthetic with
either nidocaine or lidocaine; epidurals are not possible because
anethesiologists are unavailable (J. Casellanos, personal communication, July
6, 2000). A list of medicines in
“critical short supply” include anesthetics (Frank & Reed, 1997).
The number of
routine episiotomies performed in Cuba during child birth, based on M.
Sosa-Leyva’s explanation, sounded like more of a value judgement on the part of
medical authorities: “The deep
laceration [of a natural vaginal tear] is too great, and it is easier to repair
one cut easily” (M. Sosa-Leyva, personal communication, June 27, 2000). Although episiotomies are also widely
performed in the U.S., the book The New Our Bodies, Ourselves (1984)
expresses the opinions of those who denounce this procedure as unnecessary in
most cases.
Another interesting
note is the limitation of a Cuban father’s ability to participate in the
delivery. Fathers are not allowed to be
present at their child’s birth. I received two different explanations for
this. According to Dr. Sosa-Leyva, the
presence of men in the delivery room might make the delivery too chaotic
(personal communication, June 27, 2000).
A more experienced doctor whose specializes in obstetrics noted that the
small delivery room makes it impossible to allow the father to attend the birth
(J. Puentes-Corral, personal communication, July 6, 2000).
Maternity
Leave and the Law
Two of the doctors of obstetrics and gynecology explained Cuba’s
policies regarding maternity leave from work.
The Maternity Law was modified six or seven years ago. Maternity leave is guaranteed by law, and
new mothers can take up to a year and six months leave without losing their
jobs (J. Puentes-Corral, personal communication, July 6, 2000). In the twelve weeks following delivery, a
woman will receive 100 percent of her salary for the first child. After the twelve-week period, the woman will
receive 60 percent of her salary if she decides to continue her leave. After a year, she can continue her leave
without salary (J. Casellanos, personal communication, July 6, 2000).
Abortion
is legal, safe, and provided free of cost to Cubans. In the last ten years, one woman died from abortion complications
in the entire municipality of Cerro (F. Urrusuno-Carbajal, personal
communication, July 6, 2000). Abortion is encouraged when the pregnancy will
result in grave health problems for the mother or when severe deformities exist
for the fetus, the doctors explained. Abortions are by law limited to
pregnancies at no later than 20 to 24 weeks.
They are permitted only in hospitals.
As the father of a five-month-old daughter, J. Casellanos expressed his
personal opposition to abortion (personal communication, July 6, 2000).
As a result of
the economic crisis that occurred in the early 1990s, the number of abortions
increased. “Women,” said Dr.
Urrusuno-Carbajal, “just did not want to give birth” (personal communication,
July 6, 2000). To discourage abortion
as a means of contraception, doctors educate their populations about family
planning and contraceptive methods (J. Casellanos, personal communication, July
6, 2000). These educational campaigns seemed to be successful. The abortion rate decreased from 70.0 per
100 deliveries in 1992, to 59.4 in 1996 (PAHO, 1998).
As Dr.
Urrusuno-Carbajal pointed out, economic hardships affected many women’s
decisions to terminate their pregnancies in the early 1990s. The embargo has also affected women’s access
to medicine and birth control options.
Even though contraception is provided free of charge, it is still
difficult to obtain. Until 1990, most
Cuban women relied on birth control pills as a form of contraception, according
to a study by the American Association for World Health (1997). A 1995 merger between a U.S. company and a
Swedish company, which supplied the lab equipment to produce the pills, cut off
access to repair parts when the equipment broke down. As a result, Cuban women had no choice but to rely on donated
pills from other countries that caused imbalances in their hormone levels
(Frank & Reed, 1997). Dr.
Sosa-Leyva did not have much information to give me in relation to this merger and
how it directly affected her patients, but she did acknowledge that it is
difficult to access certain types of contraceptives. She stated, “It is a lot
of trouble, but we now are producing part of it” (M. Sosa-Leyva, personal
communication, June 27, 2000). For
example, since the IUD is not domestically produced, Cuba has to buy it from
other countries, said Dr. Sosa-Leyva (personal communication, June 27,
2000). Since condoms are expensive to
produce in Cuba, they rely on donations of these supplies from other countries
(Waitzkin, Wald, et al., 1997). This is unfortunate, since 79 percent of women
use contraception (PAHO, 1998).
The
embargo affects Cuban citizens because the patents on many components in
special equipment are owned by U.S. companies.
When machines break down, the health of the Cuban population becomes
endangered. Dr. Sosa-Leyva acknowledged that U.S. policy makes it difficult for
Cuba to maintain their equipment. “We cannot buy components,” said Dr.
Sosa-Leyva (personal communication,
June 27, 2000).
“We witness
…X-ray…and other lifesaving machinery standing idle for want of US-produced
spare parts,” said Peter Bourne, chairman of the American Association for World
Health (“Cuban Health,” 1997). For
example, the U.S.-owned Eastman Kodak company produces x-ray film for mammogram
machines (Davis, 1998).
As a result,
life-saving preventative care is available to only the highest-risk groups. X-ray screenings for breast cancer are still
obligatory for women between the ages of 45 and 55 years (M. Sosa-Leyva,
personal communication, June 27, 2000).
Until 1990, however, all Cuban women over 35 received regular
mammograms. In the mid-1990s, the lack
of x-ray film caused the shutdown of breast cancer screening programs (Frank
& Reed, 1997).
Even access to
basic but necessary medicines and supplies are affected by the crisis. According to Randal, “Supplies such as
rubber gloves, are reserved for surgical procedures.” Peter Greenberg, M.D. of the Stanford University Medical School,
found that the embargo has affected Cuban doctors’ patient management due to
“lack of antibiotics, equipment, current textbooks, and basic medical supplies”
(2000). One doctor admitted that the lack of medicines sometimes forces doctors
to try to find substitutes for needed medicines. “When you need one kind of medicine for one patient, it is hard
to ask for a change” (M. Sosa-Leyva, personal communication, June 27, 2000).
Several researchers
agree that Cuba’s commitment to providing health care has kept the system
functioning. According to one World
Health Organization official, “Cuba has invested more in health services than
almost any other country, and it has a higher health profile than the United
States” (Kirkpatrick, 2000). Several
studies contradict the U.S. State Department’s assertion that Cuba, not U.S
policy, is to blame for the crisis. The
Special Period in the early 1990s forced the Cuban government to drastically
reduce its spending on healthcare: from 227.3 million in 1989, to 56.9 million
by 1993 (Davis, 1998). Theodore
MacDonald, author of “A Developmental Analysis of Cuba’s Healthcare System since
1959,” stated that Cuba’s high allotment of its budget to provide healthcare to
all its citizens saved the island from what he calls “human catastrophe.” In
addition, a 1997 study by the Washington-based Association for World Health,
which is affiliated with the World Health Organization, supported MacDonald’s
finding by acknowledging that the Cuban government’s high priority to its
health care system averted what they also called a “human catastrophe.”
(MacDonald, 1999).
In spite of setbacks caused by economic factors, Cuba has maintained its commitment to providing free health care to its citizens. This is not to say that criticisms of the system do not exist. I found the doctors that I interviewed to be accommodating and willing to answer my questions. I sensed a strong spirit of commitment to their profession, not out of material gain, but out of concern for people. The people whom I interviewed about the Cuban health system, even casually, spoke about it with pride. By observing the health care of women in particular, it seems that Che Guevara’s belief that human life is invaluable has been preserved through the decades, even during the most difficult times.
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